HomeMy WebLinkAboutBLD2002-00115 T '
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 #: BLD02-00115 Received Date 3/7/2002
SITE ADDRESS: 295313 HWY 101 Issue Date 3/7/2002
QUILCENE, 98376
APPLICANT: PHILIP R JEFFERSON PHONE:
PO BOX 748
QUILCENE WA 98376-0748
T 20
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702231007 Section: 23 Township: 27N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
OWNER, PHILIP R JEFFERSON PHONE:
if different: PO BOX 748
QUILCENE WA 98376-0748
PROJECT DESCRIPTION PROPANE TANK & STOVE INSTALLATION
a
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 03/07/2003.
REQUIRED INSPECTIONS:
• A ncee?e-.7.3/7-4
[-� RIprova?
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
`� BLD02-00115
BUILDING PEkMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-001 5 Received Date: 3/7/2002
SITE ADDRESS: 295313 HWY 101
QUILCENE, 98376
OWNER: PHILIP R JEFFERSON PHONE:
PO BOX 748
QUILCENE WA 98376-0748
SUBDIVISION: Block: Lot: T 20
PARCEL NUMBER: 702231007 Section: 23 Township: 27 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
REPRESENTATIVE(S):
PROJECT DESCRIPTIO PROPANE TANK & STOVE INSTALLATION
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
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 03/07/02 45829
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION , 'n
WOODSTOVE ' PROPANE TANK
PELLET STOVE OTHER 4-S V-
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):
29(5 /c) LA
ZIP
9 DIGIT PARCEL ID NUMBER 9 v t DO R--
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE
MAILING ADDRESS
ZIP
,PROPERTY OWNER Ph; it /O lfir rSo (/1 PHONE
MAILING ADDRESS
ZIP
CONTRACTOR +I`CiliUn48,1 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
II ONLY
BASE FEE Lf ' - Uv LE ( ►? D E PT# Lis g
[ CK# CAS N
vTOTAL 1 0 - �7RMAR
" 7 2002 j / / O 2-
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DEPT. OF COMMUNITY DEVELOPMENT