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HomeMy WebLinkAboutBLD2000-00044 • 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 #: BLD00-00044 Received Date 1/18/2000 SITE ADDRESS: 43 MCKENZIE LN Issue Date 1/18/2000 PORT LUDLOW, 98365 Expiration Date 1/18/2001 APPLICANT: DENNIS HEBERLEIN PHONE: (360) 379-5429 43 MCKENZIE LANE PORT LUDLOW WA 98365 SUBDIVISION: TIMBERTON VILLAGE Block: Lot: 4 PARCEL NUMBER: 998500004 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)385-5564 PO BOX 708 CHIMACUM WA 98325 Contractor's License RSSALS*022PB Expires 10/01/2000 OWNER, if different: PROJECT DESCRIPTION propane tank& insert 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 01/18/2001. REQUIRED INSPECTIONS: [‘„1------ ank/Lm ppliance: 1O/ /(22/0 O FinalApproval: BUILDING PERMIT APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00044 Received Date: 1/18/2000 SITE ADDRESS: 43 MCKENZIE LN PORT LUDLOW, 98365 APPLICANT: DENNIS HEBERLEIN PHONE: (360) 379-5429 43 MCKENZIE LANE PORT LUDLOW WA 98365 SUBDIVISION: TIMBERTON VILLAGE Block: Lot: 4 PARCEL NUMBER: 998500004 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)385-5564 PO BOX 708 CHIMACUM WA 98325 Contractor's License RSSALS*022PB Expires 10/01/2000 ARCHITECT/ ENGINEER : PROJECT DESCRIPTION: propane tank & insert installation TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: ADD'L: HEAT TYPE: PRO 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 Routing Date: Shoreline Aquifer Forest: Commercial Rural Proximity Type Amount Paid By: Date: Receipt: Approved/Date Permit $46.00 LMB 01/18/00 23135 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 tX.7 PROPANE TANK PELLET STOVE OTHER AsSt • - SITE ADDRESS: , 911#/ROAD NAME `7/� ;Jij/C, �r't Z r1 'e- 4- Lu d to / vJ14 ZIP 9.6'3 (.`-. S'-- 9 DIGIT PARCEL ID NUMBER ! 9$7 00 0 0 l Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT A# ' S,de3` A-14. S /C) is 'e.. PHONE 37 f .5q,z q D 30/-- // 2 Z MAILING ADDRESS 'cCI::01 U OX 708, ) �y G l..YN(Vl.t.iAtGCvv\ �f.' ii" ZIP { t3..3�.25' PROPERTY OWNER De n el S 2tePe r e i h PHONE -0- MAILING ADDRESS 13 /ff/ a/ 2ll/.) ,�- L J IQ u / witk ZIP 9 836— r.— CONTRACTOR k f.c S,`Q S 4vtd Alt iTt. PHONE 375 Se/2 l MAILING ADDRESS `t c i .8.0x. /7e)8/ � eLlWf-0.0 l.W (AtJl4 j ZIP g Ls' 3Gs/+ STATE LICENSE# CC /h-I> ,j3 C R SS AtJ S'% b �2 P1 EXP. DATE IL // l7e00 FEDERAL I.D. # (p 0/ 94 S 30 00 / ©0(a/ 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. g), APPLICANT SIGNATURE /I/a/j /...g DATE / / /'2r// FOR OFFICE USE ONLY v U 1 BASE FEE RECEIPT# 3 r j( CASH/CK# t...1' S. (d TOTAL (0 DATE I. /(x t CI L) H:\HOME\PLN CNTR\FORMS\INSTALL.DOC 10/99