HomeMy WebLinkAboutBLD2000-00020 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 #: BLD00-00020 Received Date 1/10/2000
SITE ADDRESS: 961 CHIMACUM RD Issue Date 1/10/2000
PORT HADLOCK, 98339 Expiration Date 1/10/2001
APPLICANT: LINDA L MARSHALL PHONE: (360)732-5070
PO BOX 861
CHIMACUM WA 98325
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 901114009 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR:
PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTI00088CC Expires 5/1/00
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK & STOVE 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 1/10/01.
REQUIRED INSPECTIONS: �1
[') Tank/Line/Appliance: A* a / — 0 G c/f—Le...)�
[ FinalApproval: 0& A" j_ C /ir „-i,—,4 IA e-U
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 #: BLD00-00020 Received Date: 1/10/2000
SITE ADDRESS: 961 CHIMACUM RD
PORT HADLOCK, 98339
APPLICANT: LINDA L MARSHALL PHONE: (360)732-5070
PO BOX 861
CHIMACUM WA 98325
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 901114009 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 5/1/00
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & STOVE INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: 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 01/10/00 23972
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 /y'ROPANE TANK PELLET STOVE OTHER OV
SITE ADDRESS: ( l 111� \ l-' t 1
911E/ROAD NAME II II � 11 /�� 9 �j
C 1 1 1�/1 � I C i v \ ZIP b 3
9 DIGIT PARCEL ID NUMBER q O ` k' 4- 0 0 1
Legal Description:
Subdivision Name Block Lot(s)
(SacioY0 E, /q Township fifNorth, Range WM ,111
APPLICANT k I n L C< ! '^ (l PHONE 0 7 Q
MAILING ADDRESS P F 6 y I-
q.;41, ,01(10.0 V\ ZIP - • -,S
PROPERTY OWNER 0 Je._- PHONE
MAILING ADDRESS
ZIP
CONTRACTOR Pe 0 ; ) PHONE 34g 5 42;2 0
MAILING ADDRESS V\ p 0 a (-9,
eof , C l,,) vt. .s'QtA. OSL. ZIP `"l 42
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 DATE I / / 00
FOR OFFICE USE ONLY
BASE FEE RECEIPT# ?-C1 7
CASH/CK# 7 6/
TOTAL D E C ! U l'1 E �t`PE _L! /(r'/ 7JO
H:\HOME\PLNCNTR\FORMS\INSTALL.DOC10/99 JAN 1 0 2000
r JJI
JEFFERSON COUNTY
DEPT. OF COMMUNITY DEVELOPMENT