HomeMy WebLinkAboutBLD2002-00053 •
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 #: BLD02-00053 Received Date 2/5/2002
SITE ADDRESS: 315 QUARRY RD Issue Date 2/5/2002
PORT LUDLOW, 98365 Expiration Date 2/5/2003
APPLICANT: JERRALD L WIEDNER PHONE:
PO BOX 40
CHIMACUM WA 983250040
SUBDIVISION: BASALT BEACH Block: Lot:
PARCEL NUMBER: 931500213 Section: 4 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/02
OWNER, JERRALD L WIEDNER PHONE:
if different: PO BOX 40
CHIMACUM WA 983250040
PROJECT DESCRIPTION NO MLA RQRD--PROPANE TANK ONLY.
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 2/5/03.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval:
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
i:1F_BLD_Permit_Propane.rpt 10/29/99
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00053 Received Date: 2/5/2002
SITE ADDRESS: 315 QUARRY RD
PORT LUDLOW, 98365
OWNER: JERRALD L WIEDNER PHONE:
PO BOX 40
CHIMACUM WA 983250040
SUBDIVISION: BASALT BEACH Block: Lot:
PARCEL NUMBER: 931500213 Section: 4 Township: 28 N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/02
REPRESENTATIVE(S): LEON THIBEAULT
315 QUARRY RD
PO BOX 40
PORT LUDLOW WA 98365
PROJECT DESCRIPTIO NO MLA RQRD--PROPANE TANK ONLY.
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 PRB 02/05/02 45651
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 S'HERIDAN 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 A NO
SITE ADDRESS(911#/Road Name):
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7 e/Z% Z4>t c /G1 / L 2 ZIP ,2 of C S
9 DIGIT PARCEL ID NUMBER q 3 t Lj
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT 14) / // ,A t-/ PHONE 7 --
MAILING ADDRESS ,`?//3 de Gtri-7 4 /
/(,�7 ZZ/A/j�f/ ZIP /,,v!6
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PROPERTY OWNER (...4/7 •ej 2)4/. PHONE Zrz- 0172
MAILING ADDRESS , ;''' '.ei•-,--,'' '. /../01 et-.Y/LX VZ CZ/
ZIP
CONTRACTOR [ l�sC '�/ PHONE 7Y — /5-cr-5-
MAILING ADDRESS �� /`JCfZ g
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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 4:ZZ.e.--7� � DATE / J/ d a`~-
FOR OFFICE USE ONLY �f
BASE FEE '�- RECEIPT# q>(D-1
CASH/CK# aT�S--�
TOTAL i Qe s_ DATE J/ D.2---
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