HomeMy WebLinkAboutBLD2000-00061 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 #: BLD00-00061 Received Date 1/24/2000
SITE ADDRESS: 741 FAIRMONT RD Issue Date 1/25/2000
PORT TOWNSEND, 98368 Expiration Date 1/25/2001
APPLICANT: KEN STARETT PHONE: (360)385-4705
741 FAIRMOUNT RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 902241010 Section: 24 Township: 29N Range: 02W
CONTRACTOR: R & S SALES AND SERVICE - i ANI lc_ 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, GAS PIPING & HEATER 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 01/25/2001.
REQUIRED INSPECTIONS:
[ Tank/Line/Appliance:
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[ I] FinalApproval:
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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
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BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00061 Received Date: 1/24/2000
SITE ADDRESS: 741 FAIRMONT RD
PORT TOWNSEND, 98368
APPLICANT: KEN STARETT PHONE: (360)385-4705
741 FAIRMOUNT RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 902241010 Section: 24 Township: 29 N Range: 02 W
CONTRACTOR: R & S SALES AND SERVICE -- T/\hl k PHONE: (360)385-5564
PO BOX 708
CHIMACUM WA 98325
Contractor's License RSSALS*022PB Expires 10/01/2000
ARCHITECT/ ALL SE-AS CN - S
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK, GAS PIPING & HEATER 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:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
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 24055
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 PROPANE TANK PELLET STOVE OTHER S ke" '
SITE ADDRESS:
911#/ROAD NAME
M
ZIP
9 DIGIT PARCEL ID NUMBER I V 2- 2-Li t t 0
Legal Description:
Subdivision Name �^ Block ,Lot(s)
Section 2,Lk Township 2_ 1 North, Range Z Vv WM
APPLICANT '- JSAr‘e* PHONE
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MAILING ADDRESS t trZi Yea VC `t
thSr .V"C:1 ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR T � 5{ q PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# C-,A-S EXP. DATE
FEDERAL I.D. # i (-F--4C8 / kA'
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 andlright of entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE DATE / /-
FOR OFFICE USE ONLY6-12
BASE FEE RECEIPT# Z"10
CASH/CK# � J (
TOTAL —1 U DATE t /Z / O
H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99