HomeMy WebLinkAboutBLD2001-00274 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 #: BLD01-00274 Received Date 5/16/2001
SITE ADDRESS: 293774 HWY 101 Issue Date 5/16/2001
QUILCENE, 98376 Expiration Date 5/16/2002
APPLICANT: MICHAEL HANDLY PHONE: (360)765-3826
PO BOX 163
QUILCENE WA 98376
T 18
SUBDIVISION: BISHOP'S SUB DIV Block: Lot:
PARCEL NUMBER: 932700080 Section: 14 Township: 27N Range: 02W
CONTRACTOR:
OWNER,
if different:
PROJECT DESCRIPTION NO MLA REQ'D - FIREPLACE INSERT INSPECTION
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 05/16/2002.
REQUIRED INSPECTIONS:
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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
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BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00274 Received Date: 5/16/2001
SITE ADDRESS: 293774 HWY 101
QUILCENE, 98376
APPLICANT: MICHAEL HANDLY PHONE: (360)765-3826
PO BOX 163
QUILCENE WA 98376
SUBDIVISION: BISHOP'S SUB DIV Block: Lot: T 18
PARCEL NUMBER: 932700080 Section: 14 Township: 27 N Range: 02 W
CONTRACTOR: PHONE:
PHONE:
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: NO MLA REQ'D - FIREPLACE INSERT INSPECTION
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: �rRecei�pt Plat conditions
Receipt: pp ��ate
Propane Tanks/Stoves $48.00 MAM 05/16/01 40045
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: 1360) 379-4450
<INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE / ETHER ( t \,,,( (,. I IN S`�-
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SITE ADDRESS: --7 l✓ J / % 11/ � LL ]/
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9 DIGIT PARCEL ID NUMBER 13 c 70 O O D
Legal Description:
Subdivision Name Block Lot(s)
Section 7 �/� /� Township North, Range
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APPLICANT fry^ " Jac_ -S PHONE cam'q'--c�(Q L 7
MAILING ADDRESS 1 136 JO- (� �f 9 -Q
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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 DATE 5/ /6 / O
€, FOR OFFICE USE ONLY '
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H:\H OME\PLNCNTR\FORMS\INSTALL.DOC 10/99