HomeMy WebLinkAboutBLD2000-00695 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 #: BLD00-00695 Received Date 10/19/2000
SITE ADDRESS: 1350 SNOW CREEK RD Issue Date 10/19/2000
QUILCENE, 98376 Expiration Date 10/19/2001
APPLICANT: ROBERT FRENCH PHONE: (360)796-4686
PO BOX 145
BRINNON WA 98320
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 802234006 Section: 23 Township: 28N Range: 02W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2001
OWNER, ROBERT FRENCH PHONE: (360)796-4686
if different: PO BOX 145
BRINNON WA 98320
PROJECT DESCRIPTION PROPANE TANK&GAS LINE 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 10/19/2001.
REQUIRED INSPECTIONS:
may,.
[ Tank/Line/Appliance: '/ /1
['T FinalApproval: f ct_ // 7 e el - .-.cam. C�. � r-e-k
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
•t
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00695 Received Date: 10/19/2000
SITE ADDRESS: 1350 SNOW CREEK RD
QUILCENE, 98376
APPLICANT: ROBERT FRENCH PHONE: (360)796-4686
PO BOX 145
BRINNON WA 98320
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 802234006 Section: 23 Township: 28 N Range: 02 W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2001
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & GAS LINE 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
l-'r ximlty - Plat UQ d tions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 10/19/00 34738
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:
911#/ROAD NAME / •S 0 r 0 C — 10 0 r 1 C r rA.k (,t)Ct.
r� / ZIP
(
9 DIGIT PARCEL ID NUMBER 302, -' '- 0 Q C9
Legal Description:
Subdivision Name Block Lot(s)
Section // Township North, Range WM
APPLICANT �'4v1 l� ti 1"—re '�G, PHONE h1t 0 7( L 19
\ `
MAILING ADDRESS n �� z CAS
Vt ut ' ZIP wj 7
PROPERTY OWNER 6 O �j-C'nL�, PHONE 26 0 r/ (p --(/‘,r,
MAILING ADDRESS P.c. 1 ,p I Lis
6 r 1!1 U Y7 Wes- �T�-i�5 ZIP i 3 Z 0
CONTRACTOR Pe ie Vr ( 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 SIGNATURE DATE/ / /(7 / C)Z-)
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 3Li' Cj
CASH/CK#
TOTAL L. DATE Ul /�/ OC)
H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99