HomeMy WebLinkAboutBLD2001-00287 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 #: BLD01-00287 Received Date 5/21/2001
SITE ADDRESS: 95 W EUGENE ST Issue Date 5/21/2001
PORT HADLOCK, 98339 Expiration Date 5/21/2002
APPLICANT: LAURA BLAKE PHONE: (360)385-4612
JAMES BLAKE
95 W EUGENE ST
PORT HADLOCK WA 98339 11-15
SUBDIVISION: IRONDALE Block: 86 Lot:
PARCEL NUMBER: 961808604 Section: 34 Township: 30N Range: 01W
CONTRACTOR: R & S SALES AND SERVICE - STDVC PHONE: (360)732-4585
PO BOX 708
CHIMACUM WA 98325
Contractor's License RSSALS*022PB Expires 10/01/2001
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PROJECT DESCRIPTION NO MLA REQ'D - PROPANE TANK& STOVE 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 05/21/2002.
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
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 #: BLD01-00287 Received Date: 5/21/2001
SITE ADDRESS: 95 W EUGENE ST
PORT HADLOCK, 98339
APPLICANT: LAURA BLAKE PHONE: (360)385-4612
JAMES BLAKE
95 W EUGENE ST
PORT HADLOCK WA 98339
SUBDIVISION: IRONDALE Block: 86 Lot: 11-15
PARCEL NUMBER: 961808604 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: R & S SALES AND SERVICE — S4all_ PHONE: (360)732-4585
PO BOX 708
CHIMACUM WA 98325
Contractor's License RSSALS*022PB Expires 10/01/2001
ARCHITECT/ C,en2x - t.dntL
ENGINEER :
PROJECT DESCRIPTION: NO MLA REQ'D - PROPANE TANK & STOVE 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
Type Amount Paid By: Date: �rReceipt Approved/Dateit dons
p :
Propane Tanks/Stoves $48.00 MAM 05/21/01 40124
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE ,C PROPANE TANK PELLET STOVE OTHER Code .5. f(e
SITE ADDRESS:
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9 DIGIT PARCEL ID NUMBER 94,/ g08' 6 oy
Legal Description:
Subdivision Name Block Lotls)
Section Township North, Range WM
APPLICANT AI/ ,Cps/j4!'J��r7 PHONE ,f'eb,J-T9:J -/2,
MAILING ADDRESS ?Or BOX 7d 8'
G/J 1Hd 4 GC fl i It2A ZIP
PROPERTY OWNER 7 i,iire.5 _844-le PHONE J'ff' - 5/av/2
MAILING ADDRESS /�� .cL�r� ` ea,e 7 e
, t f!/ ZIP Ariz?9
CONTRACTOR A2),/ J 4tI4J //4' -�efl//c e PHONE $60J77-r9
MAILING ADDRESS A/Q'', ,� 'X' 7p8'
C 1)/4 it' /A Jet 444 ZIP 71:WS-
STATE LICENSE # CC. jj IQSSA Z S 4 oa..27P$ EXP. DATE /o////20O/
FEDERAL I.D. # 'Pi"' j'e ' &O/ aOD/
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 /.0,7/ / 0/
FOR OFFICE USE ONLY
BASE FEE RECEIPT# a 2Li
CASH/CK# 15 L/1
TOTAL DATE . - 5 /Z l /V l
H:\HOMEIPLNCNTR\FORMS\INSTALL.DOC10/99 MAY 2 1 2001