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•UILDING PERMIT APPLICION B RD02 Oyp e:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00560 Received Date: 9/23/2002
SITE ADDRESS: 7466 COYLE RD
QUILCENE, 98376
OWNER: OLSON HARRY FAMILY LLC PHONE: (425)488-2834
PO BOX 5311
BELLINGHAM WA 98227-5311
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 701341004 Section: 34 Township: 27 N Range: 01 W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 8/1/2004
REPRESENTATIVE: HARRY OLSON PHONE: (425)488-2834
7008 NE 170TH ST
KENMORE WA 98028
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 09/23/02 49694
Total: $47.00
S
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 #: BLD02-00560 Received Date 9/23/2002
SITE ADDRESS: 7466 COYLE RD Issue Date 9/23/2002
QUILCENE, 98376
APPLICANT: HARRY OLSON PHONE: (425)488-2834
7008 NE 170TH ST
KENMORE WA 98028
2
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701341004 Section: 34 Township: 27N Range: 01W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 8/1/2004
OWNER, OLSON HARRY FAMILY LLC PHONE: (425)488-2834
if different: PO BOX 5311
BELLINGHAM WA 98227-5311
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 9/23/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval:
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
JEFFERSON COUNTY COMMUNII�DEVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X 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(9��Roa�Name): t �C,�Ci
CI W. `- 1 IAQ-- ZIP l b 37
9 DIGIT PARCEL ID NUMBER 1 0 L 3 t ( 0 0 4
Legal Description:
Subdivision Name Block Lot(s)
Section 3LA Township -. -1 41 North, Range 0 1 WM
APPLICANT Aa.)(r 1 0� �'AN PHONE (��J `fl 0 3 Y
MAILING ADDRESS a 0 l N`c 1 L U-" V`4.'L of'Q- ZIP g'^�dvD-DU
PROPERTY OWNER A ( 4 C.)l V ` C PHONE 4 a5 - 4��-2-. 3V
MAILING ADDRESS '1()bV Nt ��k• �1 q
t4 Q`k v{�' ZIP l C‘ �/6)-b
CONTRACTOR ,mil` ti\ij, �� PHONE ._3 U ro t 5 1 - l l3 J
MAILING ADDRESS
1
\)C1LI f.1rLgi P.lr I I, It- ZIP
STATE LICENSE# EXP.DATE
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 SIGNATUREi - DATE O> / /` / CZ
FOR OFFICE USE ONLY 1
BASE FEE 4 •cit. RECEIPT# LtCLCoq.LI
CASH/CK# //m8
TOTAL 4 3- `01.) DATE a/a 3/ —
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