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HomeMy WebLinkAboutBLD2001-00690 • 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 #: BLD01-00690 Received Date 12/17/2001 SITE ADDRESS: 21 KELLY RD Issue Date 12/18/2001 BRINNON, 98320 Expiration Date 12/18/2002 APPLICANT: ROWLAND C DENNIS PHONE: (360)796-4717 KATHRYN M DENNIS 21 KELLY RD BRINNON WA 98320-9612 2 SUBDIVISION: OLYMPIC CANAL ADDITION 4 Block: 23 Lot: PARCEL NUMBER: 981002302 Section: 16 Township: 25N Range: 02W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 09/06/2002 OWNER, ROWLAND C DENNIS PHONE: (360)796-4717 if different: KATHRYN M DENNIS 21 KELLY RD BRINNON WA 98320-9612 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 12/18/2002. REQUIRED INSPECTIONS: [ ] 51r;:il� Line/Appliance: [ ] FinalApproval: /11"//c Oj.Jly 4e_ d-O"L BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY is\F_BLD_Permit_Propane.rpt 10/29/19 L 0 BUILDING PERMIT APPLICATION BR vi w Typ e: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00690 Received Date: 12/17/2001 SITE ADDRESS: 21 KELLY RD BRINNON, 98320 OWNER: ROWLAND C DENNIS PHONE: (360)796-4717 KATHRYN M DENNIS 21 KELLY RD BRINNON WA 98320-9612 SUBDIVISION: OLYMPIC CANAL ADDITION 4 Block: 23 Lot: 2 PARCEL NUMBER: 981002302 Section: 16 Township: 25 N Range: 02 W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 09/06/2002 REPRESENTATIVE(S): PROJECT DESCRIPTIO NO MLA REQ'D - PROPANE TANK 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 Proximity Plat Conditions Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 MAM 12/17/01 43811 Total: $48.00 JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST;PORT TOWNSEND WA 98368 PH: (360)379-4450 A. INSTALLATION PERMIT APPLICATION WOODSTOVE PROPANE TANK PELLET STOVE OTHER Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Horn ? YES NO SITE ADDRESS(911#/Road Name): YL I/O A) UiU' 1 1.0 6 ZIP 9 DIGIT PARCEL ID NUMBER 6 1 Q G', 1 00 Z. SO 7-- Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT e00LcotY1ct -i->eof lip PHONE -79 6 —LI 7 MAILING ADDRESS -1 164.LL� )2. I) f`—>i I /3butA) ) wA- ZIP PROPERTY OWNER �0 w�� IN ��d I PHONE . .)9v — 7 17 MAILING ADDRESS 1 l -t?4 12_A. 1 ,,,i, .A yd G 0 t t ZIP CONTRACTOR ( LV\ ( PHONE 73.9.- fLI S U MAILING ADDRESS Lf 9u © A 1r JkLv1, wl W� 1ceS�� ZIP I 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. 0 APPLICANT SIGNATURE DATE 11 / ( / of � FOR OFFICE USE ONLY BASE FEE RECEIPT# 4 3g I I CASH/CK# CASA TOTAL DATE JZ/ I3/O ( H:\HOME\PLNCNTR\I NFOBLDG\FORMS\I NSTALL.DOC 11/05/01