HomeMy WebLinkAboutBLD2002-00349 •
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 #: BLD02-00349 Received Date 6/19/2002
SITE ADDRESS: 440 SMITH LN Issue Date 6/19/2002
QUILCENE, 98376
APPLICANT: FREDERICK W HILLIARD PHONE: (360)765-4009
BARBARA E S HILLIARD
1055 DEER CREEK RD
QUILCENE WA 98376-9684 8
SUBDIVISION: �1 Block: Lot:
PARCEL NUMBER: 501041008 ;a1 °3 - Section: 4 Township: 25N 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, FREDERICK W HILLIARD PHONE: (360)765-4009
if different: BARBARA E S HILLIARD
1055 DEER CREEK RD
QUILCENE WA 98376-9684
PROJECT DESCRIPTION: PROPANE TANK INSTALLTION
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: e::,'� 7 Z
[ ] FinalApproval: ��� .Z<-/—o,_
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 APPLICA BLD02-00349
N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00349 Received Date: 6/19/2002
SITE ADDRESS: 440 SMITH LN
QUILCENE, 98376
OWNER: FREDERICK W HILLIARD PHONE: (360)765-4009
BARBARA E S HILLIARD
1055 DEER CREEK RD
QUILCENE WA 98376-9684
SUBDIVISION: Block: Lot: 8
PARCEL NUMBER: 501041008 Section: 4 Township: 25 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 DESCRIPTION PROPANE TANK INSTALLTION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY:
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 06/19/02 47939
Total: $47.00
itJEFFERSON COUNTY COMMUNI EVELOPMENT,621 SHERIDAN ST,PORT TOWNS WA 98368 PH: (360)379-4450
t/ 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):
41410 51121/7L/ LA)
,4eiL- & V,‘' /!d^' - ZIP /% 7
9 DIGIT PARCEL ID NUMBER .7 U/ '� V�L, `— 220 5b 104 100Z
Legal Description:
Subdivision Name Block Lot(s)
/S/ection� /J��// Township A s� North, Range �!�`y� WM
APPLICANT �f'��C/�`���/ ��C,��,�J�,�J PHONE 7 5— 7
MAILING ADDRESS • '97 / t 5/ 7/77 /....-, V
ZIP 9 9 76
PROPERTY OWNER /1f7//62/49 ! /-1ILL ,� PHONE )65- >,(9,9
MAILING ADDRESS /2i/7-
1j/ G( -,17‘ , &Oq ZIP 9SZ7-C
CONTRACTOR (":I/! et---- PHONE 7� _ k�c
MAILING ADDRESS /q za� ,% - /
'61-74 ZIP . 7e-?Z5
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 ri entry to th plicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE DATE /J I / 6:570._
FOR OFFICE USE ONLY
BASE FEE RECEIPT# L}4G]31
CASH/CK# G11141
TOTAL DATE c' /I41 /O"LL
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