HomeMy WebLinkAboutBLD2000-00134 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 #: BLD00-00134 Received Date 2/29/2000
SITE ADDRESS: 2277 DUCKABUSH RD Issue Date 2/29/2000
BRINNON, 98320 Expiration Date 2/28/2001
APPLICANT: TIM EDGREN PHONE:
KATHY EDGREN
11248 NE 143RD PL
KIRKLAND WA 98034
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502083017 Section: 08 Township: 25N Range: 02W
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 02/28/2001
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ VnalApproval: /Z,/O O J
l
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 #: BLD00-00134 Received Date: 2/29/2000
SITE ADDRESS: 2277 DUCKABUSH RD
BRINNON, 98320
APPLICANT: TIM EDGREN PHONE:
KATHY EDGREN
11248 NE 143RD PL
KIRKLAND WA 98034
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502083017 Section: 08 Township: 25 N Range: 02 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 MAIN:
VALUATION
CODE EDITION: 1997 ADD'L: HEAT TYPE: PRO
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
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $48.00 LMB 02/29/00 25289
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 22. 7 7 D U CK A t3 v S H 12.014,
g2l6,14o/ J (AC) ZIP 983 "Z.d
9 DIGIT PARCEL ID NUMBER 5 0 2 0 S*3 017
Legal Description:
Subdivision Name Block Lot(s)
Section ()F Township 2.S North, Range O Z. WM
APPLICANT -Tim (,2e-i•-) PHONE t2b 4/0Lf-7 t /7
MAILING ADDRESS I 1 Lye tvt {L-t3 a p Pt-A CE
(<\RiCt-AN1j / w ZIP -te03l'!
PROPERTY OWNER SPrA.A P+S Pe-@-0 VE PHONE
MAILING ADDRESS
ZIP
CONTRACTOR 1/Q V(Z f3 itf,1 Pao f A/(6 PHONE o o" (D41 ` yES
MAILING ADDRESS `[p- 0 9 p 9 -� C
Po2-r w(NI s Gv./1b 1 (/ q\ ZIP / 0 3 6 g-
STATE LICENSE# S V 3 V{ZP L,O LI L/jbJ EXP. DATE � I /ZOO 0
FEDERAL I.D. # 2z - 3 Y (r� ?,c 2 l/
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 /774.1„./ DATE / 2--9 / 6-6
FOR OFFICE USE ONLY
BASE FEE '.QD RECEIPT# Z L
CASH/CK#
TOTAL -Citi DATE J /(,)
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