HomeMy WebLinkAboutBLD2002-00492 0 .
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 #: BLD02-00492 Received Date 8/23/2002
SITE ADDRESS: 5610 CAPE GEORGE RD Issue Date 8/26/2002
PORT TOWNSEND, 98368
APPLICANT: MARY S ROBSON PHONE: (360)344-7410
1230 17TH AVE E
SEATTLE WA 98112-3317
1
SUBDIVISION: HARWOOD ADDITION Block: Lot:
PARCEL NUMBER: 957200001 Section: 19 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2002
OWNER, MARY S ROBSON PHONE: (360)344-7410
if different: 1230 17TH AVE E
SEATTLE WA 98112-3317
PROJECT DESCRIPTION: PROPANE TANK, BOILER, GAS STOVE & 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 8/26/2003.
REQUIRED INSPECTIONS:
[ .1 Tank/Line/Appliance: G E d/f' PEz_�L(4/�Hf/1/e P O/p�/l/�
9 t'fr 0k LTM Ai/A ;TAz5 i S T Fp/4l '5 C,
[t I FinalApproval: ��� �/0�
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
BLD02-00492
BUILDING PERMIT APPLIION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00492 Received Date: 8/23/2002
SITE ADDRESS: 5610 CAPE GEORGE RD
PORT TOWNSEND, 98368
OWNER: MARY S ROBSON PHONE: (360)344-7410
1230 17TH AVE E
SEATTLE WA 98112-3317
SUBDIVISION: HARWOOD ADDITION Block: Lot: 1
PARCEL NUMBER: 957200001 Section: 19 Township: 30 N Range: 01 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, BOILER, GAS STOVE & PIPING
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
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 08/23/02 49559
Total: $47.00
• •
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION Qom,, � ,,�
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE `/ OTHER 80l/ / diove--,pi p4
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):
54 I Ci '1 GC_LIir
PY f (oo Gt)b se4' )9 1 0( ZIP 1 if b(1
9 DIGIT PARCEL ID NUMBER 151 zoo 0 0 (
Legal Description:6'
Subdivision Name Block Lot(s)
7 Section l Township North, Range�/�T/ WM
All
APPLICANT 11' 10Y1 PO b,S�a(V PHONE ,� I`0 0
MAILING ADDRESS (Z 2-&� 1 1 -f Fad-is
Se Ck,{rt �( v")& - c?g I t L ZIP
PROPERTY OWNER allJ- PHONE
MAILING ADDRESS
ZIP
CONTRACTOR ()U-Yl 5 A I PHONE 3 O s- 7 1 7
MAILING ADDRESS Es �'7L
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' 1- j ` C k WG— ZIP q e331.
STATE LICENSE# S c4.,y..a h p < 077 0 EXP.DATE l//az---
FEDERAL I.D.# 9 I '" ( d- ' 8S7
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 /"----- DATE S/ C791 / 6 )
01 Fa ZIC118E ONLY --1-)
BASE FEE RECEIPT# �4 551
ini AUG —2 3 ry I
. CASH/CK# �y I O
TOTAL DATE (7 /D-3/0 Z
4Y
DEPT. U GU�1" tJMTY DE��1t1�'11' Ply
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