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HomeMy WebLinkAboutBLD2002-00702 • 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 #: BLD02-00702 Received Date 12/2/2002 SITE ADDRESS: 480 JOHNSON RD Issue Date 12/2/2002 QUILCENE, 98376 APPLICANT: JANET D ROGERS PHONE: (360)765-3966 480 JOHNSON RD QUILCENE WA 98376-9619 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601342016 Section: 34 Township: 26N Range: 01W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 09/06/2004 OWNER, JANET D ROGERS PHONE: (360)765-3966 if different: 480 JOHNSON RD QUILCENE WA 98376-9619 PROJECT DESCRIPTION PROPANE TANK& FIREPLACE 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 12/02/2003. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance:‘,i , _/2—/ `t- [ ] FinalApproval: W 60Nd l,Z -//—©'- 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 BUILDING PERMIT APPLIC•ON BLD02-007702 view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD02-00702 Received Date: 12/2/2002 SITE ADDRESS: 480 JOHNSON RD QUILCENE, 98376 OWNER: JANET D ROGERS PHONE: (360)765-3966 480 JOHNSON RD QUILCENE WA 98376-9619 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601342016 Section: 34 Township: 26 N Range: 01 W CONTRACTOR: FERRELLGAS PHONE: (360)385-6998 2108SIMSWAY PORT TOWSEND WA 98368 Contractor's License FERRELP055LH Expires 8/1/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP PROPANE TANK & FIREPLACE 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 12/02/02 51465 Total: $47.00 JEFFERSON COUNTY COMMUIDEVELOPMENT,621 SHERIDAN ST,PORT TOWD 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 COOK! G STOVE XOTHER(Please Specify) 2"f�G f -e -�'---� Is this appliance(htgstove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Hom ? YES NO SITE ADDRESS(911#/Road Name): 2/ gi-A-13" ./.1iJ 4-- rt //LW- ZIP 9 .---' �`G7 jl2.9 9 DIGIT PARCEL ID NUMBER (G dl- 3 $.� / C� Legal Description: �/ Subdivision Name / Block Lot(s) Section a j/l Township , )4. North, Range / _ WM APPLICANT j%�1,�,,'I U `" .."`,,/ PHONE MAILING ADDRESS , -- %id---- /6 �lL� � / ZIP � a PROPERTY OWNER `L'.r�i T1 d"�,t �`"- PHONE 7 ' 3/ .' d MAILING ADDRESS .'�t-';11ytJZ_-._ CiG - ,o / ,t-yv 7`L-C_-- ZIP �/ CONTRACTOR /..."' 47 Tp� / �,, /tom PHONE O 6s MAILING ADDRESS / �' p� ZIP STATE LICENSE# 44r /! Z`'/(n/L i- ! - �� EXP. DATE __ / _ 45:7G FEDERAL I.D.# ! 3 -- /{v e". Z2/ )71 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 o.r agents for the purpose of application review and any required later inspections. Access and ' t of entry to the jap 's property or structure shall be requested and shall occur during regular business hours.//026_GA APPLICANT'S SIGNATURE .,.(,i 1/ /� �3 �~ DATE // / / 02 6 4 FOR OFFICE USE ONLY BASE FEE RECEIPT# CONSISTENCY REVIEW ((� (ASH/ ,}S# 0Y L TOTAL !`�� I�T�J / /C�)..- *Underground Propane Tank applications require additional information to b• •r itted. 0 01E 1 Please contact our office at 360-379-4450 if the back of this application is bi. i H:\HOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC DEC — 2 2002 .1 JL �:� Y DEPT.OF COMMUNITY DEVELOPMENT 1y Gb