HomeMy WebLinkAboutBLD2001-00171 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 #: BLD01-00171 Received Date 3/26/2001
SITE ADDRESS: 420 FOUR CORNERS RD Issue Date 3/26/2001
PORT TOWNSEND, 98368 Expiration Date 3/26/2002
APPLICANT: QUIMPER CREDIT UNION PHONE: (360)385-3663
ATTN: KIM MONROE
PO BOX 1530
PORT TOWNSEND WA 983680048 1
SUBDIVISION: CLEAVER SHORT PLAT Block: Lot:
PARCEL NUMBER: 001333048 Section: 33 Township: 30N Range: 01W
CONTRACTOR: A SQUARE PHONE: 360-796-3014
733 WA WA POINT RD
BRINNON WA 98320
Contractor's License SQUAR**023JZ Expires 04/09/2001
OWNER, QUIMPER CREDIT UNION PHONE: (360)385-3663
if different: ATTN: KIM MONROE
PO BOX 1530
PORT TOWNSEND WA 983680048
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 03/26/2002.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[L FinalApproval: -2 6 -
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 #: BLD01-00171 Received Date: 3/26/2001
SITE ADDRESS: 420 FOUR CORNERS RD
PORT TOWNSEND, 98368
APPLICANT: QUIMPER CREDIT UNION PHONE: (360)385-3663
ATTN: KIM MONROE
PO BOX 1530
PORT TOWNSEND WA 983680048
SUBDIVISION: CLEAVER SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 001333048 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR: A SQUARE PHONE: 360-796-3014
733 WA WA POINT RD
BRINNON WA 98320
Contractor's License SQUAR**023JZ Expires 04/09/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: WOODSTOVE 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
3 id 1 Shoreline Aquifer
Forest: Commercial Rural
—Proximity - Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Total:
JEFFERSON COUNTY COMMUNITY 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 64G/ / Ci CI0 Isq j
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9 DIGIT PARCEL ID NUMBER t /335 e) g
Legal Description: )
Subdivision Name C ��t//sl�/ r�/�� Block J Lot(s) %
Section Township North, Range WM
APPLICANT �/� --4' L-� / ji �i�t� PHONE
MAILING ADDRESS
ZIP
PROPERTY OWNER l6 / �/-�j L a�jj 7��j®G, PHONE
MAILING ADDRESS
ZIP
CONTRACTORtC'6;
e'I PHONE
MAILING ADDRESS 7 53 /4} /th4
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STATE LICENSE# Q C/i4-4 ' 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 + DATE 5 d'/ D/
Y h y
I .. t p ` DATE / c'I,
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