HomeMy WebLinkAboutBLD2000-00613 •
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 #: BLD00-00613 Received Date 9/22/2000
SITE ADDRESS: 5030 EAGLEMOUNT RD Issue Date 9/22/2000
PORT TOWNSEND, 98368 Expiration Date 9/22/2001
APPLICANT: B G BROWN PHONE: (360)732-4965
5030 EAGLE MT RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801091002 Section: 9 Township: 28N Range: 01W
CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)385-5564
PO BOX 708
CHIMACUM WA 98325
Contractor's License RSSALS*022PB Expires 10/01/2000
OWNER, B G BROWN PHONE: (360)732-4965
if different: 5030 EAGLE MT RD
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION PROPANE TANK& PIPING 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 09/22/2001.
REQUIRED INSPECTIONS:
(Tank/Line/Appliance: 0 tL. 1 0 "Z a 30 pS i TC.
krI:C -24-0?_,,e‘
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 #: BLD00-00613 Received Date: 9/22/2000
SITE ADDRESS: 5030 EAGLEMOUNT RD
PORT TOWNSEND, 98368
APPLICANT: B G BROWN PHONE: (360)732-4965
5030 EAGLE MT RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801091002 Section: 9 Township: 28 N Range: 01 W
CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)385-5564
PO BOX 708
CHIMACUM WA 98325
Contractor's License RSSALS*022PB Expires 10/01/2000
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & PIPING 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
Type Amount Paid By: Date: �rReceipt ity Hat Conditions
Receipt:
Propane Tanks/Stoves $48.00 MAM 09/22/00 34361
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
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Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT fc Lk--) 1 PHONE 1 3 - qci JCS
MAILING ADDRESS 5l 1 ?j F Q Q v LA ,fVV Q
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PROPERTY OWNER ,rvi_sz _ PHONE
MAILING ADDRESS
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MAILING ADDRESS 'PC) gr)i 106
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STATE LICENSE# C Cv r 6 R s Y p L.S .4- Q a pf), EXP. DATE 10 1 - ,.,OC( (
FEDERAL I.D. # Lo C) I 4C 5 3(') Li
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.
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APPLICANT SIGNATURE V a hchceyitlei DATE 9 0 o
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 1 i .I
CASH/CK# ")( ,:
TOTAL ti DATE I /- / ..
H:\HOME\PLNCNTR\FORMS\INSTALL.DO C 10/99