HomeMy WebLinkAboutBLD2000-00172 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 #: BLD00-00172 Received Date 3/15/2000
SITE ADDRESS: 144 CHERRY AVE Issue Date 3/16/2000
CHIMACUM, 98325 Expiration Date 3/16/2001
APPLICANT: LELAND MACKS PHONE: (360)732-7395
AUDREY MACKS
PO BOX 128
CHIMACUM WA 98325 7
SUBDIVISION: IRONDALE ORCHARD TRACTS BLOCK Block: 2 Lot:
PARCEL NUMBER: 963000207 Section: 10 Township: 29N Range: 01W
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/01/2001
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK& GAS 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 03/16/2001.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: D f� �ZD0 a
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
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BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00172 Received Date: 3/15/2000
SITE ADDRESS: 144 CHERRY AVE
CHIMACUM, 98325
APPLICANT: LELAND MACKS PHONE: (360)732-7395
AUDREY MACKS
PO BOX 128
CHIMACUM WA 98325
SUBDIVISION: IRONDALE ORCHARD TRACTS BLOCK Block: 2 Lot: 7
PARCEL NUMBER: 963000207 Section: 10 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 03/01/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & GAS STOVE 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 03/15/00 25447
Total: $48.00
I:\F_BLD_App_Bid.rpt 10/29/99
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (3601 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE ✓ OTHER 941 S 5 f °':-
SITE ADDRESS:
911#/ROAD NAME /2%41 C/lei;y f}i![_,
ZIP
9 DIGIT PARCEL ID NUMBER 9(0 Co c: 2c ?
Legal Description:
Subdivision Name prc_({•:.,:.! ` Yi-c i_,4 i d'o",r'4/4- Block z- Lot(s) 7
Section Township North, Range WM
APPLICANT iC /q T {r( ,
tit"c.c 1-4 S 4 ve)J Laitnn m.-c Li 3 PHONE 7 3 Z- 7 3 `%S'
MAILING ADDRESS pp yt 12 's c it,,.v.s.:_, v iv. r.✓ ,
ZIP S' 32Sr
PROPERTY OWNER Lc'- 1 j iA iio 4 c u s1/lac'vr 7 kin,,_,- (fa PHONE 7 3 2- 7 3 5 5--
MAILING ADDRESS pcl 6 V$ 1 ,Z g CPIfy vv..&_c u ti-y-
ZIP 9 5-3 2 5-
CONTRACTOR SJ C go f Fj'4-,n rru f c•n t--- 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 .----1) �C /j�L��✓�— r
DATE 3 / / S / C
FOR OFFICE USE ONLY
BASE FEE "T e j .e-' RECEIPT# `51441 .1.
CASH/CK# f , :-.1 1
TOTAL - . c`""1C3 DATE / 1 / F't`;
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