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HomeMy WebLinkAboutBLD2000-00781 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 #: BLD00-00781 Received Date 12/6/2000 SITE ADDRESS: 150 EAGLE VIEW LN Issue Date 12/6/2000 PORT LUDLOW, 98365 Expiration Date 12/6/2001 APPLICANT: KLAUS BRANICKI PHONE: (360)437-9152 150 EAGLE VIEW LN PORT LUDLOW WA 98365 22 SUBDIVISION: BRIDGEHAVEN DIV 6 Block: Lot: PARCEL NUMBER: 935400022 Section: 9 Township: 27N Range: 01 E CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License RSSALS*022PB Expires 10/01/2001 OWNER, KLAUS BRANICKI PHONE: (360)437-9152 if different: 150 EAGLE VIEW LN PORT LUDLOW WA 98365 PROJECT DESCRIPTION PROPANE TANK& FREE STANDING STOVE 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 12/06/2001. REQUIRED INSPECTIONS: [ Tank/L ni e/Apulia cP/< / ' / . V,..1----zi d [ roval: 0/C /2/,Ker)c•-) q_i_rro,,_ 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 #: BLD00-00781 Received Date: 12/6/2000 SITE ADDRESS: 150 EAGLE VIEW LN PORT LUDLOW, 98365 APPLICANT: KLAUS BRANICKI PHONE: (360)437-9152 150 EAGLE VIEW LN PORT LUDLOW WA 98365 SUBDIVISION: BRIDGEHAVEN DIV 6 Block: Lot: 22 PARCEL NUMBER: 935400022 Section: 9 Township: 27 N Range: 01 E CONTRACTOR:TAIJ K CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License RSSALS*022PB Expires 10/01/2001 ARCHITECT/ STZ'J R+ S Sales i- Sex ENGINEER : PROJECT DESCRIPTION: PROPANE TANK & FREE STANDING STOVE 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-,ree A a��donsType Amount Paid By: Date: Rcip � Approved/Date ate Propane Tanks/Stoves $48.00 MAM 12/06/00 35562 Total: $48.00 is\F_BLD_App_Bld.rpt 10/29/99 JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST,_PORT TOWNSEND WA 9$3 .-PH T6 5-4450 INSTALLATION � ` Ly PERMIT APPLICATION � /t WOODSTOVE PROPANE TANK PELLET STOVE OTHER t'"Y"- F 'e � tef Q c ' SITE ADDRESS: J 911#/ROAD NAME /SCO �Q r; /'l� V ak..) Z 4/T l Girt.' jvt/ A- • ZIP 9 DIGIT PARCEL ID NUMBER g35z/ 02-Z- Legal Description: Subdivision Name Block Lotls) Section Township` North, Range WM APPLICANT /( �'� '�F/GC moo/ sce-1/1/1( 'e PHONE 37f' SL/-2 f MAILING ADDRESS ,O. x (JX `7Q / c iLVta.C,I-l.v'v,_ VA ZIP 'tf3..2& PROPERTY OWNER 4 /j�//l S ,U Yg 1? %C k i PHONE q7- q(c 2- MAILING ADDRESS /,570 gee/`'/ �e � //(i 4J `al''uo w ", ZIP CONTRACTOR /e ' S S, !' j {A'll/( ' PHONE , '77 L.S7q MAILING ADDRESS A o. c-m 7e e L4 ' li ZIP g.i?2-(Sr- STATE LICENSE # C C Cry k SS ii-LSW. 6i. 2P. EXP. DATE /O/QZ/o/ FEDERAL I.D. # 6 0 j w S- „3O '/ d©i QQQ 7 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 ���^ �-�� 4) DATE /r,Z / 6 / 60 FOR OFFICE USE ONLY D - BASE FEE RECEIPT# 3 C ✓C7 CASH/CK# ( 74 ��,' 7— TOTAL DATE / —/ 6 / co H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99