HomeMy WebLinkAboutBLD2001-00604 . M
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 #: BLD01-00604 Received Date 10/24/2001
SITE ADDRESS: 132 CHERRY AVE Issue Date 10/25/2001
CHIMACUM, 98325 Expiration Date 10/25/2002
APPLICANT: JOE SHAW PHONE: (360)732-4248
132 CHERRY AVE
CHIMACUM WA 98325
6
SUBDIVISION: IRONDALE ORCHARD TRACTS BLOCK Block: 2 Lot:
PARCEL NUMBER: 963000206 Section: 10 Township: 29N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE:
265 CHIMACUM RD
PORT HADLOCK WA 98339
OWNER, JOE SHAW PHONE: (360)732-4248
if different: 132 CHERRY AVE
CHIMACUM WA 98325
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 10/25/2002.
REQUIRED INSPECTIONS:
[ ] Tank/ Appliance': /.4,u c L-'ni,E cps L 7/- 9•6 ,
[ FinalApproval: Oi / //.3`"i1..:1,,
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
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00604 Received Date: 10/24/2001
SITE ADDRESS: 132 CHERRY AVE
CHIMACUM, 98325
OWNER: JOE SHAW PHONE: (360)732-4248
132 CHERRY AVE
CHIMACUM WA 98325
SUBDIVISION: IRONDALE ORCHARD TRACTS BLOCK Block: 2 Lot: 6
PARCEL NUMBER: 963000206 Section: 10 Township: 29 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE:
265 CHIMACUM RD
PORT HADLOCK WA 98339
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:
CONST TYPE: OTHER. SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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 10/24/01 42298
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST,_PORT TOWNSENg WA 98368 PH; (3600)g379-445Q__
INSTALLATION PERMIT APPLICATICND E C U
WOODSTOVE it PROPANE TANK PELLET STOVE OTHER OCT2 a I
SITE ADDRESS:911#/ROAD NAME y 1 :S .1 C \N..-v y Aj F , ,r;,�,y;J i ��v.�;Y—
J wpEektgieNMUNITY DEVELOPMENT
9 DIGIT PARCEL ID NUMBER \k..61SQCC),AOcc.
Legal Description:
a_ Lot(s) �
Subdivision Name ,,p
L.n.. a Cs' av c� \v .�� Block
Section Township North, Range WM
APPLICANT OE �_ i.N-_.) PHONE 13 a`ci-),4 r
MAILING ADDRESS 132 CAN.st ,(,,.- AN)
Q.)n;vaY.Cf L w„ (a ZIP 1 q
%13 aJ
PROPERTY OWNER •-\C)Z,. E
4 C ,,,,,.-�: i v1C°,tA ) PHONE ` 3a-424r
MAILING ADDRESS 132 AV E-
1-
.mc... w �i. � �. 3Pt ZIP 1 Y rX`i
CONTRACTOR LAc-,-,",.\u; R v c. er, _ PHONE 3(00-3%5- u3
MAILING ADDRESS aLQ3 Q. v-..vv\lAC s.vr.. 1•L`` -
PGr! \\vA \ lATh(:k ZIP CIV CI
STATE LICENSE # Lk',r.\ c%.etc1'4sZs\ EXP. DATE
FEDERAL I.D. # C.pC2aC)--1 WI'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.
/ 1
APPLICANT SIGNATURE / ( �ijiT, DATE / /
r'
FOR OFFICE USE ONLY
BASE FEE RECEIPT# L( 2,..2C1
CASH/CK# 5930
TOTAL DATE (O /L(/ 0
H:1H 0 ME\PLNCNTR\FORMS\INSTALL.DOC 10/99