HomeMy WebLinkAboutBLD2001-00030 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 #: BLD01-00030 Received Date 1/17/2001
SITE ADDRESS: 761 ROBBINS RD Issue Date 1/17/2001
NORDLAND, 98358 Expiration Date 1/17/2002
APPLICANT: DIANNE MAYNARD PHONE: (360)379-1277
DONALD MAYNARD
761 ROBBINS RD
NORDLAND WA 98358
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921093003 Section: 9 Township: 29N Range: 01 E
CONTRACTOR: OWNER PHONE:
OWNER, DIANNE MAYNARD PHONE: (360)379-1277
if different: DONALD MAYNARD
761 ROBBINS RD
NORDLAND WA 98358
PROJECT DESCRIPTION WOODSTOVE 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 01/17/2002.
REQUIRED INSPECTIONS:
[ Tank/Line -Hance:
[ `liaTApproyal:
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 #: BLD01-00030 Received Date: 1/17/2001
SITE ADDRESS: 761 ROBBINS RD
NORDLAND, 98358
APPLICANT: DIANNE MAYNARD PHONE: (360)379-1277
DONALD MAYNARD
761 ROBBINS RD
NORDLAND WA 98358
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921093003 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: OWNER PHONE:
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: WOODSTOVE 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: Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: �rReceipt Approved/Dateity dons
p �
Propane Tanks/Stoves $48.00 MAM 01/17/01 37362
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (3601 379-4450
INSTALLATION PERMIT APPLICATION ice
• /WOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: n1 1f ( S _
911#/ROAD NAME �f� ✓�'jl � r�)
r, ZIP
9 DIGIT PARCEL ID NUMBER `7 cQ/ 0 9 0 0
Legal Description:
Subdivision Name Block Lotls)
Section Township North, Range WM
APPLICANT L O('\IQ LT) �-1LL A V,iAA1-b PHONE c 7 9_/,�7 7
MAILING ADDRESS 76/ IC�b b11?S
13-701 Laind__/ 4. ZIP 9O 3 Y
PROPERTY OWNER 0-6 4 PHONE
MAILING ADDRESS
ZIP
CONTRACTOR �/�l.c'�n r�J �— 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 or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE DATE f I ' ( / 0 1
":FOR OFFICE USE'ONLY
BASE FEE ��a4
RECEIPT#
CASH/CK# G fJ 6
TOTAL '"1 m DATE 1 / ( /
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