HomeMy WebLinkAboutBLD2002-00448 • •
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
PERMIT #: BLD02-00448 Received Date 8/12/2002
SITE ADDRESS: 4795 S DISCOVERY RD Issue Date 8/12/2002
PORT TOWNSEND, 98368
APPLICANT: CONNIE L MATTHES PHONE: (360)385-2416
4795 S DISCOVERY RD
PORT TOWNSEND WA 983689021
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001321023 Section: 32 Township: 30N 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, CONNIE L MATTHES PHONE: (360)385-2416
if different: 4795 S DISCOVERY RD
PORT TOWNSEND WA 983689021
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 08/12/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: lJ Z§'/- - .
l
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
ILDING PERMIT APPLICATI N BLD02-00448
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00448 Received Date: 8/12/2002
SITE ADDRESS: 4795 S DISCOVERY RD
PORT TOWNSEND, 98368
OWNER: CONNIE L MATTHES PHONE: (360)385-2416
4795 S DISCOVERY RD
PORT TOWNSEND WA 983689021
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001321023 Section: 32 Township: 30 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: PHONE:
PROJECT DESCRIPTIO 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:
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
gir...z,(
F&W Landslide
Routing Date: 2.� Shoreline Aquifer
Forest: Commercial Rural
Proximity _ Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 08/12/02 49471
Total: $47.00
JEFFERSON COUNTY COMMUNITY VELOPMENT,621 SHERIDAN ST,PORT TOVVNSEN A 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X Above Ground 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):
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Legal Description:
Subdivision Name Block Lot(s)
Section �/� Township North, Range WM
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MAILING ADDRESS
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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 bit/JP-
L// . DATE / /9 / U Z
�/� FOR OFFICE USE ONLY
BASE FEE 47, w RECEIPT#
CASH/CK#
TOTAL 47- CO DATE / /
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01