HomeMy WebLinkAboutBLD2002-00128 B
' BUILDING PERMIT APPLICATION Review Type:
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00128 Received Date: 3/11/2002
SITE ADDRESS: 6363 THORNDYKE RD
QUILCENE, 98376
OWNER: POPE RESOURCES PHONE:
C/O OLYMPIC RESOURCE MGMT
19245 10TH AVE NE
POULSBO WA 983707456
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701251001 Section: 25 Township: 27 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
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:
CONST TYPE: OTHER:
CONST TYPE: GARAGE: SHORELINE:
DECK: SETBACK:
SEWAGE DISPOSAL: BANK HEIGHT:
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
/(f / C a Shoreline Aquifer
Forest: Commercial Rural
a rwimi+ , Plat onditionuType
Amount ' Approved/Date
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 #: BLD02-00128 Received Date 3/11/2002
SITE ADDRESS: 6363 THORNDYKE RD Issue Date 3/11/2002
QUILCENE, 98376
APPLICANT: POPE RESOURCES
C/O OLYMPIC RESOURCE MGMT PHONE:
19245 10TH AVE NE
POULSBO WA 983707456
SUBDIVISION: Block: Lot.
PARCEL NUMBER: 701251001 Section: 25 Township: 27N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING
PO BOX 518 PHONE: (360)732-4585
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2002
OWNER, POPE RESOURCES PHONE:
if different: C/O OLYMPIC RESOURCE MGMT
19245 10TH AVE NE
POULSBO WA 983707456
PROJECT DESCRIPTION PROPANE TANK
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 03/11/2003.
REQUIRED INSPECTIONS:
1 y
ine/Appliance: �-� -5(q--4(c)
[ Fi Approva
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
JEFFEFFSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X PROPANE TANK PELLET STOVE OTHER
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home'
YES AY NO
SITE ADDRESS(911#/Road Name):
C� to iz JDt1 rip
( tki LL , L,0 `` ZIP t '/4
9 DIGIT PARCEL ID NUMBER ."/ :- '
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
in ny.
`2
APPLICANT -n II 15 l T 1/V SL
PHONE
MAILING ADDRESS `17 23 fib/Mai k YJ
�U1LC �r ? ) u7 ZIP q 8 0 76
PROPERTY OWNER IS �'� �Yr+I PHONE
MAILING ADDRESS 3 i0 4- l iEN r ( .n
L-L U\ I ,,OA ZIP di O 3 /1v
CONTRACTOR Ocek
PHONE 7 3 2- 1_5gs
MAILING ADDRESS 1)( /`'( 2
I/i 0 6-0.411 ZIP q S 32'c
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% /
DATE w, / /
FOR OFFICE USE ONLY
1-7 ( ) '%�..J-
BASE FEE RECEIPT# (! / /1
CASH/CK# ait
TOTAL 6V °, DATE r3/ 1/ / >?
H:\HOME\PLNCNTR\INFOBLDG\FORMS\I NSTALL.DOC 11/05/01