HomeMy WebLinkAboutBLD2002-00602 . •
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 #: BLD02-00602 Received Date 10/11/2002
SITE ADDRESS: 191 NESS' CORNER RD Issue Date 10/11/2002
PORT HADLOCK, 98339
APPLICANT: CHERI VAN HOOVER PHONE: (415)647-0625
ROCKY DAY
220 GATES ST
SAN FRANCISCO CA 94110 T 168
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901023008 Section: 2 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, MIRIAM M SMITH PHONE:
if different: 191 NESS CORNER RD
PORT HADLOCK WA 98339-9409
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 10/11/2003.
REQUIRED INSPECTIONS:
[ ] ine/Appliance:C I� r
] FinalA royal:g//1/7—tfal
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
411143
UILDING PERMIT APPLIC iON BLD02-00602Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00602 Received Date: 10/11/2002
SITE ADDRESS: 191 NESS' CORNER RD
PORT HADLOCK, 98339
OWNER: MIRIAM M SMITH PHONE:
191 NESS CORNER RD
PORT HADLOCK WA 98339-9409
SUBDIVISION: Block: Lot: T 168
PARCEL NUMBER: 901023008 Section: 2 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 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:
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
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 10/11/02 51167
Total: $47.00
JEFFERSON COUNTY COMMUNI•VELOPMENT,621 SHERIDAN ST,PORTTOWNS•WA 98368 PH: (360)379-4450
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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):. x F
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Legal Description
Subdivision Name Block Lot(s)
Section Township North, Range 1,Af M! ',
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STATE LICENSE# h.S 077 Q e EXP.DATE ///O L-
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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 ci any omission of a material tact made by the applicant/owner with respect to this application packet may result in this permit being null and void. 4
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 /v l /D I U..)--�
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DEPT. OF COMMUNITY DEVELOPMENT 414