HomeMy WebLinkAboutBLD2000-00375 ' i i
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 #: BLD00-00375 Received Date 6/12/2001
SITE ADDRESS: 111 SHERMAN RD Issue Date 6/12/2000
PORT LUDLOW, 98365 Expiration Date 6/12/2001
APPLICANT: WILLIAM A SHERMAN PHONE:
111 SHERMAN RD
PORT LUDLOW WA 983659508
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821344011 Section: 34 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License RSSALS*022PB Expires 10/01/2000
PHONE: 301 -1122
R & S Sales & Services
RSSALS*022PB 10/01 /2000
PROJECT DESCRIPTION PROPANE TANK& FREE STANDING HEATING STOVE
INS I ALLA I ION
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 06/12/2001.
REQUIRED INSPECTIONS:
[di (Tank/Line/Appliance: I ' 0 1< J 'e, -13-0o
�.L� FinalApprov� -ef-Ae t`--"_�
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 #: BLD00-00375 Received Date: 6/12/2001
SITE ADDRESS: 111 SHERMAN RD
PORT LUDLOW, 98365
APPLICANT: WILLIAM A SHERMAN PHONE:
111 SHERMAN RD
PORT LUDLOW WA 983659508
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821344011 Section: 34 Township: 28 N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License RSSALS*022PB Expires 10/01/2000
ARCHITECT/ R & S Sales 301 -1 1 22
ENGINEER :
PO BOX 708
Chimacum, WA 98325
RSSALS*022PB 10/01 /2000
PROJECT DESCRIPTION: PROPANE TANK & FREE STANDING HEATING STOVE
INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
—Proximity - Flat Conditions
Type Amount Paid By: Date: Keceipt: Approveate
Propane Tanks/Stoves $48.00 MAM 06/12/01 31673
Total: $48.00
I:\F_BLD_App_Bld.rpt 10/29/99
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: 1360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE ��0THER �t'e ��st-st
PROPANE TANK PELLET STOVE 'C)'sr ✓'�J 4 j`
SITE ADDRESS: / `c
911#/ROAD NAME /// /el)
1P / q`/QGL) ZIP ?'z 'JG .S'----
9 DIGIT PARCEL ID NUMBER/ 3 5 y 1///
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT ,PAS Ji /sS , f J i 1'j'C t, PHONE ?c'/-//Z Z
MAILING ADDRESS / ),Q, OX 7e,8'
Av)446;.ca.w, 14 a4 ZIP Pg3-25—
PROPERTY OWNER 5; // ��r`jzGLyt PHONE
MAILING ADDRESS /// fl e/-..i i y-t 'e s
hc/ Gt} (if/ia ZIP 7836 f
CONTRACTOR ,elf ,Sjez-`s Any!c J,,,vrC Yc PHONE 3 0///2 2-
MAILING ADDRESS /O,D, ,8O x' 7O 6" / f >
C 4 iYVtGt. L.(A Vlf ZIP s7, 2S.-
STATE LICENSE # CC/41)1?G. A S'S/1i--C ir 022/s EXP. DATE /C�/D/,ZDaO
FEDERAL I.D. # fpc/ 7'S ,f4 5/ O4/ OOO /
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.
)5Z2---
APPLICANT SIGNATURE , DATE [p / /Z / 0 O
FOR OFFICE USE ONLY
BASE FEE f t RE IPT# 1
CASH , K#
TOTAL ' / ` d DATE 6 // /OC)
H:\HOME\PLNCNTR\FORMS\INSTALL.DO C 10/99