HomeMy WebLinkAboutBLD2001-00533 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 #: BLD01-00533 Received Date 9/19/2001
SITE ADDRESS: 221 DIETZ DR Issue Date 9/20/2001
QUILCENE, 98376 Expiration Date 9/20/2002
APPLICANT: JACK K BINNS PHONE: (360)765-3079
KARI LINDA BINNS
221 DIETZ DR
QUILCENE WA 98376-9600 T 11
SUBDIVISION: 1,1xH¢-- Block: Lot:
PARCEL NUMBER: 501031012 av,Nkel-A- Section: 3 Township: 25N Range: 01W
UPPMA
CONTRACTOR: CENEX SRKETING PHONE: (360)732-4585
PO BOX,
AURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2002
OWNER, JACK K BINNS PHONE: (360)765-3079
if different: KARI LINDA BINNS
221 DIETZ DR
QUILCENE WA 98376-9600
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 09/20/2002.
REQUIRED INSPECTIONS:
y/ _
[ _
Tank%Lind/Appliance: 64
[ FinalApprova: r�/C ICt/i2.1/e7, l‘;:k
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
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BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00533 Received Date: 9/19/2001
SITE ADDRESS: 221 DIETZ DR
QUILCENE, 98376
OWNER: JACK K BINNS PHONE: (360)765-3079
KARI LINDA BINNS
221 DIETZ DR
QUILCENE WA 98376-9600
SUBDIVISION: Block: Lot: T 11
PARCEL NUMBER: 501031012 Section: 3 Township: 25 N Range: 01 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518 (�\
AUBURN WA 98071-0518 0
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:
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
Routing Date: C- F&W Landslide
������ � � Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
I Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 09/19/01 30418
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN Si, PORT TOWNSEND WA 98368 'PH, (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE f\ PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: 22-C 2 1 ETz Z v i v t
911#/ROAD NAME CEN
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57
EL £ LC E /V} b WA- ZIP q i �7
9 DIGIT PARCEL ID NUMBER �7 / '5/ (1I Z.
Legal Description:
Subdivision Name / Block Lotls)Tl
Section ,. Township 75 V North, Range / €5{ WM
APPLICANT - i�� PHONE
MAILING ADDRESS I / • L(I �e-, lit
LL t Le E lAM ZIP 93 7<, rt
PROPERTY OWNER 34 /C'i E PHONE
MAILING ADDRESS
ZIP
CONTRACTOR (-t G X PHONE 7 -�✓ vJ
MAILING ADDRESS p /Q,K 2 4 g
CC4,"L61'�LtCaYYl V 3Zt ZIP
STATE LICENSE# � � �� _
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2 N6 EXP. DATE
FEDERAL I.D. # (.. Cr) /Lir ` CII J
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 ,efferson County and ' 's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of en o t ` a ' ar t's,prop y or structure shall be requested and shall occur during regular business hours.
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APPLICANT SIGNATURE f� r:, DATE q / /9 / 6
FOR OFFICE USE ONLY
BASE FEE _ RECEIPT# .3O r
J CASH/CK# t�,L3 2
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TOTAL �� DATE / /1'/ 1./
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