HomeMy WebLinkAboutBLD2000-00127 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 #: BLD00-00127 Received Date 2/23/2000
SITE ADDRESS: 316 PORT HADLOCK HEIGHTSRD Issue Date 2/23/2000
PORT HADLOCK, 98339 Expiration Date 2/23/2001
APPLICANT: DICK BRODERS PHONE: (360)797-7722
4503 OLD GARDINER RD
PORT TOWNSEND WA 98368
18
SUBDIVISION: PT HADLOCK MOBILE HOME Block: Lot:
PARCEL NUMBER: 989500001 Section: 11 Township: 29N Range: 01W
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/01/2000
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 02/23/2001.
REQUIRED INSPECTIONS:
[ ] Tank/ 'ne/Appliance:
-4261 -af)Zia
[V] FinalApproval: L' 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 of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00127 Received Date: 2/23/2000
SITE ADDRESS: 316 PORT HADLOCK HEIGHTSRD
PORT HADLOCK, 98339
APPLICANT: DICK BRODERS PHONE: (360)797-7722
4503 OLD GARDINER RD
PORT TOWNSEND WA 98368
SUBDIVISION: PT HADLOCK MOBILE HOME Block: Lot: 18
PARCEL NUMBER: 989500001 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/01/2000
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK 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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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 $48.00 MAM 02/23/00 25370
Total: $48.00
I:\F_BLD_App_Bld.rpt 10/29/99
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE / PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: _
911#/ROAD NAME ,31 t P c H A D LO C K H C,-TS 1cl Cy
PORT HAbLocK. ZIP / . .339
9 DIGIT PARCEL ID NUMBER g q 5 00 ®C7 i
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT H 1./ 1 6 P(^t— PHONE 3 6 0 38 S - 375(-
MAILING ADDRESS P.O• box ao 9 z
-PoRT i oWiI S @J) WA ZIP 983L8
PROPERTY OWNER Dick i (zo.P G 2 S PHONE 3 bO - 7 9 7 - 7 7.)z.
MAILING ADDRESS I E o 3 OLD G- AkDiUE12
Pouf 1 owns€'7ci WA ZIP 2836$
CONTRACTOR S G to (A r Wl l OO -p of PHONE
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 <0...ep/Y7ifz , ti X DATE / / O®
FOR OFFICE USE ONLY
BASE FEE, y #
�� • [7"o RECEIPT
CASH/CK# : •
s»,V
TOTAL " • CD DATE
H:\HO ME\PLNCNTR\FORMS\IN STALL.DOC 10/99