HomeMy WebLinkAboutBLD2003-00687 BUILDING PERMIT APPLIOTION BLD03-00687
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00687 Received Date: 11/4/2003
SITE ADDRESS: 295492 HWY 101
QUILCENE, 98376
OWNER: RONALD R HOFFMAN PHONE:
JUDY A HOFFMAN
1210 CEDAR ST
PORT TOWNSEND WA 983684007
SUBDIVISION: JONES SHORT PLAT Block: Lot: 3
PARCEL NUMBER: 702231026 Section: 23 Township: 27 N Range: 02 W
CONTRACTOR: CENEX SUPPLY & MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 9/6/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP PROPANE TANK AND HEATER INSTALLATION
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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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 PRB 11/03/03 60351
Total: $47.00
• a
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 #: BLD03-00687 Received Date 11/4/2003
SITE ADDRESS: 29549 HWY 101 Issue Date 11/4/2003
QUILCENE, 98376
APPLICANT: RONALD R HOFFMAN PHONE:
JUDY A HOFFMAN
1210 CEDAR ST
PORT TOWNSEND WA 983684007 3
SUBDIVISION: JONES SHORT PLAT Block: Lot:
PARCEL NUMBER: 702231026 Section: 23 Township: 27N Range: 02W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 9/6/2004
OWNER, RONALD R HOFFMAN PHONE:
if different: JUDY A HOFFMAN
1210 CEDAR ST
PORT TOWNSEND WA 983684007
PROJECT DESCRIPTION: PROPANE TANK AND HEATER INSTALLATION
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 11/4/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
I ] 411111 .
' �• •val: /( 71
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
I:\F_BLD_Permit_Propane.rpt 10/29/19
JEFFERSON COUNTY COM DEVELOPMENT,621 SHERIDAN ST,PORT TO•END WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* )(Above Ground PROPANE TANK* HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify)
Is this appliance(htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name):eVqrLE.QZ
,-)6'5 '3 /7/ 6)y /C1/ Nov - 3 2(03
L,( ( C_c.e-VI c t'i: A ZIP 918 / ()
9 DIGIT PARCEL ID NUMBER 1 62?� 1 OZ7
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT "�(�� PHONE .-old _ -
MAILING ADDRESS I JO r U X 3
Ni (L_ae ZIP , 7g3 /' 6
PROPERTY OWNER .J L.A.�1 fl I" U F P.M CA V\ PHONEO3 "c r t
MAILING ADDRESS /aC /6. iG, G,[ eAc S �'� �j / (�
�" i • Lk) & ZIP 7C� b
CONTRACTOR L PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# EXP.DATE
FEDERAL I.D.#
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 the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE � �/ e '(?f. lL`'._ DATE /I / Q U / O f
FOR OFFICE USE ONLY 7 /
BASE FEE $47.00 RECEIPT# ��j/J�5/'(
CONSISTENCY REVIEW 2.3%SO CASH/CK# C%`TCJ�
TOTAL 10.'sO DATE I( / 3 / O,
Propane Tank applications require additional information to be submitted.
Please contact our office at 360-379-4450 if the back of this application is blank. OVER + 4 4
G:\PermitCenter\FORMS\BLDG FORMS\ install-revised 10-30-03.DOC
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