HomeMy WebLinkAboutBLD2001-00577 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 #: BLD01-00577 Received Date 10/12/2001
SITE ADDRESS: 640 MOUNTAIN TRAIL RD Issue Date 10/12/2001
BRINNON, 98320 Expiration Date 10/12/2002
APPLICANT: JOHN SECHENA PHONE: (360)796-3526
640 MOUNTAIN TRAIL RD
BRINNON WA 98320
56
SUBDIVISION: OLYMPIC CANAL ADDITION 5 Block: 14 Lot:
PARCEL NUMBER: 981301454 Section: 16 Township: 25N Range: 02W
CONTRACTOR: FERRELLGAS PHONE: (360)385-6998
2108 SIMS WAY
PORT TOWSEND WA 98368
Contractor's License FERRELP055LH Expires 08/01/2002
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 10/12/2002.
REQUIRED INSPECTIONS:
Lin:-/Appliance: QK �' 5TOJE5 7u0'f N ,-7`.-e
r f)
[" FinaIApprovaI f �j �
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 #: BLD01-00577 Received Date: 10/12/2001
SITE ADDRESS: 640 MOUNTAIN TRAIL RD
BRINNON, 98320
OWNER: JOHN SECHENA PHONE: (360)796-3526
640 MOUNTAIN TRAIL RD
BRINNON WA 98320
SUBDIVISION: OLYMPIC CANAL ADDITION 5 Block: 14 Lot: 56
PARCEL NUMBER: 981301454 Section: 16 Township: 25 N Range: 02 W
CONTRACTOR: FERRELLGAS PHONE: (360)385-6998
2108 SIMS WAY
PORT TOWSEND WA 98368
Contractor's License FERRELP055LH Expires 08/01/2001
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:
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
Forest: Commercial Rural
Proximity_ .Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 10/12/01 42266
Total: $48.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
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WOODSTOVE 'v` PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS:
911#/ROAD NAME (O ck r\ o t.sWL CK a V\ t t a t l gR
-2)r-'1 v‘ OA-ZIP R.
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9 DIGIT PARCEL ID NUMBER l o I " 3 0 i - i SI/
Legal Description:
Subdivision Name Block Lotls)
Section Township North, Range WM
APPLICANT j] Y A V\ R . e C V l E v\ Q PHONE ��r�0 f ? 3S 2 (12
MAILING ADDRESS ice\ �'"��1 y\ - t L
-' y. y , ZIP 'a?.3 7
PROPERTY OWNER .3'Y] 'A- �-c-?L'vle'VA PHONE .)ecLIA- 0. e::,-„ 1}`C
MAILING ADDRESS vv\. - CA c� 42-- lS
ZIP
CONTRACTOR FQf'L-)\-- ,F\ ps 5 PHONE
MAILING ADDRESS /v
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'sc.-2
property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE —. . J DATE I c, / 1.1 / .2 0 G
FOR OFFICE USE ONLY
BASE FEE y ' . r...)-(_.) RECEIPT#
CASH/CK#
�' � ` �TOTAL � =-�
DATE / ,.. / ,`_ I
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