HomeMy WebLinkAboutBLD2002-00225 41)
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 #: BLD02-00225 Received Date 4/19/2002
SITE ADDRESS: 172 HAADA LAAS RD Issue Date 4/19/2002
PORT TOWNSEND, 98368
APPLICANT: MEGAN RUST PHONE: (360)379-5608
172 HAADA LAAS RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001062029 Section: 6 Township: 30N Range: 01W
CONTRACTOR: OWNER PHONE:
OWNER, WILLIAM E HALSTENRUD PHONE:
if different: 810 W HIGHLAND DR
SEATTLE WA 981193451
PROJECT DESCRIPTION: WOODSTOVE INSERT 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 4/19/2003.
REQUIRED INSPECTIONS:
[kr ank/Line/Appliance /C- 5e/7 78 32 C
[4 alApproval:
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
BLD02-00225
03UILDING PERMIT APPLIC ON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00225 Received Date: 4/19/2002
SITE ADDRESS: 172 HAADA LAAS RD
PORT TOWNSEND, 98368
OWNER: WILLIAM E HALSTENRUD PHONE:
810 W HIGHLAND DR
SEATTLE WA 981193451
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001062029 Section: 6 Township: 30 N Range: 01 W
CONTRACTOR: OWNER PHONE:
REPRESENTATIVE(S): MEGAN RUST
172 HAADA LAAS RD
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOI WOODSTOVE INSERT 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 $47.00 MAM 04/19/02 47482
Total: $47.00
Illir, . .
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWN ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER WOCA 1 h)VZ j,/f ,eri"
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):
Tov-4- I 0\-,0,--15C?dl d W ZIP 983G6
9 DIGIT PARCEL ID NUMBER Jo(( vL 0 Z9
Legal Description:
Subdivision Name Block Lot(s)
Section W
Township North, Range M
APPLICANT Ail•(3(-A,r-\ Z..4.5L PHONE 3 7 9—5-C'OS
MAILING ADDRESS I7 Z i d liii l�cj
?Oc TO1,1"'lSf'_./1CA t )A- ZIP 9 8 3 L CU
PROPERTY OWNER S 6 , - PHONE
MAILING ADDRESS
ZIP
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 CIA �~2w1 1?-k- DATE / 19 / G
' I^ FOR OFFICE USE ONLY
"t
BASE FEE I ' • CM RECEIPT#
CASH/CK#
TOTAL Li-4- • d13 DATE / /
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