HomeMy WebLinkAboutBLD2001-00521 t 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 #: BLD01-00521 Received Date 9/17/2001
SITE ADDRESS: 833 N JACOB MILLER RD Issue Date 9/17/2001
PORT TOWNSEND, 98368 Expiration Date 9/17/2002
APPLICANT: WILLIAM HIXSON PHONE:
4220 NE 90TH ST
SEATTLE WA 981153831
SUBDIVISION: HIXSON SHORT PLAT Block: Lot:
PARCEL NUMBER: 101324018 Section: 32 Township: 31N Range: 01W
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/01/2002
OWNER, WILLIAM HIXSON PHONE:
if different: 4220 NE 90TH ST
SEATTLE WA 981153831
PROJECT DESCRIPTION PROPANE TANK AND HEAT STOVE
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:
[ ] €ank/Line/Appliance: /( (? " 6/
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[ ] FinalApproval: /6)--"AS =of
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 #: BLD01-00521 Received Date: 9/17/2001
SITE ADDRESS: 833 N JACOB MILLER RD
PORT TOWNSEND, 98368
OWNER: WILLIAM HIXSON PHONE:
4220 NE 90TH ST
SEATTLE WA 981153831
SUBDIVISION: HIXSON SHORT PLAT Block: Lot:
PARCEL NUMBER: 101324018 Section: 32 Township: 31 N Range: 01 W
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/01/2002
REPRESENTATIVE(S):
PROJECT DESCRIPTIO PROPANE TANK AND HEAT STOVE
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
9/t-7 Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 09/17/01 30292
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 v-L 46 U
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SITE ADDRESS: 3.� l dittlkex--911#/ROAD NAME 1� � cEJ
-P 'I ZIP ,.- qs L1 2
9 DIGIT PARCEL ID NUMBER
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT 7\-)1J/kr 1. C i PHONE 77gcc'..---1 / 741
MAILING ADDRESS 43 11 i -. CC6If /V k U[ ‘t°V .O
TO i<IN\ SelkiejZIP 9
PROPERTY OWNER QW 1�CUP Vitt. V tv' JD ►�J PHONE gg —]p (2.4)
MAILING ADDRESS t�;j`3 N ;`,-'-e,-61) v-- _
__2. ___ ZIP i' 7j''°-,rP SZ
CONTRACTOR SU AS'14-/-l';Z4/11 PHONE
MAILING ADDRESS
ZIP
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.
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APPLICANT SIGNATURE J`DATE / 1/ I
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0"� FOR OFFICE USE ONLY
BASE FEE �� V`J RECEIPT#
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CASH/CK# ,.
TOTAL DATE / /
H:\H OME\P W CNTR\FORMS\INSTALL.DOC 10/99