HomeMy WebLinkAboutBLD2000-00546 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 #: BLD00-00546 Received Date 8/21/2000
SITE ADDRESS: 6883 BEAVER VALLEY RD Issue Date 8/21/2000
CHIMACUM, 98325 Expiration Date 8/21/2001
APPLICANT: PHYLLIS DOOLITTLE PHONE: 360-732-7405
6883 BEAVER VALLEY RD
CHIMACUM WA 98325
T 13
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901244015 Section: 24 Township: 29N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2000
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK 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 08/21/2001.
REQUIRED INSPECTIONS:
[ Tank/Line/Appliance: `1 Dirs— 0.Q00
Oic ‘,.k CoYtie. : Z-
I
l FinalApproval: �� 1 wr t _ g-- ZZ E9(') V'er �`e1/4- C1-1,Q_V_
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 #: BLD00-00546 Received Date: 8/21/2000
SITE ADDRESS: 6883 BEAVER VALLEY RD
CHIMACUM, 98325
APPLICANT: PHYLLIS DOOLITTLE PHONE: 360-732-7405
6883 BEAVER VALLEY RD
CHIMACUM WA 98325
SUBDIVISION: Block: Lot: T 13
PARCEL NUMBER: 901244015 Section: 24 Township: 29 N Range: 01 W
CONTRACTOR: CENEX SUPPLY & MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2000
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK 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
1-'r ximityy - Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 08/21/00 33471
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 7 PROPANE TANK PELLET STOVE 6act.tul
OTHER
SITE ADDRESAME SJ _ _
911#/ROAD NAME nC/ J ,�� � , _ /� a/ /'
0+11 `il rA i V1 A ZIP (( '-7
9 DIGIT PARCEL ID NUMBER 9 o ( ' 2`"t L - O i 5
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE
MAILING ADDRESS
ZIP
PROPERTY OWNER RI/I/ Lim J PHONE /3,. 7— . Lk)
MAILING ADDRESS (Q: , :? EF 01Grj \) I-I,t -til 12—
C1�1 �1 t�
PCJA n ) �/V ti ZIP I V
CONTRACTOR Cj )&c 42 )T 6-r T 1 -6-:, PHONE 73 c.9 -- L( se
MAILING ADDRESS 9 3)5 12 t D
CH Irk j A ZIP 9q30-6
STATE LICENSE # rEpJFX iiS O 22 t• 0 EXP. DATE ("00
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 2kA,Q7-~ DATE ' V 21/ ! C�
FOR OFFICE USE ONLY
BASE FEE RECEIPT# ', >t i tt
CASH/CK# .tf 1
TOTAL DATE: ( / L k / C,L '
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