HomeMy WebLinkAboutBLD2000-00793 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 #: BLD00-00793 Received Date 12/11/2000
SITE ADDRESS: 1151 GRIFFITHS POINT RD Issue Date 12/12/2000
NORDLAND, 98358 Expiration Date 12/12/2001
APPLICANT: CHARLES SAMPLES PHONE:
PO BOX 76
NORDLAND WA 98358
T 45
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 021321021 Section: 32 Township: 30N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2001
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK, GAS PIPE & GAS HEATER 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 12/12/2001.
REQUIRED INSPECTIONS:
[ `�Tank/Line/Appliance: l- s- ` ,t w .L
[ FinalApproval:
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 #: BLD00-00793 Received Date: 12/11/2000
SITE ADDRESS: 1151 GRIFFITHS POINT RD
NORDLAND, 98358
APPLICANT: CHARLES SAMPLES PHONE:
PO BOX 76
NORDLAND WA 98358
SUBDIVISION: Block: Lot: T 45
PARCEL NUMBER: 021321021 Section: 32 Township: 30 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK, GAS PIPE & GAS HEATER INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
—Prgpximity Mat Conditions
Type Amount Paid By: Date: Receipt: Approved/Pate
Propane Tanks/Stoves $48.00 MAM 12/11/00 35537
Total: $48.00
is\F_BLD_App_Bld.rpt 10/29/99
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Hi° JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
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WOODSTOVE PROPANE TANK PELLET STOVE OTHER p J Ata-0-,--
SITE ADDRESS:
911#/ROAD NAME /(c� 9 ri tC t Pôirn-
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ZIP
9 DIGIT PARCEL ID NUMBER 001 ' 3 I 0 -I
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT al44`/44 CSCGITT
`'`V.) PHONE
MAILING ADDRESS 06 6 ox 76
crd 16vr4.0 09 ZIP ! e3SS
PROPERTY OWNER hOial-(C' '" -' _ PHONE
MAILING ADDRESS
ZIP
CONTRACTOR SU.vl s H I n e. P2O P ._ PHONE 3 8, - 5717
MAILING ADDRESS 104753 R 40 0 j Q 2
Pori- yj Las C..4C Lac. . ZIP ' rf 33 `I
STATE LICENSE # SLA vl s tl•P 0 7 7 Q P EXP. DATE I I /Ott
FEDERALI.D. # 91- Io q '7 8S-7
APPLICANT SIGNATURE .-C.C./'-c- AO-% ' ay- ( DATE 0--- / / 0 d
FOR OFFICE USE ONLY
BASE FEE ,
3 � RECEIPT # 3S S 3 7
�,� CASH/CK # /3 2 2.
TOTAL ��. DATE I Z/ /'( / y
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