HomeMy WebLinkAboutBLD2001-00626 f •
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 #: BLD01-00626 Received Date 11/5/2001
SITE ADDRESS: 21 MUIR CT Issue Date 11/6/2001
PORT LUDLOW, 98365 Expiration Date 11/6/2002
APPLICANT: HANK WEST PHONE: (360)437-0392
21 MUIR COURT
PORT LUDLOW WA 98365
53
SUBDIVISION: SOUTH BAY#1 Block: Lot:
PARCEL NUMBER: 995500053 Section: 21 Township: 28N 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, HANK WEST PHONE: (360)437-0392
if different: 21 MUIR COURT
PORT LUDLOW WA 98365
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 11/06/2002.
REQUIRED INSPECTIONS:
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[ ] Tanl ine/Appliance: "_ i (( ,
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FinalApproval: fjk l///WO t //ta . ""-'`--
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
i:1F_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 #: BLD01-00626 Received Date: 11/5/2001
SITE ADDRESS: 21 MUIR CT
PORT LUDLOW, 98365
OWNER: HANK WEST PHONE: (360)437-0392
21 MUIR COURT
PORT LUDLOW WA 98365
SUBDIVISION: SOUTH BAY#1 Block: Lot: 53
PARCEL NUMBER: 995500053 Section: 21 Township: 28 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
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 11/05/01 42328
Total: $48.00
fJEFFERSON 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: 2 / M u i•-� p ti „� '
911#/ROAD NAME � /•� ((� �-
Ro i? i Lt1DiDloa ZIP scit8364--
9 DIGIT PARCEL ID NUMBER �6.....-S�Q O.f3
Legal Description: y ��
Subdivision Name S0 #„Z(17-09 FAY Block Lotlid
Section Township North, Range +WM
APPLICANT j4 ,ES/ PHONE �/37- b 37
MAILING ADDRESS Z / /4V/aL 1 !cv/l-
�O/t4— I- v 2 L o(4) ZIP 9493C'4'
PROPERTY OWNER r. r
SA N, I-� PHONE
MAILING ADDRESS
ZIP
CONTRACTOR C "IC E K PHONE__ / ,3 Z yJ 8-_
MAILING ADDRESS q3/D /eb 4ZI vi
efri//r1 v'111 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 Jeff- on County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of entr o - applicant's property o structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE DATE / / / 0
FOR OFFICE USE ONLY
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BASE FEE RECEIPT# 9 23ZS
E r '°a 0 V E ThH/CK# 21 g
TOTAL !4j 1? ;�.
_ NOV _ J
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DEPT. OF COMMUNITY DEVELOPMENT