HomeMy WebLinkAboutBLD2002-00194 • •
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#: BLD02-00194 Received Date 4/10/2002
SITE ADDRESS: 110 HERBERT ST Issue Date 4/10/2002
QUILCENE, 98376
APPLICANT: ROBERT K CLUBB PHONE:
SHEILA G CLUBB
PO BOX 363
QUILCENE WA 983760363 4
SUBDIVISION: CAMPBELL'S H.W. ADDITION Block: 5 Lot:
PARCEL NUMBER: 937200507 Section: 24 Township: 27N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
OWNER, ROBERT K CLUBB PHONE:
if different: SHEILA G CLUBB
PO BOX 363
QUILCENE WA 983760363
PROJECT DESCRIPTION PROPANE TANK AND PROPANE HEAT STOVE
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 04/10/2003.
REQUIRED INSPECTIONS:
[ ] nk/Line/App�oe:
[ ] FinalApproval:
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 APPLICION BRD02 00p9 4
eview Tye:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00194 Received Date: 4/10/2002
SITE ADDRESS: 110 HERBERT ST
QUILCENE, 98376
OWNER: ROBERT K CLUBB PHONE:
SHEILA G CLUBB
PO BOX 363
QUILCENE WA 983760363
SUBDIVISION: CAMPBELL'S H.W. ADDITION Block: 5 Lot: 4
PARCEL NUMBER: 937200507 Section: 24 Township: 27 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE 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 AND PROPANE HEAT STOVE
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: 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: ; j ShorelineAquifer
`714?--
Forest: Commercial Rural
Proximity Plat Condition.,
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 04/10/02 46429
Total: $48.00
JEFFERSON COUNTY,,COMMAPY DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATIONT
WOODSTOVE �/ PROPANE TANK PELLET STOVE ,...OTHER -'CV c>\ 0 J
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):
J 1 \ c-
CR\Z) LL. 0 ZIP 9't- Z b .
9 DIGIT PARCEL ID NUMBER
Legal Description:
Subdivision Name Block Lot(s)
� � Section Township North, Range WM
APPLICANT c 3'k�. ( CI C_ L .21 e., PHONE
MAILING ADDRESS CIP ' (o 3 \ Q
C?1 )\L_e -- --2,-_,1,-- LA -PN'- ZIP s ? In
PROPERTY OWNER ' V") t PHONE
MAILING ADDRESS
ZIP
CONTRACTOR NA V U j 'Q Pp,y 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 Qp, (.4 : b DATE b 4- / t t7 / 24)v2
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CASH/CK#
TOTAL DATE / /
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