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HomeMy WebLinkAboutBLD2000-00501 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 #: BLD00-00501 Received Date 7/31/2000 SITE ADDRESS: 181 QUIMPER LN Issue Date 7/31/2000 PORT HADLOCK, 98339 Expiration Date 7/31/2001 APPLICANT: JAMES SWAN PHONE: (360)379-1467 181 QUIMPER LN PORT HADLOCK WA 98339 27 SUBDIVISION: CHIMACUM CREEK ESTATES DIV 2 Block: Lot: PARCEL NUMBER: 943700028 Section: 02 Township: 29N Range: 01W CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)732-4585 PO BOX 708 CHIMACUM WA 98325 Contractor's License RSSALS*022PB Expires 10/01/2000 OWNER, c JL)c TAN)r if different: PROJECT DESCRIPTION PROPANE TANK& GAS INSERT 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 07/31/2001. REQUIRED INSPECTIONS: [/ Tank/Line/Appliance): )1`m oC I% 'Oi [ ;] FinalApproval: ti/( )op( /2-j2- / 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 #: BLD00-00501 Received Date: 7/31/2000 SITE ADDRESS: 181 QUIMPER LN PORT HADLOCK, 98339 APPLICANT: JAMES SWAN PHONE: (360)379-1467 181 QUIMPER LN PORT HADLOCK WA 98339 SUBDIVISION: CHIMACUM CREEK ESTATES DIV 2 Block: Lot: 27 PARCEL NUMBER: 943700028 Section: 02 Township: 29 N Range: 01 W CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)732-4585 PO BOX 708 CHIMACUM WA 98325 Contractor's License RSSALS*022PB Expires 10/01/2000 ARCHITECT/ C' EX i \NV:-. ENGINEER : PROJECT DESCRIPTION: PROPANE TANK & GAS INSERT 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 Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: �rRecei t - Hat ea/u ttions yp Receipt: Approved a e Propane Tanks/Stoves $48.00 MAM 07/31/00 33373 Total: $48.00 i:1F_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 C>z4� WOODSTOVE 1C PROPANE TANK PELLET STOVE OTHER 61e s _. #,f2',/" SITE ADDRESS: 911#/ROAD NAME ///g/j / �(,C v'y�it p-(?/Z Tit1� 1/ // s4-cY/ec /_ / j4 ZIP 7c �� 9 DIGIT PARCEL ID NUMBER 9 J 2'0 0 0.21 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT /f)j#S �j�f c 004fif4: / , i,-plice PHONE ©/ I/Z- ?__ MAILING ADDRESS /O a.• 0,1( ,7DGr edZ✓ et64eis? 1-1/ 4 ZIP ! c5;cS>a2S-- PROPERTY OWNER .3 /01 e J .Jusfa,r7 PHO E:1�_._--37 7—/7' MAILING ADDRESS r 9 ai-L L C fL (� Pi. e �� f iq ZIP 9'�e,O CONTRACTOR O l ' 5 JAL-/. ,z7i.€C_T !L/19c .. PHONE 3j7--..Ir®2 f MAILING ADDRESS /-. ?4- 701 4 ri'72 4 C-a 14? W/17 ZIP ?s-,,,--,es----- STATE LICENSE# C CA"Z i Q / SS,L.,S' ' U 22P A EXP. DATE !"o// a® FEDERAL I.D. # C'a,,il� �t5-- / 69d/ 2)cc7/ '/ 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 SIGRA'JRE - - DATE 7 ji i 0 o FOR OFFICE USE ONLY BASE FEE RECEIPT# 333 CASH/CK#/ c .I c TOTAL • DATE i / c)c), . . H:\HOME\PLN CNTR\FORMS\IN STALL.000 10/99