HomeMy WebLinkAboutBLD2001-00689 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 #: BLD01-00689 Received Date 12/17/2001
SITE ADDRESS: 1720 CENTER RD Issue Date 12/18/2001
CHIMACUM, 98325 Expiration Date 12/18/2002
APPLICANT: ROGER D SHORT PHONE: (360)732-4601
1720 CENTER RD
CHIMACUM WA 98325-9779
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901262003 Section: 26 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, ROGER D SHORT PHONE: (360)732-4601
if different: 1720 CENTER RD
CHIMACUM WA 98325-9779
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 12/18/2002.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: 5 Cm-- 'rota - N 7-0 fAA.rt.44)..4, t�?�� ; 24 i s-1GFf
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTION
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
BUSING PERMIT APPLICATIOP BR DOeview00p 89
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00689 Received Date: 12/17/2001
SITE ADDRESS: 1720 CENTER RD
CHIMACUM, 98325
OWNER: ROGER D SHORT PHONE: (360)732-4601
1720 CENTER RD
CHIMACUM WA 98325-9779
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901262003 Section: 26 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):
PROJECT DESCRIPTIO NO MLA REQ'D - PROPANE TANK 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: Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 12/17/01 43811
Total: $48.00
• I
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE A PROPANE TANK PELLET STOVE OTHER
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home
YES I NO
SITE ADDRESS(911#/Road Name):
/ 7.- b Ce.rl-7 .E.e- i 9
�Ni41/} ca 4i J ,_,Li 4 ZIP / SJ as
9 DIGIT PARCEL ID NUMBER go I -2-4,2. ' b 0,-.;
Legal Description:
Subdivision Name Block Lot(s)
n Section Township North, Range / WM
/Q APPLICANT 04 2 /1 5 /0/277- PHONE 73 Z q (p 0`
MAILING ADDRESS /7c U (_€y7"f /2 2�
7,,+'- 4e / / 44274 ZIP 78 2 S
PROPERTY OWNER ?()‘,/L' S-Lo ,2 ! PHONE 7 2 Li.6 d/
MAILING ADDRESS 2.720 ( r, /YJ~T- ce IZ.0
n,,/iM A /2�'7 / Lv ZIP ''.g�2s
CONTRACTOR ( PI 'e-*-- PHONE 7 Z- 95aS
MAILING ADDRESS PO l a.t- 2 e.- 6
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 S DATE 1c9,/ /7/ ®/
FOR OFFICE USE ONLY (� d
BASE FEE RECEIPT# 43D I I
CASH/CK# CIII'S I'
TOTAL DATE I Z it-4-1 0 l
H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC 11/05/01