HomeMy WebLinkAboutBLD2002-00588 • 411,
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 #: BLD02-00588 Received Date 10/4/2002
SITE ADDRESS: 180 RIDGE RD Issue Date 10/4/2002
BRINNON, 98320
APPLICANT: MARK K JAMES PHONE:
PO BOX 2604
AUBURN WA 98071
SUBDIVISION: OLYMPIC CANAL ADDITION 7 Block: Lot:
PARCEL NUMBER: 981901601 Section: 16 Township: 25N Range: 02W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
OWNER, MARK K JAMES PHONE:
if different: PO BOX 2604
AUBURN WA 98071
PROJECT DESCRIPTION PROPANE TANK AND GAS STOVE
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 10/04/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval:
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_B LD_Pe rm it_Propane.rpt 10/29/19
ryti.� 41UILDING PERMIT APPLICA)N BLD02-00588
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00588 Received Date: 10/4/2002
SITE ADDRESS: 180 RIDGE RD
BRINNON, 98320
OWNER: MARK K JAMES PHONE:
PO BOX 2604
AUBURN WA 98071
SUBDIVISION: OLYMPIC CANAL ADDITION 7 Block: Lot:
PARCEL NUMBER: 981901601 Section: 16 Township: 25 N Range: 02 W
CONTRACTOR: FERRELLGAS PHONE: (360)582-0231
646 SO 3RD AVE
SEQUIM WA 98382
Contractor's License FERRELP055LH Expires 08/01/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO PROPANE TANK AND GAS STOVE
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
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 ZAN 10/04/02 51122
Total: $47.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION \ (�
WOODSTOVE`"'- � Above Ground PROPANE TANK PELLET STOVE OTHER l71 �S I v L
Is this appliance (htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Hone?
YES Nf NO
SITE ADDRESS(911#/Road Name): A
DA
-LP Sy\... - L,O A ZIP
9 DIGIT PARCEL ID NUMBER ij 11 C\D ( L O l
Legal Description:
Subdivision Name 0 i-/ono 7c., (p7,-,xs L l fj(, Block Lot(s) rr a., 3
Section Township North, Range WM
APPLICANT r\r) AP_k c A/CS PHONE ) 9- 1 �2- 2T-5--"
MAILING ADDRESS 12-r'7 X° �--6 cS L[ `
A L� ,v L't'y 1� ZIP 1 cl`�� '
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PROPERTY OWNER rV1 A? 1 , • yi1 t• _c PHONE ) ! 2 2S. c2
MAILING ADDRESS 6-,:y z(vim
L.-)Bpi 4ji),—, IA-A ZIP (%' -'>)
CONTRACTOR c-- J2 - l 61/A S PHONE
MAILING ADDRESS 1 , i l6-)t ZQ 14 )(3 1
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�- 2 r!c)f- I U�' ,, ZIP 4/ S L1 1--/
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 Jefferso ounty 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 appl' a is property or structure shall be requested and shall occur during regular business hours.
IN
APPLICANT SIGNATURE DATE ) / / a Z
FOR OFFICE USE ONLY
BASE FEE RECEIPT#
CASH/CK#
TOTAL DATE / /
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