HomeMy WebLinkAboutBLD2000-00058 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 #: BLD00-00058 Received Date 1/24/2000
SITE ADDRESS: 33 STATION PRAIRIE RD Issue Date 1/24/2000
PORT TOWNSEND, 98368 Expiration Date 1/24/2001
APPLICANT: MARION FISHER PHONE: (360)385-4193
33 STATION PRARIE
PORT TOWNSEND WA 98368
19
SUBDIVISION: WOODLAND HILLS NO. 1 Block: Lot:
PARCEL NUMBER: 001275011 Section: 27 Township: 30N 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 01/24/2001
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: .7,04/ -L /-
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 #: BLD00-00058 Received Date: 1/24/2000
SITE ADDRESS: 33 STATION PRAIRIE RD
PORT TOWNSEND, 98368
APPLICANT: MARION FISHER PHONE: (360)385-4193
33 STATION PRARIE
PORT TOWNSEND WA 98368
SUBDIVISION: WOODLAND HILLS NO. 1 Block: Lot: 19
PARCEL NUMBER: 001275011 Section: 27 Township: 30 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
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $46.00 MAM 01/24/00 24029
Total: $46.00
I:\F_BLD_App_Bld.rpt 10/29/99
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: 13601 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: '\ CC
911#/ROAD NAME .J/C , ev I !, e
/C7cvr✓� `.zi - ZIP
9 DIGIT PARCEL ID NUMBER 001-2_1"5 0 I
Legal Description:
Subdivision Name Block Lotls)
Section Township North, Range WM
APPLICANT PHONE
MAILING ADDRESS G'r^ G; 5 6 r
ZIP
PROPERTY OWNER '9) /"y IC S 412/ PHONE — / 1
MAILING ADDRESS S c`e.v Pre-+,/,`e /�
/ �,1A ' L,„4 ZIP
CONTRACTOR (.E,s_e 7e- ---7j- r i1 vS'i i i�'S PHONE � — a,5
MAILING ADDRESS J/S !C Gj�� - )TQ
. z"-� •C_t-4_ LA". /9— ZIP -I g 3
STATE LICENSE# EXP. DATE O6 " O J —6)0
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 CJ l c� � l C�Q
FOR OFFICE USE ONLY
BASE FEE RECEIPT# . .`
CASH/CK#
TOTAL DATE /
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