HomeMy WebLinkAboutBLD2001-00157 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 #: BLD01-00157 Received Date 3/20/2001
SITE ADDRESS: 223 HIGHLAND DR Issue Date 3/21/2001
PORT LUDLOW, 98365 Expiration Date 3/21/2002
APPLICANT: DAVID TOOTILL PHONE:
ANN TOOTILL
4049 W MERCER WAY
MERCER ISLAND WA 98040-3319 g
SUBDIVISION: SOUTH BAY#1 Block: Lot:
PARCEL NUMBER: 995500009 Section: 21 Township: 28N Range: 01E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2001
OWNER, DAVID TOOTILL PHONE:
if different: ANN TOOTILL
4049 W MERCER WAY
MERCER ISLAND WA 98040-3319
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 03/21/2002.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: A -2_ -0
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 #: BLD01-00157 Received Date: 3/20/2001
SITE ADDRESS: 223 HIGHLAND DR
PORT LUDLOW, 98365
APPLICANT: DAVID TOOTILL PHONE:
ANN TOOTILL
4049 W MERCER WAY
MERCER ISLAND WA 98040-3319
SUBDIVISION: SOUTH BAY#1 Block: Lot: 9
PARCEL NUMBER: 995500009 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2001
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: Shoreline Aquifer
Forest: Commercial Rural
1-'r ximity - Nlat G onditions
Type Amount Paid By: Date: Receipt: Approvewvate
Propane Tanks/Stoves $48.00 MAM 03/20/01 38851
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
MAR 202001
WOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS:
9 1#ROAD NAME v k)6,4LJA,1\ir- DO__ yy "__iJ
012�( L LtQLjlli , UUA zip gg36S
9 DIGIT PARCEL ID NUMBER -I c- �� 5 c0(_()GQ
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT r\i l O,.)2, PHONE
MAILING ADDRESS 2-3 H); 1"1 /,,(4-'j 0 J g
V0 i'Cr l L..1401Ow , 4 ZIP (311 gt5-
PROPERTY OWNER 1�-PV12L PHONE
MAILING ADDRESS }� /�
1 . y Lb1� c i( , I ZIP 3
CONTRACTOR PHONE
MAILING ADDRESS 3 1 vi. ''t
(iM— I to A 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 applica s property or structure shall be requested and shall occur during regular business hours.
. N
APPLICANT SIGNATURE w DATE / /
FOR OFFICE USE ONLY
BASE FEE RECEIPT# " � ?
CASH/CK'# (_ - S 1-
TOTAL DATE f GCI Ci
!
H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99