HomeMy WebLinkAboutBLD2000-00730 a '
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 #: BLD00-00730 Received Date 11/13/2000
SITE ADDRESS: 780 BOULTON RD Issue Date 11/13/2000
QUILCENE, 98376 Expiration Date 11/13/2001
APPLICANT: JOHN G BOULTON PHONE:
3590 E QUILCENE RD
QUILCENE WA 983769598
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 802141005 Section: 14 Township: 28N Range: 02W
CONTRACTOR: NORTHWEST CHIMNEY SERVICE PHONE:
510 DEKALB
SUITE D
PORT ORCHARD WA 98366
Contractor's License NORTHCS101CB Expires 01/24/2001
OWNER, JOHN G BOULTON PHONE:
if different: 3590 E QUILCENE RD
QUILCENE WA 983769598
PROJECT DESCRIPTION Propane tank and fireplace insert
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:
i
[L1' 7Gne/App a : riC r? �C: , _6
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 #: BLD00-00730 Received Date: 11/13/2000
SITE ADDRESS: 780 BOULTON RD
QUILCENE, 98376
APPLICANT: JOHN G BOULTON PHONE:
3590 E QUILCENE RD
QUILCENE WA 983769598
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 802141005 Section: 14 Township: 28 N Range: 02 W
CONTRACTOR: NORTHWEST CHIMNEY SERVICE PHONE:
510 DEKALB
SUITE D
PORT ORCHARD WA 98366
Contractor's License NORTHCS101CB Expires 01/24/2001
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: ' 4 c Aino .. - h;
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MAIN:
VALUATION
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:
ATER 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 RuralOtl
Type Amount Paid By: Date: �rReceipt: Approved/Datey conditions
Propane Tanks/Stoves $48.00 PRB 11/13/00 34638
Total: $48.00
is\F_BLD_App_Bld.rpt 10/29/99
1
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X PROPANE TANK PELLET STOVE OTHER r , r p\.CAL, tr\ -a
j-\----
SITE ADDRESS: 7g0 6 M• / 'fw led_
911#/ROAD NAME n U/�(.-1 TO/i�� ��//'' p /
gt,(.t tCLka, W4 ZIP i 3 1ta
9 DIGIT PARCEL ID NUMBER / g02--/10('-
Legal Description: E U ArloloailCikr,, 1 se P
Subdivision Name La) 6 (YE p ,aA I ,kt 03 to Block Lot(s)
Section 1 q Township% a8- North, Range o2,(.(, WM
APPLICANT -L3n(C2 yavi--- PHONE 3(P00-,385-0.2J3
MAILING ADDRESS 7, O Ig £(
9u.ace/ht_ 1424- ZIP '7�37/
PROPERTY OWNER J Ohn (. ,6 PHONE 3(00 - 74,5-- 339`f
MAILING ADDRESS 35 90 E E. (,(14('Q/j•-Q__A
q(A,uc..P/h_A (.0A ZIP G<P376
CONTRACTOR Alor t, LIJ,P SG C/'I,(m SPAY v(Ce..• PHONE,36,O - (09,2 - .303
MAILING ADDRESS �t b Pzk ) Su, D Or 3�0O /- p (' ^ 3.5q
Pork Or
,,I I ,f1
cd and 1 � ZIP 9tf �j
STATE LICENSE# /V O R -HC.s it,' EXP. DATE `""•=2.. '-6/
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 t( / (3 / el)
a FOR OFFICE USE ONLY
BASE FEE U ` RECEIPT#
CASH/CK#
TOTAL -/11 '/ V , G O DATE / /
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