Loading...
HomeMy WebLinkAboutBLD2001-00676 -, , i 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 #: BLD01-00676 Received Date 12/6/2001 SITE ADDRESS: 201 S PALMER DR Issue Date 12/6/2001 PORT TOWNSEND, 98368 Expiration Date 12/6/2002 APPLICANT: GEORGE E BALASKI PHONE: 201 S PALMER DR PORT TOWNSEND WA 983689497 4 SUBDIVISION: CAPE GEORGE COLONY DIV 4 Block: 11 Lot: PARCEL NUMBER: 938701104 Section: 12 Township: 30N Range: 02W CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420 PO BOX 1031 PORT TOWNSEND WA 98368 Contractor's License PETTIOCO88CC Expires 5/1/02 OWNER, GEORGE E BALASKI PHONE: if different: 201 S PALMER DR PORT TOWNSEND WA 983689497 PROJECT DESCRIPTION: NO MLA RQRD PROPANE TANK AND STOVE 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 12/6/02. REQUIRED INSPECTIONS: Tank/Line/Appliance / / Z/7700 ,e(3< 44 Fi nalAppro t • 0/C. /767j/8 l tl-- 2/4110° 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 10/29/99 f BUILDING PERMIT APPLICATION Review 0676 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00676 Received Date: 12/6/2001 SITE ADDRESS: 201 S PALMER DR PORT TOWNSEND, 98368 OWNER: GEORGE E BALASKI PHONE: 201 S PALMER DR PORT TOWNSEND WA 983689497 SUBDIVISION: CAPE GEORGE COLONY DIV 4 Block: 11 Lot: 4 PARCEL NUMBER: 938701104 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420 PO BOX 1031 PORT TOWNSEND WA 98368 Contractor's License PETTI00088CC Expires 5/1/02 REPRESENTATIVE(S): PROJECT DESCRIPTIOP NO MLA RQRD PROPANE TANK AND STOVE 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: Shoreline Aquifer Forest: Commercial Rural Prnvimitu Plat rnnriitinnc Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 PRB 12/06/01 43713 Total: $48.00 JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION ..ff WOODSTOVE Ni .-PROPANE TANK PELLET STOVE OTHER H2O U a.. Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home? YES NO SITE ADDRESS(911#/Road Name): �.> / .? 6� 1 0 ) SG Pci ebi e ✓ er . /l...c? pc -e..•.7E Cr' 1..,., 1 PC1 :''� "O s c , c L1i ZIP C7C4 ?6 V 9 DIGIT PARCEL ID NUMBER 3 g 70 1 10 41 Legal Description: Subdivision Name VP e G e°'-'e C.-LI 1-o y p ; 1.' , 11 Block II Lot(s) 7 Section Township North, Range VVM / APPLICANT l -e t'r I cj L. i^'ct a sk I PHONE > lv C1 --3 7 9 (EE•79 MAILING ADDRESS 2 L)i `>o P- L rz,e c (4 e r. `7c et To cv.. �e✓� cl J L)q , T*dS4-4*---- ZIP ?S' 3 L.-1/ PROPERTY OWNER C-'C/i,41 e PHONE MAILING ADDRESS ZIP CONTRACTOR . q ©C 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 �,., L,F t�<'..,- Y-'�',-' " DATE I2 lig l 0/ FOR OFFICE USE ONLY BASE FEE 00 RECEIPT# Cf;V? qf CASH/CK# 1 TOTAL 4-GC I DATE I?.-/ /0 C H:HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01