HomeMy WebLinkAboutBLD2002-00003 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 #: BLD02-00003 Received Date 1/2/2002
SITE ADDRESS: 155 OLD ANDERSON LAKE RD Issue Date 1/2/2002
CHIMACUM, 98325 Expiration Date 1/2/2003
APPLICANT: JON D GOOD PHONE: (360)732-7099
JAMES L GOOD
155 OLD ANDERSON LK RD
CHIMACUM WA 98325 8
SUBDIVISION: IRONDALE ORCHARD TRACTS Block: 6 Lot:
PARCEL NUMBER: 963000608 Section: 10 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, JON D GOOD PHONE: (360)732-7099
if different: JAMES L GOOD
155 OLD ANDERSON LK RD
CHIMACUM WA 98325
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 01/02/2003.
REQUIRED INSPECTIONS:
[ ] ine/Appliance: D /--/51—e)
[7 FinalApproval: 7 A) < 60,44C.
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 B evie 000 03
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00003 Received Date: 1/2/2002
SITE ADDRESS: 155 OLD ANDERSON LAKE RD
CHIMACUM, 98325
OWNER: JON D GOOD PHONE: (360)732-7099
JAMES L GOOD
155 OLD ANDERSON LK RD
CHIMACUM WA 98325
SUBDIVISION: IRONDALE ORCHARD TRACTS Block: 6 Lot: 8
PARCEL NUMBER: 963000608 Section: 10 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 01/02/02 43878
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 /\ NO
SITE ADDRESS(911#/Road Name):
/CS CMG /,� ),z4 4,rl 2 11
ZIP
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9 DIGIT PARCEL ID NUMBER t(0 3 ' c o 6 . d
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range W
'76 M
APPLICANT JO 600W
nPHONE 73 - /
MAILING ADDRESS //JCS S C// / alid 7 -r Q/
L `j//27X 7- 'i'22 / e,u4 ZIP �i7�
PROPERTY OWNER vZ)72 C�`*7b� PHONE 7 ?` --2l�7j
MAILING ADDRESS ASS ( //CY l/l /i 0/07,:s /7 /gc�
( /iiwGG / / )I ZIP 9y 7a's
CONTRACTOR PHONE / ,:::; ,
:525
MAILING ADDRESS
1�G /Sax ( ve
ai.47,4ce, / ��� ZIP O j' -
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 / °a._ 2
DATE / /
FOR OFFICE USE ONLY
BASE FEE RECEIPT# t_1323-1
CASH/CK# C. ki
TOTAL DATE I /Z /DI-
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01