HomeMy WebLinkAboutBLD2001-00264 •
•
•
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 #: BLD01-00264 Received Date 5/8/2001
SITE ADDRESS: 1281 OLD GARDINER RD Issue Date 5/8/2001
SEQUIM, 98382 Expiration Date 5/8/2002
APPLICANT: HELEN N DENT PHONE: (360)797-7321
1281 OLD GARDINER RD
SEQUIM WA 983828703
79
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002341001 Section: 34 Township: 30N Range: 02W
CONTRACTOR: FERRELLGAS PHONE: (360)385-6998
2108 SIMS WAY
PORT TOWSEND WA 98368
Contractor's License FERRELP055LH Expires 08/01/2001
OWNER, HELEN N DENT PHONE: (360)797-7321
if different: 1281 OLD GARDINER RD
SEQUIM WA 983828703
PROJECT DESCRIPTION PROPANE TANK, HEATER& GAS LINE 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 05/08/2002.
REQUIRED INSPECTIONS:
[ J ank ine ppliance:) 411
[ a • •prova // pl
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
# e
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00264 Received Date: 5/8/2001
SITE ADDRESS: 1281 OLD GARDINER RD
SEQUIM, 98382
APPLICANT: HELEN N DENT PHONE: (360)797-7321
1281 OLD GARDINER RD
SEQUIM WA 983828703
SUBDIVISION: Block: Lot: 79
PARCEL NUMBER: 002341001 Section: 34 Township: 30 N Range: 02 W
CONTRACTOR: FERRELLGAS PHONE: (360)385-6998
2108 SIMS WAY
PORT TOWSEND WA 98368
Contractor's License FERRELP055LH Expires 08/01/2001
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK, HEATER & GAS LINE 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:
OTHER:
CONST TYPE: 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
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
—Proximity - Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/pate
Propane Tanks/Stoves $48.00 MAM 05/08/01 40021
Total: $48.00
S1-r-�c lc , vi � ,T , i rnrr(.AeTa �` �7c
L
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (3601 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE TANK PELLET STOVE OTHER ktC.; .1Qom.
SITE ADDRESS: XPROPANE
y�
911#/ROAD NAME 2 6 i 6 1 v L D p eo n/ H--Go y
sLGRuom ZIP c(83e --g-703
9 DIGIT PARCEL ID NUMBER OOo2 3 ?f a 0
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT 14 ELEN yS: P E,A/ 'T PHONE .76'O 991 1 3 aZ I
MAILING ADDRESS / 1/ ol d G04-§'i 42/N g-- K da,..s4- q U f A-- / (,4 - ZIP 6✓r'36/7.2-
PROPERTY OWNER 1-A .-L E N s , 0 .N ! PHONE ,. 17-7"2 a,1
MAILING ADDRESS I a_ 1 0 t-'( PrgOi NEk -w``
5E,(;?u\‘M / it,.-A . — pp ZIP q o3gA—dr
703
CONTRACTOR fC"Cg. it /hrG n'4s' t,,� PHONE 3�.f r- ‘j /�f
MAILING ADDRESS 2/ o f ..S-/✓, .5 k Ay
fors 7`bW..V5fvd , ifl/rA . - ZIP 9, 33,
STATE LICENSE# 6 C / S 53 S -z EXP. DATE ')- 3 ( - -a �+ %
FEDERAL I.D. # f` 1` I\ -C P o S.S L
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- / 67 /�
F%. _
�
FOR OFFICE USE ONLY
BASE FEE" RECEIPT# }
' -- ' ' 9 CASH/CK# K ct Li
TOTAL47412:' n w' "DATE �/ / {
H:\HOME\PLN CNTR\FORMS\INSTALL.DOC 10/99
MAY - 8 2001
I
i
L.