HomeMy WebLinkAboutBLD2001-00350 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 #: BLD01-00350 Received Date 6/14/2001
SITE ADDRESS: 981 GIBBS LAKE RD Issue Date 6/14/2001
CHIMACUM, 98325 Expiration Date 6/14/2002
APPLICANT: JEFFERSON COUNTY PHONE: 360-385-9129
ATTN PARKS & REC
PO BOX 1220
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901283001 Section: 28 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/08/2001
OWNER,
if different:
PROJECT DESCRIPTION NO MLA REQ'D -PROPANE TANK 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 06/14/2002.
REQUIRED INSPECTIONS:
[ ] f Tanll%Line/Appliance:
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[ ] FinalApproval: /PAX (�/' ' 6 6 A-0 r
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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 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00350 Received Date: 6/14/2001
SITE ADDRESS: 981 GIBBS LAKE RD
CHIMACUM, 98325
APPLICANT: JEFFERSON COUNTY PHONE: 360-385-9129
ATTN PARKS & REC
PO BOX 1220
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901283001 Section: 28 Township: 29 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/08/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: NO MLA REQ'D - PROPANE TANK 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: 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
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: —Proximity
Approved/Date
fa conditions
Yp
Propane Tanks/Stoves $48.00 MAM 06/14/01 28477
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: q s i 5 c3Bc , Fc-1 / d4 J ,-cy �v
911#/ROAD NAME `�� t,7 �.J r 11.`� G
ZIP ? 3Z5
9 DIGIT PARCEL ID NUMBER go( Z93 OO
Legal Description:
Subdivision Name Block Lot(s)
Section (_ Township North, Range WM
APPLICANT ( �� 42\Lt PHONE 732�/6ZMAILING ADDRESS j. 1 ZS "�---VADZ- 6.- -• 9 & �j7j
ZIP ( R 3-3 9
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PROPERTY OWNER < '��5# • �. `P 35C' PHONE
MAILING ADDRESS , - N `�g'
ZIP
CONTRACTOR MCORTOiI\-� Q�0ICt„I PHONE ��`�6c' C�3
MAILING ADDRESS 269 (( kkaA.0 . b
P1�� R�3 3 ZIP , v —
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 / /
c V ''''i �' FOR OFFICE USE ONLY „
BASE FEE ,r �« + "=y'' .�-, ' �' 3 4' RECEIPT# � jL
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JEFFERSON COUNTY
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