HomeMy WebLinkAboutBLD2002-00565 • •
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 #: BLD02-00565 Received Date 9/24/2002
SITE ADDRESS: 111 HAYDEN ST Issue Date 9/24/2002
PORT HADLOCK, 98339
APPLICANT: OTTO J M SMITH PHONE: (360)385-4504
111 HAYDEN ST
PORT HADLOCK WA 98339-9521
1-5
SUBDIVISION: PHILLIPS ADDN TO IRONDALE Block: 5 Lot:
PARCEL NUMBER: 986400501 Section: 2 Township: 29N 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, OTTO J M SMITH PHONE: (360)385-4504
if different: 111 HAYDEN ST
PORT HADLOCK WA 98339-9521
PROJECT DESCRIPTION: PROPANE TANK, PIPE& HEAT 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//_,Y-0 A--
[[ ] FinalApproval: ✓K /l tv-o2.-
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_Perm it_Propane.rpt 10/29/19
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UILDING PERMIT APPLICAON BL Review T Ty y565
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00565 Received Date: 9/24/2002
SITE ADDRESS: 111 HAYDEN ST
PORT HADLOCK, 98339
OWNER: OTTO J M SMITH PHONE: (360)385-4504
111 HAYDEN ST
PORT HADLOCK WA 98339-9521
SUBDIVISION: PHILLIPS ADDN TO IRONDALE Block: 5 Lot: 1-5
PARCEL NUMBER: 986400501 Section: 2 Township: 29 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 DESCRIPTIOr PROPANE TANK, PIPE & HEAT 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 51053
Total: $47.00
0
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION ��`�
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE 1 OTHER F' ' '"�\
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):
/0 6/44-ve—e4^) St
P I tb,4.,Q., A f ZIP 61 ? i9
9 DIGIT PARCEL ID NUMBER q G - //op-L5/k.)/
Legal Description:
Subdivision Name Block Lot(s)
Section „ Township North, Range /�C WM
APPLICANT • J L�� '" - PHONE 3 �� `J O(( C I 1
MAILING ADDRESS 1 f 1 r/-1 J I 'P. - 't' 1 Oc-te__ p ZIP S 0 9, 7
PROPERTY OWNER ��GT �'"� PHONE ,4d x V,.5 U �" C s''1
MAILING ADDRESS 2 0 3.0rc / �/Y( ) ) L
P 1 (Q(yYt-3- - Q ( C.✓� ZIP 7 d'1 a
CONTRACTOR f(f/1� PHONE �`�- �57 ` 7
MAILING ADDRESS /c O�? ��` I I r y
/ - ( n 'C / C.✓/4 ZIP 7G JJ /i'
STATE LICENSE# cSlh t JNa� 0 ?7 Q 0 EXP.DATE ///0 L
g
FEDERAL I.D.# !l'/67 J'f j7
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.
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APPLICANT SIGNATURE \ '"X DATE c. / 2'3 / 0 L
U FOR OFFICE USE ONLY
BASE FEE RECEIPT# f��(
CASH/CK# -(el
TOTAL DATE / /
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