HomeMy WebLinkAboutBLD2001-00022 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 #: BLD01-00022 Received Date 1/11/2001
SITE ADDRESS: 2333 CAPE GEORGE RD Issue Date 1/11/2001
PORT TOWNSEND, 98368 Expiration Date 1/11/2002
APPLICANT: DAVID JOHNSON PHONE: (360)385-3407
2333 CAPE GEORGE RD
PORT TOWNSEND WA 98368
T 16
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002124011 Section: 12 Township: 30N Range: 02W
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/01/2001
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 01/11/2002.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: h � �
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 #: BLD01-00022 Received Date: 1/11/2001
SITE ADDRESS: 2333 CAPE GEORGE RD
PORT TOWNSEND, 98368
APPLICANT: DAVID JOHNSON PHONE: (360)385-3407
2333 CAPE GEORGE RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: T 16
PARCEL NUMBER: 002124011 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/01/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 1997 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 Floodplain
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
—Proximity - Mat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $46.00 MAM 01/11/01 37293
Total: $46.00
r+
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE KPROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: �,3 3 3 C'1 C�� r Po 0, _C�/
911#/ROAD NAME � '
ya ,-Y' /61,v"is_O; d joq ZIP 11 Q3.6
9 DIGIT PARCEL ID NUMBER 0 0 0._ ( 0. L t 0 it
Legal Description:
Subdivision Name Block Lot(s)
Section ' " Township 50 N North, Range 0 litt
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APPLICANT David ego h v., S6_7'L PHONE 3 (N.) -g�S ^e 4/d 7
MAILING ADDRESS 01 33 A
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ZIP _TY3(p
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PROPERTY OWNER 5 __. Q..4 at4Lik PHONE
MAILING ADDRESS
ZIP
CONTRACTOR ��‘/4 r'tQ/yt/ AD i"O I n 7(-12. PHONE 5t'S .5/"'d O Ci C,
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MAILING ADDRESS c ,yr{h Y pot-a /C.L-CJ)Y1
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STATE LICENSE # W nSv 8 00 0 k 4- 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 or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE f ---. -' 01 /__C)i/ 6
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 2 Cl 3
CASH/CK# I t I T
TOTAL DATE t /I{ / O I
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