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HomeMy WebLinkAboutBLD2000-00309 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 #: BLD00-00309 Received Date 5/17/2000 SITE ADDRESS: 1130 E QUILCENE RD Issue Date 5/17/2000 QUILCENE, 98376 Expiration Date 5/17/2001 APPLICANT: ROGER CONN 1130 E QUILCENE RD PHONE: (360)379-5429 QUILCENE WA 98376 SUBDIVISION: 6 Block: Lot: PARCEL NUMBER: 701184006 Section: 18 Township: 27N Range: 01W CONTRACTOR: CENEX SUPPLY& MARKETING — -"FAKIR PHONE: PO BOX 518 (360)732-4585 AUBURN WA 98071-0518 Contractor's License RSSALS*022PB Expires 10/01/2000 OWNER, S if different: SaIZS + �y ervlC� SUp j2SSA L.S 02.2313 Ip/OI ( ?..o cc PROJECT DESCRIPTION PROPANE TANK& FREE STANDING 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 05/17/2001. REQUIRED INSPECTIONS: [ Tank/Line/Appliance: [ FinalApproval: t)i< (549 p,> 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 #: BLD00-00309 Received Date: 5/17/2000 SITE ADDRESS: 1130 E QUILCENE RD QUILCENE, 98376 APPLICANT: ROGER CONN PHONE: 1130 E QUILCENE RD (360)379-5429 QUILCENE WA 98376 SUBDIVISION: PARCEL NUMBER: 701184006 Section: 18 Township: 27B1ock:N Range: 01 Wt. 6 CONTRACTOR: CENEX SUPPLY& MARKETING TANI PO BOX 518 PHONE: (360)732-4585 AUBURN WA 98071-0518 Contractor's License RSSALS*022PB Expires 10/01/2000 ARCHITECT/ ENGINEER : Sa les C�rvi C STZ>VG RSSALS * 02,2_Pi3 jb/ot (2co PROJECT DESCRIPTION: PROPANE TANK & FREE STANDING STOVE INSTALLATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 1997 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: WATER SYSTEM: BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Flood Plane Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural 1-'r xlmlt Nlat Co r1ditions Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 MAM 05/17/00 31509 Total: $48.00 I:\F_BLD_App_Bld.rpt 10/29/99 Ger"X 4u, «! ` JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE PROPANE TANK PELLET STOVE OTHER Y"Yrt'' S ic4 yte 56./' SITE ADDRESS: / 911#/ROAD NAME //30 £ '2 i c..e►t /ei am.'bcern to,* ZIP 9.6• 7c 9 DIGIT PARCEL ID NUMBER 70// 8'y c?0 /_ Legal Description: �F' Subdivision Name Block Lotls) Section Township North, Range �7 WM /t APPLICANT I S ,5:9-/eS' A-t7I ,S`r,Vak , PHONE 3'79-s'9. 2 MAILING ADDRESS F 0. eel, 767 - 61f%/oia!e(;ii 14./i ZIP 7.6r-,_ 62. PROPERTY OWNER Alf wide ono PHONE 7 , --3 7,5,, MAILING ADDRESS //3 O E C.V44 4 e"C bl /2 ^� (_; t.f her < >t4 ZIP 9 iJ 76 CONTRACTOR /( ,rs` S' Ste? eS ifixtr J;i1/7<C PHONE 307--J/ , 'Z MAILING ADDRESS //©., ) j '7j'5 / C!7 i417Qcw24 t[/J4, ZIP 9e3_25- STATE LICENSE# C Cif L 136 iC SS/q-/,5, C2,2.:2P8 EXP. DATE /0--d/ - ,zdoo FEDERAL I.D. # (�C/ 9'oS' 3Dc7 Oo/ QpO/ 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 ? �� ot..�2 � 47 DATE ti- / / 00 FOR OFFICE USE ONLY - BASE FEE `RECEIPT# '' '\ 0 CASH/CK# > t"3 .- TOTAL L C. 0" t� DATE i fl i O H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99