HomeMy WebLinkAboutBLD2002-00730 ! •
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 #: BLD02-00730 Received Date 12/17/2002
SITE ADDRESS: 1701 DUCKABUSH RD Issue Date 12/17/2002
BRINNON, 98320
APPLICANT: FRED S SHAW PHONE:
PAMELA J SHAW
1701 DUCKABUSH RD
BRINNON WA 983209623
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502083008 Section: 8 Township: 25N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, FRED S SHAW PHONE:
if different: PAMELA J SHAW
1701 DUCKABUSH RD
BRINNON WA 983209623
PROJECT DESCRIPTION PROPANE TANK AND HEAT STOVE
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 12/17/2003.
REQUIRED INSPECTIONS:
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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
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UILDING PERMIT APPLICA'l'! DN BLD02-00730
Jefferson County Department of Community Development Review Type:
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD02-00730 Received Date: 12/17/2002
SITE ADDRESS: 1701 DUCKABUSH RD
BRINNON, 98320
OWNER: FRED S SHAW
PAMELA J SHAW PHONE:
1701 DUCKABUSH RD
BRINNON WA 983209623
SUBDIVISION:
PARCEL NUMBER: 502083008 Section: 8 Township: 2510 N Range: 02 Wt
CONTRACTOR: OWNER/BUILDER
PHONE:
REPRESENTATIVE:
PHONE:
PROJECT DESCRIPTIO PROPANE TANK AND HEAT STOVE
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:
CONST TYPE: GARAGE: SHORELINE:
DECK: SETBACK:
SEWAGE DISPOSAL: BANK HEIGHT:
WATER SYSTEM:
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
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
lit •1
•e Amount Paid i Approved/Date
Propane Tanks/Stoves $47.00 ZAN 12/17/02 52728
Total: 11
JEFFERSON COUNTY COMMUNIOEVELOPMENT,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* t/ 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 1� NO
SITE ADDRESS(911 #/Road Name): , /
t.d 1 Obiel 7 es.
ZIP 9?3 r Q
9 DIGIT PARCEL ID NUMBER .�0 b�y.P3 0O g
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT r c ..0 J t ,'loy PHONE 36-&" f 9 o//
MAILING ADDRESS / 70/ 4)G16 k iO Pf IN
/arel rI YJ 6 7-\, 44. ZIP 9 &.1,:;,-0
PROPERTY OWNER S iY✓.1 PHONE 36)" "79/ ,Zo7/
MAILING ADDRESS
�y
ZIP
CONTRACTOR 0L✓4 e1/L PHONE
_
MAILING ADDRESS ,con')e As q/- I---C....
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 en ry to Jeffer ounty and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right y t e... .�'s property or structure shall be requested and shall occur during`re�ggular business hours.
APPLICANTS SIGNATURE DATE / 2 / /7 / 62
BASE FEE (,f o FOR OFFICE USE ONLY
RECEIPT# Sa tJ
CONSISTENCY REVIEW CASH/CK# C_./ z 14
TOTAL Ltt - 0t DATE 12 /C? / D 2--
*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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