HomeMy WebLinkAboutBLD2001-00450 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 #: BLD01-00450 Received Date 8/7/2001
SITE ADDRESS: 761 ROBBINS RD Issue Date 8/7/2001
NORDLAND, 98358 Expiration Date 8/7/2002
APPLICANT: DIANNE MAYNARD PHONE: (360)379-1277
DONALD MAYNARD
761 ROBBINS RD
NORDLAND WA 98358
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921093003 Section: 9 Township: 29N Range: 01E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2001
OWNER, DIANNE MAYNARD PHONE: (360)379-1277
if different: DONALD MAYNARD
761 ROBBINS RD
NORDLAND WA 98358
PROJECT DESCRIPTION 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 08/07/2002
REQUIRED INSPECTIONS:
[" ] Tank/Line/Appliance: �� v(nro(v )
A-11:-Dtfi4A-‘ _
[,-}/ FinalApproval: 04- lic, 10 ii /k,
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_Perm it_Propane.rpt 10/29/19
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BUILDING PERMIT APPLICATION BReviD w Type0
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00450 Received Date: 8/7/2001
SITE ADDRESS: 761 ROBBINS RD
NORDLAND, 98358
OWNER: DIANNE MAYNARD PHONE: (360)379-1277
DONALD MAYNARD
761 ROBBINS RD
NORDLAND WA 98358
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921093003 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2001
REPRESENTATIVE(S):
PROJECT DESCRIPTIO 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
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 08/07/01 29098
Total: $48.00
,
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (3601 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER}
SITE ADDRESS: 7 / / //-� /�S 2b
911#/ROAD NAME � +�b
/v /eI A '. / a2. ZIP
9 DIGIT PARCEL ID NUMBER 4?6 -/ --C753 —
Legal Description:
Subdivision Name Block Lot(s)
Section/ )/ Township North, Range WM
APPLICANT /✓ /4�U1 V/6 4-V/J PHONE ,5 79'- /2 7 7
MAILING ADDRESS 7 , / se0 /31/vs Z2
/
/.(9 . r✓ �(/L7 , a)-ci ZIP
PROPERTY OWNER 1)/ 4'9-4/•4/-. /9".244/j'9 PHONE 2/ 9 -/2'7
MAILING ADDRESS 7 / 1 - i7 /A ' /Z-.. °
A // -L7Z-64/z7 1 th ZIP
CONTRACTOR 6/1/6j- PHONE /3 1
D
MAILING ADDRESS / �U)/1/ ,i2I/#2
C //7 ��(// / / 6e 4 ZIP 98,?25
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 - try to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE �� /��// DATE C.:9/ 7/ ��
FOR OFFICE USE ONLY
BASE FEE 4g RECEIPT# C19003
CASH/CK# Cr"1
37
7 ,
l 0
TOTAL DATE /
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