The URL can be used to link to this page

Home My WebLink AboutBLD2003-00688 at a UILDING PERMIT APPLICATION BLD03-00688 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD03-00688 Received Date: 11/4/2003 SITE ADDRESS: 1541 DABOB POST OFFICE RD QUILCENE, 98376 OWNER: ANNE R TAYLOR PHONE: 7737 19TH AVE NE SEATTLE WA 981154433 SUBDIVISION: Block: Lot: 4 PARCEL NUMBER: 701044003 Section: 4 Township: 27 N Range: 01 W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/06/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP Replace A/G Propane Tank with U/G Propane Tank TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 11/04/03 60249 Total: $47.00 JEFFERSON COUNTY COMMUNIT" EVELOPMENT,621 SHERIDAN ST,PORT TOWNS,WA 98368 PH: (360)379-4450 IIV�TALLATION PERMIT APPLICATIO li 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): / II ( U4 (...P PO 0 o-TT, ( € ,?C A et .7 a. i ( e i.A. ZIP /es 5--- 9 DIGIT PARCEL ID NUMBER 70/ 74 4 0c J Legal Description: Subdivision Name Block Lot(s) Section 2-1,--. Township 2 7 North, Range I k) WM #,., ZO (,:, 3Zcf V "( a Z.Z.S APPLICANT Ai ii+{ TA.y Cj{'- PH�NE 2041 �-? 7 80 7,3- 7'7 r� / �*- oc4 t 3 6,C0 73 a_ 40 4 ( MAILING ADDRESS / /� ( ] � ��a 1 �/ v�Q cZ i.t -t!' G� q Jec��t-1 W4t sIh l ✓t.. 40 1— ZIP ( j 5` PROPERTY OWNER ul vvt t iN PHONE MAILING ADDRESS , ZIP CONTRACTOR C,e.In ?, 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 ttie applicant's properly or structure shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE :-/* _---•----c .._,rj_ (IA"- DATE // I /0 5 FOR OFFICE USE ONLY BASE FEE $47.00 RECEIPT# 6204 9 CONSISTENCY REVIEW So CASH/CK# `— ) 5 r TOTAL 4 i(j. 3 Q DATE i f / 1 / 4-)°,3 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 4 G:\PermitCenter\FORMS\BLDG FORMS\ install-revised 10-30-03.DOC BLD03-00688 UILDING PERMIT APPLICA ON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00688 Received Date: 11/4/2003 SITE ADDRESS: 1541 DABOB POST OFFICE RD QUILCENE, 98376 OWNER: ANNE R TAYLOR PHONE: 7737 19TH AVE NE SEATTLE WA 981154433 SUBDIVISION: Block: Lot: 4 PARCEL NUMBER: 701044003 Section: 4 Township: 27 N Range: 01 W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/06/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOF Replace A/G Propane Tank with U/G Propane Tank 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 NW CJ t-Erosion ' 4,k- Prop: Prop: Seismic ALL- Streams '"Nt:'c Cf 3 Total: Total: Flood Way t Floodplain sk-& - Routing Date: F&W Landslide - € Shoreline C.ziat,enAastNi Aquifer S'uc..- Forest: Commercial'rt' sRural - Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 CJZ 11/04/03 60249 014. P CAt91 v```\I Total: $47.00 ' MAPP � `- e0' ti/.4/ . JEFFERSON COUNTY COMMU•DEVELOPMENT,621 SHERIDAN ST,PORT TOWD 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): /A 4 ( bd I.D>, IC.) PO 5' OFF; c t. PO A C e ZIP 963 Z- -- 9 DIGIT PARCEL ID NUMBER 701 04 4 Oc?j Legal Description: Subdivision Name Block Lot(s) Section 4- Township 2 7 North, Range (( WM `� W ZOt� s3Zci (,o zzs APPLICANT v2+vt-er- 1-4 y ( 0 r PHONE �� t� C 7 807,,�� MAILING ADDRESS l /3 / l /� �l2 A/ v.e �� „q -e o c 1 360 /3 a- 40 4 ( Se0,: -f- l Qt S� f►mot es l�L ZIP l 6 I S� PROPERTY OWNER c . vLt e PHONE MAILING ADDRESS ZIP CONTRACTOR C,42.14 ?, 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 attomey'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 t- applicant's prope or structure shall be requested and shall occur during regular business hours. APPLICANTS SIGNATURE �'_ - DATE // /t /0 FOR OFFICE USE ONLY /_ BASE FEE $47.00 RECEIPT# (.0 49 CONSISTENCY REVIEW 013 So CASFUCK# C.. hS fl1 TOTAL V'1n 5 C� DATE I /. '.rr e"3 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 G:\PermitCenter\FORMS\BLDG FORMS\ install-revised 10-30-03.DOC 110 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 #: BLD03-00688 Received Date 11/4/2003 SITE ADDRESS: 1541 DABOB POST OFFICE RD Issue Date 11/4/2003 QUILCENE, 98376 APPLICANT: ANNE R TAYLOR PHONE: 7737 19TH AVE NE SEATTLE WA 981154433 4 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701044003 Section: 4 Township: 27N Range: 01W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/06/2004 OWNER, ANNE R TAYLOR PHONE: if different: 7737 19TH AVE NE SEATTLE WA 981154433 PROJECT DESCRIPTION: Replace A/G Propane Tank with U/G Propane Tank 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 11/04/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: 40 Ler-E-e/GR S L/NE l/f< t _45 [ ] FinalApproval: cC /G 14/er? 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 10/29/19c .,4„, ----7' - 0 NDA s Rt C a n i.. (Pi Z \_..ik a r\ q o r„4 b °� -mil ' �- --b 4 7C b y ,c �.9 c 1 =�m \d % 1! 14 eL_____ , N (‘` _____ ___.! U rr cA /tt I N 0 1 i ' r . , b`' r • i x L N N A i (Al/ ,(31431i1::\ ___.= .) ---; ritricH Ir _ a di „i g I._ . b j L_. k ......... ,--. fk. __.... -z --q } L n " , , •ts g cz 0 0 \gi..K 0 N. f � .��. . . -Om L /\ 0 1 z O •N F'•• • •• 'p 'p r 'c Z cn , EL:- a V,, o G O aa p m Z y ._ .._... .' .- .. . . v<s 11 " m 3 ,mil , o G