HomeMy WebLinkAboutBLD2001-00014 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 #: BLD01-00014 Received Date 1/9/2001
SITE ADDRESS: 123 RHODY CT Issue Date 1/9/2001
CHIMACUM, 98325 Expiration Date 1/9/2002
APPLICANT: DON JORDAN PHONE: (360)379-5420
123 RHODY COURT
CHIMACUM WA 98325
14
SUBDIVISION: RHODODENDRON ESTATES Block: Lot:
PARCEL NUMBER: 963100014 Section: 10 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/08/2001
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK 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 01/09/2002.
REQUIRED INSPECTIONS:
[ ] Tank Line/Appliance: O ��/�•d L
[ FinalApproval: 'T'%NK
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.
HOT LINE AVAILABLE 24 HOURS A DAY
is\F_BLD_Permit_Propane.rpt 10/29/19
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00014 Received Date: 1/9/2001
SITE ADDRESS: 123 RHODY CT
CHIMACUM, 98325
APPLICANT: DON JORDAN PHONE: (360)379-5420
123 RHODY COURT
CHIMACUM WA 98325
SUBDIVISION: RHODODENDRON ESTATES Block: Lot: 14
PARCEL NUMBER: 963100014 Section: 10 Township: 29 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/08/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 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 Floodplain
F&W Landslide
Routing Date: \0, Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: —Proximity Approved/pate
Conditions
Receipt: pp ��ate
Permit $46.00 ZAN 01/09/01 37282
Total: $46.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450 ,
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS:
911#/ROAD NAME
ZIP
9 DIGIT PARCEL ID NUMBER
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE
•
MAILING ADDRESS
ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR PHONE S"'to O O 3
MAILING ADDRESS lV(
Pco c RAOL E; i toc- ZIP /1
STATE LICENSE# I9U u� l- PL_.Qq 4Et4 EXP. DATE 12/ K/0 A
FEDERAL I.D. # etL^ 1� 5
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 ;
8
wA .
BASE FEE
CASH/CK'#
TOTAL DATE '/ /
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