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Home My WebLink AboutBLD2000-00062 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 #: BLD00-00062 Received Date 1/24/2000 SITE ADDRESS: 1740 SHINE RD Issue Date 1/25/2000 PORT LUDLOW, 98365 Expiration Date 1/25/2001 APPLICANT: LEROY A HEBERT PHONE: 1740 SHINE RD PORT LUDLOW WA 98365 2 SUBDIVISION: LONGMIRE SP Block: Lot: PARCEL NUMBER: 721031009 Section: 03 Township: 27N Range: 01E CONTRACTOR: R & S SALES AND SERVICE - TA101 K 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 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 01/25/2001. REQUIRED INSPECTIONS: [ nk/ iCne%Applian /C ? ®© [ 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 tf-Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00062 Received Date: 1/24/2000 SITE ADDRESS: 1740 SHINE RD PORT LUDLOW, 98365 APPLICANT: LEROY A HEBERT PHONE: 1740 SHINE RD PORT LUDLOW WA 98365 SUBDIVISION: LONGMIRE SP Block: Lot: 2 PARCEL NUMBER: 721031009 Section: 03 Township: 27 N Range: 01 E CONTRACTOR: R & S SALES AND SERVICE T/a1\P K PHONE: (360)385-5564 PO BOX 708 CHIMACUM WA 98325 Contractor's License RSSALS*022PB Expires 10/01/2000 ARCHITECT/ CEr aEX -- 6/-\c, ENGINEER : PROJECT DESCRIPTION: PROPANE TANK & GAS INSERT INSTALLATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: 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 Shoreline Aquifer Routing Date: Forest: Commercial Rural Proximity Type Amount Paid By: Date: Receipt: Approved/Date Permit $46.00 MAM 01/24/00 23689 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 i•- PROPANE TANK PELLET STOVE X OTHER Cad ..„4424e SITE ADDRESS: L/ / 911#/ROAD NAME /7 7O ///„5-j;i7 e �- "O? �Gres/�c,�J M-I ! ZIP y 836 S`- 9 DIGIT PARCEL ID NUMBER 7..2/03/DO 9 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM /� APPLICANT , IS Sj9 %,S //9/,o ,�,v/'- PHONE 377-.S-Vvz 2 ��- 30/ -//_2 2.MAILING ADDRESS /l 1 a, zi'/(' 7' ? / p L 7//�Q6'a//7 ie4f ZIP fO'S-2.5— PROPERTY OWNER Xe' 07 ,'-r43f7‘ X-h>71 PHONE MAILING ADDRESS /77D /5i,27e / Jff b c� / / :9�,�= -2-- itvAi ZIP /e3�PCI CONTRACTOR "if f)9/es l�- /i e PHONE �T f7 �7 MAILING ADDRESS , Q 4U'X 7c) ' �� // 2 C<<7/%rIGL G Li it' ZIP ,9a2 f STATE LICENSE # CC/f P i3 X sS '/S 0.2o2/D8 EXP. DATE jD /--20070 FEDERAL I.D. # 1p / 7, 7 321 g Cc'/ oao/ 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 str tur shall be requested and shall occur during regular business hours. Z:X7 APPLICANT SIGNATURE DATE / l,747'l 41° FOR OFFICE USE ONLY //_� BASE FEE RECEIPT# , ( :Rt' CASH/CK# / TOTAL DATE / �1:,7C� C(t,) H:\HOME\PLNCNTR\FORMS\INSTALL.D0C10/99 / 1eii e- /f C 5'