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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
PERMIT #: BLD02-00469 Received Date 8/19/2002
SITE ADDRESS: 140 E RHODODENDRON Issue Date 8/20/2002
PORT TOWNSEND, 98368
APPLICANT: ABERCROMBIE TRUSTEE JERRY T PHONE: (360)385-7367
ABERCROMBIE TRUST 10/6/97
140 E RHODODENDRON DR
PORT TOWNSEND WA 98368-9414 11
SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 6 Lot:
PARCEL NUMBER: 938400610 Section: 12 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
OWNER, ABERCROMBIE TRUSTEE JERRY T PHONE: (360)385-7367
if different: ABERCROMBIE TRUST 10/6/97
140 E RHODODENDRON DR
PORT TOWNSEND WA 98368-9414
PROJECT DESCRIPTION: PROPANE TANK& PIPING 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 8/20/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval:�, -- I 1 ' 7 DL
I
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
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UILDING PERMIT APPLICAN BLRDOe 0044e69
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00469 Received Date: 8/19/2002
SITE ADDRESS: 140 E RHODODENDRON
PORT TOWNSEND, 98368
OWNER: ABERCROMBIE TRUSTEE JERRY T PHONE: (360)385-7367
ABERCROMBIE TRUST 10/6/97
140 E RHODODENDRON DR
PORT TOWNSEND WA 98368-9414
SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 6 Lot: 11
PARCEL NUMBER: 938400610 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION PROPANE TANK & PIPING 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: 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 49450
Total: $47.00
'JEFFERSON COUNTY COMMUNI•EVELOPMENT,621 SHERIDAN ST,PORT TOWNSEIQD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATIONON
.
WOODSTOVE — Above Ground PROPANE TANK PELLET STOVE 1/ OTHER "1"1:' ,c- �"
U
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):
/ /C) L"--- . ghosos,,i2_,-,
pv �O ZIP fr161
9 DIGIT PARCEL ID NUMBER el 3 O goo co!/O
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
,
APPLICANT 4 F ir1 `4-4 e1''C%►- (C_ PHONE 10--^ /36 7
MAILING ADDRESS S
ZIP
PROPERTY OWNER Grr-GY✓T PHONE
MAILING ADDRESS
ZIP
CONTRACTOR / 44L Pit -A----- PHONE f COD 3 4 J J `V
MAILING ADDRESS //Q'8 J .? ' n n/ t�+� / L r
/ / //�l -�/,v�t / (�(J�- ZIP % �)�
STATE LICENSE# l��nJ4, k 6 7 7 Q ta EXP.DATE /1/O 2--
FEDERAL I.D.# `Z, - /O 7 es 7
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 ?Ar r DATE / I` l 1/
FOR OFFICE USE ONLY
BASE FEE ,� M EIPT#
IEC
H/CK#
/ -3 S
TOTAL E / /
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01
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DEPT. OF COMMUNITY DEVELOPMENT