HomeMy WebLinkAboutBLD2000-00675 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 #: BLD00-00675 Received Date 10/12/2000
SITE ADDRESS: 143 FERN GULLY RD Issue Date 10/12/2000
PORT LUDLOW, 98365 Expiration Date 10/12/2001
APPLICANT: JORDAN BROWN PHONE: (360)437-8217
143 FERN GULLY
PORT LUDLOW WA 98365
23
SUBDIVISION: OLYMPIC RIDGE ESTATES Block: Lot:
PARCEL NUMBER: 821355059 Section: 35 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2001
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 10/12/2001.
REQUIRED INSPECTIONS:
[ 7an /Line/Appliance: %�9,i(/ eD/e_ l%l% e'e
[ ]- Fi provat.- IC /tof .,4(md -(96----•-—<...--7
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 #: BLD00-00675 Received Date: 10/12/2000
SITE ADDRESS: 143 FERN GULLY RD
PORT LUDLOW, 98365
APPLICANT: JORDAN BROWN PHONE: (360)437-8217
143 FERN GULLY
PORT LUDLOW WA 98365
SUBDIVISION: OLYMPIC RIDGE ESTATES Block: Lot: 23
PARCEL NUMBER: 821355059 Section: 35 Township: 28 N Range: 01 E
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
VALUATION MAIN:
CODE EDITION: ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
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: -Proximity - flat C; d tions
yp Receipt: ApprovedR ate
Propane Tanks/Stoves $48.00 MAM 10/12/00 34708
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 PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: I '7 1�3 re tZ� / l. `1
911#/ROAD NAME i - �� p.
PO44- Lod 1oL 1 0 . CIZIP 0 36
9 DIGIT PARCEL ID NUMBER Ti.I " 3S5 ' OE ei
Legal Description: ED 1 i e. (L;;O'I;,
Subdivision Name Block Lot(s) 2 3
Section Township North, Range WM
APPLICANT C,®- 1 C.. 0 ( . r.., ""•- PHONE 1(3-I 'g Z-1
MAILING ADDRESS 1413 Fe,fa-4A, a--L.) tt y f(,ti(-` Lud tbc•. �y, A ZIP l ? 36v.3--
PROPERTY OWNER 55 c9 v,., e, PHONE
MAILING ADDRESS
ZIP
CONTRACTOR C--e- PHONE
MAILING ADDRESS �.\
C_.,-"`.°r,"-411-e-i 9 Y-... ZIP
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 t efferson County a d it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access a right of entry the applicant's pr p rty or structure shall be requested and shall occur during regular business hours.n.\
APPLICANT SIGNATURE d DATE 10 / Il / co
FOR OFFICE USE ONLY
BASE FEE RECEIPT# /�.3'Q� D
CASH/CK# b03^ -
TOTAL DATE to/l2/____00
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