HomeMy WebLinkAboutBLD2001-00649 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 #: BLD01-00649 Received Date 11/19/2001
SITE ADDRESS: 12 KETCH LN Issue Date 11/19/2001
PORT LUDLOW, 98365 Expiration Date 11/19/2002
APPLICANT: CHARLES H SWINNEY PHONE:
BEVERLY SWINNEY
PO BOX 65251
PORT LUDLOW WA 983650251 82
SUBDIVISION: PORT LUDLOW NO. 3 Block: Lot:
PARCEL NUMBER: 990700082 Section: 8 Township: 28N Range: 01E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2002
OWNER, CHARLES H SWINNEY PHONE:
if different: BEVERLY SWINNEY
PO BOX 65251
PORT LUDLOW WA 983650251
PROJECT DESCRIPTION NO MLA RQRD-PROPANE TANK AND PROPANE FIREPLACE
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 11/19/2002,
REQUIRED INSPECTIONS:
[ ] Tank/Line/Applian ec '/K 4.2-3-0 7
[ 4" FinalApproval: 0/Z fa•-'J -o/
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_Propa ne.rpt 10/29/19
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BUILDING PERMIT APPLICATION BRevi w00p64 9
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00649 Received Date: 11/19/2001
SITE ADDRESS: 12 KETCH LN
PORT LUDLOW, 98365
OWNER: CHARLES H SWINNEY PHONE:
BEVERLY SWINNEY
PO BOX 65251
PORT LUDLOW WA 983650251
SUBDIVISION: PORT LUDLOW NO. 3 Block: Lot: 82
PARCEL NUMBER: 990700082 Section: 8 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 RQRD-PROPANE TANK AND PROPANE FIREPLACE
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: t l U.
r Cif 61 ?If
Ilf Shoreline Aquifer
t Forest: Commercial Rural
Proximity - a 'id• '•■
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 PRB 11/19/01 42389
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION r� �-
WOODSTOVE X PROPANE TANK PELLET STOVE OTHER 4 R����f�'-Ae
Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES X NO
SITE ADDRESS(911#/Road Name):
/ 2 k4 rem L ,V ron i L. t,D1-04(--.
7 ZIP 9'7<O
9 DIGIT PARCEL ID NUMBE a . .2. f yD / a °P ,Z
Legal Description: ��
Subdivision Name r6 7 4 G!p oCr.,...t3 Block Lot(s)
�SSection /� (' Township North, Range WM
APPLICANT "//,1/ S //`��-9 J W 1/)/JI/l�% PHONE .76a 43 7. a�'j,3J�
MAILING ADDRESS / 0 06 Y (O J 5l
/p a fr 4 4 D I.0 — Gri',j ZIP //""y 6J
PROPERTY OWNER Xi/./12/1 PHONE
MAILING ADDRESS
ZIP
CONTRACTOR l/ //VA//,IT i4 �0 rfi/f x 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 right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
JAPPLICANT SIGNATURE -�;4.0 0 ! 7 DATE /I / /7/
�P (
co FOR OFFICE USE ONLY L�
BASE FEE -[(D RECEIPT# 2 s2/-D- 1
CASH/CK# }-c js
TOTAL 4-Q()�--/ DATE ./ tl ioJ
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