HomeMy WebLinkAboutBLD2000-00053 A
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 #: BLD00-00053 Received Date 1/21/2000
SITE ADDRESS: 3280 DABOB RD Issue Date 1/21/2000
QUILCENE, 98376 Expiration Date 1/21/2001
APPLICANT: RAY MCDONALD PHONE:
3280 DABOB RD
QUILCENE WA 98376
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801332004 Section: 33 Township: 28N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 06/01/2000
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 01/21/2001.
REQUIRED INSPECTIONS:
[U' aril/Line/Appliance: ' -'.a11/c ''7C i///Ar'P ' ,
t. pproval: /C /7,//e) t` tt�_� e
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
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00053 Received Date: 1/21/2000
SITE ADDRESS: 3280 DABOB RD
QUILCENE, 98376
APPLICANT: RAY MCDONALD PHONE:
3280 DABOB RD
QUILCENE WA 98376
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801332004 Section: 33 Township: 28 N Range: 01 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 06/01/2000
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. 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 01/21/00 24019
Total: $46.00
I:\F_BLD_App_Bld.rpt 10/29/99
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: ^ /
911#/ROAD NAME 3 2�� l✓l4 f j!J (� Pd
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9 DIGIT PARCEL ID NUMBER O I 3�'Z ec K
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT A # f C O Yj,q.// PHONE 71.9 36,01
MAILING ADDRESS ,) z-75Q Ord bO 6 Rd /
Ci ICe e / w ZIP q3 T6
PROPERTY OWNER 4 Kill )'V14C ee4 jd PHONE 16 S -J 6e
MAILING ADDRESS 320 Oi' bcb
aLt;k, l.Jss ZIP _/ S S 7 6
CONTRACTOR NIEZ PHONE
MAILING ADDRESS
ZIP
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 D I / Z f / Oce)
FOR OFFICE USE ONLY
BASE FEE ''t . RECEIPT# 1 °t
CASH/CK # CaSk
TOTAL 1, t. -4 C) DATE /-1 /00
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