HomeMy WebLinkAboutBLD2001-00632 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 #: BLD01-00632 Received Date 11/8/2001
SITE ADDRESS: 794 JUPITER LOOP RD Issue Date 11/8/2001
BRINNON, 98320 Expiration Date 11/8/2002
APPLICANT: MIKE WELLS PHONE: (360)897-9593
PATSY WELLS
21722 147TH ST E
SUMNER WA 98390 T 4
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502094004 Section: 9 Township: 25N Range: 02W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2002
OWNER, MIKE WELLS PHONE: (360)897-9593
if different: PATSY WELLS
21722 147TH ST E
SUMNER WA 98390
PROJECT DESCRIPTION PROPANE TANK
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 11/08/2002.
REQUIRED INSPECTIONS:
fr"]'- (Tank/Line/Appliance: ;//57e�, 17 -.—.
c
[ Fi na vaI ,' — 4— 9— J
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
is\F_BLD_Permit_Propane.rpt 10/29/19
BUILDING PERMIT APPLICATION .RevieveType:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00632 Received Date: 11/8/2001
SITE ADDRESS: 794 JUPITER LOOP RD
BRINNON, 98320
OWNER: MIKE WELLS PHONE: (360)897-9593
PATSY WELLS
21722 147TH ST E
SUMNER WA 98390
SUBDIVISION: Block: Lot: T 4
PARCEL NUMBER: 502094004 Section: 9 Township: 25 N Range: 02 W
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 PROPANE TANK
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
Routing Date: I( / F&W Landslide
/�'/0/ Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 11/08/01 42191
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (3S0)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER
Is this appliance (htg stove, hot water tank, furnace,etc.)to be installed in a Manufactured/Mobile Home?
47/3 ie 4 /14e4' 'E i YES ,( NO
SITE ADDRESS(911#/Road Name): f�
7qy /Wti 9 r Xi V '0--,72 /mac
/ t.f�d?Din &%/q- ZIP O �
9 DIGIT PARCEL ID NUMBER Z - 0i — G 7
Legal Description: --
Subdivision Name (GX '� Block Lot(s)
Section Township 01 , X 1 North, Range 2- L4=" WM
APPLICANT /U 1\ (67 GL 4'CC,Y PHONE — 77-
r
MAILING ADDRESS 77 2 Z f�7 'J"-, G-
LC YYI IYI e c 12.)(A- ZIP 1
PROPERTY OWNER 414/1 PHONE
MAILING ADDRESS
ZIP
`J
CONTRACTOR ei7ie 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 rig, e try to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE G rQ;t„,' '� c' DATE // / / C1(
,i FOR OFFICE USE ONLY z
BASE FEE �� V O /RECEIPT# / a/9 /
/
CASH/CK# /3 i' /
TOTAL b `d(-) DATE (/ // / Q / O
H:\HOME\PLNCNTR\I NFOBLDG\FORMS\I NSTALL.DOC 11/05/01