HomeMy WebLinkAboutBLD2000-00194 r
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 #: BLD00-00194 Received Date 3/27/2000
SITE ADDRESS: 7244 FLAGLER RD Issue Date 3/28/2000
NORDLAND, 98358 Expiration Date 3/28/2001
APPLICANT: EILEEN ULBERG PHONE: (360)379-9434
PO BOX 132
NORDLAND WA 98358
SUBDIVISION: NORDLAND TAX 5 Block: 3 Lot:
PARCEL NUMBER: 976200301 Section: 33 Township: 30N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2000
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK& GAS PIPE 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 03/28/2001.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:Ta :
[ ] FinalApproval: li / y ®Q71.2L
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 #: BLD00-00194 Received Date: 3/27/2000
SITE ADDRESS: 7244 FLAGLER RD
NORDLAND, 98358
APPLICANT: EILEEN ULBERG PHONE: (360)379-9434
PO BOX 132
NORDLAND WA 98358
SUBDIVISION: NORDLAND TAX 5 Block: 3 Lot:
PARCEL NUMBER: 976200301 Section: 33 Township: 30 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2000
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & GAS PIPE 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
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 03/27/00 27088
Total: $48.00
I:\F_BLD_App_BId.rpt 10/29/99
JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORE TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE V OTHER ye)
-/ v
SITE ADDRESS:911#/ROAD NAME 7�L� r(/
9
�p f`7 ZIP
9 DIGIT PARCEL ID NUMBER -I / 6 d 0 3 0
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Oditt tLee,,,_ U. L J-e-/-2 PHONE T r / _9 cf
MAILING ADDRESS
PO 682- /3 ..,
`Y1 ey , 7 k1l6.— �
ZIP e3�
PROPERTY OWNER 6212 C e'i_+-119 PHONE
MAILING ADDRESS c e'er---,----
ZIP
CONTRACTOR SU.VI S N 1 n�' P A P _ PHONE 3 86"-- S7(f 7
MAILING ADDRESS 10 I?5 3 R 4-D p 4 0(2. .
Po,--I- t' L-o c c CO( . ,, ZIP 5 of' 33
STATE LICENSE # SLA V1 S ff P i( 07 7 CO EXP. DATE I I /DC?
FEDERAL I.D. # `I I- l o q -7 8 c7
APPLICANT SIGNATURE aG4C."'4--- ,dJ)- 01, ( DATE LY / 3.3 / "
FOR OFFICE USE ONLY
BASE FEE rflECEIPT # '2-7-0g3
IECEHE
MASH/CK # T1 [5
.
TOTAL ^ !,DATE 3 /211 (7)
JEFFERSON COUNTY
H:\HOME\PLNCNTR\FORMS\INSTALL.DOC4/98 DEPT. OF COMMUNITY DEVELOPMENT