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BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00017 Received Date: 1/9/2001
SITE ADDRESS: 260 MC MINN RD
PORT TOWNSEND, 98368
APPLICANT: JOHN T CARSON PHONE:
260 MC MINN
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001072014 Section: 7 Township: 30 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
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 Floodplain
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
—I-'r ximit Flat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $46.00 MAM 01/09/01 37217
Total: $46.00
JEFFERSON COUNTY CO MUNITY 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 2 6 0 it4k,14,,v,,) Q-)) , / /
T oi'- TO(A./ .../ (Eti� / 14./ Al , ZIP 9B 3 6D - �lv 4-4
9 DIGIT PARCEL ID NUMBER 0 0 /— 0 7 Z — O 1 4
Legal Description:
Subdivision Name Block Lot(s)
Section '-) Township Z 0 North, Range / WM
APPLICANT inRii 'f• C.,AIL CO3J PHONE 2 Jr.:-el/ 6 a
MAILING ADDRESS Z 6 O M Q ni l ti, / 2b ,
1'oR.7 Tow„__.fEnJ j wA , ZIP 90360-9,64‘
PROPERTY OWNER ,J04,.-- 1-. C-A 1L jp,J PHONE 31J— 416 b
MAILING ADDRESS Z 6 0 M Mf ,--..--- 21,
POn.T 7-ow„if ,.�), wA . ZIP 5$36, -969‘
CONTRACTOR /vt D v..,-3-74' Ph.°P 4,-/E PHONE 3 gr-6 B.3
MAILING ADDRESS 2 6, CM I.v7 A C v i-i ICI) ,
PQ'Cr Ni4b Cdz(�- 1 t-v /9 , ZIP qg 33 q
STATE LICENSE# 'Q / — o -) — R--9 - EXP. DATE // —3 O —r2
FEDERAL I.D. # / / — _- s
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 an ht of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Acces ight of entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE DATE 0 / / 0 % / 0 1
FOR OFFICE USE ONLY
BASE FEE 1 RECEIPT# ';; 1 /
CASH/CK # 5 (.
TOTAL DATE ' / `-. ° / ...) ,l
14—
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