HomeMy WebLinkAboutBLD2003-00050 .� .r
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 #: BLD03-00050 Received Date 1/24/2003
SITE ADDRESS: 527 VALLEY VIEW LN Issue Date 1/29/2003
BRINNON, 98320
APPLICANT: WILLIAM S WOLINSKI PHONE: (360)796-9926
AURILLIA J WOLINSKI
12314 239TH AVE E
BUCKLEY WA 98321-9398 3
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502072027 Section: 7 Township: 25N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, WILLIAM S WOLINSKI PHONE: (360)796-9926
if different: AURILLIA J WOLINSKI
12314 239TH AVE E
BUCKLEY WA 98321-9398
PROJECT DESCRIPTION: WOODSTOVE 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 1/29/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[11 FinalApproval: 577) `1.(- L-6^03
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
�-. 41°BUILDING PERMIT APPLICSION BLD03-00050
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00050 Received Date: 1/24/2003
SITE ADDRESS: 527 VALLEY VIEW LN
BRINNON, 98320
OWNER: WILLIAM S WOLINSKI PHONE: (360)796-9926
AURILLIA J WOLINSKI
12314 239TH AVE E
BUCKLEY WA 98321-9398
SUBDIVISION: Block: Lot: 3
PARCEL NUMBER: 502072027 Section: 7 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP WOODSTOVE 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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 01/24/03 54921
Total: $47.00
JEFFERSON COUNTY COMMU EVELOPMENT,621 SHERIDAN ST,PORT TOWIOD WA 98,368 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):
5 2-7 V.n LE) Vl .d LAA1
a le/A✓4/1,i L✓A • ZIP Z g 32- 17
9 DIGIT PARCEL ID NUMBER So 2 o7 Z o Z 7
Legal Description:
�""�� 3 RAr.Y.3
Subdivision Name /tee/v / it 0-✓'y NEB e'y'r r Block Lot(s) Z 6/2
Section 7 / Township 2 S North, Range 0 Z-- WM
APPLICANT vi/////t A pet S. 14.1.9/.a..n4-• PHONE 3 6e) 7 P6 9 P2-6
MAILING ADDRESS /2_3 /5/ 2 3 9 Avt - a N "T
` (/ .ier411J
/3 g/4c-L--c y L4/.4 ZIP 9 g 32 -/
PROPERTY OWNER /4.4 //,t... J, 404 444 J 4t' A PHONE 3 b O get 7-- Z-J 3 3
MAILING ADDRESS /2. 3 / `' Z 3 9 4--4' A v'1/47 c
t.,c. -(,t 1 1,a/A ZIP 98 32- /
CONTRACTOR PHONE
MAILING ADDRESS
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 and right of entry to the applicant's property orstructure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE 4 '4 4 76 • DATE / / 2.3 / o 3
FOR OFFICE USE ONLY �j f 9 2
BASE FEE I•}� RECEIPT# J _f `�
CONSISTENCY REVIEW CASH/CK# (0 I 9..
TOTAL . , in) DATE i lay/
*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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