HomeMy WebLinkAboutBLD2001-00463 •
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 #: BLD01-00463 Received Date 8/14/2001
SITE ADDRESS: 611 CEDAR AVE#39 Issue Date 8/14/2001
PORT HADLOCK, 98339 Expiration Date 8/14/2002
APPLICANT: ALLEN SHAW PHONE:
PO BOX 211
PORT HADLOCK WA 983390211
SUBDIVISION: B & R MOBILE HOME COURT 2 Block: Lot:
PARCEL NUMBER: 930806039 Section: 2 Township: 29N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/01/2001
OWNER, B & R MOBILE HOME PHONE:
if different: 611 CEDAR
PORT HADLOCK WA 98339
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 08/14/2002.
REQUIRED INSPECTIONS:
rnic,ppriance: if/Y/441 %140
[0/ dp-proval: P l6 g U i I � � 1701-0A"
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.
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 #: BLD01-00463 Received Date: 8/14/2001
SITE ADDRESS: 611 CEDAR AVE#39
PORT HADLOCK, 98339
OWNER: ALLEN SHAW PHONE:
PO BOX 211
PORT HADLOCK WA 983390211
SUBDIVISION: B & R MOBILE HOME COURT 2 Block: Lot:
PARCEL NUMBER: 930806039 Section: 2 Township: 29 N Range: 01 W
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 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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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: III / y / Shoreline Aquifer
ll Forest: Commercial Rural
Proximity Plat Conditione
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 08/14/01 30115
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 9_8368 PH: 13601 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE / PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: / //W / / -5T
911#/ROAD NAME
9: ZIP
9 DIGIT PARCEL ID NUMBER ?O
Legal Description:
Subdivision Name Block Lotls)
•
Section Township North, Range WM
APPLICANT L_ /V 57#19 PHONE �is-c J,69f
MAILING ADDRESS / �/ Eex c9,,/7
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR PHONE
MAILING ADDRESS /3 / M 2,V 7
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 t efferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access a t of en to he applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE d— DATE g / /
CV FOR OFFICE USE ONLY
BASE FEE l (�( RECEIPT# 3 V •
CASH/CK#
TOTAL ' fc DATE F'/ / 4/ '
H:\HO ME\PLN CNTR\FORMS\INSTALL.000 10/99