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HomeMy WebLinkAboutBLD2002-00054 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 #: BLD02-00054 Received Date 2/6/2002 SITE ADDRESS: 4655 OAK BAY RD Issue Date 2/6/2002 PORT LUDLOW, 98365 Expiration Date 2/6/2003 APPLICANT: JOHN N DALE PHONE: JACQUELINE C DALE 4655 OAK BAY RD PORT LUDLOW WA 983659203 A SUBDIVISION: OAK BAY WATERFRONT TRACTS Block: Lot: PARCEL NUMBER: 976800061 Section: 29 Township: 29N Range: 01E CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 9/6/02 OWNER, JOHN N DALE PHONE: if different: JACQUELINE C DALE 4655 OAK BAY RD PORT LUDLOW WA 983659203 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 2/6/03. REQUIRED INSPECTIONS: [ ] ank/ ine/Appliance: O'Z [ FinalApproval: ©fit 33— 1g ` Z 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 10/29/99 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00054 Received Date: 2/6/2002 SITE ADDRESS: 4655 OAK BAY RD PORT LUDLOW, 98365 OWNER: JOHN N DALE PHONE: JACQUELINE C DALE 4655 OAK BAY RD PORT LUDLOW WA 983659203 SUBDIVISION: OAK BAY WATERFRONT TRACTS Block: Lot: A PARCEL NUMBER: 976800061 Section: 29 Township: 29 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): PROJECT DESCRIPTIO NO MLA RQRD--PROPANE TANK ONLY TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 1997 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 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 Routing Date: F&W Landslide 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 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( 11 /Road Name): � /� / (1/2T �(9/�L4/ � 1 ZIP___Yll7b 5 9 DIGIT PARCEL ID NUMBER 97 b Sao 06 C Legal Description: Subdivision Name Block Lot(s) jSection Township North, Range /� WM �,/ a APPLICANT / �3ZPHONE 4<7-- C1 2'� 2' MAILING ADDRESS �"�� �T / i f.0 � / �,��' :31 p / � �, / / d ZIP Yeri?b PROPERTY OWNER le:2/74:A/ �6 PHONE 0/7Or� �j �MAILING ADDRESS � - �� /g 12-7���-7"- Z- ', .P�� K/ . �/ 1"`b ZIP 7 fir 6. CONTRACTOR (2e14/ PHONE 7 c9------ 5 - ' MAILING ADDRESS ://'"q) (/x` Z;►'Z `' 1/!%1 �-// d ` ZIP 13--5- 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 C. i DATE v l `J / cam' FOR OFFICE USE ONLY,Si BASE FEE 4-3.0 . RECEIPT# `t `�-' ,S CASH/CK# ciK1T TOTAL DATE Z./ ' /--,Z^'— H:\HOME\PLNCNTRUNFOBLDGFORMSUNSTALL.DOC 11/05/01