HomeMy WebLinkAboutBLD2000-00729 } P
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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 #: BLD00-00729 Received Date 11/13/2000
SITE ADDRESS: 710 MADRONA RIDGE DR Issue Date 11/13/2000
BRINNON, 98320 Expiration Date 11/13/2001
APPLICANT: JOANN MOSER PHONE:
710 MADRONA RIDGE
BRINNON WA 98320
20
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502094002 Section: 9 Township: 25N Range: 02W
CONTRACTOR: JIMS APPLIANCE &TV INC PHONE: (360)385-2100
141 N 7TH AVE
SEQUIM WA 98382
Contractor's License JIMSAT1028NJ Expires 07/13/2001
OWNER,
if different:
PROJECT DESCRIPTION Propane heating 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 11/13/2001.
REQUIRED INSPECTIONS:
ank/Lin pplianc //'I9 T/c°? (77,3
[11,---clEroaJApprota - c". //2.,7/ece) _71)-757
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 #: BLD00-00729 Received Date: 11/13/2000
SITE ADDRESS: 710 MADRONA RIDGE DR
BRINNON, 98320
APPLICANT: JOANN MOSER PHONE:
710 MADRONA RIDGE
BRINNON WA 98320
SUBDIVISION: Block: Lot: 20
PARCEL NUMBER: 502094002 Section: 9 Township: 25 N Range: 02 W
CONTRACTOR: JIMS APPLIANCE &TV INC PHONE: (360)385-2100
141 N 7TH AVE
SEQUIM WA 98382
Contractor's License JIMSATIO2NJ Expires 07/13/1999
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: Propane heating 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
—Proximity - Flat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 11/13/00 34637
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 PROPANE TANK PELLET STOVE >("OTHER CAS G.Tzu E.
SITE ADDRESS: _
911#/ROAD NAME //Q- a4-op
‘9
/.1J4. ZIP yg3, ern
9 DIGIT PARCEL ID NUMBER Sp
Legal Description:
Subdivision Name Block Lotls)
Section Township North, Range WM
APPLICANT ,Jl/NA/ ,77 5 2 PHONE S1j0^ 7 '/_- .A7
MAILING ADDRESS ,D, p, /Yo x y1j�
/5/9/A//✓O� 4a/4 . ZIP 3 d
PROPERTY OWNER �'qC�J� PHONE
MAILING ADDRESS
ZIP
CONTRACTOR .T/!J7 S /<9/L le,C $ T, V PHONE 56 ,-Iov-3—//`/Z&O
MAILING ADDRESS /471/ 4/. 77//
o�Equi�/ 11./i9 , ZIP 9 s38a2
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 dei. DATE // / /3 /49.49-0-6,
,,//�� FOR OFFICE USE'ONLY
BASE FEE `.s 2 RECEIPT#
CASH/CK# 1 423
TOTAL 44 .j _. DATE 1 / I7/ CO 1125
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