HomeMy WebLinkAboutBLD2002-00251 • •
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 #: BLD02-00251 Received Date 5/1/2002
SITE ADDRESS: 71 CAMANO LN Issue Date 5/1/2002
PORT LUDLOW, 98365
APPLICANT: HARVEY R HEGSTROM PHONE:
CAROLOVE HEGSTROM
448 W BROADWAY#2103N
SALT LAKE CITY UT 84401 45
SUBDIVISION: PORT LUDLOW NO 2 AREA 2 Block: 2 Lot:
PARCEL NUMBER: 990600245 Section: 9 Township: 28N Range: 01E
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2002
OWNER, HARVEY R HEGSTROM PHONE:
if different: CAROLOVE HEGSTROM
448 W BROADWAY#2103N
SALT LAKE CITY UT 84401
PROJECT DESCRIPTION PROPANE TANK,RANGE AND STOVE 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 05/01/2003.
REQUIRED INSPECTIONS:
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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 APPLIc1ION BLD02-00251
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00251 Received Date: 5/1/2002
SITE ADDRESS: 71 CAMANO LN
PORT LUDLOW, 98365
OWNER: HARVEY R HEGSTROM PHONE:
CAROLOVE HEGSTROM
448 W BROADWAY#2103N
SALT LAKE CITY UT 84401
SUBDIVISION: PORT LUDLOW NO 2 AREA 2 Block: 2 Lot: 45
PARCEL NUMBER: 990600245 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: PETTIT OIL CO PHONE: (360)385-1420
PO BOX 1031
PORT TOWNSEND WA 98368
Contractor's License PETTIOCO88CC Expires 05/01/2002
REPRESENTATIVE(S):
PROJECT DESCRIPTIO PROPANE TANK,RANGE AND STOVE 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
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditionc
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 05/01/02 47526
Total: $47.00
• •
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE PELLET STOVE
Is this appliance (htg stove, hotTANK water tank,furnace,etc.)to beOTHER installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name:
i l ( - iriq 1 Z 'l
�� //(4- 'ry d ZIP ,015 r
/
9 DIGIT PARCEL ID NUMBER 99 CLOD 5/ r
Legal Description:
Subdivision Name Block Lot(s) .
Section Township North, Range WM
—7
APPLICANT - PHONE 73 7- l�GYf
MAILING ADDRESS 7 -1-Clf ,C.('
/f..,d/e 4l al44 ZIP Wd5CPc.--
PROPERTY OWNER �2 PHONE
MAILING ADDRESS . .------------
ZIP
CONTRACTOR /-47,-Z/4"ti PHONE 5CQ a - ,S~/ /:-)-0
MAILING ADDRESS 4147< /GGl
/ -/ ZIP 'f:41/
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 /, ,17)' G DATE / ( / �
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CASH/CK#
TOTAL DATE / /
H:\HOM E\PLN C NTR\I N FOB LDG\FORMS\I NSTAL L.D OC 11/05/01