HomeMy WebLinkAboutBLD2001-00665 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 #: BLD01-00665 Received Date 11/28/2001
SITE ADDRESS: 310 DISNEY RD Issue Date 11/28/2001
NORDLAND, 98358 Expiration Date 11/28/2002
APPLICANT: DON AULT PHONE: (360)379-6965
310 DISNEY RD
NORDLAND WA 98358
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921094011 Section: 9 Township: 29N Range: 01E
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE:
265 CHIMACUM RD
PORT HADLOCK WA 98339
OWNER, DON AULT PHONE: (360)379-6965
if different: 310 DISNEY RD
NORDLAND WA 98358
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 11/28/2002.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[_] FinalApproval: -7";4'ijj . m 4 /0-Z I-a-z_
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 #: BLD01-00665 Received Date: 11/28/2001
SITE ADDRESS: 310 DISNEY RD
NORDLAND, 98358
OWNER: DON AULT PHONE: (360)379-6965
310 DISNEY RD
NORDLAND WA 98358
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921094011 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE:
265 CHIMACUM RD
PORT HADLOCK WA 98339
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 ADDI: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
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: Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 11/28/01 43753
Total: $48.00
,
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 Home?
YES Home?_,,
SITE ADDRESS(911#/Road Name) C .
0\r-G`CXV �, _)..) 1 \ ZIP 9, (8 3 J 8
9 DIGIT PARCEL ID NUMBER (4-2., I r o q 1•'1 0 1 (
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT aZ CD\r\ V �� \ PHONE 7 — (I 6
MAILING ADDRESS \( C \ S r\e— c c. • r ,
•�U" C),\C�..�1r,...`. 1 W N ZIP B 3 �"')
7
PROPERTY OWNER SC.it`ry O.c AC)0 ve- PHONE
MAILING ADDRESS
ZIP
CONTRACTOR �� `,`{� 3.\� U�!7 ,(l 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.
APPLICANT SIGNATURE iC}�NIl.1•1R;l I.NN, DATE l / LJ / 0
FOR OFFICE USE ONLY
BASE FEE RECEIPT# --`I 3--f-S 3
CASH/CK# SOS
TOTAL 1(, DATE 1�/Z / 0 j
H:U-IOME\PLNCNTR\I NFOBLDG\FORMS\I NSTALL.DOC 11/05/01