HomeMy WebLinkAboutBLD2002-00682 • •
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 #: BLD02-00682 Received Date 11/18/2002
SITE ADDRESS: 3930 LINDSAY HILL RD Issue Date 11/18/2002
QUILCENE, 98376
APPLICANT: WILSON WESTERN LLC PHONE:
RALPH J WILSON
1851 HASTINGS AVE W
PORT TOWNSEND WA 983689638
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701321027 Section: 32 Township: 27N Range: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, WILSON WESTERN LLC PHONE:
if different: RALPH J WILSON
1851 HASTINGS AVE W
PORT TOWNSEND WA 983689638
PROJECT DESCRIPTION WOODSTOVE 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 11/18/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
(1[ ] Fi nalApproval: TDt/!E. OA- / yC .s'pE411 iw�� //i 0Z
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
• BLD02-00682
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00682 Received Date: 11/18/2002
SITE ADDRESS: 3930 LINDSAY HILL RD
QUILCENE, 98376
OWNER: WILSON WESTERN LLC PHONE:
RALPH J WILSON
1851 HASTINGS AVE W
PORT TOWNSEND WA 983689638
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701321027 Section: 32 Township: 27 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO WOODSTOVE 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
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Total:
JEFFERSON COUNTY COMMUNSEVELOPMENT,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 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 fit.:.))
SITE ADDRESS(911#/Road Name):
.3930 L, /�IQ' 6 b
sV / L � D
l (7: I "_t), LAe ) lily ZIP ? c3 3 / 6
9 DIGIT PARCEL ID NUMBER 7 0 I T 2- I b Z. 7
Legal Description: X CZ- uc 1. ° ! t 7 ' I
Subdivision Name -FAA / '3 C LS 'V S b/ / L. 7c s )Block Lot(s)
Section 3 2-- Township Z-- '7 North, Range 1 kl WM
APPLICANT R4. L17/1 j• W C LS Z'>N PHONE 7 b(I 3C1 —(309)/
MAILING ADDRESS Ivy?5� /4 .4S/ //Vg--S -Lie' LA/. 8
PO 7 65 j vJ ��1,1 AJ S . , �V A - ZIP - s3 6 q
PROPERTY OWNER W/L- sc 1�g / 1-A) L L--C�s PHONE 3C Ci 3 -��< 7
MAILING ADDRESS ./g 5 I t4 A2 1 Ai' - kiC. l{.
Po J771 -'] O Liu Ai S /4,/A , L 1 I A ZIP 9 8 :6,C_)
CONTRACTOR 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 ri t f ntry o th applic is property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE - A_ -„,.: DATE // I /8-/ c? Z
FOR OFFICE USE ONLY /� J
BASE FEE ' L7 RECEIPT# 5/ `1 P
CONSISTENCY REVIEW CASH/CK#
TOTAL L13 'co DATE 1 t. / V y /D —
*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. .111111*
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