HomeMy WebLinkAboutBLD2002-00051 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 #: BLD02-00051 Received Date 2/5/2002
SITE ADDRESS: 5440 CAPE GEORGE RD Issue Date 2/5/2002
PORT TOWNSEND, 98368 Expiration Date 2/5/2003
APPLICANT: MARY JANE E PEABODY PHONE: (360)379-0511
5440 CAPE GEORGE RD
PORT TOWNSEND WA 98368
2
SUBDIVISION: OCEAN GROVE ESTATES#2 Block: 5 Lot:
PARCEL NUMBER: 977100509 Section: 24 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
OWNER, MARY JANE E PEABODY PHONE: (360)379-0511
if different: 5440 CAPE GEORGE RD
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION PROPANE TANK& STOVE 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 02/05/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: 7,4413[ ] FinalApproval: —On- l/ b
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 BeDOw-00
Type 1
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00051 Received Date: 2/5/2002
SITE ADDRESS: 5440 CAPE GEORGE RD
PORT TOWNSEND, 98368
OWNER: MARY JANE E PEABODY PHONE: (360)379-0511
5440 CAPE GEORGE RD
PORT TOWNSEND WA 98368
SUBDIVISION: OCEAN GROVE ESTATES#2 Block: 5 Lot: 2
PARCEL NUMBER: 977100509 Section: 24 Township: 30 N Range: 02 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
REPRESENTATIVE(S):
PROJECT DESCRIPTIO PROPANE TANK & STOVE 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 02/05/02 45589
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE JC PROPANE TANK PELLET STOVE OTHER t7ro(?®VL(°_. ye. _
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
Al 5 /, ��c�/? ropes e- (� -� YES � NO
SITE ADDRESS(911#/Road Name): h6t t..4 e OVid
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ZIP l F
9 DIGIT PARCEL ID NUMBER q7 7/ e:90 6-cc'?
Legal Description:
Subdivision Name Block Lot(s)
Section / Township North, Range �// WM
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APPLICANT / WY�I V � �Gt✓ PHONE 3 / / ^ ' I
MAILING ADDRESS `7G '1462--
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ZIP
PROPERTY OWNER rife2---13-....1 �r '�-- i� "� PHONE
MAILING ADDRESS `2 a-
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ZIP
CONTRACTOR -rz s ' 1' ` 'e , 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 DATE / /
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
1 CASH/CK# 122 3
TOTAL L1 g DATE
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