HomeMy WebLinkAboutBLD2000-00482 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 #: BLD00-00482 Received Date 7/21/2000
SITE ADDRESS: 31 BRIGHTON ST Issue Date 8/28/2000
PORT HADLOCK, 98339 Expiration Date 8/28/2001
APPLICANT: ROY BOSLEY PHONE:
31 BRIGHTON ST
PORT HADLOCK WA 983399508
12&1
SUBDIVISION: SHOLD'S ADDITION Block: 2 Lot:
PARCEL NUMBER: 994800210 Section: 02 Township: 29N Range: 01W
CONTRACTOR: SILVERDALE PLUMBING PHONE: (360)692-8840
11875 SILVERDALE WY NW
STE 104
SILVERDALE WA 98383
Contractor's License SILVEI`220NV Expires 08/01/2001
OWNER, ROY BOSLEY PHONE:
if different: 31 BRIGHTON ST
PORT HADLOCK WA 983399508
PROJECT DESCRIPTION KIDNEY DIALYSIS MACHINE
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 08/28/2001.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ FinalApproval: /%/,'.. tJ t�'7� 621 9� --0?
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
r
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00482 Received Date: 7/21/2000
SITE ADDRESS: 31 BRIGHTON ST
PORT HADLOCK, 98339
APPLICANT: ROY BOSLEY PHONE:
31 BRIGHTON ST
PORT HADLOCK WA 983399508
SUBDIVISION: SHOLD'S ADDITION Block: 2 Lot: 12&1
PARCEL NUMBER: 994800210 Section: 02 Township: 29 N Range: 01 W
CONTRACTOR: SILVERDALE PLUMBING PHONE: (360)692-8840
11875 SILVERDALE WY NW
STE 104
SILVERDALE WA 98383
Contractor's License SILVEI*220NV Expires 08/01/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: KIDNEY DIALYSIS MACHINE
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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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
F&W Landslide
Routing Date: U 4, —GO Shoreline Aquifer
Forest: Commercial Rural
1-'r xlmlty - Mat Uo d tlons
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 07/21/00 33269 APPROVED
State Building Code $4.50 MAM 07/21/00 33269
Total: $52.50 -AUG 2 8 2000
Jefferson County Planning
Suilding O partiicnt
is\F_BLD_App_Bld.rpt 10/29/99
itit i 8 RECO ,
' JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE VOTHER ��{ p
SITE ADDRESS: a)QGC��I.IC'!/ -
911#/ROAD NAME I for I I�ft n S+-.
Porf ITaa ZIP atr.
9 DIGIT PARCEL ID NUMBER -I q l-F-', CO_ 2-1 0
Legal Name See A FtC��� Vi€ _! I2_ I3
Subdivision Name l., (� Block Lot(s) ,
Section Township North, Range QWM
APPLICANT � I I vt rd cl e PI u I / 1 is i '�q PHONE (.3('`)0)(:)q �C 2" ))
MAI'_ING ADDRESS I !I)CJ 7 5 Si I v e rc �,i€ V Vy 1 V .}V V/, J I{
Si !v rcio Ie / V V1 ZIP gc3303
PROPERTY OWNER l „p 1 1CS 11 PHONE
MAILING ADDRESS sae as s
ZIP
CONTRACTOR S i lve rd u e PI (,uv)-1 bin 9 PHONE
MAILING ADDRESS
ZIP
STATE LICENSE # 5 1 LV E I X 2_20 N U EXP. DATE B/0 I
FEDERAL I.D. # q I-0 1 -1 o'(J 3 I
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 ATRA) 7 DATE i / ICJjr / VljC)CLt .mCi.
0 FOR OFFICE USE ONLY
BASE FEE „' U RECEIPT# 3j �„
9 so I^l CASH/CK# 7 1 !-
TOTAL' 3 DATE " / /__(:)._()
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