HomeMy WebLinkAboutBLD2000-00094 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 #: BLD00-00094 Received Date 2/8/2000
SITE ADDRESS: 154 MASONIC HALL RD Issue Date 2/9/2000
PORT HADLOCK, 98339 Expiration Date 2/9/2001
APPLICANT: AL STRANDSKOV PHONE:
154 MASONIC HALL RD
PORT HADLOCK WA 98339
1
SUBDIVISION: OLSON LONG SUBDIVISION Block: ? Lot:
PARCEL NUMBER: 977600001 Section: 02 Township: 29N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING - TANK PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License RSSALS*022PB Expires 10/01/2000
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK& GAS (FREE STANDING) STOVE 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:
[ ] Tank Line/Appliance:/') C °�' (� _ 1-
[ l FinalApproval: (4t- be)
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 #: BLD00-00094 Received Date: 2/8/2000
SITE ADDRESS: 154 MASONIC HALL RD
PORT HADLOCK, 98339
APPLICANT: AL STRANDSKOV PHONE:
154 MASONIC HALL RD
PORT HADLOCK WA 98339
SUBDIVISION: OLSON LONG SUBDIVISION Block: ? Lot: 1
PARCEL NUMBER: 977600001 Section: 02 Township: 29 N Range: 01 W
CONTRACTOR: CENEX SUPPLY& MARKETING - TAN)K PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License RSSALS*022PB Expires 10/01/2000
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & GAS (FREE STANDING) STOVE 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
Shoreline Aquifer
Routing Date: Forest: Commercial Rural
Proximity
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $46.00 MAM 02/08/00 24177
Total: $46.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE >OROPANE TANK PELLET STOVE X OTHER 6 ckS a.ec Sjl:¢G1`l l -s
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SITE ADDRESS:
911#/ROAD NAME / S 4/ A S O/2/C_ 14-1I 2.N
f1`Ld4CL I c k A /A ZIP 9$33 C7* �'
9 DIGIT PARCEL ID NUMBER 9774 co .60/ .,
Legal Description:
Subdivision Name Block Lotls)
Section Township North, Range WM
APPLICANT !( /".S _Cigle $ A tcY Ser iJ I c e PHONE
MAILING ADDRESS A O, 2 OX 70 S�,�1
CAir a.c cc vv�. W ZIP 9c3 o2S
PROPERTY OWNER /1Z s //'4-/(/5 0 s' 0 V PHONE
MAILING ADDRESS /SV j'21ersev)%C/%/7 ie
Y7`/4 IDc , !ii),4 ZIP 983_1 9
UT — Thi
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CONTRACTOR 1eI S -,4'1- J5277 c/ ,JC•Vice PHONE 7y'-.S's/...,-,5'
MAILING ADDRESS p,0/ /6''7 7c g"
i/04.ecid7-71 4 i 40 ZIP 9) . ' .5----
STATE LICENSE # C C``'p4DNE /? S,Si(Z S ' oaaP 8EXP. DATE /Q--/ -c,,v,r,e90
FEDERAL I.D. # C.vQ/ 905 .?O / OO/ 0OO
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 �GTif7icy f �'�yt DATE 07 / 8 / Pa70
FOR OFFICE USE ONLY
BASE FEE yy---, 00 , ^�
. , -- EIPT# !f 1
" CASH/C #
Q�.
TOTAL (' • DATE i t j 7 lJ
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