HomeMy WebLinkAboutBLD2002-00512 4111.
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 #: BLD02-00512 Received Date 9/3/2002
SITE ADDRESS: 401 OTTO ST Issue Date 9/4/2002
PORT TOWNSEND, 98368
APPLICANT: FLOYD D KIMBALL PHONE: (360)385-3812
MIRRIEL M KIMBALL
PO BOX 807
PORT TOWNSEND WA 98368-0807 T 2
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001212007 Section: 21 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, FLOYD D KIMBALL PHONE: (360)385-3812
if different: MIRRIEL M KIMBALL
PO BOX 807
PORT TOWNSEND WA 98368-0807
PROJECT DESCRIPTION: PROPANE TANK, 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 9/4/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: AN)I
[ ] FinalApproval: ')L t/ V-14-03
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
41,
BUILDING PERMIT APPLI ION
BLD02-00512 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00512 Received Date: 9/3/2002
SITE ADDRESS: 40 I OTTO ST
PORT TOWNSEND, 98368
OWNER: FLOYD D KIMBALL PHONE: (360)385-3812
MIRRIEL M KIMBALL
PO BOX 807
PORT TOWNSEND WA 98368-0807
SUBDIVISION: Block: Lot: T 2
PARCEL NUMBER: 001212007 Section: 21 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, 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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 09/03/02 49588
Total: $47.00
•
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION Q / `f
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE (/OTHER r / , 71' �/ l-._
(_.,
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):
17/c r &7—e) f/
Pz �GcJ /7 J �l W� W
� ZIP -r,✓ 6ey
9 DIGIT PARCEL ID NUMBER O6) i . /c�-- O 7
Legal Description:
Subdivision Name Block Lot(s)
/Section Township North, Range M
APPLICANT L� —L" ��fr'/ (' / � PHONE `- 3j)/
MAILING ADDRESS ,0' r 0 a--i'-,, 1 Ci 7
/� Y%erz,� .f ZIP J�ej��
PROPERTY OWNER "�c c_e' a` PHONE
MAILING ADDRESS
ZIP
CONTRACTOR At---)-1.,444.7„..i,_ P71'6-p 0---Q_—_ PHONE J (l
MAILING ADDRESS / 6) i S] � '? ✓
STATE LICENSE# ci5Gz f/ 7 7 & (/ EXP.DATE ///O Z_
/ '7 FEDERAL I.D.# / 0 p- 'I
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 C 4
/fr7 // DATE U / /
Al-
Ft.,.......,-- yll
BASE FEE PT# -1 L S U V
SEP — 3 are fCK# b(p O
TOTAL Jr t i_i»U ti u Jc r' 'DATE q / 3 / DZ
OFPT OF COMMUNITY DEVELOPMENT
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01