HomeMy WebLinkAboutBLD2002-00651 • •
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 #: BLD02-00651 Received Date 11/4/2002
SITE ADDRESS: 13903 CENTER RD Issue Date 11/5/2002
QUILCENE, 98376
APPLICANT: RANDALL D LINDQUIST PHONE: (360)765-3337
LINDA L LINDQUIST
PO BOX 62
QUILCENE WA 98376-0062
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701182008 Section: 18 Township: 27N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 9/26/2004
OWNER, RANDALL D LINDQUIST PHONE: (360)765-3337
if different: LINDA L LINDQUIST
PO BOX 62
QUILCENE WA 98376-0062
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 11/5/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: PROPA OK (6/6/o3
[ ] FinalApproval: 'Ot� Gr �D (o/6
(e.,.3
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_Perm it_Propane.rpt 10/29/19
UILDING PERMIT APPLICON BLD02-00651Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00651 Received Date: 11/4/2002
SITE ADDRESS: 13903 CENTER RD
QUILCENE, 98376
OWNER: RANDALL D LINDQUIST PHONE: (360)765-3337
LINDA L LINDQUIST
PO BOX 62
QUILCENE WA 98376-0062
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701182008 Section: 18 Township: 27 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP 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:
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 11/04/02 51295
Total: $47.00
41
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWED WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE DC Above Ground PROPANE TANK PELLET STOVE OTHER
Is this appliance (htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Hom
YES NO
SITE ADDRESS(911#/Road Name):
‘ 3c\03 Ce\A-Ver (,z.( C \ c ),()e , Lti
ZIP `1E 3 i
9 DIGIT PARCEL ID NUMBER -t(~i \ \g c°, R
Legal Description:
Subdivision Name Block Lot(s)
Section I Township L,:l North, Range I L.) .'s± WM
NIA L
APPLICANT % \--\v1C' C, L r1C'�C ,i PHONE LI( -7)-5+V1
MAILING ADDRESS ;X Co
c \ \C .\1 1 .,C.: !r
ZIP O -I(
PROPERTY OWNER \n Ct L.\'1cc�,u6 -s PHONE -Ito -Y- - �I
MAILING ADDRESS U �Q
0U.\ `C :e e . U:; IC\ ZIP `/�\Ul) 1
CONTRACTOR I\&(%U_n CU t\ ' E . PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# EXP.DATE
FEDERAL I.D.#
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material
falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void.
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments, court costs, reasonable attorney's fees and expenses which
may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE �( �J.7.�l DATE I C / r rt/ C�r�
J
FOR OFFICE USE ONLY
BASE FEE I D LE ; (_ g Wi E --NrECEIPT# 5 1 2-9 5
'' II-7 SH/CK# I$a--�--
TOTAL `1 7 NOV - Ll�U2 i I / Li / OZ
JATE
1
H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01
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