HomeMy WebLinkAboutBLD2000-00679 .
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 #: BLD00-00679 Received Date 10/13/2000
SITE ADDRESS: 82 E GO-ONNA DR Issue Date 10/16/2000
QUILCENE, 98376 Expiration Date 10/16/2001
APPLICANT: GLEN E ALDRICH PHONE: (360)765-3424
82 E GO-ONNA DR
QUILCENE WA 98376
30
SUBDIVISION: GO-ONNA BEACH TR DIV 2 Block: Lot:
PARCEL NUMBER: 955000030 Section: 27 Township: 26N Range: 01W
CONTRACTOR: NORTHWEST CHIMNEY SERVICE PHONE:
510 DEKALB
SUITE D
PORT ORCHARD WA 98366
Contractor's License NORTHCS101CB Expires 01/24/2001
OWNER,
if different:
PROJECT DESCRIPTION WOODSTOVE 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 10/16/2001.
REQUIRED INSPECTIONS:
[ -"Tank/Li lance: Jr - //e//c:
prova L1 f` /( Cy/Lec—,
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
i .
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00679 Received Date: 10/13/2000
SITE ADDRESS: 82 E GO-ONNA DR
QUILCENE, 98376
APPLICANT: GLEN E ALDRICH PHONE: (360)765-3424
82 E GO-ONNA DR
QUILCENE WA 98376
SUBDIVISION: GO-ONNA BEACH TR DIV 2 Block: Lot: 30
PARCEL NUMBER: 955000030 Section: 27 Township: 26 N Range: 01 W
CONTRACTOR: NORTHWEST CHIMNEY SERVICE PHONE:
510 DEKALB
SUITE D
PORT ORCHARD WA 98366
Contractor's License NORTHCS101CB Expires 01/24/2001
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: WOODSTOVE 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: �rHat Conditions
Receipt:
Propane Tanks/Stoves $48.00 MAM 10/13/00 34665
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
XWOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: CC
911#/ROAD NAME O _,O,h ilek Pr �/P
Vomit%to`7 e. ,�)c •• ZIP 9c . 3 7
9 DIGIT PARCEL ID NUMBER 9,5� - 6900 - 030
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Cl/e f /.�- A/C/A /1(D A PHONE 2_ �o_5_ ,
MAILING ADDRESS g, e 190-Q� i, aPh
q,a/r/(0 ,,.e L!/G/ . ZIP ,F�/gr�.
PROPERTY OWNER `fl ,-, /T /o4 ,'a ly PHONE, 10 el-/4.- --5c j
MAILING ADDRESS > a e_ p - on //A Di
1 � ® 9
fa/r/ en Ge Q-. ZIP ak.5
CONTRACTOR PHONE
MAILING ADDRESS
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 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 SIGNATURE9,,,,,,(4," 7 �rl�%E-GYfl.�� — DATE/6 l /.3I s� 1C)
FOR OFFICE USE ONLY
BASE FEE ( r RECEIPT# 37 7
CASHICK# I �"f.-
0
TOTAL Z/�(f r DATE It // 3/ 0°
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