HomeMy WebLinkAboutBLD2002-00514 •
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 #: BLD02-00514 Received Date 9/4/2002
SITE ADDRESS: 464 CAMELOT RD Issue Date 9/5/2002
QUILCENE, 98376
APPLICANT: ADAM S ROSS PHONE: (360)765-4694
PO BOX 772
QUILCENE WA 98376-0772
T 149
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702131036 Section: 13 Township: 27N Range: 02W
CONTRACTOR: PENINSULA HEAT INC PHONE: 457-2775
502 W 8TH ST
PORT ANGELES WA 98362
Contractor's License PENNINI*0440W Expires 3/2/2004
OWNER, ADAM S ROSS PHONE: (360)765-4694
if different: PO BOX 772
QUILCENE WA 98376-0772
PROJECT DESCRIPTION: L P FURNACE
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 9/5/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line pliance) d,e l� �x �l» 9/3D/ery
ao. ;.proval: a ,��
G
/1
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
4 UILDING PERMIT APPLICAI)N B RD02-005eview pe1.4
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00514 Received Date: 9/4/2002
SITE ADDRESS: 464 CAMELOT RD
QUILCENE, 98376
OWNER: ADAM S ROSS PHONE: (360)765-4694
PO BOX 772
QUILCENE WA 98376-0772
SUBDIVISION: Block: Lot: T 149
PARCEL NUMBER: 702131036 Section: 13 Township: 27 N Range: 02 W
CONTRACTOR: PENINSULA HEAT INC PHONE: 457-2775
502 W 8TH ST
PORT ANGELES WA 98362
Contractor's License PENNINI'0440W Expires 3/2/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr L P FURNACE
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:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
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 $48.00 MAM 09/04/02 49595
Total: $48.00
08/03/2001 14:37 3603794451.kJEFF CO DOD PAGE 02/02
E •
T
INSTALLATION PERMIT APPLICATION
WOOOSTOVE PROPANE TANK PELLET STOVE (�
OTHER �[� lia,L irri L ,r
SITE ADDRESS: •
9119/ROAD NAME (0. 1-1- CCi iyg 111— (o Gh C4
ql.,4 I l (4' �`1t - ZIP Cr' �7•,
8 DIGfT PARCEL ID NUMBER • I r7 - 0 w
Legal Description: _"—
Subdivision Name Block
Lotis)
Section Township North, Range _ WM
APPLICANT Pe YL l,Y1 u-L' a -eu f 71/t',c PHONE Lc-7~r), -7-2S—
MANO•ADDRESS j C
W )- t,'L,' . `ti.)
- 6 i t , 1 ,'' ei i' �,{ )/T' Ztr 4'% t� .
•
PROPERTY OWNER Met,Vt• \0 `�-4/Act WI Rocc� PHONE 7 6 --L„f C.,q
MAILING ADDRESS f X 7- 7 /T� "`
L.'l 114/ -rl 1<k L,�JJ'- ZIP Cis 3
(z
'CONTRACTOR PhtONE
MAIUNG ADDRESS 413 C }, ,)
ZIP
STATE LICENSE B 2 e 1 g U t-1(3C�L� ( EXP. DATE
•
FEDERAL I.D.P 0 I- 17.�7'z:A—7
By signing the application form,the applicant/owner attests that the information provided hereon Is true and correct to the best of their knowtepge. My material
fe1/6Ywod or any odniesion of a material feet made by the appllaant/owner with respect t0 this application packet may result In this permit being null and void.
I furtlwr spree to rive,Indemnify and hold harmiw Jefferson County against ail nobilities,)udgmanta,court Coits,reasonable shorn ey's fees and expenses which
may in any way accrue against Jefferson County es a result of or in consequence of the granting of this permit.
I Sunni,agree to provide access and right of entry to Jefferson County and It'a employees,representatives required later inspections. Access t of on to a agents occurfor the u ing re of r application ors, end en Wh cry to the applicant's property or structure sham Oe requested and shall during regular business Hours, y
APPUCANT SIGNATURE 7
�`�L
` BATE e.- t-) --'/ei! ----r
�,r••::i h,Y 't r. ':.<t•...,i.yf.N`�11 +}:f:vet l?..Y4.�5 Y�M:IhZn.r :iM}�:�J. ••�w1%'
••..:.!. 1. .:`I:.{:i:5•J !r.,'r'I.'.'f.'.:•:i'i'1;.:..y.r..... ... .::.:..i,:,:}Y,... BSI::.'::''. ':}:.. •i f. .— .1..
•::lf,�l :t>: �1, •, t �; I,�gg< sl+} ..r,:''r:••' aa.a,...
's:i}a1,e..l•s-, a. W..I.-.'f•a:'• + f'.i,'.�ult :il:1h;n4i .kC.�SRogtY±'j .' ), h�y.�: '' t, 4 i'•' L µ - .'1 x ��µ.• t .c}+ u"�t('1�
".rt^ .41.'.aA'_u..-.4....i f`M'' +'i `T� '�i'i W41;,,,° . •..FOiR•...,."I..G USE QNL S+ : M r,5 ,•: W:?
.r nrt ': 7L.�. r.S ..,Y, 14 P,r 8 f p ,. -T Rir ;h.t'•..'.:.L '�473h.e�rw K
,, n{;+1:1Y9:41...::•.;.�3�•.(..+'e'HVt• -.. }.,N ihr • j.^-� :v�-F'1 13 r"S "i.Y •��'•'iat<'z�i:Si:Y e4yai�i7 .1 ,&
..:�� 1 �:. +.f.u•C•_xi'•T+rri.�'•Y4tu i• ,i-.•.. • , t'�5• ,.r : � .r5. , , 1�
.r '4 .t yj 1 '';5�tl:r tS r.ps- .i{ F 11Eg4ry41Pir itSl.:�:, i; i;.444(3 1J:i.il..: Rti:,..t '
• �:'11'M�1 ..• ,�,'fi ��`"�u';it WS:t. x �i?''• - t l� • f7EV Glfr�'7R + �'Zt'3 31. �4r i � r,�y::
•1 ' c• ...Y w x::.:.i Xpey::(;iv{.; i + ' •(r.. Y L •3i R !
•• . ;,m.A5.';4+•k 11 ti,,i 3Ki :}ir h'r r.j4..K...,L it !k1 f•� , {t 5 /i 3'r1 L.al };1:4,_4,•
1<z.t.n Hill'k„1 ( ;^ ,} :
`i { ,u,• .+•LIf1 'CI 5}, 1. �'�,Y kl 1l•'1r rr',.�`#• Jt,l,-� •r} 'C1'L, ;,.
,•;:41. ' % •}'y�+}{ �Y�ilit04 7. • ,r� :r...�::.:1ar.JL .I'rR + i Zii,r ii N1 ••�:SlytLr y, t... ,�`+F. +x'i,..1•a1ll *"'' ?�'Y 4ly, IA: :'�;
/ieii4 •! �ii';5,� ,,i+IFYI{e., L•„r. ' f 4 r 1 " S 4 fit r, In?:, ra+R h^9Pf j
. v' Y' l. y{,'1,•'i t, _•^FP.' TS. •.ia ,, I,� r 3 .i
.1.:' 1y' �'•1: Trl� t'}'S' 1!i• si 1 2 j yn -k.3 lv Ir. Ili}SW rt'i"�r+ti :Rti'yl i'f' 1 'a 1 S*:' t•5
... .J....r) 4. I:!c�1. •i51i :Jul, {. _ •k1., 1)1.1, Eliy).�.lat "L, ,;-, f,4AilT•f.T. ,.
r, M r
• �d4.�•c, 3'4. r.''�a?+!i'AF.•::'�.:.:,., _r.;,.+.;;,t• :.• r.."r t•
• 'll.. '.'i;f '4 };,,5,;,, T,3M 3•'.}.. .�e 1.- H 3 yr:
,^�4'.::. ,• .. , �',:�i�' ..T' ^�c4.:';i"�"P'I }S• .ir8i���:.+''^'�T�}1�•r�;,.^S�{r:•:
f•r• ,,.• 7.. P• '�'x.},31 Tr;a!i:n• ":!`,;li�J,�'v}i'r:z, . '
.. ..., 'rye. ..... . :,'�^.
IiiuiOmmotNCNTIAFORMSUNSTALL,DOCI0/99 (� c E O U
(�/]
I Lac IS
ED
SEf - 4 ?fit
JEFFthS �
UN UUUNIY
DEPT.OF COMMUNITY DEVELOPMENT