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HomeMy WebLinkAboutBLD2002-00252 • 0 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 #: BLD02-00252 Received Date 5/2/2002 SITE ADDRESS: 1920 SWANSONVILLE RD Issue Date 5/2/2002 PORT LUDLOW, 98365 APPLICANT: ALAN E ANDERSON PHONE: DAVID W ANDERSON 51 REUBEN JOHNSON RD PORT LUDLOW WA 983658713 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821053009 Section: 5 Township: 28N Range: 01 E CONTRACTOR: CENEX SUPPLY & MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 09/06/2002 OWNER, ALAN E ANDERSON PHONE: if different: DAVID W ANDERSON 51 REUBEN JOHNSON RD PORT LUDLOW WA 983658713 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 05/02/2003. REQUIRED INSPECTIONS: [ ] `7TankgUne/Appliance: ) r.esE. Lure -Es`r e6R-r 1Z6-QuE3flD `,ec;cJo 5/2143 Fina �►pprov , ,gyp dtiPT ,r-/z-�/ �. 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 i:\F_BLD_Permit_Propane.rpt 10/Y9/19 . BUILDING PERMIT APPLILION BRD02 OOp2e 2 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00252 Received Date: 5/2/2002 SITE ADDRESS: 1920 SWANSONVILLE RD PORT LUDLOW, 98365 OWNER: ALAN E ANDERSON PHONE: DAVID W ANDERSON 51 REUBEN JOHNSON RD PORT LUDLOW WA 983658713 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821053009 Section: 5 Township: 28 N Range: 01 E CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 09/06/2002 REPRESENTATIVE(S): PROJECT DESCRIPTIO Propane tank installation TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 1997 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 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 Conditions Type Amount Paid By: Date: Receipt: Approved/Date Total: • JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST, PORT TO END WA 98368 PH: (360)379-4450 ��// INSTALLATION PERMIT APPLICATION WOODSTOVE J� 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): /r24 Sc,,Jaa.s,p vr%J 'e d 1ttd h�0' L�l //�� /W 4 ZIP ?8(J6l- 9 DIGIT PARCEL ID NUMBER Spe/ 050-36b t Legal Description: Subdivision Name Block Lot(s) Sectiont��Q Township North, RangeW 7 pM APPLICANT KiAn A+ P /J A eoo/t ) PHONE ( /37 ! p? MAILING ADDRESS l!q, V(Ala iti«.Y/N())/l e, Pad./* /ot,..,r Li `i, Z 14-15— zIP JG.s-- PROPERTY OWNER Viol 4fri�e,�u�0,./ )) PHONE ! 3 7< /`f""C/ MAILING ADDRESS 19,�0 �C, .tJ itJc/, /Ie a / 0,4 G(Ad/ 1.4./ ZIP 18365 CONTRACTOR C.e)C1' PHONE 132`- VJ e6---/ MAILING ADDRESS /"U 9t- a 1(J Chi\✓'-7G<.e_(,J� b vA- ZIP 18 3as-- 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 DATE � / (:,. ' / ©V FOR OFFICE USE ONLY BASE FEE 7 Q d RECEIPT# CASH/CK# TOTAL DATE / / H:\HOME\PLNCNTR\I NFOBLDG\FORMS\I NSTALL.DOC 11/05/01