HomeMy WebLinkAboutBLD2000-00588 ,
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 #: BLD00-00588 Received Date 9/12/2000
SITE ADDRESS: 196 OLD GARDINER RD Issue Date 9/12/2000
SEQUIM, 98382 Expiration Date 9/12/2001
APPLICANT: ANNE M LEWIS PHONE: (360)797-7908
PO BOX 2707
SEQUIM WA 98382
T 54
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002332020 Section: 33 Township: 30N Range: 02W
CONTRACTOR: FERRELLGAS PHONE: 1-888-933-7735
PO BOX 67
HOODSPORT WA 98548
Contractor's License FERRELPO55LH Expires 07/31/2001
OWNER,
if different:
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 09/12/2001.
REQUIRED INSPECTIONS:
[' ank/Ling/Appliance: (9"-- ,j7.uC' a-- -.3 PSL ( ir % co�zri)
[1' FinalApproval: (9)4, ((--b.-�'
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 #: BLD00-00588 Received Date: 9/12/2000
SITE ADDRESS: 196 OLD GARDINER RD
SEQUIM, 98382
APPLICANT: ANNE M LEWIS PHONE: (360)797-7908
PO BOX 2707
SEQUIM WA 98382
SUBDIVISION: Block: Lot: T 54
PARCEL NUMBER: 002332020 Section: 33 Township: 30 N Range: 02 W
CONTRACTOR: FERRELLGAS PHONE: 1-888-933-7735
PO BOX 67
HOODSPORT WA 98548
Contractor's License FERRELPO55LH Expires 07/31/2001
ARCH ITECT/
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 Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 09/12/00 34250
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 r! PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: a
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9 DIGIT PARCEL ID NUMBER CO 3 , Z ` 0 a,!
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT p(aC�f/JtC�I 777. c���� � PHONE�'OL9— 7 �I7— 7 ?C)Cf'
MAILING ADDRESS 4e' Z. 7 O 1
ZIP
PROPERTY OWNER .—r • -1-c-8—e'°2'"" PHONE L' ` 7 l 7-77Qf
MAILING ADDRESS ,`g' 2.-70 7
ZIP '0 - —
CONTRACTOR ,/ t PHONEi j
MAILING ADDRESS / Cc? z-I✓'
a^ ZIP 9 �+
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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 -,7 7/( DATE j / 12 / 2 CA
FOR OFFICE USE ONLY
BASE FEE RECEIPT it 34'Z5 0
CASH/CK# d) Q 9
TOTAL I r DATE 9 cad tie)
H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99