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Home My WebLink AboutBLD2003-00787 O BUILDING PERMIT APPLIC 'ION B Review-00787 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00787 Received Date: 12/18/2003 SITE ADDRESS: 1621 DABOB RD QUILCENE, 98376 OWNER: CLAYTON L SWANSON PHONE: JOAN SWANSON 1621 DABOB RD QUILCENE WA 983769712 SUBDIVISION: Block: Lot: 7+ PARCEL NUMBER: 801213008 Section: 21 Township: 28 N Range: 01 W CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/06/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION 500 GAL ABOVE GROUND 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: 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: A ••r ved/Date VEDPropane Tanks/Stoves $47.00 ZAN 12/18/03 60534 H Total: $47.00 DEC 1 $ 2003 Jefferson County Planning & Building Depf7i,//,ytkarture t iA, 4 JEFFERSON COUNTY COM•TY DEVELOPMENT,621 SHERIDAN ST,PORT TO END WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICA N MARK ALL ITEMS BELOW THAT PERTAI 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): (ot�\ Ac - (A) CAA �Q'�,-�) 1� Q ZIP g Z -')74IL) 9 DIGIT PARCEL ID NUMBER 80i ` (Dag Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT PHONE MAILING ADDRESS '` , ��i ZIP PROPERTY OWNER � V I ]�� • na �� PHONE 3 -�- 3L+ A II MAILING ADDRESS I L2-t Ce�, � (A CkkA 1 keeAn ZIP q + G� CONTRACTOR V-kPHONE ) C 0 MAILING ADDRESS ZIP STATE LICENSE# O1� '�c` i�/ 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 iCannf's property or structure shall be requested and shall occur during regular business hours. / APPLICANTS SIGNATURE BATE b l 2-7 FOR OFFICE USE ONLY O �� BASE FEE $47.00 RECEIPT# CONSISTENCY REVIEW 23.O CASH/CK# et9 ' /� TOTAL *70 •C S-0 DATE 12/ /v 03 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 3 3 3 G:\PermitCenter\FORMS\BLDG FORMS\install-revised 10-30-03.DOC • 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 #: BLD03-00787 Received Date 12/18/2003 SITE ADDRESS: 1621 DABOB RD Issue Date 12/18/2003 QUILCENE, 98376 APPLICANT: CLAYTON L SWANSON PHONE: JOAN SWANSON 1621 DABOB RD QUILCENE WA 983769712 7+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 801213008 Section: 21 Township: 28N Range: 01W CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/06/2004 OWNER, CLAYTON L SWANSON PHONE: if different: JOAN SWANSON 1621 DABOB RD QUILCENE WA 983769712 PROJECT DESCRIPTION: 500 GAL ABOVE GROUND 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 12/18/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApprovalitii* !`2,� .Q''0 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 S v-A,owN i C,LekyT *)CTCH a T Eyts-R i6 iG7.I 'DA °(2) 1`1 ( LtM TANK 3u i ; -C, ,, WA sc C1PL.Q1-1 Agovc 3c0 - 34 --- 22-,5 ele-t0 --W,\ C--.12P I- -2-13- cx) ( CE 7Pl2-0P= Li IV E it I 1 r Gtk `� '13' WA 1' 1 Lj I A 1 ' I kki I i\'; .i kI ev 1 , `'L`'>.AC30 fit)