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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 #: BLD02-00721 Received Date 12/11/2002
SITE ADDRESS: 251 JANSEN RD Issue Date 12/11/2002
NORDLAND, 98358
APPLICANT: EFFRAN JO E LOVATO PHONE: (360)385-5804
LILLIAN T LOVATO
251 JANSEN RD
NORDLAND WA 98358-9538 3
SUBDIVISION: JANSEN SHORT PLAT 1.14AC Block: Lot:
PARCEL NUMBER: 977700084 Section: 4 Township: 29N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2004
OWNER, EFFRAN JO E LOVATO PHONE: (360)385-5804
if different: LILLIAN T LOVATO
251 JANSEN RD
NORDLAND WA 98358-9538
PROJECT DESCRIPTION: PROPANE TANK& FIREPLACE 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 12/11/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: L- C o,-J 0 1--hi_oy
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 •
Revviewiew T Ty PERMIT APPLIC•ON BL y721
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00721 Received Date: 12/11/2002
SITE ADDRESS: 251 JANSEN RD
NORDLAND, 98358
OWNER: EFFRAN JO E LOVATO PHONE: (360)385-5804
LILLIAN T LOVATO
251 JANSEN RD
NORDLAND WA 98358-9538
SUBDIVISION: JANSEN SHORT PLAT 1.14AC Block: Lot: 3
PARCEL NUMBER: 977700084 Section: 4 Township: 29 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractors License MOUNTPI983O6 Expires 9/26/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr PROPANE TANK & FIREPLACE INSTALLATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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 12/11/02 51490
Total: $47.00
JEFFERSON COUNTY COMMU•DEVELOPMENT,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 NO
SITE ADDRESS(911#/Road Name):
7-1 - / 1pa'J . t:Aj,
( it r ,js%, b,r,., et ZIP G�.,1 4),
9 DIGIT PARCEL ID NUMBER OTT4-0C) C:c
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range VVM
4-%F1(./riti .I-
APPLICANT `a 'id--a 7'-6 PHONE 3 g C` T 8,0 V-
MAILING ADDRESS .2 ti ( j d.q.-': is r,,
ZIP
PROPERTY OWNER •, 1-1?/2 c%. PHONE
MAILING ADDRESS
ZIP
CONTRACTOR ,1/,..,.I .,.:TM I - v Z.N .4/b'c;
/// ,fin' PHONE ��ilj�-�O 3 g.j
MAILING ADDRESS A 65.yeili /g-d (,(!� 'el-
PM r /1 /Pe-`2- f ti- /(1` ZIP 91319
STATE LICENSE# faC),ei2 " 33 --9 ' EXP.DATE 9/3d/o 3
FEDERAL I.D.# Ll - as V G
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 ani.rigtflt of entry to the appli+cYnt's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE .( ``( "
7'1' l DATE f', / f / fir.,.
D FOR OFFICE USE ONLY
BASE FEE 41 O RECEIPT# el OCR)
CONSISTENCY REVIEW CASH/CK# ll1 133 g
TOTAL LI—I , DATE !a /1I / 0)-
*Underground Propane Tank applications require additional information to be submitted. OVER
GIC an uNF f3BL ,1F N.•r •tST' Q"�f the back of this application is blank. .1.1.*
C `
DEC 11 2002 iL.
JErtti,; ;; urdY
DEPT.OF COMMUNITY DEVELOPMENT