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HomeMy WebLinkAboutBLD2001-00541 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 #: BLD01-00541 Received Date 9/26/2001 SITE ADDRESS: 222 E MIDDLEPOINT RD Issue Date 9/26/2001 PORT TOWNSEND, 98368 Expiration Date 9/26/2002 APPLICANT: JOHN BAILEY PHONE: (360)385-6351 ANN BAILEY PO BOX 205 PORT TOWNSEND WA 98368 3 4 + SUBDIVISION: Block: Lot: PARCEL NUMBER: 001052014 Section: 5 Township: 30N 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, if different: 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 09/26/2002. REQUIRED INSPECTIONS: [ j Tank/Line/Appliance: .x r /t(i5 ©ic .3/47/0 R q [ j FinalApproval: 2--- 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 #: BLD01-00541 Received Date: 9/26/2001 SITE ADDRESS: 222 E MIDDLEPOINT RD PORT TOWNSEND, 98368 OWNER: JOHN BAILEY PHONE: (360)385-6351 ANN BAILEY PO BOX 205 PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: 3,4,+ PARCEL NUMBER: 001052014 Section: 5 Township: 30 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 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 Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Proximity Plat Conditions Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 MAM 09/26/01 30394 Total: $48.00 JEFFERSON COUNTY COMMUNITY DEVELOPMENT,_621 SHERIDAN S rT, PORT TOWNS_END WA 98368 PH: (MO) 379-4450 INSTALLATION PERMIT APPLICATION W00DSTOVE / PROPANE TANK PELLET STOVE OTHER SITE ADDRESS: / r 911#/ROAD NAME L Z 2 j /lei(A,) Z}i A j Aii-] 97 f v ZIP cle 6E.� 9 DIGIT PARCEL ID NUMBER Cps r' D z O/(71 Legal Description: Subdivision Name Block Lotls) Section Township North, Range WM APPLICANT \/e/ // Y PHONE 3BS 65' i MAILING ADDRESS 1�C7 . (3c x l rc 1 - VJ i4 ZIP q e 36s PROPERTY OWNER SA-A/C(=`� PHONE MAILING ADDRESS ZIP CONTRACTOR Su?3 1 f3/+vJ 726P 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. APPLICANT SIGNATURE (11 � � DATE Cl / 24, / G( FOR OFFICE USE ONLY BASE FEE RECEIPT# 30-j9 /�y1 QQ CASH/CK# �f ! I TOTAL L4 D• orDATE "1 / of H:\H O ME\PLNCNTR\FORMS\INSTALL.DOC 10/99