HomeMy WebLinkAboutBLD2001-00520 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 #: BLD01-00520 Received Date 9/17/2001
SITE ADDRESS: 252 SOMERVILLE RD Issue Date 9/17/2001
PORT HADLOCK, 98339 Expiration Date 9/17/2002
APPLICANT: STEPHEN R BRUNETTE PHONE: 385-3306
252 SOMERVILLE RD
CHIMACUM WA 98325
4
SUBDIVISION: SEAVIEW LAND CO INC SHORT PLAT Block: Lot:
PARCEL NUMBER: 901034014 Section: 3 Township: 29N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2002
OWNER,
if different:
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 09/17/2002.
REQUIRED INSPECTIONS:
[ ]-/ Tank/ ine/Appliance: 146 9 /0 I '
[1-eFi nalApproval: s j e ) t „ 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 #: BLD01-00520 Received Date: 9/17/2001
SITE ADDRESS: 252 SOMERVILLE RD
PORT HADLOCK, 98339
OWNER: STEPHEN R BRUNETTE PHONE: 385-3306
252 SOMERVILLE RD
CHIMACUM WA 98325
SUBDIVISION: SEAVIEW LAND CO INC SHORT PLAT Block: Lot: 4
PARCEL NUMBER: 901034014 Section: 3 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 09/06/2002
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:
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: ` �/ 7 1 /
Shoreline Aquifer
t Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 09/17/01 30291
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
SITE ADDRESS: �� .s 911#/ROAD NAME a00 may-/// //
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9 DIGIT PARCEL ID NUMBER
Legal Description:
Subdivision Name Block Lot(s)
Section / Township North, Range WM
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APPLICANT 5 i f2 iiL A) . I I PHONE 3 O -S E 5 6/o
MAILING ADDRESS 2-6 a-- Scam r ✓ Vf I I -i-- ^/
0 [✓14-A C_LLi ii / 'GO A ZIP 1 3 ?"s-
PROPERTY OWNER S re V" 7 ✓L-i/� A. 6 7-77 : PHONE 4j g - 3 0 4
MAILING ADDRESS /a as-2- 5 all A -e r v i l / .0
+; /L t k Lb( fik- / ZIP ! 3 ?-
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CONTRACTOR ( .V1-L,SC PHONE "73 a- ��
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MAILING ADDRESS ' O ` �'ox �i 6
kit Mic LA.)Vlti I A- ZIP 96 3 S
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.
APPLICANT SIGNATURE �i!yL 'l "e.--"--x„ DATE 9 / ''''' "/
FOR OFFICE USE ONLY
BASE FEEgic____00
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RECEIPT# �� .
CASH/CK#
Oa -7
TOTAL 4(e' DATE / // Cd
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