HomeMy WebLinkAboutBLD2002-00163 •
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#: BLD02-00163 Received Date 3/27/2002
SITE ADDRESS: 571 RAINIER LN Issue Date 3/27/2002
PORT LUDLOW, 98365
APPLICANT: WILLIAM HANSEN PHONE: 360-437-5152
571 RAINIER LANE
PORT LUDLOW WA 98365
22
SUBDIVISION: PORT LUDLOW NO 7 Block: Lot:
PARCEL NUMBER: 990100022 Section: 8 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY & MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2002
OWNER, WILLIAM HANSEN PHONE: 360-437-5152
if different: 571 RAINIER LANE
PORT LUDLOW WA 98365
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 03/27/2003.
REQUIRED INSPECTIONS:
[f r €_ny,kine/A pplia nce: (A,. 7
Fi nalApproval:e*' , __Vied j� ��L2c--
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 APPLIC ION Review00163
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00163 Received Date: 3/27/2002
SITE ADDRESS: 571 RAINIER LN
PORT LUDLOW, 98365
OWNER: WILLIAM HANSEN PHONE: 360-437-5152
571 RAINIER LANE
PORT LUDLOW WA 98365
SUBDIVISION: PORT LUDLOW NO 7 Block: Lot: 22
PARCEL NUMBER: 990100022 Section: 8 Township: 28 N Range: 01 E
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: 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
Routing Date: F&W Landslide
3/2Shoreline Aquifer
Forest: Commercial Rural
•
Proximity Pl.-at Cenditiont
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 03/27/02 46284
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWIND 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(911 #/Road Name):
%/ i � LP/L n
v lt' rl d j.ri 6-t ZIP (7 676 76 4.3'
9 DIGIT PARCEL ID NUMBER g L / O O 0 �2
Legal Description: l
Subdivision Name Block Lot(s) 2 2_
Section Township ,. 5 North, Range U I. L-' WM
APPLICANT W,, �//1.� f J�
�A /�C Cl/ PHONE 3� 6 go 7 - 5-7°S 2-
MAILING ADDRESS 51 t"i 6,444 L A 11h
6204
x,-u4.4 63 ZIP 7 X,j6 S,
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR d204 (JS Lk .1_,6 4.1' C. PHONE
MAILING ADDRESS L j /atliip i,
N( A O-t' ;i ) ZIP ?? 6 S
STATE LICENSE# oPCIg 'J„0i. q1 Gj'7 is,5EXP.DATE ®`i/V-c/0 2_
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 d'( ) '/flAJ A4 ""J42"— DATE 0 3 / 02 ? / O 2-
(
FOR OFFICE USE ONLY14 (el ,
BASE FEE RECEIPT# �
LL CASH/CK# {').1 o r �y
TOTAL r� fj DATE 3 / �/ l�a
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