HomeMy WebLinkAboutBLD2000-00157 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 #: BLD00-00157 Received Date 3/9/2000
SITE ADDRESS: 135 RHODY CT Issue Date 3/9/2000
CHIMACUM, 98325 Expiration Date 3/9/2001
APPLICANT: SECRETARY OF VE PHONE:
HENRY JACKWSON FED BLD
915 2ND AVE #MS263
SEATTLE WA 98174-1009 13
SUBDIVISION: RHODODENDRON ESTATES Block: Lot:
PARCEL NUMBER: 963100013 Section: 10 Township: 29N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING 5 i O kitE - PHONE: (360)732-4585
PO BOX 518 C-1-1
AUBURN WA 98071-0518
Contractor's License NORTHCS101CB Expires 01/24/2001
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK& 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 03/09/2001.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ Fi na(Approval: 0 (VY6Z—-
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
WOODSTOVE /\ PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: J 6 n j _ t d �ur
911#/ROAD NAME I`�/� L� z -}
Ch~ mr� Ct��-y ZIP Cl �JJLS
9 DIGIT PARCEL ID NUMBER 9( 1 O O O
Legal Description: �r /` ^ ,,\ ��r ee
Subdivision Name ---(.J_I}._ 15 k l In(i a d e in Ur �S loch Lot(s) I
Section ) L \ Township North, Range 1
APPLICANT � 11 I L A , R )\nc.'c(s PHONE () 7 -70-7 7
MAILING ADDRESS PJ , 6—U))( f Z
0_V11i11C& cl..t (Y) �l "0 ZIP
PROPERTY OWNER (c\d e „ Re c j no(dS PHONE
MAILING ADDRESS ) O 1l1,-e-
ZIP
CONTRACTOR fCC O -5 1 ( ((Y)n Pv( PHONE �'j l D 0J �Ci7( o -L� -c T
MAILING ADDRESS 510 be Ka ( k ,n ci , 1
Pc)C± V(CnCUI U �YC� ZIP
STATE LICENSE# nO 's o ) c b 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 righ 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 ri t of entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE1(/:::
C(2-1/ DATE / 9 / D
jf
FOR OFFICE USE ONLY
BASE FEE
`a� _'�°'�° RECEIPT# 2,4
CASH/CK#
TOTAL t; 1 DATE
HA HOME CNT R\FORMS\I N STA LL.D 0 C 10/9 9
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00157 Received Date: 3/9/2000
SITE ADDRESS: 135 RHODY CT
CHIMACUM, 98325
APPLICANT: SECRETARY OF VE PHONE:
HENRY JACKWSON FED BLD
915 2ND AVE #MS263
SEATTLE WA 98174-1009
SUBDIVISION: RHODODENDRON ESTATES Block: Lot: 13
PARCEL NUMBER: 963100013 Section: 10 Township: 29 N Range: 01 W
CONTRACTOR: NORTHWEST CHIMNEY SERVICE PHONE:
510 DEKALB
SUITE D
PORT ORCHARD WA 98366
Contractor's License NORTHCS101CB Expires 01/24/2000
ARCHITECT/ TASK (-E.r)t.X
ENGINEER : �Ep.JE HSUZ2�Jtu 01 /00
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 $48.00 MAM 03/09/00 25424
Total: $48.00
I:\F_BLD_App_Bld.rpt 10/29/99