HomeMy WebLinkAboutBLD2002-00590 • •
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 #: BLD02-00590 Received Date 10/7/2002
SITE ADDRESS: 1297 VAN TROJAN RD Issue Date 10/8/2002
CHIMACUM, 98325
APPLICANT: TRILLIUM (A LAND TRUST) PHONE:
PO BOX 261
CHIMACUM WA 98325-0261
T 23
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901223001 Section: 22 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, TRILLIUM (A LAND TRUST) PHONE:
if different: PO BOX 261
CHIMACUM WA 98325-0261
PROJECT DESCRIPTION: PROPANE TANK, STOVE & PIPE 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 10/8/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: IC-
F--1/ 2 �lo -03
FinalApproval: OK _ '7='6-0-j
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
BLD02-00590
11143UILDING PERMIT APPLICAON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00590 Received Date: 10/7/2002
SITE ADDRESS: 1297 VAN TROJAN RD
CHIMACUM, 98325
OWNER: TRILLIUM (A LAND TRUST) PHONE:
PO BOX 261
CHIMACUM WA 98325-0261
SUBDIVISION: Block: Lot: T 23
PARCEL NUMBER: 901223001 Section: 22 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 DESCRIPTION PROPANE TANK, STOVE & PIPE 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 10/07/02 51096
Total: $47.00
•
JEFFERSON COUNTY r COMMUNITY III 621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
/ INSTALLATION PERMIT APPLICATION
WOODSTOVE v Above Ground PROPANE TANK PELLET STOVE ✓ OTHER / —! `f 7/4 J'w
Is this appliance(htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES X' NO
SITE ADDRESS(911#1 Road Name):
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, ZIP. ....
9 DIGIT PARCEL ID NUMBER 9 0 ( Z Z3 D O
Legal Description:
Subdivision Name Block Lot(s)
Section _ Township North, Range WM
APPLICANT Qr,1 L-C...( -. 2- —d c"--r - PHONE
MAILING ADDRESS O/ to 1' L 4.s.1
cjeA=,Z . GJG-- ZIP ' J'/i 2—
PROPERTY OWNER t ( .I L LA Urn .r(L 444 �� PHONE
MAILING ADDRESS cl O $ (( a-A.e
ZIP
CONTRACTOR 4-1+9a �ti. itait-irr - PHONE J es -/^? T 1
MAILING ADDRESS /0 ? S _) O,
PC IQ"1-0 Loc4c (.J1-____ ZIP /cr.?3S
STATE LICENSE# S (n J HI;G y?P EXP.DATE // C Z
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FEDERAL I.D.# !( ^ 707 1 d'S?
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 4' 'y DATE /a / 1 / OL
(di
OL`,C S NYe E r-
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BASE FEE
lEIPT#
OCT - 7 2002 cK#
TOTAL L i DATE / /
Jti Lt,Z)uN utAitvlY
H:WOMEVPLNCNTRUNFOBLDGtFORMSUNSTALL.DOC11/D5/o1 DEPT. OF )MMUNiTY DEVELOPMENT