HomeMy WebLinkAboutBLD2002-00704 • •
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 #: BLD02-00704 Received Date 12/2/2002
SITE ADDRESS: 81 REEF RD Issue Date 12/2/2002
NORDLAND, 98358
APPLICANT: HENRY I NICHOLS PHONE:
835 JEFFERSON ST
PORT TOWNSEND WA 983685819
1
SUBDIVISION: KILISUT REEF ESTATES Block: Lot:
PARCEL NUMBER: 021184002 Section: 18 Township: 30N Range: 01 E
CONTRACTOR: JEFF WHITTING PHONE:
1111 GRIFFITHS PT RD
NORDLAND WA 98358
OWNER, HENRY I NICHOLS PHONE:
if different: 835 JEFFERSON ST
PORT TOWNSEND WA 983685819
PROJECT DESCRIPTION PROPANE HEATING 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 12/02/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
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 BLD02-00704
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00704 Received Date: 12/2/2002
SITE ADDRESS: 81 REEF RD
NORDLAND, 98358
OWNER: HENRY I NICHOLS PHONE:
835 JEFFERSON ST
PORT TOWNSEND WA 983685819
SUBDIVISION: KILISUT REEF ESTATES Block: Lot: 1
PARCEL NUMBER: 021184002 Section: 18 Township: 30 N Range: 01 E
CONTRACTOR: JEFF WHITTING PHONE:
1111 GRIFFITHS PT RD
NORDLAND WA 98358
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO PROPANE HEATING STOVE INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
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 12/02/02 51343
Total: $47.00
JEFFERSON COUNTY COMMUI EVELOPMENT,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 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):
Rt / f /9-6
Aft7.0-61 %L IAJA . ZIP 9,r3S8
9 DIGIT PARCEL ID NUMBER 02.1 / 8 1---/ c9692.
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT j AJ///T/7N PHONE _AO _ a 'DS 4-/e
MAILING ADDRESS / / 61 i i7Mi' /P7 )2_A.
Axe r2-4 L f IN ZIP 9GPL3s-cf'
PROPERTY OWNER //e/V/Z y hJ((-7101.S PHONE 36 0 '-3 8.5-iy 7S67
MAILING ADDRESS St ! �/G ,9O
/U0/2-6c- /j / ZIP 783s6J
CONTRACTOR /cF IAJH/TT/NC PHONE : 60 -379-06-`-/y
MAILING ADDRESS //// e /Z-;/G//Tht5 P P-ai-i 6
Al d'�G O
l f/V , ZIP .3 6
STATE LICENSE# /1/ YS% w ? 90r,I 6 EXP.DATE 6/2-7/04"
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 ri ht of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access an r' entry t�licant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE , Z / a /0 2-
BASE FEE �7,� FOR OFFICE USE ONLY r/
RECEIPT# SJ 373
CONSISTENCY REVIEW -7 CASH/CK# 7(S9
TOTAL 4 1 -cO DATE 7_-/ Z.--/ 0 Z 0217
-
*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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