HomeMy WebLinkAboutBLD2001-00583 4
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 #: BLD01-00583 Received Date 10/15/2001
SITE ADDRESS: 6883 BEAVER VALLEY RD Issue Date 10/15/2001
CHIMACUM, 98325 Expiration Date 10/15/2002
APPLICANT: PHYLLIS DOOLITTLE PHONE: 360-732-7405
6883 BEAVER VALLEY RD
CHIMACUM WA 98325
T 13
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901244015 Section: 24 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 AND PROPANE HEAT STOVE 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 10/15/2002.
REQUIRED INSPECTIONS:
Tank/Line'�~
[ ) /Appuarf`ce:671K 1 0 —r—O t
[ ] FinalApproval: t/<_ lO--1 --0 t
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_Perm it_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 #: BLD01-00583 Received Date: 10/15/2001
SITE ADDRESS: 6883 BEAVER VALLEY RD
CHIMACUM, 98325
OWNER: PHYLLIS DOOLITTLE PHONE: 360-732-7405
6883 BEAVER VALLEY RD
CHIMACUM WA 98325
SUBDIVISION: Block: Lot: T 13
PARCEL NUMBER: 901244015 Section: 24 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 AND PROPANE HEAT STOVE 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 Landslide
outing Date:
I0��-..) & Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 10/15/01 42225
Total: $48.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT. 621 SHERIDAN ST. PORT TOWNSEND WA 98368 PH: 13601 3Z9-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE '-'`r OTHER J/ti='/e....
SITE ADDRESS: / a `
911#/ROAD NAME 6'03 f-wiled" ehtilev /�,
G6tl�mar-a✓h / 14/4- ZIP 9 f `_r-
9 DIGIT PARCEL ID NUMBER y0/2 L/I/O O/c
-
Legal Description:
Subdivision Name Block Lot(s)
Section / Township North, Range WM
APPLICANT /- Ay/f/t/S s'c'/!///e PHONE 739 -7/z�
MAILING ADDRESS �j 3 /. a(fer veq//yy ,�
(1�( 0eZ"/1? k/AL • ZIP ,,e3 t �
PROPERTY OWNER why/4,5 P(�$2(i H/e PHONE 73 7VU5
MAILING ADDRESS (? g83 /-�'6,(J(' i/a'' f/`� If 2d
G1/4/1,0Gt441 , /4/(- / ZIP l 3 S
CONTRACTOR G�el�6� PHONE 739 � S----
MAILING ADDRESS j3�� Rt�tpe/�e , Or
Gc r'ihu ei,07j 14/A ZIP 73
STATE LICENSE# EXP. DATE 7/ / ,
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 �- DATED, / / ! (/
FOR OFFICE USE ONLY
BASE FEE 64l RECEIPT# `�
CASH/CK# C ES f
ull
TOTAL qtr/ DATE tO //g I a f
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