HomeMy WebLinkAboutBLD2003-00748 •
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 #: BLD03-00748 Received Date 12/2/2003
SITE ADDRESS: 292 MERRY RD Issue Date 12/2/2003
NORDLAND, 98358
APPLICANT: GEORGE CHECHOPOULOS PHONE:
HELENA CHECHOPOULOS
PO BOX 193
NORDLAND WA 98358 14
SUBDIVISION: OLSON & HAMBLETON'S Block: Lot:
PARCEL NUMBER: 977700045 Section: 9 Township: 29N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE: 800-750-7868
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2004
OWNER, GEORGE CHECHOPOULOS PHONE:
if different: HELENA CHECHOPOULOS
PO BOX 193
NORDLAND WA 98358
PROJECT DESCRIPTION: WOODSTOVE 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 12/2/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: idGe2D470VE ' /.,3/,43
[ ] FinalApproval: t ceit eh. JL,s1/o3 'i
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_Pe rm it_Propa ne.rpt 10/29/19
•
BUILDING PERMIT APPLICI`I BLD03-00748
�N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00748 Received Date: 12/2/2003
SITE ADDRESS: 292 MERRY RD
NORDLAND, 98358
OWNER: GEORGE CHECHOPOULOS PHONE:
HELENA CHECHOPOULOS
PO BOX 193
NORDLAND WA 98358
SUBDIVISION: OLSON & HAMBLETON'S Block: Lot: 14
PARCEL NUMBER: 977700045 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE: 800-750-7868
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION WOODSTOVE 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 12/02/03 60392
Total: $47.00
JEFFERSON COUNTY COMM.DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
r
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* HEAT STOVE HOT WATER TANK
X 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):
,Z q oZ Merr gA . ) ovc tck✓►ci WA
�J J Q c
ZIP 1,83 B
9 DIGIT PARCEL ID NUMBER 4177 7D t 7 0 4-5
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
I.
APPLICANT (r',Q/"c e ci , Neck,./J /d s PHONE
MAILING ADDRESS / c2 e 6.5c /g A4 r/d/Q pf ` A �53�8
1 l
� r_ J ZIP -7�j �*
PROPERTY OWNER 4,,o e lJ , C�/cc4ore2d 5- PHONE 1 r�`�3 l ( — %-�6
MAILING ADDRESS 54 141 e q g q 60 c/e.
����// ZIP
CONTRACTOR Ev�eY 11 'Yg7 , PHONE
MAILING ADDRESS p2 97 157 i41w /C,// 6 Qom'/ 4rJ ek5
ZIP 7 856 2--
STATE LICENSE# 4 h EA kt,/f* 7c /41- 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 ranting of this permit.
I further agree to provide access and right of en ryto Jeffers Cdu ty n it's e lees,reprece tatives or agents for the purpose of application review and any required later
inspections. Access and right of entry to the licant's pr y or t re sh requested and II occur during regular business hours.
APPLICANTS SIGNATURE mac, 4f DATE / / '',"
FOP2 OFFICE USE ONLY
BASE FEE $47.00 RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE / /
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