HomeMy WebLinkAboutBLD2000-00443 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 #: BLD00-00443 Received Date 7/3/2000
SITE ADDRESS: 13871 CENTER RD Issue Date 7/3/2000
QUILCENE, 98376 Expiration Date 7/3/2001
APPLICANT: MARK KNUTZEN PHONE:
PO BOX 51
QUILCENE WA 98376-0609
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701182017 Section: 18 Township: 27N Range: 01W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2001
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 07/03/2001.
REQUIRED INSPECTIONS:
[ ] Tan Lute/Appliance 0/ 3— 7-0 Z-
[ ] FinalApproval: 4.-/N/E PErc /fie=/7 7
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 #: BLD00-00443 Received Date: 7/3/2000
SITE ADDRESS: 13871 CENTER RD
QUILCENE, 98376
APPLICANT: MARK KNUTZEN PHONE:
PO BOX 51
QUILCENE WA 98376-0609
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701182017 Section: 18 Township: 27 N Range: 01 W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & STOVE INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: ADD'L: HEAT TYPE: PRO
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: 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
Type Amount Paid By: Date: 1'r xlmlt - Nlat conditions
Receipt: Approved/ ate
Propane Tanks/Stoves $48.00 LMB 07/03/00 32073
Total: $48.00
is\F_BLD_App_Bld.rpt 10/29/99
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
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WOODSTOVE PROPANE TANK PELLET STOVE V OTHER STOJ G
SITE ADDRESS: j�� ����1� 1 l; e� �i� - ) 6-/ ai I /�G��SITE ROAD NAME <S ( /
'1 ZIP 516e- 7 t� 1119 DIGIT PARCEL ID NUMBER �(� / / �� L/ c(
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT q r ) K), t.C-7/0�t-1 PHONE 7t;_5.- C_(O-267
MAILING ADDRESS po, 6/7(r- c /
6)(4,< (6_7(',f' •
ZIP
PROPERTY OWNER ,, rj c.-C G'L PHONE
MAILING ADDRESS q
ZIP
CONTRACTORe A yi/ /(9/�0 )'/? !/t PHONE-,CJ `J " ( Lt 2 0
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MAILING ADDRESS .L2 Se d (4.,), cc�/ i 2, 7
ZIP 1
STATE LICENSE# p I l j oc ®(s-ems- C c- EXP. DATE L. 'l o/ / 2-6PO
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 7// i __Y / DATE / 3 c
,- FOR FFICE USE ONLY
BASE FEE ` � RECEIPT# L.w
, .�-
,,��� yr:' CASH
TOTAL . DATE / 11J^"'
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