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HomeMy WebLinkAboutBLD2002-00606 S • 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 #: BLD02-00606 Received Date 10/15/2002 SITE ADDRESS: 880 SCHWARTZ RD Issue Date 10/16/2002 NORDLAND, 98358 APPLICANT: MERLE W BARCLAY II PHONE: (360)385-6441 KATERINA K BARCLAY PO BOX 134 NORDLAND WA 98358 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021282002 Section: 28 Township: 30N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2002 OWNER, MERLE W BARCLAY II PHONE: (360)385-6441 if different: KATERINA K BARCLAY PO BOX 134 NORDLAND WA 98358 PROJECT DESCRIPTION: GAS HEAT STOVE & PIPING 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 10/16/2003. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: i' (L" i CN [ ] FinalApproval: OC. te.‘ V i I (P c5-1--- 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_Perm it_Propane.rpt 10/29/19 4111113UILDING PERMIT APPLICON B RD02 00606 eview Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00606 Received Date: 10/15/2002 SITE ADDRESS: 880 SCHWARTZ RD NORDLAND, 98358 OWNER: MERLE W BARCLAY II PHONE: (360)385-6441 KATERINA K BARCLAY PO BOX134 NORDLAND WA 98358 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021282002 Section: 28 Township: 30 N Range: 01 E 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 GAS HEAT STOVE & PIPING 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 10/15/02 51174 Total: $47.00 JEFFERSON COUNTY COMMUNI1WVELOPMENT,621 SHERIDAN ST.PORT TOWNSOWA 98368 PH: (360)379-4450 ' '..; INSTALLATION PERMIT APPLICATION WOODSTOVE Above Ground PROPANE TANK PELLET STOVE ~/ 4 .57 � E 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): 19 pc) 0 0 S--) ( 4( c-, c „,.... ,_77 _ , , „4, . ,-.,,„ . ,,,,_,,,, ` ()--, ZIP / c1 w ,,,,z I _..,,,4. 4}} 9 DIGIT PARCEL ID NUMBER D 2/ p n®,, .. <-, Legal Description: � � Subdivision Name Block Lot(s) `r` e Section Township North, Range WM "°; APPLICANT (J) (6-6-7— PHONE g li----6 y MAILING ADDRESS Z© /; / Q9 1�"�''����-�`"."'� . 1,�-�- ZIP �U_�7�J� ,,.. P ,,. s 1 PROPERTY OWNER PHONE MAILING ADDRESS ZIP 4 CONTRACTOR 61-1-Q° PHONE , ? `J 'r J ! /7 1.4 MAILING ADDRESS vvo3 01_,er_z_.(_ ��i 7 —' ,4_ )� ZIP it'l33( r, STATE LICENSE# �Z-�.J, * 7 7 °73 EXP.DATE ///d Z____ FEDERAL I.D.# �'/— �0 ? ` d 2 f"7 t:, 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. f i 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 t the applicant's property or structure shall be requested and shall occur during regular business hours. tT; . APPLICANT SIGNATURE ` _ y /11, DATE ,�6 1 1O l G� F,QR OFFICE USE ONLY BASE FEE RECEIPT# :? e "(,..LJ s' CASH/CK# ,s TOTAL DATE J.Q/'L(0/ C • H:W OME W LNCNTRV NFOBLDG\FORMSU NSTALL.DOC 11/05/01