HomeMy WebLinkAboutBLD2002-00035 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 #: BLD02-00035 Received Date 1/23/2002
SITE ADDRESS: 221 DIETZ DR Issue Date 1/23/2002
QUILCENE, 98376 Expiration Date 1/23/2003
APPLICANT: JACK I N BINNS PHONE: (360)765-3079
221 DIETZ DR
QUILCENE WA 98376
T 11
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 501031012 Section: 3 Township: 25N 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, JACK I N BINNS PHONE: (360)765-3079
if different: 221 DIETZ DR
QUILCENE WA 98376
PROJECT DESCRIPTION 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 01/23/2003.
REQUIRED INSPECTIONS:
[ ] Tanl Line/Appliance: /j<—
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[ ] FinalApproval: cQ/rGG /mac:2---
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
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JAN 2 3 2002
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST, PORT TOWNSEND 368 PH: (3601 -4450
INSTALLATION PERMIT APPLICATION
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DEPT.OF COMMUNITY DEVELOPMENT
W000STOVE ,' PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: �7-d `) S E7 Z T�� % ` ,�
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9 DIGIT PARCEL ID NUMBER 1 (j '3/ O[ 2--
Legal Description:
Subdivision Name /. / Block Lotlsl
Section 3 Township 'at/ V� North, Range / 141 WM
APPLICANT jo' t C t< < L. !V/VJS PHONE t(te 5 3679
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STATE LICENSE# EXP.DATE
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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 the approperty or structure shall be requested and shall occur during regular business hours.
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APPLICANT SIGNATURE _ DATE / / /1
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H:\HOME1PLNCNTR\FORMS\INSTALL.DOC1 0/99
5
BUILDING PERMIT APPLICATION BeDOw Typ e:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00035 Received Date: 1/23/2002
SITE ADDRESS: 221 DIETZ DR
QUILCENE, 98376
OWNER: JACK I N BINNS PHONE: (360)765-3079
221 DIETZ DR
QUILCENE WA 98376
SUBDIVISION: Block: Lot: T 11
PARCEL NUMBER: 501031012 Section: 3 Township: 25 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 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 01/23/02 45552
Total: $48.00