HomeMy WebLinkAboutBLD2002-00741 0
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 #: BLD02-00741 Received Date 12/27/2002
SITE ADDRESS: 1555 VAN TROJEN RD Issue Date 12/27/2002
CHIMACUM, 98325
APPLICANT: HEATHER M HARDING PHONE: (360)732-4638
PO BOX 12
CHIMACUM WA 98325-0012
TX 18
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901223007 Section: 22 Township: 29N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, HEATHER M HARDING PHONE: (360)732-4638
if different: PO BOX 12
CHIMACUM WA 98325-0012
PROJECT DESCRIPTION: PROPANE TANK 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 12/27/2003.
REQUIRED INSPECTIONS:
[(,K- I ine/Appliance: C E'
[ nalApprove /'e• /�/?/7a 'i .7....2 .
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
1
JEFFERSON COUNTY COMMUS DEVELOPMENT,621 SHERIDAN ST,PORT TOWD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
JcJArUnderground PROPANE TANK* X Above Grou d 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):
tS 55 V ----1 / D ( ,
6 -`rye 1.&-c. . G.) A. ZIP q f l LS
9 DIGIT PARCEL ID NUMBER g o t 0\,)-3 007
Legal Description:
Subdivision Name Block Lot(s)
Section
4 Township North, Range WM
APPLICANT 1`4 e'7-Ks v c�p- 7I i n f PHONE 73 a_ ,iG 3
MAILING ADDRESS P�d� Bax (I-- 5
(I-
CA ip y c kw` ZIP [ d)1
PROPERTY OWNER L . PHONE 7/
MAILING ADDRESS I,
ZIP
CONTRACTOR SUNSHINE PROPANE PHONE
Quality Energy Services Since 1980
MAILING ADDRESS 10853 Rhody Dr.Hadlock,WA 98339
ilk (360)385- or 683-4010 Ip
ZIP
STATE LICENSE# S u n c y p 2r 077 C1 P EXP.DATE ///O
FEDERAL I.D.# 9/ - /O 71 8 S 7
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 right entry to the a licant's property or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE DATE ( L/ L y/ o L___-
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 52:380
CONSISTENCY REVIEW CASH/CK# C t V Li
TOTAL DATE 1-2-/Zf/ OZ-
*Underground Propane Tank applications require additional information to be submitted. Please contact our office at 360-379-4450 if the back of
this application is blank.
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