HomeMy WebLinkAboutBLD2000-00008 411
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 #: BLD00-00008 Received Date 1/5/2000
SITE ADDRESS: 201 RAINIER LN Issue Date 1/6/2000
PORT LUDLOW, 98365 Expiration Date 1/6/2001
APPLICANT: ROBIN HANSEN
201 RAINIER LANE PHONE: (360)437-7643
PORT LUDLOW WA 98365
SUBDIVISION: PL #1 AREA 3 Block:
Lot: 16
PARCEL NUMBER: 990600216 Section: 09 Township: 28 N Range: 01 E
CONTRACTOR:
NORTHWEST CHIMNEY SERVICE PHONE:
510 DEKALB
SUITE D
PORT ORCHARD WA 98366
Contractor's License NORTHCS101CB Expires 1/24/00
OWNER,
if different:
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 1/6/01.
REQUIRED INSPECTIONS:
k/Line/Applianc : /// /6),0
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. - 4:30 p.m.
Inspector's Phone Hours 8:00 a.m. -9:00 a.m.
SPECIAL CONDITIONS MAY APPLY - SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
I:\F_BLD_Permit_Propane.rpt
10/29/99
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00008 Received Date: 1/5/2000
SITE ADDRESS: 201 RAINIER LN
PORT LUDLOW, 98365
APPLICANT: ROBIN HANSEN PHONE: (360)437-7643
201 RAINIER LANE
PORT LUDLOW WA 98365
SUBDIVISION: PL#1 AREA 3 Block:
PARCEL NUMBER: 990600216 Section: 09 Township: 28 N Range: 01 E Lot: 16
CONTRACTOR: NORTHWEST CHIMNEY SERVICE
510 DEKALB PHONE:
SUITE D
PORT ORCHARD WA 98366
Contractor's License NORTHCS101CB Expires 1/24/00
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: ADD'L: HEAT TYPE
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER:
CONST TYPE: GARAGE: SHORELINE:
DECK: SETBACK:
SEWAGE DISPOSAL: BANK HEIGHT:
WATER SYSTEM:
BEDROOMS: BATHROOMS: Wetland STORMWATER: YES NO AREA
Erosion
Exist: Exist: Seismic Streams
Prop: Prop: Flooding Landslide
Total: Total: F&W Plat Conditions
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $46.00 MAM 01/05/00 23667
Total: $46.00
I:\F_BLD_App_Bld.rpt
10/29/99
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE /'\,.QTHER (-'
SITE ADDRESS: �S �— �.
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/ZIP /� j13‘S'- !/� \
9 DIGIT PARCEL ID NUMBER 996 660 (-V/ 6 %
Legal Description: P L /
Subdivision Name " A��- cam` Block Lot(s) (o
Section Township North, Range WM \J
APPLICANT \j
PHONE
MAILING ADDRESS "s a '►"-e_
ZIP
PROPERTY OWNER y' `U b/f✓ /LI`( `f It-J PHONEG` -'-- �.7 .�lG 7-�J�' d'��•..�7
MAILING ADDRESS '
ZIP
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CONTRACTOR Ale f `--iv vV'e'J C /' Co
PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# AiGf -1/- 1 S'/ / a e '
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
DATE / / S/ o?ODD
FOR OFFICE USE ONLY
BASE FEE 14.eV RECEIPT#
CASH/CK# .' /
TOTAL / ;�
DATE
H:\H 0 M E1PLN CNTR\FORMS\IN STALL.D0 C 10/99
/ CO