HomeMy WebLinkAboutBLD2001-00327 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 #: BLD01-00327 Received Date 6/7/2001
SITE ADDRESS: 180 E ARDEN ST Issue Date 6/7/2001
PORT HADLOCK, 98339 Expiration Date 6/7/2002
APPLICANT: COLLEEN WHITE PHONE: (360)379-2685
180 E ARDEN ST
PORT HADLOCK WA 98339
11-13
SUBDIVISION: IRONDALE Block: 16 Lot:
PARCEL NUMBER: 961801604 Section: 35 Township: 30N Range: 01W
CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)385-5564
PO BOX 708
CHIMACUM WA 98325
Contractor's License RSSALS*022PB Expires 10/01/2001
OWNER,
if different:
PROJECT DESCRIPTION PROPANE TANK AND PROPANE COOK TOP
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 06/07/2002.
REQUIRED INSPECTIONS:
[ ] ank/LiWppliance:,Tp e—"- tex7 L i rac=s 4 i i iVk e
[ ] FinalApproval: . t7-
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 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00327 Received Date: 6/7/2001
SITE ADDRESS: 180 E ARDEN ST
PORT HADLOCK, 98339
APPLICANT: COLLEEN WHITE PHONE: (360)379-2685
180 E ARDEN ST
PORT HADLOCK WA 98339
SUBDIVISION: IRONDALE Block: 16 Lot: 11-13
PARCEL NUMBER: 961801604 Section: 35 Township: 30 N Range: 01 W
CONTRACTOR: R & S SALES AND SERVICE PHONE: (360)385-5564
PO BOX 708
CHIMACUM WA 98325
Contractor's License RSSALS*022PB Expires 10/01/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK AND PROPANE COOK TOP
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: 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: 6 i Shoreline Aquifer
L' Forest: Commercial Rural
—Proximity - Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Uate
Propane Tanks/Stoves $48.00 ZAN 06/07/01 28387
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST,_PORT TOWNSEND WA 98368 PH: (3a01 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE > PROPANE K PELLET STOVE OTHER C404. �i0
SITE ADDRESS:
911#/ROAD NAME /rO Arles si•
-- r-a n d/a`e. WA ZIP 9F'J.T y
9 DIGIT PARCEL ID NUMBER 96 /80 6 /G7
tiGt Legal Description: 8 0 1 04
Subdivision Name Block Lotls)
Section Township North, Range WM
APPLICANT ,t S 5.4-5 tz S /L1/C PHONE 37 9- S y,'
MAILING ADDRESS /O- , X' 7er /
G?i1 144 a Apr 4f//4 ZIP ?SYS z Sr-
PROPERTY OWNER CO�/GGP/ i/ 74 PHONE 3.79— 2' PS`
MAILING ADDRESS /J0 // 4/leiq r 7
�rdr/Ct'Q le W i4 ZIP QP„ r5
•CONTRACTOR Me f .$ 94`e.,§ ,4 `d Se4 /C"2 PHONE 3oi//2 -
MAILING ADDRESS ,Qc. )Q 70 Sr
C k ma Lu m iv/4 • zIP lc?'32J
STATE LICENSE # CC RD 3 a R. SSR Lr•S * d 22,f EXP. DATE /Q1 dl*
FEDERAL I.D. # (00 I ?OS SOY
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 /eGAf/j e, _Gc:�s%t ' DATE (p / 7 I (//
gL_____OL) FOR OFFICE USE ONLY
BASE FEE RECEIPT# r t,�
CASH/CK# /t<.>;✓ct`.
TOTAL I� / DATE . (0/ ( / 0/
H:\HOME\PLNCNTR\FORMS\INSTALL.D0 C 10/99