HomeMy WebLinkAboutBLD2002-00320 •
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 #: BLD02-00320 Received Date 6/5/2002
SITE ADDRESS: 312684 HWY 101 Issue Date 6/6/2002
BRINNON, 98320
APPLICANT: BOB F NEWMON PHONE:
312684 HWY 101
BRINNON WA 98320
2
SUBDIVISION: PETERSEN-SMITH SHORT PLAT Block: Lot:
PARCEL NUMBER: 502294023 Section: 29 Township: 25N Range: 02W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2002
OWNER, BOB F NEWMON PHONE:
if different: 312684 HWY 101
BRINNON WA 98320
PROJECT DESCRIPTION: PROPANE TANK INSTALLATION RZ=h 'r
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 6/6/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: 7:79 7/. V ' ,;"5'
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
UILDING PERMIT APPLICAN BLD02-00320Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00320 Received Date: 6/5/2002
SITE ADDRESS: 312684 HWY 101
BRINNON, 98320
OWNER: BOB F NEWMON PHONE:
312684 HWY 101
BRINNON WA 98320
SUBDIVISION: PETERSEN-SMITH SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 502294023 Section: 29 Township: 25 N Range: 02 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2002
REPRESENTATIVE(S):
PROJECT DESCRIPTION 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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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 06/05/02 47827
Total: $47.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE 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):
olzd 64 AA?), 161
giiimen / L4[4 - ZIP 9g57---O
9 DIGIT PARCEL ID NUMBER 50Z • 'Zi 4 • 02.3
Legal Description:
Subdivision Name Block Lot(s)
Section W
Township North, Range M
APPLICANT 02 -Ado A /t) " PHONE
MAILING ADDRESS •,;?/Z ,SV 1714y Al
yy� f
�i�/`�,L//L /1�4 ZIP 9,..q0--e,
PROPERTY OWNER �/�7�3� /t/ ._(i/7'3�/"� PHONE
MAILING ADDRESS c�j 2 gay A4, y ie/
2/ 712e 12 ` b�.d ZIP / rJ god
CONTRACTOR �4e `i PHONE 7sz- -r,'
MAILING ADDRESS ? 12D,G c7(�
/ �'' C` - ZIP 9EXP.
���sSTATE LICENSE# 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 K DATE / Z '
FOR OFFICE USE ONLY t I
BASE FEE RECEIPT# "{911;4-
CASH/CK# r m#-
TOTAL DATE / /-2i
H:\HOME\PLNCNTR\IN FOBLDG\FORMS\INSTALL.DOC 11/05/01