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HomeMy WebLinkAboutBLD200-00201 • 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 #: BLD02-00201 Received Date 4/11/2002 SITE ADDRESS: 1650 S JACOB MILLER RD Issue Date 4/12/2002 PORT TOWNSEND, 98368 APPLICANT: TERESA D TETZLAFF PHONE: (360)385-0658 E L BURNHAM PO BOX 841 PORT TOWNSEND WA 98368-0841 T 92 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001171010 Section: 17 Township: 30N Range: 01W CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096 P 0 BOX 989 PORT TOWNSEND WA 98368 Contractor's License SUBURPL044DA Expires 3/8/2003 OWNER, TERESA D TETZLAFF PHONE: (360)385-0658 if different: E L BURNHAM PO BOX 841 PORT TOWNSEND WA 98368-0841 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 4/12/2003. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: ' Y i N 7 z ,,v:,r%( r. v-,5 FinalApproval: d9,C4s/o 2-, ' 9..- 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,ON BLD02-00201 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00201 Received Date: 4/11/2002 SITE ADDRESS: 1650 S JACOB MILLER RD PORT TOWNSEND, 98368 OWNER: TERESA D TETZLAFF PHONE: (360)385-0658 E L BURNHAM PO BOX 841 PORT TOWNSEND WA 98368-0841 SUBDIVISION: Block: Lot: T 92 PARCEL NUMBER: 001171010 Section: 17 Township: 30 N Range: 01 W CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096 P 0 BOX 989 PORT TOWNSEND WA 98368 Contractor's License SUBURPL044DA Expires 3/8/2003 REPRESENTATIVE(S): PROJECT DESCRIPTION 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: 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 Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 MAM 04/11/02 46379 Total: $48.00 • +JEFFERSON COUNTY COMMUNITY EVELOPMENT,621 SHERIDAN ST,PORT TOWN D 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): 16 57D S , --, nb /ñ ? / (e d p OP i (` vwn*`�/� d ZIP ,J KR 9 DIGIT PARCEL ID NUMBER - ©©I I . f Legal Description: Subdivision Name Block Lot(s) Section Township North, Range Q WM APPLICANT S(J by f�lR le' PHONE -Ca� SO7C MAILING ADDRESS I'\ oe de1 �T P,,,,, ,--, 1 oc__.,.)1 seet.n ZIP 'VQ 3 6 PROPERTY OWNER r. L L . 6U(I 11 tv►1r' PHONE "6.-s - MAILING ADDRESS pe=i1o)y g�C3`7' I J Pc%RTV cat S'P.vl W ZIP 8 - V CONTRACTOR) J�.0 ` V\ PHONE J VC� MAILING ADDRESS 2 T q �c ` � - 1 L . C_,/ /� ZIP ?� 1.� STATE LICENSE# S U> UP, e L ® 7 LI D I EXP.DATE 3/Cs- 3 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 pplicant's property or structure shall be requested and shall occur during regular business hours. APPLICANT SIGNATURE DATE L/ / / j / b c-) FOR OFFICE USE ONLY BASE FEE RECEIPT# ,3 -91 CASH/CK# ( HiS g TOTAL q - Cr‘) DATE /,11_/In._ H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01