HomeMy WebLinkAboutBLD2002-00747 ilkBUILDING PERMIT APPLICON B Review
7
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00747 Received Date: 12/30/2002
SITE ADDRESS: 290 W SWANEY ST
PORT HADLOCK, 98339
OWNER: MARIA A LAROCQUE PHONE: (360)385-4226
290 W SWANEY ST
PORT HADLOCK WA 98339
SUBDIVISION: IRONDALE Block: 71 Lot: 40-45
PARCEL NUMBER: 961807109 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
TANK PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS 0 2 2NQ Expires 9/6/2 0 0 4
CONTRACTOR PHONE:
RANGE & FRPLCE Alan D Vanassche
VANASADO12DE Expires 3/6/2003
PROJECT DESCRIPTION PROPANE TANK, RANGE & FIREPLACE
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
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 12/30/02 52750
Total: $47.00
• •
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 #: BLD02-00747 Received Date 12/30/2002
SITE ADDRESS: 290 W SWANEY ST Issue Date 12/31/2002
PORT HADLOCK, 98339
APPLICANT: MARIA A LAROCQUE PHONE: (360)385-4226
290 W SWANEY ST
PORT HADLOCK WA 98339
40-45
SUBDIVISION: IRONDALE Block: 71 Lot:
PARCEL NUMBER: 961807109 Section: 34 Township: 30N Range: 01W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518 CENEXHS022NQ 9/6/2004
Alan D Vanasscicontractor's License VANASAD012DE Expires 3/6/2003
OWNER, MARIA A LAROCQUE PHONE: (360)385-4226
if different: 290 W SWANEY ST
PORT HADLOCK WA 98339
PROJECT DESCRIPTION: PROPANE TANK, RANGE& 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 12/31/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: a< -ar- eh /72 a3,
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_Perm it_P ropane.rpt 10/29/19
JEFFERSON COUNTY COMMUP DEVELOPMENT,621 SHERIDAN ST,PORT TOW/D 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) L P /Z4 6 __ gl 4 P / '/cLp44-6.6_
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):
2Se r). sco, ° y S7 -
2-7" A4z.)4o sr fit),4}" ZIP 9c
9 DIGIT PARCEL ID NUMBER /ur/ W-O 7 l d 9
.... /,
Legal Description:
Subdivision Name ,/----- Bloc Lot(s)
Section Towns North, Range WM
APPLICANT /'�//S1/Z/� /S D I.�L/ j PHONE v� 226
MAILING AD RE .!✓,O A 14fil6-V,-S7 .
%ZT (. G/ /� / ZIP �cf 3.i
PROPERTY 0 ER ',- � `- /�r PHONE
MAILING ADDRES f-----
/� ----- '.� / ZIP
(-F-/CONTRACTOR 'EX &Pi9iV E /AW 4UL PHONE
MAIL4NG-4511DRESS- AAA/ Vi T— / E'L 9( Fig
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 entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access andyrigghh of entry to t a applicant's property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE %4224 s yCG ___-- DATE /2 / d / e32-
�, `F OR OFFICE USE ONLY RECEIPT# ,' J O
BASE FEE /�
/
CONSISTENCY REVIEW CASH/CK# 2O �,
TOTAL l 7"6 DATE "9 / ✓O 0&---
*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 bla Milk
H:\I-TOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC , i
DEC 3 0 2002
JEFFEFIC)ON COUNTY DCD