HomeMy WebLinkAboutBLD2001-00608 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 #: BLD01-00608 Received Date 10/25/2001
SITE ADDRESS: 91 MATS MATS BEACH RD Issue Date 10/25/2001
PORT LUDLOW, 98365 Expiration Date 10/25/2002
APPLICANT: THOMAS LACY PHONE: (360)437-2271
LOUISE LACY
PO BOX 351
PORT HADLOCK WA 98339 2
SUBDIVISION: THE LACY SHORT PLAT Block: Lot:
PARCEL NUMBER: 921321011 Section: 32 Township: 29N Range: 01 E
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 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/Line/Appliance:
[' ] FinalApproval: ak/(..
L°� /p/4//'Z -4'
d
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 #: BLD01-00608 , Received Date: 10/25/2001
SITE ADDRESS: 91 MATS MATS BEACH RD
PORT LUDLOW, 98365
OWNER: THOMAS LACY PHONE: (360)437-2271
LOUISE LACY
PO BOX 351
PORT HADLOCK WA 98339
SUBDIVISION: THE LACY SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 921321011 Section: 32 Township: 29 N Range: 01 E
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 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:
CONST TYPE: OTHER:
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 10/25/01 42304
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE ✓PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS:
911#ROAD NAME 9)/ 14 T S (, 7LSr/ 7?)
fe r1 /o 4/ ZIP c G
9 DIGIT PARCEL ID NUMBER c4 2.I - '3 Z I ' I
Legal Description: r� � � � �����
Subdivision Name / i � Block Lotlsl
Section Township North, Range WM
APPLICANT 7iie t.aS VI- R. X 611 24 C PHONE 360 � /
MAILING ADDRESS O ,B� � /
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PROPERTY OWNER 7 /(oil j)J 1 \ A.6 (� ) SC L ft HONE Q �� 7 0-7/
MAILING ADDRESS (/2 V Ego x
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CONTRACTOR C ` 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 ��_t ke_c. [ DATE f r) 0. (,
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CASH/CK# 1
TOTAL '.., DATE
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