HomeMy WebLinkAboutBLD2000-00595 f
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 #: BLD00-00595 Received Date 9/15/2000
SITE ADDRESS: 2367 OLD GARDINER RD Issue Date 9/18/2000
SEQUIM, 98382 Expiration Date 9/18/2001
APPLICANT: JAMES T FARRICKER PHONE:
CINDY L FARRICKER
15717 451 ST AVE SE
NORTH BEND WA 98045
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002352017 Section: 5 Township: 30N Range: 2W
CONTRACTOR: EVERWARM INC PHONE:
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/04/2001
OWNER, JAMES T FARRICKER PHONE:
if different: CINDY L FARRICKER
15717 451ST AVE SE
NORTH BEND WA 98045
PROJECT DESCRIPTION Woodburning fireplace insert
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 09/18/2001.
REQUIRED INSPECTIONS:
[''] Tank/Line/Appliance:
[ ,] FinalApproval: 0,-14v6r9,42: // e(r'C-)l< ��rrC% rr��,
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 #: BLD00-00595 Received Date: 9/15/2000
SITE ADDRESS: 2367 OLD GARDINER RD
SEQUIM, 98382
APPLICANT: JAMES T FARRICKER PHONE:
CINDY L FARRICKER
15717 451ST AVE SE
NORTH BEND WA 98045
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002352017 Section: 5 Township: 30 N Range: 2
CONTRACTOR: EVERWARM INC PHONE:
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/04/2000
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: ' o 0'..L u. a ; ,.,s F e'-'c L.l� 1 —� � � 4.—
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 1997 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER:
GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: OSS
WATER SYSTEM: OTHER
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: 'l-'r ximity - Plat Conditions
Receip : Approved/ate
Permit $48.00 RAC 09/15/00 34278
Total: $48.00
is\F_BLD_App_Bld.rpt 10/29/99
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (3E13) 379-4;50
INSTALLATION.PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER r .�`
SITE ADDRESS:
911#/ROAD NAME ,3(p 7 ( ) r id rQr RA
Gott 7 ) VVA ZIP
9 DIGIT PARCEL ID NUMBER 0 3 Qs, 3 E.:)...... Q 17
Legal Description:
Subdivision Name Block Lotls)
Section 35 Township 31:)I North, Range & \f‘) WM
APPLICANT (--I()C)A.0 EC2r'('t( f PHONE
MAILING ADDRESS 1 t ) 7 i- .Ai 1 Aw E-E
or na ) 'J ZIP L
PROPERTY OWNER QQ � 1 cal A tlI1')c1Q PHONE
MAILING ADDRESS
ZIP
CONTRACTOR F VP1rU aCV(1 \, PHONE 1 -FM " 750- 7 g fP
MAILING ADDRESS ' 57 1 ( 101
A^yJQ, WA ZIP qnit))--
STATE LICENSE # EVERV) I k vim? JL 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 _A_ C��Z�1� DATE C� / / /5 /Z}
9
r t FOR OFFICE USE ONLY
BASE FEE ..yy--t V
RECEIPT# 3'` /
CASH/CK# c+ --
TOTAL F 0 Q
DATE /7 r.. / C.1
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