HomeMy WebLinkAboutBLD2001-00016 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 #: BLD01-00016 Received Date 1/11/2001
SITE ADDRESS: 20 RAINIER CT Issue Date 1/11/2001
PORT LUDLOW, 98365 Expiration Date 1/11/2002
APPLICANT: JAN BRUUSGAARD PHONE: (360)437-1067
KATHRYN A BRUUSGAARD
2023 E SIMS WAY#171
PORT TOWNSEND WA 98368 60
SUBDIVISION: PORT LUDLOW NO. 1 Block: Lot:
PARCEL NUMBER: 990400456 Section: 8 Township: 28N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/08/2001
OWNER, JAN BRUUSGAARD PHONE: (360)437-1067
if different: KATHRYN A BRUUSGAARD
2023 E SIMS WAY#171
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION Propane Tank
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 01/11/2002.
REQUIRED INSPECTIONS:
nk/\ ne/Appliance:
[�J� nalAppro a c�/�C /! /:- /
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 #: BLD01-00016 Received Date: 1/11/2001
SITE ADDRESS: 20 RAINIER CT
PORT LUDLOW, 98365
APPLICANT: JAN BRUUSGAARD PHONE: (360)437-1067
KATHRYN A BRUUSGAARD
2023 E SIMS WAY#171
PORT TOWNSEND WA 98368
SUBDIVISION: PORT LUDLOW NO. 1 Block: Lot: 60
PARCEL NUMBER: 990400456 Section: 8 Township: 28 N Range: 01 E
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
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: Shoreline Aquifer
Forest: Commercial Rural
1-'r ximit Conditions Nlat
Type Amount Paid By: Date: Receipt: Approveae
Propane Tanks/Stoves $46.00 PRB 01/11/01 37222
Total: $46.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT 6TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE 3(, PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: � ��
911#/ROAD NAME a o �,q..j,U/ems/(
1)0(c L u LOLL) ZIP 9 8 3 6 5"
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9 DIGIT PARCEL ID NUMBER ??0 �OJj �Legal Description: (�
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT JT'MJ L72 (JU54 (0 PHONE 36o V37` `06
MAILING ADDRESS —0 ��M16E ,
Gv9z i4 J ZIP 7 2 3 /.S�
PROPERTY OWNER /�/U /(?(/>7 k eM ViJ /,,��,/ t,f� PHONE
MAILING ADDRESS TT
ZIP
CONTRACTOR /WQ(.J,(/ AJ A.0 ®471JS PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# EXP. DATE
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 r structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE DATE D/ / / p/ /
` 1
FOR OFFICE USE ONLY
BASE FEE D RECEIPT# 2 2--
CASH/CK# �
TOTAL DATE / / /// U
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