HomeMy WebLinkAboutBLD2000-00772 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 #: BLD00-00772 Received Date 12/1/2000
SITE ADDRESS: 403 CEDAR Issue Date 12/1/2000
PORT HADLOCK, 98339 Expiration Date 12/1/2001
APPLICANT: STAN SOUTHWORTH PHONE:
MARY SOUTHWORTH
403 CEDAR AVE
PORT HADLOCK WA 98339 7-9
SUBDIVISION: PHILLIPS ADDN TO IRONDALE Block: 10 Lot:
PARCEL NUMBER: 986401005 Section: 2 Township: 29N Range: 01W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTI00088CC Expires 05/01/2001
OWNER, STAN SOUTHWORTH PHONE:
if different: MARY SOUTHWORTH
403 CEDAR AVE
PORT HADLOCK WA 98339
PROJECT DESCRIPTION PROPANE TANK AND 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 12/01/2001.
REQUIRED INSPECTIONS:
Appliance: EXTC ma's or r dkr-t T c -DO /a
wr �1d1;4=_1h -proval: l9( p' 2a7/..=;../r"'e"_'
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
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BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00772 Received Date: 12/1/2000
SITE ADDRESS: 403 CEDAR
PORT HADLOCK, 98339
APPLICANT: STAN SOUTHWORTH PHONE:
MARY SOUTHWORTH
403 CEDAR AVE
PORT HADLOCK WA 98339
SUBDIVISION: PHILLIPS ADDN TO IRONDALE Block: 10 Lot: 7-9
PARCEL NUMBER: 986401005 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK AND HEATING STOVE
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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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: 1 F&W Landslide
/ ��,� � , Shoreline Aquifer
Forest: Commercial Rural
Nr xlmity - Fiat U cl tions
Type Amount Paid By: Date: Receipt: Approved/Date
Total:
is\F_BLD_App_Bld.rpt 10/29/99
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (3601 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER rt& t ify Sierk
SITE ADDRESS: 110 3 Cadiz_ (RO BOX 117)
AneAdeeie911#/ROAD NAME � �j 7/�G�j . ZIP 9f/!C��`'C L Q 3,3 7
9 DIGIT PARCEL ID NUMBER / 5 6 vQi00,5-
Legal Description:
Subdivision Name pfz-giajae4„tBlock /0 Lotls) 7 _/
Section O i Township .a.q 4/' North, Range 0 1 1/1/./ WM
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APPLICANT �j�/�J /� PHON���J 3 7 7'��0
MAILING ADDRESS /�V , acx // 7 CCCCCC
A z� ZIP 7 Y37
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
+.� e:/p_. ( 0sCr PHONFO Of sJ 7,5' /9 2
CONTRACTOR ���
MAILING ADDRESS Z 3 rv,I .�iC
STATE LICENSE# /` do dQV'ClJ EXP. DATE 5/0/
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 /2./ / /'60
C
FOR OFFICE USE ONLY
4_() __ UU
BASE FEE RECEIPT#
.\ CASH/CK#
TOTAL '� l dV DATE / /
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