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HomeMy WebLinkAboutBLD2001-00633 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 #: BLD01-00633 Received Date 11/13/2001 SITE ADDRESS: 232 FERN WAY Issue Date 11/13/2001 CHIMACUM, 98325 Expiration Date 11/13/2002 APPLICANT: JEFFERSON COUNTY PHONE: (360)385-9160 DEPT OF PUBLIC WORKS PO BOX 2070 PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901113007 Section: 11 Township: 29N Range: 01W 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 11/13/2002 REQUIRED INSPECTIONS: [ ] . ine/Appliance: OIL t 1-(4.-O I [7 FinalApproval: TiAOK. OK II-- 19 ^Ot 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 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00633 Received Date: 11/13/2001 SITE ADDRESS: 232 FERN WAY CHIMACUM, 98325 OWNER: JEFFERSON COUNTY PHONE: (360)385-9160 DEPT OF PUBLIC WORKS PO BOX 2070 PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot PARCEL NUMBER: 901113007 Section: 11 Township: 29 N Range: 01 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): JERRY SMITH PO BOX 855 CHIMACUM WA 98325 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: GARAGE: SHORELINE CONST TYPE: 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 Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Proximity Plat Condition Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 MAM 11/13/01 42345 Total: $48.00 A JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)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 Horn YES 0 SITE ADDRESS(911#/Road Name): L: 3 Z. t'-€YYJ (i� Chi�1aCW41 ( ZIP 7 "> Z� 9 DIGIT PARCEL ID NUMBER 701 11 OO7 Legal Description: Nw 5 J I L5 'l,�/ /� Subdivision Name w /�'V JC'C, ��i ��,�J /�/r Eli� BlockPA"ih.Lots) Section I/ Township 9 North, Range i I WM APPLICANT \/eP`Y 6 %` �+l� PHONE 73,�'�i" 3 MAILING ADDRESS PO Ai i g C/)fi etcow/ (V4 ZIP 32 5 PROPERTY OWNER Je rls9 £ J/>// I4Ik i. �r2� PHONE 3 MAILING ADDRESS ZIP CONTRACTOR !/je)( / / PHONE .�3 - E-f6- g 5 MAILING ADDRESS ci /C 4 z1'4'c,� ii / L C/4//'l'!4 c r/iAs--1 / /•1/41 9 J 3 2 5 2/ a L I1.,7 a/4" ZIP 7 '3 Z S- 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 app' a 's operty or structure shall be requested and shall occur during regular business hours. APPLICANT SIGNATURE '�/ /f (// DATE J/ / /e / `ii„ sso FOR OFFICE USE ONLY BASE FEE RECEIPT# 1 CASH/CK# --4"Z 3 U TOTAL DATE j/j_/_C)._I H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01 pA42( triAd- /©•-( v Jar idgq11-(Si A L (711 C+ %mil cc' 0/4 1 `, >e ale Tf�,Ce2 S £6-5/0 e- r c 'ed ,d :)/ MPc•7 1 / I n i i fr t I � Fes/ IWAy