HomeMy WebLinkAboutBLD2004-00018 11ItUILDING PERMIT APPLICON 13LD04-00018
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD04-00018 Received Date: 1/12/2004
SITE ADDRESS: 390 BERRY HILL LN
CHIMACUM, 98325
OWNER: JOHN JACOB WIEDERRICH PHONE:
PO BOX 2704
SEQUIM WA 983822704 •
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901333009 Section: 33 Township: 29 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 250 GAL ABOVE GROUND PROPANE TANK, HOT WATER HEATER,
HEAT STOVE, AND COOKING STOVE
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 $48.00 ZAN 01/12/04 62417
Total: $48.00
JEFFERSON COUNTY COMM.DEVELOPMENT,621 SHERIDAN ST,PORT TOND WA 98368 PH: (360)379-4450
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INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* `�.,%HEAT STOVE S HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE ��C�OOKING STOVE
OTHER(Please Specify)
Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES NC
SITE ADDRESS(911#/Road Name):
-39T 33 6.,1Sfel
)LL Ly4(
ZIP f v3a5-
9 DIGIT PARCEL ID NUMBER ot. c 1 3 3.3 d 0 9
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT al fill#14 ti) I FR l/C11 y
PHONE - ( Fe / 4?/
MAILING ADDRESS 06X 4C3 ( C'1 t I///
f( ZIP cr773 --
PROPERTY OWNER VIVA) W i EDE V,R,1 C,� PHONE
MAILING ADDRESS f D l?O7( a-'7 0 5C1
6.-- c-p Cl 1 n ZIP 78-
CONTRACTOR PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# ``� 1 2 2�04 EXP.DATE
�A
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 str cture sh I be requested and sh I occur during regular business hours.
f
APPLICANTS SIGNATURE 1441141141 U % DATE t)/ /
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK# [(C) 0 S
TOTAL la-Cr° DATE I / I Z/aS
Propane Tank applications require additional information to be submitted. OVER
Please contact our office at 360-3794450 if the back of this application is blank.
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 10-30-03.DOC
S
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
Received Date 1/12/2004
PERMIT #: BLD04-00018 SITE ADDRESS: 390 BERRY HILL LN Issue Date 1/12/2004
CHIMACUM, 98325
APPLICANT: MARIAN WIEDERRICH PHONE: 360-732-7431
P 0 BOX 487
CHIMACUM WA 98325
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901333009 Section: 33 Township: 29N 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, JOHN JACOB WIEDERRICH PHONE:
if different: PO BOX 2704
SEQUIM WA 983822704
PROJECT DESCRIPTION: 250 GAL ABOVE GROUND PROPANE TANK, HOT WATER HEATER,
HEAT STOVE, AND COOKING 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 01/12/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval:
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
A:\F_BLD_Permit_Propane.rpt 10/29/19
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