HomeMy WebLinkAboutBLD2002-00348 • •
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 #: BLD02-00348 Received Date 6/17/2002
SITE ADDRESS: 923 CARL JOHNSON RD Issue Date 6/19/2002
QUILCENE, 98376
APPLICANT: ANNE M BASELT PHONE: (360)337-5235
923 CARL JOHNSON RD
QUILCENE WA 98376
T 18
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701043011 Section: 4 Township: 27N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2002
OWNER, ANNE M BASELT PHONE: (360)337-5235
if different: 923 CARL JOHNSON RD
QUILCENE WA 98376
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 6/19/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
/ Final royal: amfoi —
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
BLD02-00348 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00348 Received Date: 6/17/2002
SITE ADDRESS: 923 CARL JOHNSON RD
QUILCENE, 98376
OWNER: ANNE M BASELT PHONE: (360)337-5235
923 CARL JOHNSON RD
QUILCENE WA 98376
SUBDIVISION: Block: Lot: T 18
PARCEL NUMBER: 701043011 Section: 4 Township: 27 N Range: 01 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 DESCRIPTIOI PROPANE TANK 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:
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 06/17/02 47932
Total: $47.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X PROPANE TANK PELLET STOVE OTHER
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES A. NO
SITE ADDRESS(911#/Road Name): _
ai'e CCji (JC/74 ZIP l F3.-2
9 DIGIT PARCEL ID NUMBER w l _043 -Oil
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
/ '
APPLICANT All SALT' PHON(�'' ) 337
"_523S
MAILING ADDRESS 9 2 A r i -1oi., )coid R D
t.4/1,Cq ' WA ZIP
_RS.L.Z.
PROPERTY OWNER " lil e �-),�r .�L 7' PHON� ✓g? - 52
MAILING ADDRESS +1-3 CA :j U 44"J$o&
COY�ilLC 4 ] oil ZIP 616 --2Y
CONTRACTOR &Y PHONE `7-Z` LyS as
MAILING ADDRESS I C) l', 2X 246
(hi / fiOJAZIP gg3z5
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 6 I I -7/ O
FOR OFFICE USE ONLY
BASE FEE --i--v j jZ (t ( II n(] E IPT# yq°I 32
TOTAL 1F1 CD rfj/I / i'7i
JUN 1 7 2002 i-t.
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DEPT. OF COMMUNITY DEVELOPMENT