HomeMy WebLinkAboutBLD2003-00043 • •
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 #: BLD03-00043 Received Date 1/22/2003
SITE ADDRESS: 604 ROBBINS RD Issue Date 1/24/2003
NORDLAND, 98358
APPLICANT: WILLIAM S ECHOLS TRUSTEE PHONE: (360)379-2664
MICHELLE M ECHOLS TRUSTEE
604 ROBBINS RD
NORDLAND WA 98358-9672 T 58
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921093012 Section: 9 Township: 29N Range: 01E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
OWNER, WILLIAM S ECHOLS TRUSTEE PHONE: (360)379-2664
if different: MICHELLE M ECHOES TRUSTEE
604 ROBBINS RD
NORDLAND WA 98358-9672
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 1/24/2004.
REQUIRED INSPECTIONS:
[� 40k/Line/Appliance: 24r01
[*1 FinalApproval:'7 fl"/ 2-1 'off
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
UILDING PERMIT APPLICON BLD03-00043
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00043 Received Date: 1/22/2003
SITE ADDRESS: 604 ROBBINS RD
NORDLAND, 98358
OWNER: WILLIAM S ECHOLS TRUSTEE PHONE: (360)379-2664
MICHELLE M ECHOLS TRUSTEE
604 ROBBINS RD
NORDLAND WA 98358-9672
SUBDIVISION: Block: Lot: T 58
PARCEL NUMBER: 921093012 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP PROPANE TANK 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
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 01/22/03 52959
Total: $47.00
JEFFERSON COUNTY COMMUNII,EVELOPMENT,621 SHERIDAN ST PORT TOW 'rut:j wig ma'Ili' - -,a.;
INSTALLATION PERMIT APPLICATIOtL �
—
I
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION ^ ! i
,�aN z L i
underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE"' "� HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
DEPT. OF COMlviLltkii(Y i EVELOPMENT
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):
N
/ l ev -
A.)C-- ZIP ` di-J.
9 DIGIT PARCEL ID NUMBER 9c G/ D 7 O/_--
Legal Description:
Subdivision Name Block Lot(s)
Section/ti / Township / North, Range �7 C / VVM
APPLICANT /CJ/1` r m rL 'd L &i"`-ty-�/ PHONE 3 r j )- 6
MAILING ADDRESS {O 0 Li �� 'y/bi!'uo , 1
L ZIP Q di d
47 PROPERTY OWNER PHONE
MAILING ADDRESS f
ZIP
r'�
)21 CONTRACTOR / ; / 'L+^- J PHONE $F '_ 77 7
/MAILING ADDRESS 68 J3 •Q- 9j/'� ZIP STATE LICENSE# ��'� * 07 7 eP EXP.DATE /VO y
FEDERAL I.D.# T - /O 7 99,1>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 C my and it's employees, representatives or agents for the purpose of application review and any
required later inspections. Access and right of entr to the applica t's property or structure shall be requested�a pal
l all occur during regular business hours.
APPLICANTS SIGNATURE Y — (' 4 J ) DATE l /2/ / ..?
FOR OFFICE USE ONLY
BASE FEE RECEIPT# 529 59
CONSISTENCY REVIEW CASH/CK# 9)_
TOTAL DATE I 122 103
*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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