HomeMy WebLinkAboutBLD2002-00564 10 0
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 #: BLD02-00564 Received Date 9/24/2002
SITE ADDRESS: 1260 E QUILCENE RD Issue Date 9/24/2002
QUILCENE, 98376
APPLICANT: MICHAEL L RAGON PHONE: (360)765-3457
MARY RAGON
PO BOX 116
QUILCENE WA 98376-0116 T 4+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701184004 Section: 18 Township: 27N 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, MICHAEL L RAGON PHONE: (360)765-3457
if different: MARY RAGON
PO BOX 116
QUILCENE WA 98376-0116
PROJECT DESCRIPTION: PROPANE TANK, PIPE & STOVE 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 9/24/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: >V,/i /0-g`-oc ,
[ (inalApprovaL OK rat- C/o 8A9/a3p
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
1108 � BLD02-00564
UILDING PERMIT APPLICA!ON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00564 Received Date: 9/24/2002
SITE ADDRESS: 1260 E QUILCENE RD
QUILCENE, 98376
OWNER: MICHAEL L RAGON PHONE: (360)765-3457
MARY RAGON
PO BOX 116
QUILCENE WA 98376-0116
SUBDIVISION: Block: Lot: T 4+
PARCEL NUMBER: 701184004 Section: 18 Township: 27 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 DESCRIPTIOt PROPANE TANK, PIPE & STOVE 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 09/24/02 51054
Total: $47.00
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JEFFERSON COUNTY COMMUNI DEVELOPMENT,621 SHERIDAN ST,PORT TOWN D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE t Above Ground PROPANE TANK PELLET STOVE OTHER 7119 p tf _/ 41 5��
1
Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home?
YES L.---"'"'NO
SITE ADDRESS(911#/Road Name):
I a(oo 2. Qlcl(cam_ 12—D
QC-Q�✓.-t--- ) 4 ZIP Ci, e 3? ‘,
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9 DIGIT PARCEL ID NUMBER 7 C3 ( / Q T 00
Legal Description:
Subdivision Name Block Lot(s)
Section M r•r Townsh
ip North, Range M
IlAAPPLICANT t k 4 ' — � PHONE 76s-3 f 5 7
MAILING ADDRESS Pe) 8'?4._. I I b
ZIP ct U'3 7 fo
PROPERTY OWNER C' IIa r " ' PHONE t i
MAILING ADDRESS d/
ZIP
CONTRACTOR tl a.•-.._. PHONE 3 P S 7 r 7
MAILING ADDRESS Eo1�53 �►', A� ►-+ . -v'a/ C�c. / V2�
1
7
ZIP STATE LICENSE# CC (t— yc.S7V-1()9K
-7 7 OP EXP.DATE 1L/
�O/
4FEDERAL I.D.# i -- J 07 0�1 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.
4
APPLICANT SIGNATURE Isin"/vr- DATE / ` / t'-
FOR OFFICE USE ONLY
BASE FEE RECEIPT#CASH/CK# gapp
6
TOTAL DATE / /
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01