HomeMy WebLinkAboutBLD2002-00327 •
BUILDING PERMIT APPLICOION BReview yp3e7
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00327 Received Date: 6/10/2002
SITE ADDRESS: 653 PAYNE RD
QUILCENE, 98376
OWNER: LARRY K CATUZO / r��� �•� k� PHONE:
GLENNA CATUZO 't
37436 OLYMPIC RD NE
HANSVILLE WA 98340
SUBDIVISION: Block: Lot: T 40
PARCEL NUMBER: 601283022 Section: 28 Township: 26 N Range: 01 W
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,STOVE,REFRIGERATOR AND
HOTWATER TANK
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 ' a sod' '•■
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 06/10/02 47744
Total: $47.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION pF 7ne
WOODSTOVE PROPANE TANK PELLET STOVE OTHER f S'T(00A--rerl(L '-iic944 P0k6je_I 846VE
Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Horn
YES NO
SITE ADDRESS(911#/Road Na
67Y5 QM 0,\j'SA- \ sr'\S)
ZIP%s\ a
9 DIGIT PARCEL ID NUMBER \ c 4
,t\ )
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT C;;'\NC�CV �� V .<3 PHONE
MAILING ADDRESS c ' Css :;
QW4G
R"� ZIP 0
PROPERTY OWNER \ PHONE
MAILING ADDRESS
ZIP
CONTRACTOR cE c PHONE
MAILING ADDRESS (LliT
-‘(\1� � ZIP 0r1)"37)
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 a ight of entry efferso County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access nd n t of entr to th app is nt's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE \\,., -\ � DATE \{-) / \73 / v -
` OR OFFICE USE ONLY
BASE FEE _47.00 RECEIPT# Z1 7-724
CASH/CK# 32 J
TOTAL g7-nD DATE Io//0 LC_12.--,.
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01
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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#: BLD02-00327 Received Date 6/10/2002
SITE ADDRESS: 653 PAYNE RD Issue Date 6/10/2002
QUILCENE, 98376
APPLICANT: LARRY K CATUZO PHONE:
GLENNA CATUZO
37436 OLYMPIC RD NE
HANSVILLE WA 98340 T 40
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 601283022 Section: 28 Township: 26N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2002
OWNER, LARRY K CATUZO PHONE:
if different: GLENNA CATUZO
37436 OLYMPIC RD NE
HANSVILLE WA 98340
PROJECT DESCRIPTION PROPANE TANK INSTALLATION,STOVE,REFRIGERATOR AND
HOTWATER TANK
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 06/10/2003.
REQUIRED INSPECTIONS:
[ I Tank/Line/Appliance: 2W 44r11 i n,�c ��T - oK J cf_// .82
[ J FinalApproval: F$ ? C 8°-4.4- s'
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