The URL can be used to link to this page

Home My WebLink AboutBLD2002-00676 UILDING PERMIT APPLIC BLD02-00676 N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD02-00676 Received Date: 11/12/2002 SITE ADDRESS: FORT GATE RD NORDLAND, 98358 OWNER: MICHAEL J ALDERMAN PHONE: (800)660-3309 CONNIE A ALDERMAN PO BOX 1702 BELFAIR WA 98528-1702 SUBDIVISION: Block: Lot: T 29 PARCEL NUMBER: 021202016 Section: 20 Township: 30 N Range: 01 E 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 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 MAM 11/12/02 51362 Total: $47.00 • BLD02-00676 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00676 Received Date: 11/12/2002 SITE ADDRESS: FORT GATE RD NORDLAND, 98358 OWNER: MICHAEL J ALDERMAN PHONE: (800)660-3309 CONNIE A ALDERMAN PO BOX 1702 BELFAIR WA 98528-1702 SUBDIVISION: Block: Lot: T 29 PARCEL NUMBER: 021202016 Section: 20 Township: 30 N Range: 01 E 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 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $47.00 MAM 11/12/02 51362 Total: $47.00 JEFFERSON COUNTY COMMUNITYDEVELOPMENT,621 SHERIDAN ST,PORT TOWN SEND WA 98368 PH: (360)379-4450 X 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 Horn YES / NO SITE ADDRESS(911#/Road Name): c7 / UY -/ . G4T 2 � A...)e' r2nLAN17 / •uvA ZIP ` 9 DIGIT PARCEL ID NUMBER ,h ..,/ - 2 0 Z - D t 1p Legal Description: Subdivision Name Block Lot(s) 7:tion / Township North, Range WM APPLICANT Ail /l� !r I 2 fV1 Fi/�� PHONE .I-SOO�- (() - :i 09 MAILING ADDRESS ' '/1 ., J I2 TN &A 1- J2 ID `� t,12'D i-P D / W/41 ZIP 9 ZJ cg PROPERTY OWNER it/I 1 166 Al...`-be-n //,A.N fJ PHONE I-4YO -LG.0 -- 3G9 MAILING ADDRESS �� lJo;2r14 caATE j2 D �g fjC\2?t-Ar �-.)'D , to A ZIP q�S 71 (../CONTRACTOR e,,,,,_„ PHONE L�-7z✓2-4 c a S �, ` MAILING ADDRESS Vi 2`/ tS ( li►MAGvt/L, ) v.)A ZIP (46-32- 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 .0--ul„-e/y0 . DATE // / // O '� 11 FOR OFFICE USE ONLY BASE FEE -i ` (�'IJ (� fa (�/] CEIPT# ?(, __ ® !, �/-1 ej�C K# TOTAL -1 v� NOV 1 2 2002 ' ,_ i, /I,-/ H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01 1-/ DEPT. OF COMMUNI(Y DEVELOPMENT y