HomeMy WebLinkAboutBLD2002-00491 . •
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 #: BLD02-00491 Received Date 8/26/2002
SITE ADDRESS: 194 SEVEN SISTERS RD Issue Date 8/26/2002
PORT LUDLOW, 98365
APPLICANT: GORDON L THOMAS PHONE:
KATHRYN F THOMAS
13229 LINDEN AVE N #205B
SEATTLE WA 981337556 T 4&7
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821351008 Section: 35 Township: 28N Range: 01 E
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2002
OWNER, GORDON L THOMAS PHONE:
if different: KATHRYN F THOMAS
13229 LINDEN AVE N #2058
SEATTLE WA 981337556
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 08/26/2003.
REQUIRED INSPECTIONS:
[ ] Tan Line/Appliance: 6 -Z1-V-
I I FinalApproval: 'fC) --t-- P=zs
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
i:\F_BLD Permit_Propane.rpt 10/29/19
BLD02-00491
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00491 Received Date: 8/26/2002
SITE ADDRESS: 194 SEVEN SISTERS RD
PORT LUDLOW, 98365
OWNER: GORDON L THOMAS PHONE:
KATHRYN F THOMAS
13229 LINDEN AVE N#205B
SEATTLE WA 981337556
SUBDIVISION: Block: Lot: T 4&7
PARCEL NUMBER: 821351008 Section: 35 Township: 28 N Range: 01 E
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:
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
. �O d l 0/ F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity _ Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 08/26/02 49601
Total: $47.00
• •
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
/ INSTALLATION PERMIT APPLICATION
WOODSTOVE '�/ Above Ground PROPANE TANK PELLET STOVE OTHER
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/M,9bile Home?
Y YES NO
SITE ADDRESS(911#/Road Name): /y
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(/ O�' 1 Gc!/t �mto , //I% ZIP f-J.-' S
9 DIGIT PARCEL ID NUMBER .6P2 / .S 3-7 a0 D
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT �4rd ,1 L. , r/ Iry
� )-7 /H Zcr i PHONE .5 — f 7—/cc�l7
MAILING ADDRESS /' �J -5;-"c k J /Serf 47k,
/ j L,-v/C e ou / / p ZIP / cP13'�5r
PROPERTY OWNER �a PHONE
MAILING ADDRESS
ZIP
CONTRACTOR Lie s'r e 4, PHONE - �d 732- - F
MAILING ADDRESS
�1/mi e-aT-m ' (OA ZIP
/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 en y to the applicant's property or structure shall be requested and shall occur during regular business hours.
...._.---)
.,
APPLICANT SIGNATURE � Qc�-�— ��c
O FOR OFFICE USE ONLY
BASE FEE 4'7O''" RECEIPT# _4601
,{'7 CASH/CK# (1
TOTAL ''C DATE /2(0/
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