HomeMy WebLinkAboutBLD2002-00150 • •
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 #: BLD02-00150 Received Date 3/21/2002
SITE ADDRESS: HWY 101 Issue Date 3/21/2002
BRINNON, 98320
APPLICANT: STAN N JOHNSTON PHONE:
CANDY L JOHNSTON
PO BOX 88
BRINNON WA 983200088
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502022005 Section: 2 Township: 25N Range: 02W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2002
OWNER, STAN N JOHNSTON PHONE:
if different: CANDY L JOHNSTON
PO BOX 88
BRINNON WA 983200088
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 03/21/2003.
REQUIRED INSPECTIONS:
[ ] anw1ine/Appliance: X ,6. -3'_// -`
[ J FinalApproval: 70 /(� �//-"O
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
•
BUILDING PERMIT APPLOATION BLD02-00150Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00150 Received Date: 3/21/2002
SITE ADDRESS: HWY 101
BRINNON, 98320
OWNER: STAN N JOHNSTON PHONE:
CANDY L JOHNSTON
PO BOX 88
BRINNON WA 983200088
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502022005 Section: 2 Township: 25 N Range: 02 W
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2002
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:
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:2- /Q / Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 03/21/02 46269
Total: $48.00
JEFFERSON COUNTY CO•NITY DEVELOPMENT,621 SHERIDAN ST,PORT•NSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE XPROPANE TANK PELLET STOVE OTHER
Is this appliance(htg stove, hot wate Lk, k,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name):
ZIP
9 DIGIT PARCEL ID NUMBER !:' 5—
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Rangee/' p� WM
APPLICANT / � PHONE J d - 7 5>, 7- '9
MAILING ADDRESS o®, e7 e/ ''3
iylliGUyJ /�/ ZIP
PROPERTY OWNER 1 /'t.-i Q ? _ PHONE 3407
MAILING ADDRESS
r,-e.A4 9 ZIP / r3,e o
CONTRACTOR :°,. 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 -3 /'/ /
FOR OFFICE USE ONLY '` C
BASE FEE /{ ✓ RECEIPT# `�"'
L� CASH/CK# /'�-i 1
TOTAL e/ �Jl DATE " l2l l
H:\HOME\PLNCNTR\I NFOBLDG\FORMS\I NSTALL.DOC 11/05/01