HomeMy WebLinkAboutBLD2003-00606 UILDING PERMIT APPLIC/SON BLD03-00606
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00606 Received Date: 9/26/2003
SITE ADDRESS: 3624 OAK BAY RD
PORT HADLOCK, 98339
OWNER: WILFRED M POLK PHONE:
JOAN B POLK
3624 OAK BAY RD
PORT HADLOCK WA 983399730
SUBDIVISION: Block: Lot: T 114
PARCEL NUMBER: 921194077 Section: 19 Township: 29 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOF Above Ground Propane Tank & Heat Stove
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 1997 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 CJZ 09/26/03 60202
Total: $47.00
JEFFERSON COUNTY COMMUNjEVELOPMENT,621 SHERIDAN ST,PORT TOWNflip WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TOOT THIS INSTALLATION ,
Underground PROPANE TANK* 1� Above Ground PROPANE TANK ✓ HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
'OTHER(Please Specify) rip 1NS
Is this appliance(htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home? �
YES l�_,, NO
SITE ADDRESS(911#/Road Name):
36 L9 ooK s47 fae,P .
Po>''t a)QdDD)oG1 w 4- . ZIP Qf p s /
9 DIGIT PARCEL ID NUMBER 7 /9 1 ` 0 7 7
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Mountain Propane PHONE 3 S s— 6 g S 3
265 Chimacum Rd.
MAILING ADDRESS Port Hadiock,WA 98339
ZIP
PROPERTY OWNER 1,2 r ? ) PHONE L}3 7 — df/3
MAILING ADDRESS 36 V g G3y
Poet J�9c//ac k , 1,✓/ !g . ZIP 9153.3 9
CONTRACTOR Mountain Propane PHONE 3$,S - 6 15'5 3
265 Chimacum Rd.
MAILING ADDRESS Port Hadlock,WA 98339
ZIP
STATE LICENSE# /1)o %4 n t- 9 530-6 EXP.DATE 7 -- l6 - O y
FEDERAL I.D.# 6.Ss
By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or
any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any
way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and it's employees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry to thedpplicant's property or structure shall be requested and shall occur during regular business hours. f,
APPLICANTS SIGNATURE DATE 5 / ;`�/ 0 3
FOR OFFICE USE ONLY
BASE FEE RECEIPT# (00ao.
CONSISTENCY REVIEW CASH/CK# 3 /i
1
TOTAL 1 DATE 1 ADG, /a�o3
*Underground Propane Tank applications require additional information to be submitted. 0 V E R
Please contact our office at 360-379-4450 if the back of this application is blank.
g\permitcenter\forms\bldg forms\install-revised 10-23-02.doc
) 'I
SEP 2 6 2003
• •
PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD03-00606 Received Date 9/26/2003
SITE ADDRESS: 3624 OAK BAY RD Issue Date 9/26/2003
PORT HADLOCK, 98339
APPLICANT: WILFRED M POLK PHONE:
JOAN B POLK
3624 OAK BAY RD
PORT HADLOCK WA 983399730 T 114
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921194077 Section: 19 Township: 29N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 09/26/2004
OWNER, WILFRED M POLK PHONE:
if different: JOAN B POLK
3624 OAK BAY RD
PORT HADLOCK WA 983399730
PROJECT DESCRIPTION: Above Ground Propane Tank& Heat Stove
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 09/26/2004.
REQUIRED INSPECTIONS:
[ ] Tan ine ppliance: �ru Or, fe jt- j
[ ] FinalApproval ( ECG' ``I—03
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
[:\F_BLD_Permit_Propane.rpt 10/29/19�