HomeMy WebLinkAboutBLD2000-00582 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 #: BLD00-00582 Received Date 9/11/2000
SITE ADDRESS: ) HWY 101 2-25L33 Z.. Issue Date 9/11/2000
PORT TOWNSEND, 98368 Expiration Date 9/11/2001
APPLICANT: LUCILLE BROWN PHONE:
C/O MRS MILDRED NORTHUP
282332 B HWY 101
PORT TOWNSEND WA 98368 T 8
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 902234013 Section: 23 Township: 29N Range: 02W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2001
OWNER, LUCILLE BROWN PHONE:
if different: C/O MRS MILDRED NORTHUP
282332 B HWY 101
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION PROPANE TANK 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 09/11/2001.
REQUIRED INSPECTIONS:
[ /Line/Appliance:
[t"( FinalApproval: / Api K o y , ( I N Aa�S►Sf►N o vc 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
r $
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: RLD00-00582 Received Date: 9/11/2000
SITE ADDRESS: I HWY 101 2dZ332
PORT TOWNSEND, 98368
APPLICANT: LUCILLE BROWN PHONE:
C/O MRS MILDRED NORTHUP
282332 B HWY 101
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: T 8
PARCEL NUMBER: 902234013 Section: 23 Township: 29 N Range: 02 W
CONTRACTOR: CENEX SUPPLY & MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 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 - Plat Uonditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 09/11/00 34238
Total: $48.00
is\F_BLD_App_Bld.rpt 10/29/99
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE XPROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: .9 1#ROAD NAME / 2 a 2 3 3� I (' / /o 1
/ Gd/l.m]Z/C.)! &/4? ZIP
9 DIGIT PARCEL ID NUMBER 91(12c.:Q - c 3C -
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
7D/56411/E7,2 -73.9 9 S,Od �
APPLICANT /! //' (',c/ PHONE J8 —
3 0 8
MAILING ADDRESS /96 17267/9 /1-7/1j C e
,Z /C,Qr .y.61-) (,& uJJ/ ')/Q ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR �-11.7 e-x PHONE 73 2-Y.�.0S
MAILING ADDRESS 9S/5 � p�s
�T//� /�j/ a.7- Z I P 95.'3 ";)1S-
STATE LICENSE# EXP. DATE
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 DATE / ////
FOR OFFICE USE ONLY
BASE FEE RECEIPT# �1.Z�j C.>
CASH/CK# CAS `
TOTAL DATE -1 I I / "')
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