HomeMy WebLinkAboutBLD2002-00621 ID 6
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 #: BLD02-00621 Received Date 10/18/2002
SITE ADDRESS: 10804 RHODY DR Issue Date 10/21/2002
PORT HADLOCK, 98339
APPLICANT: HARLAN M WOLFF PHONE: (360)385-1741
LINDA E WOLFF
120 OAK RD
PORT HADLOCK WA 98339-9731 1-4
SUBDIVISION: CHALMER'S 2ND ADDITION Block: 32 Lot:
PARCEL NUMBER: 942903201 Section: 3 Township: 29N Range: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, HARLAN M WOLFF PHONE: (360)385-1741
if different: LINDA E WOLFF
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:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: (21�� 7Q2-C!/
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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
1.3
UILDI BLD02-00621NG PERMIT APPLICAN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00621 Received Date: 10/18/2002
SITE ADDRESS: 10804 RHODY DR
PORT HADLOCK, 98339
OWNER: HARLAN M WOLFF PHONE: (360)385-1741
LINDA E WOLFF
120 OAK RD
PORT HADLOCK WA 98339-9731
SUBDIVISION: CHALMER'S 2ND ADDITION Block: 32 Lot: 1-4
PARCEL NUMBER: 942903201 Section: 3 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
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 10/18/02 51194
Total: $47.00
MILsar
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWARD WA 98368 PH: (360)379-4450
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?
X YES NO
SITE ADDRESS(911#/Road Name):
/47 et) PAA°. "ig/ DA ,
elb ��L ZIP ;15'33 7
9 DIGIT PARCEL ID NUMBER ` q 9t22 0/
Legal Description:Subdivision Name G12,0./27 -114 +71Q/6l1 1, Block 3)_ Lot(s) 7�
Section Township _7 9 North, Range / G,,/ WM
APPLICANT /7/2J-/rJ /°/ . L["/ff PHONE 3
MAILING ADDRESS /1 (' 1 .q"r C �i
li 1 441 r ZIP / 83.3
PROPERTY OWNER /a— A / gs/- -17e, ? PHONE (D
MAILING ADDRESS /0,2 (/' (9L7.-
ZIP 9 7
CONTRACTOR //f/-/V7? �`� /6 PHONE 3 (✓e '355- /?//
MAILING ADDRESS 42 0 2 ,f/ a{
9 /rf , 2// 7 e- ZIP rg..35
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.
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APPLICANT SIGNATURE ("1 '01,, 27227. ,i'U DATE / /
j� FOR OFFICE USE ONLY
-BASE FEE I- - rr [E ( D /] RECEIPT# 51 ( C) i
CASH/CKATE # g�01�
TOTAL LI� j /b�Y
3 OCT 1 8 2002 ,�'
H:\HOME\PLNCNTRUNFOBLDGIFORMS\INSTALL.DOC11/05/01 �tl I iY
DEPT.OF COMMUNITY DEVELOPMENT]