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HomeMy WebLinkAboutBLD2004-00358 I 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#: BLD04-00358 Received Date 6/4/2004 SITE ADDRESS: 1361 E MARROWSTONE RD Issue Date 6/4/2004 NORDLAND, 98358 APPLICANT: HEATHER J TILLMAN PHONE: 1291 E MARROWSTONE RD NORDLAND WA 98358 _ 2 SUBDIVISION: RUES SHORT PLAT#2 Block: Lot: PARCEL NUMBER: 977700079 Section: 4 Township: 29N Range: 01 E CONTRACTOR: BOB FITZPATRICK CONSTRUCTION PHONE: (360) 301-0973 PO BOX 1466 PORT TOWNSEND WA 98368 Contractor's License BOBFIFC963JL Expires 04/13/2006 OWNER, HEATHER J TILLMAN PHONE: if different: 1291 E MARROWSTONE RD NORDLAND WA 98358 PROJECT DESCRIPTION: Fireplace insert 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 06/04/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: /,t 11-p-r �� 8//40).5 [ ] FinalApproval: -cam. -P AA.) /0/Oj 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. • BUILDING PERMIT APPLI BLD04-00358'ION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00358 Received Date: 6/4/2004 SITE ADDRESS: 1361 E MARROWSTONE RD NORDLAND, 98358 OWNER: HEATHER J TILLMAN PHONE: 1291 E MARROWSTONE RD NORDLAND WA 98358 SUBDIVISION: RUE'S SHORT PLAT#2 Block: Lot: 2 PARCEL NUMBER: 977700079 Section: 4 Township: 29 N Range: 01 E CONTRACTOR: BOB FITZPATRICK CONSTRUCTION PHONE: (360) 301-0973 PO BOX 1466 PORT TOWNSEND WA 98368 Contractor's License BOBFIFC963JL Expires 04/13/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION Fireplace insert TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 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 CJZ 06/04/04 66270 Total: $48.00 JEFFERSON COUNTY COMMIY DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND 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* SIZE OF PROPANE TANK HEAT STOVE HOT WATER TANK WOODSTOVE V FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) Is this appliance(woodstove, htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home? YES NO SITE ADDRESS(911#/Road Name): i.. E t 14 &v v-o Sltrhe.. rA2 1`I o A l A.A.L(. ZIP A b 9 DIGIT PARCEL ID NUMBER GI/11 O O O"1 9 Legal Description: { Subdivision Name 1 Vie.9 ��I �� Block z Lot(s) 2- Section LA Township L- 1 North, Range O I WM APPLICANT -P yri_(14.p y/ l (ii VIt a_,1.` PHONE Val ,--niL O �5 MAILING ADDRESS i le 1 E. 1'` vinr� Tilt� R 4 q, `�__ `� mr, c 1. 0,, g '(ZIP j�✓' g PROPERTY OWNER ) OI,,,LL,_A/ PHONE 2- £6 - c a - 25-©3--- MAILING ADDRESS � /n� /", ��1J ZIP CONTRACTOR CU l� 1 S€O1A4 PHONE 3 " 1 - o ci"'i -j MAILING ADDRESS T. Q o x l (Cd to efv-.1-. ' e-to .-ti-� ZIP q Y) STATE LICENSE# a 0 i3 P kFC CO 3.S L EXP.DATE Lk'--k 3 -C7 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 prope y or structure-( shall be requestedr and shall occur during regular business hours. �APPLICANTS SIGNATURE `l-� 1 1�Q., v 1 LLQ ld t [(A/ DATE / 0 11 / /011' FOR OFFICE USE ONLY � ` BASE FEE $48.00 RECEIPT# t/(,s, CONSISTENCY REVIEW CASH/CK# 85 03 TOTAL DATE 6 /4 / * 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 01-26-04.DOC