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HomeMy WebLinkAboutBLD2000-00093 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 #: BLD00-00093 Received Date 2/9/2000 SITE ADDRESS: 311134 HWY 101 Issue Date 2/9/2000 BRINNON, 98320 Expiration Date 2/9/2001 APPLICANT: ART TOZIER PHONE: (360) 796-4603 C/O JOHNSTON REALTY PO BOX 88 BRINNON WA 98320 4 SUBDIVISION: JOHNSTON SHORT PLAT#2 Block: Lot: PARCEL NUMBER: 502213015 Section: 21 Township: 25N Range: 02W CONTRACTOR: FERRELLGAS PHONE: 1-888-933-7735 PO BOX 67 HOODSPORT WA 98548 Contractor's License FERRELPO55LH Expires 08/01/2000 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 02/09/2001. REQUIRED INSPECTIONS: 4,4 nk/Line A liance: "e // - �p zr y-�`,�..rn3r ..moo-a r� �il� 1 /��' [ co, z 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 #: BLD00-00093 Received Date: 2/9/2000 SITE ADDRESS: 311134 HWY 101 BRINNON, 98320 APPLICANT: ART TOZIER PHONE: (360) 796-4603 C/O JOHNSTON REALTY PO BOX 88 BRINNON WA 98320 SUBDIVISION: JOHNSTON SHORT PLAT#2 Block: Lot: 4 PARCEL NUMBER: 502213015 Section: 21 Township: 25 N Range: 02 W CONTRACTOR: FERRELLGAS PHONE: 1-888-933-7735 PO BOX 67 HOODSPORT WA 98548 Contractor's License FERRELPO55LH Expires 08/01/2000 ARCHITECT/ ENGINEER : PROJECT DESCRIPTION: PROPANE TANK 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 Propane Tanks/Stoves $46.00 LMB 02/09/00 24087 Total: $46.00 I:\F_BLD_App_Bld.rpt 10/29/99 f � • JEFFErRSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: 1360) 379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE XX PROPANE TANK PELLET STOVE OTHER SITE ADDRESS: 911#/ROAD NAME 311134 Hwy 101 Brinnon , Wa ZIP 98320 9 DIGIT PARCEL ID NUMBER 502213015 Legal Description: Parcel #4 Johnston Short Plat Subdivision Name Block Lot(s) Sectior2 l Township 2 5N North, Range 2 WM APPLICANT Art Tozier PHONE 796-4603 MAILING ADDRESS C/o Johnston Realty ( attn. Karen . ) P.O. Box 88 Brinnon, Wa ZIP 98320 PROPERTY OWNER Art Tozier PHONE 796-4603 MAILING ADDRESS c/o Johnston Realty P.O. Box 88 Brinnon Wa ZIP 98320 ATetel,e//94-1t 7/ ? COCONTRACTOR 6wiieL a>i /U�� PHONE '3 6 _277 S2 // MAILING ADDRESS Art Tozier/C/O Johnston Realty P.O. Box 88 Brinnon , Wa ZIP 98320 STATE LICENSE# 5 EXP. DATE =$0- P"/- 2 C tJJ FEDERALI.D. # 537-38-5720 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 far 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 �`� / 030.-1. DATE a / `!' / t� FOR OFFICE USE ONLY BASE FEE 14 I, RECEIPT# Ztt o CASHICK# f�1Z �. TOTAL ry' 144, DATE t0� H:1HO ME\PLN CNTR\FORMS\INSTALL.DOC 10/99 (�(��) ©O /o"—