HomeMy WebLinkAboutBLD2002-00684 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 #: BLD02-00684 Received Date 11/20/2002
SITE ADDRESS: 294 SEAMOUNT DR Issue Date 11/20/2002
BRINNON, 98320
APPLICANT: GREGORY K CLUCKEY PHONE:
PREEDA L CLUCKEY
294 SEAMOUNT DRIVE
BRINNON WA 98320 21
SUBDIVISION: SEAMOUNT ESTATES DIV 1 Block: Lot:
PARCEL NUMBER: 993000022 Section: 29 Township: 25N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 09/26/2004
OWNER, GREGORY K CLUCKEY PHONE:
if different: PREEDA L CLUCKEY
294 SEAMOUNT DRIVE
BRINNON WA 98320
PROJECT DESCRIPTION PROPANE TANK AND LINE 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 11/20/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: ,f2/< t_/ 2 `3 -es
�1
[ ] FinalApproval: T'Ot- e l) /O/4/3
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
i:\F_BLD_Permit_Propane.rpt 10/29/19
411L
UILDING PERMIT ISDN BLD02-00684
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00684 Received Date: 11/20/2002
SITE ADDRESS: 294 SEAMOUNT DR
BRINNON, 98320
OWNER: GREGORY K CLUCKEY PHONE:
PREEDALCLUCKEY
294 SEAMOUNT DRIVE
BRINNON WA 98320
SUBDIVISION: SEAMOUNT ESTATES DIV 1 Block: Lot: 21
PARCEL NUMBER: 993000022 Section: 29 Township: 25 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPL994BH Expires 09/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO PROPANE TANK AND LINE 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: 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
Seismic Streams
Prop: Prop: Flood Way Floodplain
Total: Total: F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity Plat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 11/20/02 51331
Total: $47.00
JEFFERSON COUNTY COMMUNI•VELOPMENT,621 SHERIDAN ST,PORT TOWN*WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN T 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?
X YES NO
SITE ADDRESS(911#/Road Name):
1�r nu v�✓FI��j/j l/". . ZIP 98 ao�C.)
9 DIGIT PARCEL ID NUMBER `( /-� ODO 0 alc
Legal Description: /� j� 3
Subdivision Name -�r�0 t.x.14, T ‘S 7 rSS Block �I)1 A_, Lot(s) o2
Section Township North, Range WM
APPLICANT [%��1�0v��/ ( _L ��C � PHONE � O/ 30 6
MAILING ADDRESS / r�O=-z it) r sbr�__
736'_I i C�1\.) uJlT/ ZIP Q g 0 /776
PROPERTY OWNER C7,�.C�li��(� C L(�f�'f�L�- PHONE ��O 06
MAILING ADDRESS 24 i S ! /��tc} a .cj T- ,6 fL
- ( L) (w,-% � -
/�/ � , ZIP 9, ,?a 0
CONTRACTOR t�1D vJ 7-6- i rJ 1 2- 16,9/)C_ PHONE 3-6-0/7f( - S V'
MAILINGADDRESS c' C./ ( 6 y C c v+ jej� 360 /? 5 — (o 3
PoiL f -( bi_.v CA( / LAM ZIP qn 5-3 9
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 F} of entry to the app' ant' ropert cture shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE �i — " r-' DATE / d 5 / (JJ
FOR OFFICE USE ONLY
BASE FEE 1-{-4- - (T) RECEIPT# 5i ' '3/
CONSISTENCY REVIEW CASH/CK# ' •2.__
TOTAL 1-I-q" - tr DATE 1< / ZC)/ 0
*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. IIM*
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