HomeMy WebLinkAboutBLD2001-00256 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 #: BLD01-00256 Received Date 5/4/2001
SITE ADDRESS: 1364 HAZEL POINT RD Issue Date 5/4/2001
QUILCENE, 98376 Expiration Date 5/4/2002
APPLICANT: FRANCINE ROSE PHONE: 765-4518
121 WOLF RD
QUILCENE WA 98376-9642
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 501031005 Section: 3 Township: 25N Range: 01W
CONTRACTOR: CENEX SUPPLY & MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2001
OWNER,
if different:
PROJECT DESCRIPTION Propane Tank
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 05/04/2002.
REQUIRED INSPECTIONS:
[w1 Cank Lirie Appliance: ce,/< ,5"/,q/O/
[t�/ i na Approval: 400/C r ce3/ 411/0
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
i:\F_BLD_Permit_Propane.rpt 10/29/19
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BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00256 Received Date: 5/4/2001
SITE ADDRESS: 1364 HAZEL POINT RD
QUILCENE, 98376
APPLICANT: FRANCINE ROSE PHONE: 765-4518
121 WOLF RD
QUILCENE WA 98376-9642
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 501031005 Section: 3 Township: 25 N Range: 01 W
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
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 - Fiat uoncl bons
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 05/04/01 38981
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE K PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS:
911#/ROAD NAME
/ ZIP
7�
9 DIGIT PARCEL ID NUMBER v ( 0 3 j CIO s
Legal Description:
Subdivision Name Block Lot(s)
Section TownshipA North, Range WM
APPLICANT FFO�J�--t t� �� F PHONE 76 S 7 s- g
MAILING ADDRESS 2-1 1 OC C f
( )E , n7�
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR 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 t DATE Dr/09( / O I
FOR OFFICE USE ONLY
BASE FEE _1� �.- RECEIPT#
CASH/CK#
TOTAL _ DATE /
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