HomeMy WebLinkAboutBLD2004-00088 BLD04-00088
OUILDING PERMIT APPLICA N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00088 Received Date: 2/17/2004
SITE ADDRESS: 60 WASHINGTON ST
QUILCENE, 98376
OWNER: FLORENCE J REEVES PHONE:
PO BOX 340
QUILCENE WA 983760340
SUBDIVISION: HAMILTON'S 5AC TRACTS Block: Lot:
PARCEL NUMBER: 956100028 Section: 13 Township: 27 N Range: 02 W
CONTRACTOR: MARK AIR PHONE: 360-849-5184
534 TAYLOR ST
PORT ORCHARD WA 98366
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION 120 GALLON ABOVE GROUND PROPANE TANK AND HEAT STOVE
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 $48.00 ZAN 02/17/04 62622
Total: $48.00
JEFFERSON COUNTY COMMUNI.VELOPMENT,621 SHERIDAN ST,PORT TOWN.WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION i Z O —
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
'r +
Underground PROPANE TANK* L ' Above Ground PROPANE TANK* r 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): BB
L.) �4
6.L,t a aC SC --2 4 i .t I ei 4 ... ZIP 17 C e
9 DIGIT PARCEL ID NUMBER 9) 5 l p j D a b a g
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range/ WM
.
APPLICANT t �`.,t.
1 \ ,,�e.SZA , PHONE 2 (a a '7 i S 3 a,
MAILING ADDRESS D
1.�J. / ZIP —1 8'3 ? W
PROPERTY OWNER Qi j .9, PHONE
MAILING ADDRESS
ZIP '
CONTRACTOR ! Y 1 CKJN,C? PHONE
MAILING ADDRESS J 3 1
1 )S,?L 04
f' „it en cLu.,,s, eta 3/,( ZIP ~�
STATE LICENSE# EXP.DATE ,
14 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 ent to the applicant's property or str cture shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE — C •/\--- ,_O Q_,_AJ2. DATE (l. / 1 i / 6 h'
FOR OFFICE USE ONLY /
BASE FEE $48.00 RECEIPT# (Q 6 d,
CONSISTENCY REVIEW $24.00 CASH/CK# S`1 2
TOTAL a DATE . /f 7 /
Propane Tank applications require additional information to be submitted. OVER Please contact our office at 360-379-4450 if the back of this application is blank.
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 #: BLD04-00088 Received Date 2/17/2004
SITE ADDRESS: 60 WASHINGTON ST Issue Date 2/17/2004
QUILCENE, 98376
APPLICANT: FLORENCE J REEVES PHONE:
PO BOX 340
QUILCENE WA 983760340
SUBDIVISION: HAMILTON'S 5AC TRACTS Block: Lot:
PARCEL NUMBER: 956100028 Section: 13 Township: 27N Range: 02W
CONTRACTOR: MARK AIR PHONE: 360-849-5184
534 TAYLOR ST
PORT ORCHARD WA 98366
OWNER, FLORENCE J REEVES PHONE:
if different: PO BOX 340
QUILCENE WA 983760340
PROJECT DESCRIPTION: 120 GALLON ABOVE GROUND PROPANE TANK AND HEAT 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 02/17/2005.
REQUIRED INSPECTIONS:
[ ] ZO in plia C/jC 04/a,
FinalApproval: 0 2 r- ! Z Z Oy
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
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