HomeMy WebLinkAboutBLD2002-00240 i
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 #: BLD02-00240 Received Date 4/26/2002
SITE ADDRESS: 11-1 SEAVIEW CT Issue Date 4/26/2002
PORT TOWNSEND, 98368
APPLICANT: JOHN M GRAHAM PHONE:
KIMBERLY R GRAHAM
PO BOX 2428
KIRKLAND WA 98083
SUBDIVISION: KALA HEIGHTS Block: Lot:
PARCEL NUMBER: 965500012 Section: 27 Township: 30N Range: 01W
CONTRACTOR: EVERWARM INC PHONE:
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/02
OWNER, JOHN M GRAHAM PHONE:
if different: KIMBERLY R GRAHAM
PO BOX 2428
KIRKLAND WA 98083
PROJECT DESCRIPTION CONVERSION FROM WOOD TO PROPANE FIREPLACE
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 4/26/03.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: f
., 4.s / i...‹rre,--frt k‹.-__ '
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 10/29/99
BLD02-00240
BUILDING PERMIT APPLIION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00240 Received Date: 4/26/2002
SITE ADDRESS: 11-1 SEAVIEW CT
PORT TOWNSEND, 98368
OWNER: JOHN M GRAHAM PHONE:
KIMBERLY R GRAHAM
PO BOX 2428
KIRKLAND WA 98083
SUBDIVISION: KALA HEIGHTS Block: Lot:
PARCEL NUMBER: 965500012 Section: 27 Township: 30 N Range: 01 W
CONTRACTOR: EVERWARM INC PHONE:
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/02
REPRESENTATIVE(S):
PROJECT DESCRIPTIO CONVERSION FROM WOOD TO PROPANE FIREPLACE
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: (2! O? — Shoreline Aquifer
Forest: Commercial Rural
Proximity_ Plat Condition&
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 04/26/02 47519
Total: $47.00
•
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST, PORT TOWNS END WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION f
WOODSTOVE PROPANE TANK PELLET STOVE OTHER Dl/f u ersld 12 RAO wl um d
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Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
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YES x NO
SITE ADDRESS(911#/Road Name):
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9 DIGIT PARCEL ID NUMBER a-/ cv 6,.+sp aL J 'c . )�✓l a l a 'PI(a1 t 47 96S-.SDD O/Z__.
Legal Description: ff ( �r fI
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Subdivision Name 11Q 1 I" € l tS ( ) N (1 6 u s.r, Block Lot(s)
Section /� I Township North, Range WM
APPLICANT I t Cl/& IV , CIA a_ a Wl PHONE !?g -0!7 7f
MAILING ADDRESS Jl_ / ,SE 4 U I e_w e-----1-i
ZIP
PROPERTY OWNER 0'k h T f\(rVl r a- CZ 1.44 PHONE /` "12_ ✓ - (Le e -O / S^
MAILING ADDRESS I "1 3 I i„.. A_1 toW V P tk.) �,
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[�J U vt. A J ZIP
CONTRACTOR !" r) e r (,l.) Cp V WI 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.
c.
APPLICANT SIGNATURE r c __ DATE / l D
FOR OFFICE USE ONLY ,t`�
BASE FEE 4 ``'�.0 4O RECEIPT# 5/9
CASH/CK# 51C-5—
TOTAL DATE ! /Q7.--
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