HomeMy WebLinkAboutBLD2002-00301 • •
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 #: BLD02-00301 Received Date 5/23/2002
SITE ADDRESS: 321 DENNIS BLVD Issue Date 5/23/2002
PORT TOWNSEND, 98368
APPLICANT: WILLIAM A SERY PHONE:
CAROLINA B SERY
202 5TH AVE
ANTIGO WI 544092708 24
SUBDIVISION: CAPE GEORGE VILLAGE DIV 1 Block: Lot:
PARCEL NUMBER: 939900025 Section: 13 Township: 30N Range: 02W
CONTRACTOR: SUNDANCE SOLAR PHONE: 888-373-1974
3301 HWY 16
PORT ORCHARD WA 98366
Contractor's License SUNDAS*066MG Expires 05/19/2004
OWNER, WILLIAM A SERY PHONE:
if different: CAROLINA B SERY
202 5TH AVE
ANTIGO WI 544092708
PROJECT DESCRIPTION PROPANE TANK , FIREPLACE INSERT, WATER HEATER,SPACE
HEATER
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 05/23/2003.
REQUIRED INSPECTIONS:
l a in Appliance:7 /S//' " ( /tV ;le 1 tVc /2 C F/F P( ?9 C (--r
liffj_ oval: 7 (/6 v
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
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BUILDING PERMIT APPLI# BLDo2
TION - ti
Review003 Type:1
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00301 Received Date: 5/23/2002
SITE ADDRESS: 321 DENNIS BLVD
PORT TOWNSEND, 98368
OWNER: WILLIAM A SERY PHONE:
CAROLINA B SERY
202 5TH AVE
ANTIGO WI 544092708
SUBDIVISION: CAPE GEORGE VILLAGE DIV 1 Block: Lot: 24
PARCEL NUMBER: 939900025 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: SUNDANCE SOLAR PHONE: 888-373-1974
3301 HWY 16
PORT ORCHARD WA 98366
Contractor's License SUNDAS*066MG Expires 05/19/2002
REPRESENTATIVE(S):
IPROJECT DESCRIPTIO PROPANE TANK , FIREPLACE INSERT, WATER HEATER,SPACE
HEATER
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 Conditions _
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 05/23/02 47721
Total: $47.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TO�SEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION -+ 1_ -s c
WOODSTOVE .' PROPANE TANK PELLET STOVE OTHER c Par) ��Se'-� ( ,)o ` �A�Q /er
/h eerier, 2na1 9(13
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES XC NO
SITE ADDRESS(911 #/Road Name):
(� ZIP
9 DIGIT PARCEL ID NUMBER 939 / 6�� Q z
Legal Description: G `fXp� V' 1 a y� y� j / ��
Subdivision Name J / /-` / Lot(s)
Section /3 Township 3 C North, Range 2 61 WM
APPLICANT W1))10144 t Se�}� PHONE 3 6°-3g5 ^ 0/5 7
MAILING ADDRESS ` ���n i S Y/
AK,- %ov//2SP.I1 W4 q.g'36 O ZIP
/! r `� C OhC i .9 , S e j✓ PHONE ✓ 6 0 -3 & - o 152
PROPERTY OWNER W/7/1 0
MAILING ADDRESS -Sqt Ph e,
ZIP
CONTRACTOR rrybpah 'e Pe,l/, 1 Fi1^�,p/a&e ' J/�frf4? 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.
I
APPLICANT SIGNATURE 16 CI
DATE / -i / ('
FOR OFFICE USE ONLY
BASE FEE 47 _oto RECEIPT#
CASH/CK#
TOTAL 47.0 DATE / /
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