HomeMy WebLinkAboutBLD2002-00570 • •
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 #: BLD02-00570 Received Date 9/26/2002
SITE ADDRESS: 134 BROTHERS RD Issue Date 9/27/2002
CHIMACUM, 98325
APPLICANT: VIRGINIA R MC INTYRE PHONE: (360)732-7453
134 BROTHERS RD
CHIMACUM WA 98325-9773
18
SUBDIVISION: COUNTRY RIDGE Block: Lot:
PARCEL NUMBER: 801045018 Section: 4 Township: 28N 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, VIRGINIA R MC INTYRE PHONE: (360)732-7453
if different: 134 BROTHERS RD
CHIMACUM WA 98325-9773
PROJECT DESCRIPTION: PROPANE PIPE & HEATER
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 9/27/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: Li' CoAJA /® -L.Z- on
[ ) FinalApproval:_ h LCYvi,, l� LZ-o 1
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
"'BUILDING PERMIT APPLIC$ON B Review
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00570 Received Date: 9/26/2002
SITE ADDRESS: 134 BROTHERS RD
CHIMACUM, 98325
OWNER: VIRGINIA R MC INTYRE PHONE: (360)732-7453
134 BROTHERS RD
CHIMACUM WA 98325-9773
SUBDIVISION: COUNTRY RIDGE Block: Lot: 18
PARCEL NUMBER: 801045018 Section: 4 Township: 28 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 DESCRIPTION PROPANE PIPE & HEATER
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 09/26/02 51060
Total: $47.00
4
JEFFERSON COUNTY COMMUNITYDEVELOPMENT,621 SHERIDAN ST,PORT TOWARD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION elfttl
WOODSTOVE Above Ground PROPANE TANK PELLET STOVE OTHER G
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):
`I' a_SZTC— ..Q..L s E c. .
c` _ ZIP ( V 3 L S
9 DIGIT PARCEL ID NUMBER 2a( 04"S ep t
Legal Description:
Subdivision Name Block Lot(s)
Section , Township North, Range ,,//r VVM
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APPLICANT M ( 1� ,(Y1 t �(�," \ c PHONE 3 7 - T
MAILING ADDRESS
ZIP
PROPERTY OWNER I C' C PHONE
MAILING ADDRESS
ZIP
CONTRACTOR 60 =-'--- PHONE
MAILING ADDRESS I O SS3 ,,I<n�A� tl p q
c.s_ 1 o `-k�-7—7/� �-c/� ZIP q a 3 3 /
STATE LICENSE# �. (Air% G7 r O / / (*1 P EXP.DATE
FEDERAL I.D.# 9 - !U -7 l eS 7
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 DATE C / K/ U
FOR OFFICE USE ONLY
BASE FEE D lE C E M ECEIPT#
SH/CK#
TOTAL S E P 2 6 2002 ATE _/ /
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01 JLi i_i !-t IY
DEPT. OF COMMUNITY DEVELOPMENT