HomeMy WebLinkAboutBLD2001-00691 r
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 #: BLD01-00691 Received Date 12/17/2001
SITE ADDRESS: 1534 RIPLEY CREEK RD Issue Date 12/18/2001
QUILCENE, 98376 Expiration Date 12/18/2002
APPLICANT: BRIAN E DOWDS PHONE:
NAHRIN Y DOWDS
13001 123RD LN NE#302
KIRKLAND WA 98034 T 13
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 802352003 Section: 35 Township: 28N 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, BRIAN E DOWDS PHONE:
if different: NAHRIN Y DOWDS
13001 123RD LN NE#302
KIRKLAND WA 98034
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:
[ ) (` Tank/Line/Appliances f'
[ ] FinalApproval: 2)f, — `-/ '-2 S c-z_.
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
D
-0091
BUILDING PERMIT APPLICATION BRvi wTyp :
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00691 Received Date: 12/17/2001
SITE ADDRESS: 1534 RIPLEY CREEK RD
QUILCENE, 98376
OWNER: BRIAN E DOWDS PHONE:
NAHRIN Y DOWDS
13001 123RD LN NE#302
KIRKLAND WA 98034
SUBDIVISION: Block: Lot: T 13
PARCEL NUMBER: 802352003 Section: 35 Township: 28 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
u INSTALLATION PERMIT APPLICATION
WOODSTOVE /` PROPANE TANK PELLET STOVE OTHER
k.
Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home
YES NO
SITE ADDRESS(911#/Road Name):
/534/ /e/pLv (rreX R D
au/L , z)A ZIP
9 DIGIT PARCEL ID NUMBER a 2 — 5 2- DO 3
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT Al!ee' I jJ RI 1OW DS PHONE
MAILING ADDRESS I'&)O 1 li jg Rb L,/�' J h € i �. s r
VI 14 La I C� tu) ZIP 9 o /
PROPERTY OWNER J()-�I) t
J 1) S PHONE
MAILING ADDRESS r 306 I 125 °D I M ,i QT)T ZASr
V.I/2 k LA t.D , A ZIP 9 e Ogq
CONTRACTOR (?'Lf)e- PHONE 7 %45
MAILING ADDRESS Po ,.nS r g G�
4_1+•Vt bit fh , (A) AZIP 1$3 Z
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 ent to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE .„---- DATE /at/ /7 / 4
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 4361 I
CASH/CK# CA 514
TOTAL DATE 1 49- / 0 1
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