HomeMy WebLinkAboutBLD2000-00014 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 #: BLD00-00014 Received Date 1/7/2000
SITE ADDRESS: 361 MOUNTAIN TRAIL RD Issue Date 1/7/2000
BRINNON, 98320 Expiration Date 1/7/2001
APPLICANT: GERALD C OLSON PHONE: (360)796-4787
361 MOUNTAIN TRAIL RD
BRINNON WA 98320
SUBDIVISION: OLYMPIC CANAL DIV5 Block: 15 Lot: 8-9
PARCEL NUMBER: 981301508 Section: 16 Township: 25 N Range: 02 W
CONTRACTOR:
FERRELLGAS PHONE: 1-888-933-7735
PO BOX 67
HOODSPORT WA 98548
Contractor's License FERRELPO55LH Expires 8/1/00
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 1/7/01.
REQUIRED INSPECTIONS:
[1 Tank/Line/Appliance: U A / l a Q a
[ FinaIApprovaI: �� f"F": 430 Q 4_Ye-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:1F_BLD_Permit_Propane.rpt 10/29/99
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00014 Received Date: 1/7/2000
SITE ADDRESS: 361 MOUNTAIN TRAIL RD
BRINNON, 98320
APPLICANT: GERALD C OLSON PHONE: (360)796-4787
361 MOUNTAIN TRAIL RD
BRINNON WA 98320
SUBDIVISION: OLYMPIC CANAL DIV5 Block: 15 Lot: 8-9
PARCEL NUMBER: 981301508 Section: 16 Township: 25 N Range: 02 W
CONTRACTOR: FERRELLGAS PHONE: 1-888-933-7735
PO BOX 67
HOODSPORT WA 98548
Contractor's License FERRELPO55LH Expires 8/1/00
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:
GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
STORMWATER: YES NO AREA
BEDROOMS: BATHROOMS: Wetland Erosion
Exist: Exist: Seismic Streams
Prop: Prop: Flooding Landslide
Total: Total: F&W Plat Conditions
Shoreline Aquifer
Routing Date: Forest: Commercial Rural
Proximity
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $46.00 MAM 01/07/00 23966
Total: $46.00
I:1F_BLD_App_Bld.rpt 10/29/99
,1EFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
'/I
WOODSTOVE Jc PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: l \
911#/ROAD NAME (9 eV \���` �j` L
c , c' . 1-� l�a� I �, �- ZIP C* Z G
9 DIGIT PARCEL ID NUMBER (c6\ �jO\ G SC
Legal Description: 5
Subdivision Name UL C j qk__ \ f O Biock \- Lot(s) %
Section Township North, Range WM
APPLICANT G�Ec�1,� C PHONE 6 rI `1\. - 1-Q75S-1
MAILING ADDRESS (O I" V� (�;,+> ,�NN L \..
�J s \ U �G1� W,� ZIP \56 O
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR '��o�. "lr� C%` PHONE I —%C&.�
MAILING ADDRESS U C)-- G 7A
c/A , ZIP 5 4
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 ent t Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of tr to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE DATE / / 7 / p'LO® G
FOR OFFICE USE ONLY
BASE FEE .O'D RECEIPT#
f / CASH/CK# {. f
TOTAL T�I d�
�� DATE I
H:\H O ME\PLNCNTR\FORMS\INSTALL.DOC 10/99