HomeMy WebLinkAboutBLD2002-00572 6,
II
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 #: BLD02-00572 Received Date 9/27/2002
SITE ADDRESS: 202 BOBCAT LN Issue Date 9/27/2002
QUILCENE, 98376
APPLICANT: JOHN T BRAASCH PHONE: (360)765-4314
MILDRED R BRAASCH
PO BOX 778
QUILCENE WA 98376-0778
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701294017 Section: 29 Township: 27N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE LLC PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 12/14/2002
OWNER, JOHN T BRAASCH PHONE: (360)765-4314
if different: MILDRED R BRAASCH
PO BOX 778
QUILCENE WA 98376-0778
PROJECT DESCRIPTION: PROPANE TANK& HEATING 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 9/27/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApprovaI: j�G�C ,-q'�S_ 3
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_Pe rm it_Propane.rpt 10/29/19
•
BUILDING PERMIT APPLICJION
BLD02-00572 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00572 Received Date: 9/27/2002
SITE ADDRESS: 202 BOBCAT LN
QUILCENE, 98376
OWNER: JOHN T BRAASCH PHONE: (360)765-4314
MILDRED R BRAASCH
PO BOX 778
QUILCENE WA 98376-0778
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701294017 Section: 29 Township: 27 N Range: 01 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 DESCRIPTIOF PROPANE TANK & HEATING 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 09/27/02 51068
Total: $47.00
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNWND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
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WOODSTOVE /� Above Ground PROPANE TANK PELLET STOVE , OTHER p C�1 1 u ICI �U q '-
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 ( /°� /o q
ZO Z (JobCt'�'t 1 l Y iL,c �L c/o A-
ZIP q 837(0
9 DIGIT PARCEL ID NUMBER 7 0 act`[' 0 1 7
Legal Description:
Subdivision Name I L Block Lot(s)
Section Township North, Range t w'1 WM
APPLICANT 6(z�Mr C (F PHONE ( 26) bS - I3 17
1 MAILING ADDRESS 0` 16 X L ig
v tL t`. ' �
�}+( ZIP ( �J 3 7`/
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PROPERTY OWNER S 4 04 C PHONE
MAILING ADDRESS
ZIP
CONTRACTOR lAVOQ N\ /� PP-cS0i4 PHONE 4199) J�S - 62 8 '3
MAILING ADDRESS z(0S C.G1 itt C.v�'t1 f?-�;'�r'
f z,f2f� t C,Ic V� / Gt+�f ZIP `'Z�},
g35c7
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 tructure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE t DATE g / dZ
FOR OFFICE USE ONLY Q
BASE FEE LI -C RECEIPT# 5 10(Q p
CASH/CK#
TOTAL DATE ! 1.2_1'f dZ
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