HomeMy WebLinkAboutBLD2002-00227 •
BLD02-00227
BUILDING PERMIT APPLIC4gION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00227 Received Date: 4/22/2002
SITE ADDRESS: 293211 HIGHWAY 101
QUILCENE, 98376
OWNER: JUEL S SIMONSON PHONE:
CASSIE M SIMONSON
PO BOX 2568
QUARTZSITE AZ 853462568
SUBDIVISION: Block: Lot: T 17
PARCEL NUMBER: 702114009 Section: 11 Township: 27 N Range: 02 W
CONTRACTOR: CENEX SUPPLY&MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/02
REPRESENTATIVE(S):
PROJECT DESCRIPTIO PROPANE TANK 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:
OTHER:
CONST TYPE: 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
outing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Total:
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TO SEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE )C PROPANE TANK PELLET STOVE OTHER
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):
7 '3 ail h' i 1 1 1 u y / 0 /
gob L cEiv. w ik • ZIP 9?
9 DIGIT PARCEL ID NUMBER -7 0 D— / /L( 0 0'
Legal Description:
Subdivision Name Block Lot(s)
Section// Township North, Range WM
APPLICANT d (it�L S / 111 DP S 0 4 PHONE 7 b .. J 9 6 3
MAILING ADDRESS S / o CJa Luc.j A
�/'11j1011 VV 14 ZIP 9S37- a
PROPERTY OWNER J-G{e L S / m o n s Oil PHONE -7 (-c 3 % '3
MAILING ADDRESS ‘P-- !9 p19(9 0 3 4 t)R i vf- Q
BI/2 Di') W/9 ZIP 9F3;--e)
CONTRACTOR a A E x PHONE
MAILING ADDRESS / /
C 1 t1/YIPrbt Yi ' ZIP
STATE LICENSE# 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 applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE (94/(0 S DATE / / O 2.-----
FOR OFFICE USE ONLY
BASE FEE ""71•QL/ RECEIPT#
CASH/GK# `"f'
TOTAL 4.746 DATE ,—/ /
H:\HOMEIPLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01
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 (800)831-2678
PERMIT#: BLD02-00227 Received Date 4/22/2002
SITE ADDRESS: 293211 HIGHWAY 101 Issue Date 4/22/2002
QUILCENE, 98376
APPLICANT: JUEL S SIMONSON PHONE:
CASSIE M SIMONSON
PO BOX 2568
QUARTZSITE AZ 853462568 T 17
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702114009 Section: 11 Township: 27N Range: 02W
CONTRACTOR: CENEX SUPPLY&MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/02
OWNER, JUEL S SIMONSON PHONE:
if different: CASSIE M SIMONSON
PO BOX 2568
QUARTZSITE AZ 853462568
PROJECT DESCRIPTION PROPANE TANK 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 4/22/03.
REQUIRED INSPECTIONS:
[ ] dletT Line/Appliance 3///o3
[t( FinalApproval: Ti,'K Q^l/y _ 5-6-01
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 10/29/99