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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 #: BLD01-00625 Received Date 11/2/2001
SITE ADDRESS: 174 RIDGE RD Issue Date 11/5/2001
BRINNON, 98320 Expiration Date 11/5/2002
APPLICANT: LINDA R CORTESI PHONE: (360)796-0196
P 0 BOX 371
BRINNON WA 98320
5
SUBDIVISION: OLYMPIC CANAL ADDITION 7 Block: 16 Lot:
PARCEL NUMBER: 981901603 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, LINDA R CORTESI PHONE: (360)796-0196
if different: P 0 BOX 371
BRINNON WA 98320
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 11/05/2002.
REQUIRED INSPECTIONS:
H ek/Line/Appliance: ////: ( 41� • ''[4-""-<nal,642prov;
K.-- / 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_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 #: BLD01-00625 Received Date: 11/2/2001
SITE ADDRESS: 174 RIDGE RD
BRINNON, 98320
OWNER: LINDA R CORTESI PHONE: (360)796-0196
P 0 BOX 371
BRINNON WA 98320
SUBDIVISION: OLYMPIC CANAL ADDITION 7 Block: 16 Lot: 5
PARCEL NUMBER: 981901603 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 08/01/2002
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
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 11/02/01 42323
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSBI A p3s Pic (16C7 4
• INSTALLATION PERMIT APPLICATIO NOV
- 2 2001 ._-_di
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WOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: 4_r •_.,.;.)4.2...........4,
911#/ROAD NAME f 'f q I e ('O4 (I DEP T OF COMMUNIY DEVI OPMFNT
9 DIGIT PARCEL ID NUMBER L7 c1 ci of �j D-
Legal Description: I r.�
Subdivision Name r7� I (� �-(, (Di I()�) Block / ti Lot(s) S
HNC 1iip/� �.
Section Township 2 ,� North, Range ,. (,je� ( WM
APPLICANT i HI d 0 iq, COP,'C,j/ PHONE , 6?l✓ 96 —6/96
MAILING ADDRESSV. Q o f ) .9 17
IJ k. /i,' Iv 0 /iJ , G•4.J ZIP r7 .- C; 6
PROPERTY OWNER !�r/(� � � I �C�C� (L`�� PHONE . lG/
MAILING ADDRESS p. p. Box ,3 (� //(D ��0/
6 i.-f-J)/�d ,dC Lt_J/9 ' ZIP 0_57 LJ)
CONTRACTOR FFt P R L LL 9 19- s PHONE / — L0— S9/7-S3f1
MAILING ADDRESS 8 Z, 'j2 1�-vtk15 l tL)4 ,. E} "S Y:q ZIP 9 �^-5 g
STATE LICENSE# tj () I 5 j 5 1 f -- EXP. DATE //.j i/U a.
FEDERAL I.D. # ,, 3 jy7'es, CLS R _ .1)E1.
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 „z Z%4...) 4 / DATE 11 / 6 /1 6 `f
FOR OFFICE USE ONLY
BASE FEE RECEIPT# y0-3
CASH/CK# 5-2 p
TOTAL g � DATE t I / ,/0)
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