HomeMy WebLinkAboutBLD2001-00627 •
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 #: BLD01-00627 Received Date 11/6/2001
SITE ADDRESS: 130 RANDOLPH ST Issue Date 11/6/2001
PORT HADLOCK, 98339 Expiration Date 11/6/2002
APPLICANT: BRUCE E BARRETT PHONE: 360-732-6876
2751 W VALLEY RD
CHIMACUM WA 98325
1&2
SUBDIVISION: PORT HADLOCK Block: 5 Lot:
PARCEL NUMBER: 989400501 Section: 1 Township: 29N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2001
OWNER,
if different:
PROJECT DESCRIPTION NO MLA REQ'D - PROPANE TANK& 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 11/06/2002.
REQUIRED INSPECTIONS:
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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_B LD_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 #: BLD01-00627 Received Date: 11/6/2001
SITE ADDRESS: 130 RANDOLPH ST
PORT HADLOCK, 98339
OWNER: BRUCE E BARRETT PHONE: 360-732-6876
2751 W VALLEY RD
CHIMACUM WA 98325
SUBDIVISION: PORT HADLOCK Block: 5 Lot: 1&2
PARCEL NUMBER: 989400501 Section: 1 Township: 29 N Range: 01 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2001
REPRESENTATIVE(S):
PROJECT DESCRIPTIO NO MLA REQ'D - PROPANE TANK & STOVE INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION .
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 11/06/01 42332
Total: $48.00
,
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 62_1 SHERIDAN ST, PORT TOWNSEND WA 9836_8 PH: (360) 3Z9-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER 7C\/
SITE ADDRESS: _
911#/ROAD NAME 1 3 0 'RA o�,.._�� s� c�,
k--ki �o(.,_,Y` u.:) , ZIP LI 2) 3 1
9 DIGIT PARCEL ID NUMBER <I B 00 0
Legal Description: _
Subdivision Name c-'0 -_ti }SAbi.O Block b Lot(s) \k 2
Section Township North, Range WM
APPLICANT 3 R Lac . C , (\ e' .\ PHONE
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MAILING ADDRESS 1 5 I us) V, AL,L .,-; ' .=�
C ` vv,p,C- ) "v°1, 'v.7rNs-1-N. ZIP 6 -G .5
PROPERTY OWNER 3R,L)L. �E.` (.. C 2t"'1�"\ e+1` PHONE 'S )— 1. "(0 ' -71j
MAILING ADDRESS 3.-1 S\ W \\J L'l `-1 Q,'
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C.--k--\i Vv'1"( C.k.) v'•r's• 0.:P.SA-1, ZIP Q? q
CONTRACTOR �(/`/, //�/e %i fie_ PHONE 38 �, �l JZ
MAILING ADDRESS /()ij - yy (1((' y' Or-'
D7`74 ,�/kr7 Tr 44 ZIP 98337
STATE LICENSE # S7i%17 jD - 07?0 EXP. DATE //`�00�
FEDERAL I.D. # 7r - /0? S?`
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 ''( '`^ --- c at
DATE `‘• / 0 Z../ 0 i
FOR OFFICE USE ONLY
BASE FEE RECEIPT# }G
CASH/CK# ( D�3' .,
TOTAL DATE 11_/( 1 /
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