HomeMy WebLinkAboutBLD2002-00655 • •
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#: BLD02-00655 Received Date 11/5/2002
SITE ADDRESS: 121 WILDWOOD RD Issue Date 11/6/2002
QUILCENE, 98376
APPLICANT: PETER C BRACKNEY PHONE: (360)765-3181
MARY C BRACKNEY
PO BOX 579
QUILCENE WA 98376-0579 2
SUBDIVISION: IRENE'S SHORT PLAT Block: Lot:
PARCEL NUMBER: 932700024 Section: 14 Township: 27N Range: 02W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
OWNER, PETER C BRACKNEY PHONE: (360)765-3181
if different: MARY C BRACKNEY
PO BOX 579
QUILCENE WA 98376-0579
PROJECT DESCRIPTION: PROPANE TANK& HEAT STOVE 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 11/6/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: (....f,x,1-4,14-o05 (46 o r IO--"2,o-00
[ 1 FinalApproval: _10-30-os.
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
03
UILDI BLD02-00655NG PERMIT APPLICON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00655 Received Date: 11/5/2002
SITE ADDRESS: 121 WILDWOOD RD
QUILCENE, 98376
OWNER: PETER C BRACKNEY PHONE: (360)765-3181
MARY C BRACKNEY
PO BOX 579
QUILCENE WA 98376-0579
SUBDIVISION: IRENE'S SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 932700024 Section: 14 Township: 27 N Range: 02 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr PROPANE TANK & HEAT STOVE 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 11/05/02 51225
Total: $47.00
E FE J F RSON COUNTY COMMUNOFEVELOPMENT,621 SHERIDAN ST,PORT TOWN WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* ' Above Ground PROPANE TANK A/ HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify)
Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
YES X. NO
SITE ADDRESS(911#/Road Name):
I wood dcJ
00-i c.m c ('(4 ZIP < F 76
9 DIGIT PARCEL ID NUMBER �, 700 o /y
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE
MAILING ADDRESS
ZIP PROPERTY OWNER Qr.6.-(el- /3reAckq��/ PHONE 6 0 7652 3i g /
(
MAILING ADDRESS I � 0 (Sox (,
QUrfc (int_ 6(4. 9O3'7 ZIP
CONTRACTOR Ceti 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 entr to the applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE fc-elA ✓J ' — DATE /0 / 0 5 / CJZ
FOR OFFICE USE ONLY
BASE FEE RECEIPT#/
CONSISTENCY REVIEW CASH/CK#
TOTAL DATE // / S^/ U �--
*Underground Propane Tank applications require additional information to be submitted. OVER
Please contact our office at 360-379-4450 if the back of this application is blank.
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