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HomeMy WebLinkAboutBLD2001-00381 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 #: BLD01-00381 Received Date 7/3/2001 SITE ADDRESS: 124 SWANSON AVE Issue Date 7/3/2001 PORT TOWNSEND, 98368 Expiration Date 7/3/2002 APPLICANT: EUGE NE BURKE PHONE: 466-3784 PO BOX 183 LACONNER WA 98257 10 SUBDIVISION: OCEAN GROVE ESTATES#2 Block: 8 Lot: PARCEL NUMBER: 977100816 Section: 24 Township: 30N Range: 02W CONTRACTOR: OWNER, if different: PROJECT DESCRIPTION 0 CLEARANCE PROPANE FIREPLACE,TANK AND LINE 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 07/03/2002. REQUIRED INSPECTIONS: [ ] f ne/Appliance <i /< , 7—s=" v FinalApproval: Of -.2:19-"0') 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 2 BUILDING PERMIT APPLICATION SR evi w Typ e: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00381 Received Date: 7/3/2001 SITE ADDRESS: 124 SWANSON AVE PORT TOWNSEND, 98368 OWNER: EUGE NE BURKE PHONE: 466-3784 PO BOX 183 LACONNER WA 98257 SUBDIVISION: OCEAN GROVE ESTATES#2 Block: 8 Lot: 10 PARCEL NUMBER: 977100816 Section: 24 Township: 30 N Range: 02 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE(S): PROJECT DESCRIPTIO 0 CLEARANCE PROPANE FIREPLACE,TANK AND LINE 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 Proximity Plat Conditions Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 PRB 07/03/01 28584 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 0-ezE e4 /c.5 SITE ADDRESS: 911#/ROAD NAME /QZ'-� s MJ4//5 U� 7. �(//� �j d d/ / GL{//r(/c ,l/-� 1/V 4 ZIP 5'O 3L� 9 DIGIT PARCEL ID NUMBER 77 — /c 7 -- Legal Description: �^ ��� Subdivision Name U6/CG% /7 Block Lot(s) � Section 2-5z- Township 3d North, Range a Z WM APPLICANT E06E-41 74 , 3c}x_K-- - PHONE�.36v) g /6`1 MAILING ADDRESS .I 23 Sff[�c_7ex /�/3/t -p/ , L C& ',/ p 1 /4 ZIP 21S 2S7 PROPERTY OWNER S/4ME PHONE MAILING ADDRESS ZIP CONTRACTOR PHONE{ O)3?j j f90 MAILING ADDRESS uQS / 97115 u/ Y 1 e(//1 /1/P U/T f ZIP ��3,46, STATE LICENSE# f E,Q,�EG to j 52.711 EXP. DATE 6g� 2Qp 7 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 6,7 / O3/ 0/ FOR OFFICE USE ONLY BASE FEE 4-8- CEO RECEIPT# ,�, CASH/CK# t©q TOTAL DATE 7j 2)/ H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99