HomeMy WebLinkAboutBLD2000-00068 t
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 #: BLD00-00068 Received Date 1/28/2000
SITE ADDRESS: 131 MARKET ST Issue Date 1/28/2000
PORT HADLOCK, 98339 Expiration Date 1/28/2001
APPLICANT: SAM RAYMOR �� a PHONE: (360)379-9116
ANDREA RAYMOR J7�y
PO BOX 1144
PORT HADLOCK WA 98339 11
SUBDIVISION: IRONDALE Block: 39 Lot:
PARCEL NUMBER: 961803903 Section: 35 Township: 30N Range: 01W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2000
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK& FURNACE 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 01/28/2001
REQUIRED INSPECTIONS:
Tank/Line/Appliance: ] rd' 23l t/` /(-
V 4ajpproval: ter, /4 40(
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
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
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SITE ADDRESS: ,/ ( 1
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9 DIGIT PARCEL ID NUMBER 9//
Legal Description:
Subdivision Name /Cs�??�"� Block _/ Lot(s)
Section Township North, Range WM
APPLICANT / /���///l -% /77/�� PHONC :f7c
MAILING ADDRESS GX //
ZIP
PROPERTY OWNER i�Z4 �. n/ PHONE
MAILING ADDRESS
ZIP
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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 / ly�l
FOR OFFICE USE ONLY
BASE FEE ,+ RECEIPT# 9 s
CASH/CK#
TOTAL '1_ DATE / u /O
H:\H OME\PLNCNTR\FORMS\INSTALL.D0C 10/99
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00068 Received Date: 1/28/2000
SITE ADDRESS: 131 MARKET ST
PORT HADLOCK, 98339
APPLICANT: SAM RAYMOR PHONE: (360)379-9116
ANDREA RAYMOR
PO BOX 1144
PORT HADLOCK WA 98339
SUBDIVISION: IRONDALE Block: 39 Lot: 11
PARCEL NUMBER: 961803903 Section: 35 Township: 30 N Range: 01 W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTI00088CC Expires 05/01/2000
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & FURNACE 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 01/28/00 23695
Total: $46.00
I:\F_BLD_App_Bld.rpt 10/29/99