HomeMy WebLinkAboutBLD1994-00382 i
JEFFERSON COUNTY WOODST VE/
PROPANE TANK INSTALLATION PERMIT
-2/964/r74)
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
206-379-4450
PERMIT # •BLD94-0382 DATE ISSUED. : 06/15/94
SITE ADDRESS: 5632 UPPER HOH RD
:FORKS, WA 98331
APPLICANT. . . :JEFFERSON COUNTY PHONE:
MAILING ADDR:PO BOX 238
:QUILCENE WA 98376
PROPERTY OWNER: t -FF E RsoPHONE:
MAILING ADDR. . :
CONTRACTOR. . : PHONE:
MAILING ADDR:
•
CONTR. LIC #: EXPIRATION DATE: / /
PARCEL NO. . . :711292009
LEGAL DESC. . :STR 29-27-11 WWM, TAX #
LOT , BLOCK ,
DESCRIPTION OF IMPROVEMENT: Underground tank removal
THERE IS ONLY ONE INSPECTION REQUIRED. PLEASE CONTACT THE PERMIT CENTER IN
ORDER TO SCHEDULE YOUR INSPECTION. IF THE INSTALLATION DOES NOT COMPLY WITH
THE INSTALLATION REQUIREMENTS, THE INSPECTOR SHALL PROVIDE A LIST OF NECESSARY
CORRECTIONS. PLEASE CONTACT THE BUILDING DEPARTMENT WHEN CORRECTIONS ARE
COMPLETE IN ORDER TO SCHEDULE A REINSPECTION F TTHE INSTALLATION.
( ) Final Approval: 1
( ./;) .AA--- 1 z6h'/
CALL 379-4455 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9 a.m. to 4:30 p.m.
Inspector's Hours 8 - 10 a.m.
24 Hour Recorder for Inspections
JEFFERSO COUNTY
INSTALLATION APPLICATION
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Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
206-379-4450
PERMIT # •BLD94-0382 DATE RECEIVED. : 06/14/94
SITE ADDRESS: 5632 UPPER HOH RD
:FORKS, WA 98331
APPLICANT. . . :JEFFERSON COUNTY PHONE: 765-3699
MAILING ADDR:PO BOX 238
:QUILCENE WA 98376
PROPERTY OWNER:JL E-F61V(3 J T7 PHONE:
MAILING ADDR. . :
CONTRACTOR. . : PHONE:
MAILING ADDR:
CONTR. LIC #: EXPIRATION DATE: / /
PARCEL NO. . . :711292009 ALT: CON: NA _
LEGAL DESC. . :STR 29-27-11 WWM, TAX # WATER: DATE:
LOT , BLOCK , SHORELINES:
BY: DATE:
DESCRIPTION OF IMPROVEMENT: Underground tank removal
BUILDING TYPE *NON BEDROOMS--- BATHROOMS-- MAIN FL. . . : 0 sf
TYPE OF IMPROVEMENT:DEM EXIST. : 0 EXIST. : 0 ADD'L FL. . : 0 sf
GARAGE/CARPORT • PROP. . : 0 PROP. . : 0 HTED BSMT. : 0 sf
WOODSTOVE • TOTAL. : 0 TOTAL. : 0 UNHT BSMT. : 0 sf
UBC OCCUPANCY GROUP: SEWAGE DISP. . : CARPORT. . . : 0 sf
TYPE OF CONST • WATER SUPPLY. : GARAGE 0 sf
UNITS. : 0 STORIES: 0 HEAT TYPES. : DECKS • 0 sf
DIMENSIONS: MOBILE HOME COMMERCIAL: 0 sf
FRAME TYPE: MAKE: YR: INDUSTRIAL: 0 sf
EST COST. $: 0 SIZE: BANK HT. . . : 0 ft
PROJ GRP. . : 5745 SH SETBACK: 0 ft
Owner/agent FEES
Signature: type amount by date recpt
PRMT $ 30. 00
Date: B.C. $ 4.50
Issued By: 10 Vie. t
Date: &//`)
$ 34 .50 TOTAL
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***JEFFERSON COUNTY INSTAttAfitteN PERMIT APPLICATION
APPLICANT MAME 3-0.4re✓r'S0/•1 GtA.. 6LY�tI C GiQrd ) PHONE 2a d 699
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MAILING ADDRESS P( .� • ife < c, 3
4%,1CP.w.P ZIP 9r3 Ifo
PROPERTY OWNER NAME �),p^r T'P{•SOP. C6(44, PHONE 3s0,5--g/4 6MAILING ADDRESS P.O-• Jewx �pnZo�Q
Parr lQt._1N5'Pit1�P' ZIP 9f3 6
CONTRACTOR (4 h Kd i M GU *i i s /'j rh•G
MAILING ADDRESS PHONE
STATE LICENSE NUMBER EXPIRATION DATE
FEDERAL I.D. NUMBER
SITE
911B/ROAD
NAME
,5-6 3 1 cPTI /AA
/1 ZIP CODE
LEGAL DESCRIPTION: d
SUBDIVISION NAME �7 LOT BLOCK DIVISION
/
TAX NUMBER / 9 DIGIT PARCEL NUMBER 7/1? 9,;.e.) O 9
SECTION a 9 TOWNSHIP 2 7 NORTH RANGE // WM
DESCRIPTION OF IMPROVEMENT: IV i �`t" �a .* 0\( L
SIGNATURE /(414/titda4.41 DATE fGj***********************************************************************9040********* ,4***************
FOR OFFICE USE ONLY
Planning Area Fire District School District
BUILDING TYPE IMPROVEMENT TYPE UGC OCCUPANCY
❑ NON ❑ WOO ❑ NEW GROUP
FRAME TYPE
❑ WOOD 0 MANUFACTURED 0 STEEL 0 MASONRY OTHER
BASE FEE
PLAN CHECK RECEIPT #
STATE SURCHARGE DATE
TOTAL CASH/CHECK # I C/°
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