HomeMy WebLinkAboutBLD2000-00704 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 #: BLD00-00704 Received Date 10/25/2000
SITE ADDRESS: 4865 FLAGLER RD Issue Date 10/25/2000
NORDLAND, 98358 Expiration Date 10/25/2001
APPLICANT: KAREN VAUGHN PHONE: 360-698-2065
7533 BRIDGE PL NE
BREMERTON WA 98311
T9
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921084009 Section: 8 Township: 29N Range: 01E
CONTRACTOR: OWNER S 1-cvte PHONE: (360)385-1420
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Contractor's License PETTI00088CC Expires 05/01/2001
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK& STOVE
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 10/25/2001.
REQUIRED INSPECTIONS:
[C°}�, appliance:' C,
[y alApproval.' i = ^
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 #: BLD00-00704 Received Date: 10/25/2000
SITE ADDRESS: 4865 FLAGLER RD
NORDLAND, 98358
APPLICANT: KAREN VAUGHN PHONE: 360-698-2065
7533 BRIDGE PL NE
BREMERTON WA 98311
SUBDIVISION: Block: Lot: T 9
PARCEL NUMBER: 921084009 Section: 8 Township: 29 N Range: 01 E
CONTRACTOR: OWNER PHONE: (360)385-1420
Pe++►f - -fan K
Contractor's License PETTIOCO88CC Expires 05/01/2001
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK & STOVE
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: —Proximity A prove conditions
Receipt: pp ��ate
Propane Tanks/Stoves $48.00 MAM 10/25/00 34755
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 el
WOODSTOVE PROPANE TANK PELLET STOVE OTHER (
SITE
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9 DIGIT PARCEL ID NUMBER /a/ Q gc/ O a /
Legal Description: r�Subdivision Name S b 7-c2 9
ik .. E Block Lot(s)
Section 1/ Township North, Range WM
APPLICANT Y C Ih Y Gt 1- 1,\Y) PHONE 3 \G 0-�9 -c���S
MAILING ADDRESS 753 3 8� lc t 1°) l�A ei'erner +oV� �,DR . ZIP '"( Z1(�
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PROPERTY OWNER PHONE
MAILING ADDRESS _]r;�7Yyt.e,
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CONTRACTOR i!Z--r-t- PY'b1OA y>i'.Q / 1 �q�y PHONE .3gS'r--
MAILING ADDRESS c93 SP .+o 1 Pot1 r-1---lo t�r►SPNGi1 3a 9 3(o cS
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
FOR OFFICE USE ONLY
BASE FEE RECEIPT# jla I L!
CASH/CK#
TOTAL L4 lc DATE / /
H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99