HomeMy WebLinkAboutBLD2002-00620 0 •
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 #: BLD02-00620 Received Date 10/18/2002
SITE ADDRESS: 10782 RHODY DR Issue Date 10/21/2002
PORT HADLOCK, 98339
APPLICANT: HARLAN M WOLFF PHONE: (360)385-1741
120 OAK RD
PORT HADLOCK WA 98339-9731
SUBDIVISION: CHALMER'S 2ND ADDITION Block: Lot:
PARCEL NUMBER: 942903202 Section: 3 Township: 29N Range: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, HARLAN M WOLFF PHONE: (360)385-1741
if different: 120 OAK RD
PORT HADLOCK WA 98339-9731
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 10/21/2003.
REQUIRED INSPECTIONS:
[ ] 'fan .Line/Appliance I I - lct'O'Z,
[ ] FinalApproval: , jif-- 6K` -- 1 ) , )°(- r01__
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
•UILDING PERMIT APPLICION BLD02-00620
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00620 Received Date: 10/18/2002
SITE ADDRESS: 10782 RHODY DR
PORT HADLOCK, 98339
OWNER: HARLAN M WOLFF PHONE: (360)385-1741
120 OAK RD
PORT HADLOCK WA 98339-9731
SUBDIVISION: CHALMER'S 2ND ADDITION Block: Lot:
PARCEL NUMBER: 942903202 Section: 3 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOD 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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 10/18/02 51194
Total: $47.00
JEFFERSON COUNTY COMM,DEVELOPMENT,621 SHERIDAN ST,PORT TOW ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE S
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?
K YES NO
SITE ADDRESS(911#/Road Name):
/°.1 ,,2 '/9&7 ' {
1rh/ Ifiti4eXe�/ G , /' /1'" , ZIP 9,k33 /�
9 DIGIT PARCEL ID NUMBER q q,z l 03 ) 0).
Legal Description:Subdivision Name CA di. 1..1.� ,mod sic/t �'i,y, Block '301-- Lot(s) Alliae,3 ` O
Section , ? Township 2 5' North, Range / 4./ WM
APPLICANT 41^/Q9/ Ms 10%' // PHONE 2 lsr'o--3 s -1›`y/
MAILING ADDRESS !," 0 (:. /`dt D
ft//a../�� r l-4,1 - ZIP ye33f
PROPERTY OWNER /y�L47J A'. lee,/ 7 PHONE e -3&"J`� --/>X/
MAILING ADDRESS !ll���/6 2 ,2 /e
��iJ"f /7 '%f ZIP y6-'3v52
CONTRACTOR f��/�_T AVa=2.--, ft `,L/v/ 7elP PHONE .. 5 7//
MAILING ADDRESS 42 6 (%Qk 4.,' / /�
flu/ ,,,,j�eY ` SA//i ZIP 791 7
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 AL``«;7 %. i DATE �. . l / l /(
)OCSFNIIY `' -E j '
BASE FEE
1 OCT 1 8 2002 1.es l/CK# ` 5S�
I I
TOTAL `I R - cs� L ---- DATE 10/(ta I O ---
_...,;DIY
DEPI. Of COMMUNITY 0LVELOPMEN
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