HomeMy WebLinkAboutBLD2002-00575 • •
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 #: BLD02-00575 Received Date 9/30/2002
SITE ADDRESS: 201 WILDWOOD RD Issue Date 9/30/2002
QUILCENE, 98376
APPLICANT: ALAN E ROHWEDER PHONE:
INAMON L MOFFETT
BOX 217
cP0
QUILCENE WA 983760217
SUBDIVISION: BISHOP'S SUB DIV Block: Lot:
PARCEL NUMBER: 932700086 Section: 14 Township: 27N Range: 02W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2004
OWNER, ALAN E ROHWEDER PHONE:
if different: CINAMON L MOFFETT
PO BOX 217
QUILCENE WA 983760217
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 09/30/2003.
REQUIRED INSPECTIONS: �'
[ ] Tank/Line/Appliance: ils0) C. 14TeTAGG.t1T.0.6 Ck Q/4/ag g7.4
[ ] FinalApprovaI: OR Gf/';G7I?eklio-n ) Q 4/63° ,
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
dUILDING PERMIT APPLICAN BLD02-00575
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00575 Received Date: 9/30/2002
SITE ADDRESS: 201 WILDWOOD RD
QUILCENE, 98376
OWNER: ALAN E ROHWEDER PHONE:
CINAMON L MOFFETT
PO BOX 217
QUILCENE WA 983760217
SUBDIVISION: BISHOP'S SUB DIV Block: Lot:
PARCEL NUMBER: 932700086 Section: 14 Township: 27 N Range: 02 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO PROPANE TANK INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Seismic Streams_
Prop: Prop: Flood Way Floodplain
Total: Total: F&W Landslide
Routing Date: 9fr20i Shoreline Aquifer
�� Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 09/30/02 51016
Total: $47.00
11
JEFFERSON COUNTY COMMUNI DEVELOPMENT,621 SHERIDAN ST,PORT TOWN ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE )<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(911#/Road Name):
2O/ 1 L--' 1-o00'3> (7--
0v,1 1--c 1%:1 4, W':.' ZIP LIl/c'1
9 DIGIT PARCEL ID NUMBER 7 7 4700'- Dec;,
Legal Description:
Subdivision Name Block Lot(s)
Section 7 ����T�o�wnn�ship North, Range WM
APPLICANT 14 L4 J J O 1-1L 4 Y PHONE
MAILING ADDRESS 20) L4DI L 'Wo,(,a/'�_J /2.P t (�
titi I/ 1 f. V ZIP C/ (e
PROPERTY OWNER 41.,,>1'"J A) IG--v 44 w�' C PHONE
MAILING ADDRESS '2-L 1 (A I..7 IAN,Thr, b /�t� �/
tbido L-L ►�1 �� % j ZIP "I v /
CONTRACTOR e t /7 PHONE !j2- g.
MAILING ADDRESS +7 b 6; 7--1 ej y
64-IMA- Y'I, ) 1. ZIP q f 2,5
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 SIGNATURE !S/� � DATE 9 / . ul 02.
FOR OFFICE USE ONLY
BASE FEE 41. 00 RECEIPT#
CASH/CK#
TOTAL • DATE _/ /
H:\HOM E\PLNC NTRU N FOBLDG\FORMS\I NSTALL.DOC 11/05/01