HomeMy WebLinkAboutBLD2000-00711 N
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 #: BLD00-00711 Received Date 10/26/2000
SITE ADDRESS: 1054 RIPLEY CREEK RD Issue Date 10/30/2000
QUILCENE, 98376 Expiration Date 10/30/2001
APPLICANT: TOM MEYER PHONE: 206-842-0218
PO BOX 11727
BAINBRIDGE ISLAND WA 98110
T 20
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 802351003 Section: 35 Township: 28N Range: 02W
CONTRACTOR: OWNER PHONE:
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 10/30/2001.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
Fi na oval: t 1
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 #: BLD00-00711 Received Date: 10/26/2000
SITE ADDRESS: 1054 RIPLEY CREEK RD
QUILCENE, 98376
APPLICANT: TOM MEYER PHONE: 206-842-0218
PO BOX 11727
BAINBRIDGE ISLAND WA 98110
SUBDIVISION: Block: Lot: T 20
PARCEL NUMBER: 802351003 Section: 35 Township: 28 N Range: 02 W
CONTRACTOR: OWNER PHONE:
ARCHITECT/
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
—Proximity - Plat Uo dit Ions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 10/26/00 34620
Total: $48.00
is\F_BLD_App Bld.rpt 10/29/99
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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: l / �p an
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9 DIGIT PARCEL ID NUMBER Y02 Si L` j
Legal Description: %/Mg-
Subdivision Name r 0I2-6 Ak, Zoo, ritA-cJ Block Lot(s) . z-/ 7
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APPLICANT J 10/44 ' L ,4t c.Y'C,e. PHONE • 6 (Ll
MAILING ADDRESS �® 73a X `/ 7,2..7
// 10/J41./ 6- . /s / 4 ZIP /e/tt-/
PROPERTY OWNER 5/4 - PHONE
MAILING ADDRESS
ZIP
CONTRACTOR P//w' 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 the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURES "C DATE / fcr / 02j
FOR OFFICE USE ONLY
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BASE FEE CV RECEIPT#
CASH/CK # J ?
TOTAL DATE /d/ _ a
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