HomeMy WebLinkAboutBLD2002-00468 •
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 #: BLD02-00468 Received Date 8/19/2002
SITE ADDRESS: 151 DISNEY RD Issue Date 8/20/2002
NORDLAND, 98358
APPLICANT: KATHARINA M HAGER PHONE: (360)385-4859
151 DISNEY RD
NORDLAND WA 98358-9535
T 34+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921094006 Section: 9 Township: 29N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
HEATER 10853 RHODY DR
RANGE PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
CONTRACTOR: Mountain Propane PHONE: (360)385-6883
TANK 265 Chimacum RD
Port Hadlock, WA 98339 MOUNTPL994BH 12/14/2002
PROJECT DESCRIPTION: PROPANE TANK, RANGE,WATER HEATER& PIPING
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 8/20/2003.
REQUIRED INSPECTIONS:
[4j Tank/Line/Appliance C g c7 7
[ ], FinalApproval (- j -- 2--
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
IIEUIL PERMIT APPLICA00
N B Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00468 Received Date: 8/19/2002
SITE ADDRESS: 151 DISNEY RD
NORDLAND, 98358
OWNER: KATHARINA M HAGER PHONE: (360)385-4859
151 DISNEY RD
NORDLAND WA 98358-9535
SUBDIVISION: Block: Lot: T 34+
PARCEL NUMBER: 921094006 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
HEATER 10853 RHODY DR
PORT HADLOCK WA 98339
RANGE
Contractor's License SUNSHP"077QP Expires 11/17/2002
TANK MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339 MOUNTPL9 9 4 BH 1 2/1 4/2 0 0 2
PROJECT DESCRIPTION PROPANE TANK, RANGE, WATER HEATER & PIPING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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 08/19/02 49446
Total: $47.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS 1D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATI/ON ,p ,
WOODSTOVE ✓Above Ground PROPANE TANK PELLET STOVE 1 OTHER Pro p IA e dropa-"'e--- her
er.
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES / NO
SITE ADDRESS(911#/Road Name):
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9 DIGIT PARCEL ID NUMBER ! 2- I C' ! 9"a Ci
Legal Description: 1,�
Subdivision Name Wes 1-1Gtcxes i'1 w 1' 4 V 5e IV4 Block Lot(s)
Section 9 Township 2_9 North, Range I L�a-S-1- WM
APPLICANT Lt I`-= K I(S.11�' 61A-✓") PHONE
MAILING ADDRESS I S�
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MAILING ADDRESS /S / 49)-Sr)e?J�y K�
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CONTRACTOR J`��'��"'� r6Pa^s Ocdl�`I�}i►� � �/tJ� PHONE 3SSSZ917 3g5 '223
MAILING ADDRESS I0.gs3 �Leo$ �r (�� CLI►'rl1.4,u mv1 l
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STATE LICENSE# St,tnSIf94 O77 Q P Moans T,�L44N /-1 EXP.DATE 112.00-�_ / z.,'z�
FEDERAL I.D.# a i 41" -1-0V /S S
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 nut 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.
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APPLICANT SIGNATURE �'`"— ic / DATE � / // / 6
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 4 ►L q(p
CASH/CK#
TOTAL 1-1 4, ` DATE 6 / / / 0 Z--�
H:FIOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01