HomeMy WebLinkAboutBLD2002-00130 r .
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 #: BLD02-00130 Received Date 3/11/2002
SITE ADDRESS: 91 MONTGOMERY ST Issue Date 3/11/2002
PORT HADLOCK, 98339
APPLICANT: BARBARA A NAILOR PHONE:
DON NAILOR
91 E MONTGOMERY ST
PORT HADLOCK WA 98339-9633 9,10
SUBDIVISION: HARRISBURG Block: 3 Lot:
PARCEL NUMBER: 956700304 Section: 2 Township: 29N Range: 01W
CONTRACTOR: CENEX SUPPLY & MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2002
OWNER, BARBARA A NAILOR PHONE:
if different: DON NAILOR
91 E MONTGOMERY ST
PORT HADLOCK WA 98339-9633
PROJECT DESCRIPTION PROPANE TANK 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 03/11/2003,
REQUIRED INSPECTIONS:
-7_„,./ "44
., ]'6ank/nk/ ne/A ppliance:('��. '/ L//",
[ r--- tiaalAppEsxa----it, --- 75./ . /Al
,.../„.yit -
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_Perm it_Propane.rpt 10/29/19
BUILDING 'PERMIT APPLICATION BR evi
w TypeO
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00130 Received Date: 3/11/2002
SITE ADDRESS: 91 MONTGOMERY ST
PORT HADLOCK, 98339
OWNER: BARBARA A NAILOR PHONE:
DON NAILOR
91 E MONTGOMERY ST
PORT HADLOCK WA 98339-9633
SUBDIVISION: HARRISBURG Block: 3 Lot: 9,10
PARCEL NUMBER: 956700304 Section: 2 Township: 29 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 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: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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 03/11/02 45834
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X PROPANE TANK PELLET STOVE OTHER
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name):Ci
'
I E�+s T O'N-r(-1big�L►
1 la. (oGk ) W(il ZIP q S 3 9
9 DIGIT PARCEL ID NUMBER 4 S ' ' 3014
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
•APPLICANT =�O In t\?a ( I 0 PHONE
MAILING ADDRESS II l 1 1[A.IST (n'�W 1 9 0✓� -v 1 �+
t l CMG�L� i ZIP q 0"3-9
PROPERTY OWNER V O 6 1\10t,i 10( PHONE
MAILING ADDRESS CI` &t Sl f r dn'lqi e ar y
.A UOck IA)a, I ZIP -I 8 3s 9
CONTRACTOR C en PHONE / 3 2— i-t 'S 2
MAILING ADDRESS Po fox 2.-i 'CJ
On/I'ha zurvi ) ZIP 8 3 Z 5
STATE LICENSE# EXP.DATE
FEDERAL I.D.#
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material
falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void.
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which
may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of entry to the plicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE `��'�?<��l.A/�-- DATE / /
" /
FOR OFFICE USE ONLY 14 S$ 3 1
BASE FEE RECEIPT# /4-Err-CC;
4111') K#
TOTAL LI O DATE ?/ ( I / 0>,-
H:HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01