HomeMy WebLinkAboutBLD2000-00557 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 #: BLD00-00557 Received Date 8/28/2000
SITE ADDRESS: 90 STARK RD Issue Date 8/28/2000
PORT LUDLOW, 98365 Expiration Date 8/28/2001
APPLICANT: PAUL CLEMENTS PHONE:
CHARLEEN CLEMENTS
90 STARK RD
PORT LUDLOW WA 98365 T 58
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821344048 Section: 34 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2000
OWNER, PAUL CLEMENTS PHONE:
if different: CHARLEEN CLEMENTS
90 STARK RD
PORT LUDLOW WA 98365
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 08/28/2001.
REQUIRED INSPECTIONS:
[ ank/Ljne/Appliance:
V„1-- FinalApproval: L '4 CO
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 #: BLD00-00557 Received Date: 8/28/2000
SITE ADDRESS: 90 STARK RD
PORT LUDLOW, 98365
APPLICANT: PAUL CLEMENTS PHONE:
CHARLEEN CLEMENTS
90 STARK RD
PORT LUDLOW WA 98365
SUBDIVISION: Block: Lot: T 58
PARCEL NUMBER: 821344048 Section: 34 Township: 28 N Range: 01 E
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
Pr xlmlty - Hat conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 08/28/00 34155
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 kPROPANE TANK . PELLET STOVE OTHER
SITE ADDRESS: 2 /?
911#/ROAD NAME [ -y'S � )
C4i ZIP
9 DIGIT PARCEL ID NUMBER
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT /t I _ PHONE
MAILING ADDRESS 9 ) /Jqi k Ph �j 3 �% /
g l L c.C�JLz9s{)` �l ZIP �cJ Sit7
PROPERTY OWNER X /L /?, i PHONE
MAILING ADDRESS V 7T, e,e Ri
11.1) ZIP 9F1?('?„
CONTRACTOR ay) PHONE /�� � s
MAILING ADDRESS p377/�y� /�7Z7� [� PR
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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# {;
• CASH/CK#
TOTAL DATE t / / > , ,
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