HomeMy WebLinkAboutBLD2002-00548 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#: BLD02-00548 Received Date 9/18/2002
SITE ADDRESS: 2840 OAK BAY RD Issue Date 9/18/2002
PORT HADLOCK, 98339
APPLICANT: MICHAEL J NOVACK PHONE: 360 385 5096
SARA L NOVACK
PO BOX 537
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921183003 Section: 18 Township: 29N Range: 01 E
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/08/2003
OWNER, MICHAEL J NOVACK PHONE: 360-385-5096
if different: SARA L NOVACK
PO BOX 537
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION ABOVE GROUND PROPANE TANK AND HEAT STOVE
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 09/18/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: OX int eD /23/,3
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 APPLICON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00548 Received Date: 9/18/2002
SITE ADDRESS: 2840 OAK BAY RD
PORT HADLOCK, 98339
OWNER: MICHAEL J NOVACK PHONE: 360-385-5096
SARA L NOVACK
PO BOX 537
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921183003 Section: 18 Township: 29 N Range: 01 E
CONTRACTOR: SUBURBAN PROPANE PHONE: 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
Contractor's License SUBURPL044DA Expires 03/08/2003
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO ABOVE GROUND PROPANE TANK AND HEAT STOVE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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
Seismic Streams
Prop: Prop: Flood Way Floodplain
Total: Total: F&W Landslide
Routing Date: 9Shoreline Aquifer
//e�Z Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 09/18/02 50975
Total: $47.00
/1
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWARD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE )Above Ground PROPANE TANK PELLET STOVE X OTHER 1 �-C- Je.-
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):
z0' 011 sAt7 Q
0 2rLL ZIP 9FR 36
9 DIGIT PARCEL ID NUMBER q2t /f33 0CJ 3
Legal Description:
Subdivision Name Block Lot(s)
Section (- Township North, Range WM
APPLICANT �U�J� `Y��` -Pt PHONE S� r �
MAILING ADDRESS 0 PC
P ` ' -1PC ZIP -6 C,
PROPERTY OWNER 7( 1<' /I ( N O V i PHONE '3 / - X28
MAILING ADDRESS � 6 ,,<, j,
P . ( it )el 7S Y ' ZIP
CONTRACTOR L_Lt (C"'\ " ram'` PHONE 5---3
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MAILING ADDRESS 5— e.. `'
Lit/-} / \ /� ZIP ? �/J
STATE LICENSE# ��c` U('� 2 L- o%/ P A- EXP.DATE �iT C"
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 entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE b / DATE ! / / 6/ 0?
m FOR OFFICE USE ONLY '7
BASE FEE 11' V- RECEIPT# 5" 9 `J
CASH/CK# c7R03:.-
TOTAL 44-7 f DATE L /C 0p/ 0 Z
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