HomeMy WebLinkAboutBLD2002-00549 , ,
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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 #: BLD02-00549 Received Date 9/18/2002
SITE ADDRESS: 3990 LELAND VALLEY RD WEST Issue Date 9/18/2002
QUILCENE, 98376
APPLICANT: ALFRED J MONROE PHONE: (360)765-3992
3990 LELAND VALLEY RD W
QUILCENE WA 98376
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702111026 Section: 11 Township: 27N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
OWNER, ALFRED J MONROE PHONE: (360)765-3992
if different: 3990 LELAND VALLEY RD W
QUILCENE WA 98376
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 9/18/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:__
4 L,
[ ] Fin alApproval:_ _ ---
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
lUILDING PERi �IIT APPLICAON RD0200549
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Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00549 Received Date: 9/18/2002
SITE ADDRESS: 3990 LELAND VALLEY RD WEST
QUILCENE, 98376
OWNER: ALFRED J MONROE PHONE: (360)765-3992
3990 LELAND VALLEY RD W
QUILCENE WA 98376
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702111026 Section: 11 Township: 27 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr 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 ______
Routing Date: F&W Landslide
Shoreline _Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 09/18/02 49682
Total: $47.00
JEFFERSON COUNTY COMM ,DEVELOPMENT,621 SHERIDAN ST,PORT TOW ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE OTHER
Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name):
3 cO Fe)9nd I/9 )1?-y i'V r lit- '
(
'9v1) ! CZ°j - / W.4- ZIP 7 s 376
9 DIGIT PARCEL ID NUMBER 70? — /i/ o --6
Legal Description:
Subdivision Name Block Lot(s)
/] /)) 4/Section Township
Township North, Range j WM
4 APPLICANT . Oil 1O f PHONE j / '—7 -3 W-
MAILING ADDRESS (1 )'
ZIP
PROPERTY OWNER J Q I'Al ( PHONE
MAILING ADDRESS
ZIP
CONTRACTOR Mountain Propane PHONE 36( - wS
MAILING ADDRESS 265 Chimacum Rd.
Port Hadlock, WA 98339
_ ZIP
STATE LICENSE# _ /W,rf)--9qyg EXP.DATE J2—` )4 —U.2
//
FEDERAL I.D.# 66)p-- 0 27 9 2'
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material
falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void.
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which
may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE 1-1'�l2T.t 2/ ` ''/..1 11' /' - DATE 9 l 7 / 0�"�
!J FOR OFFICE USE ONLY
BASE FEE RECEIPT# 17"1 W$-
CASH/CK#
TOTAL DATE / 4 ?0/ e). -
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01