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Home My WebLink AboutBLD2003-00051 111 • 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 #: BLD03-00051 Received Date 1/27/2003 SITE ADDRESS: 355 RHODODENDRON DR Issue Date 1/29/2003 QUILCENE, 98376 APPLICANT: FRANK K MC CUBBINS JR PHONE: (360)765-3110 ANGELA/JOHANNA MC CUBBINS 355 RHODODENDRON DR QUILCENE WA 98376-8609 26 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701344033 Section: 34 Township: 27N Range: 01W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 9/6/2004 OWNER, FRANK K MC CUBBINS JR PHONE: (360)765-3110 if different: ANGELA/JOHANNA MC CUBBINS 355 RHODODENDRON DR QUILCENE WA 98376-8609 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 1/29/2004. REQUIRED INSPECTIONS: i '' ''>1 Tank/Line/Appliance: pe A -, \%),( FinalApproval: at< -cor C, / u G3 ,eg/-- 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 1113 BLD03-0005'I UILDING PERMIT APPLICON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00051 Received Date: 1/27/2003 SITE ADDRESS: 355 RHODODENDRON DR QUILCENE, 98376 OWNER: FRANK K MC CUBBINS JR PHONE: (360)765-3110 ANGELA/JOHANNA MC CUBBINS 355 RHODODENDRON DR QUILCENE WA 98376-8609 SUBDIVISION: Block: Lot: 26 PARCEL NUMBER: 701344033 Section: 34 Township: 27 N Range: 01 W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 9/6/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI, PROPANE TANK INSTALLATION 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: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 01/27/03 52974 Total: $47.00 JEFFERSON COUNTY COMMUN•EVELOPMENT,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* ,' 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 x. NO SITE ADDRESS(911#/Road Name): 3 E3 ROO.ND NTt or'l OUI LCENe, \N k ZIP qi�S 3-7(O 9 DIGIT PARCEL ID NUMBER -701 3`44-1- 033 Legal Description: Subdivision Name DIA GO\J COm mL&M IT"' Block Lot(s) a4' Section Township North, Range WM IW1 Pu)(... APPLICANT FRANK ,f IATtGE-A l 1a CuBP,tPS PHONE ( (7� .11O5-31 I MAILING ADDRESS '365 RI0-D017Ef.IDe-Om .'N k'- QUIZ.-GENE 1 \Nk ZIP 1N37(v PROPERTY OWNER PHONE MAILING ADDRESS ZIP CONTRACTOR Cet e X 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' pr perty or structure shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE a1 71/C DATE 0 / / _7 / 03 BASE FEE L 1'q - FOR OFFICE USE ONLY RECEIPT# 5�2-9 ! -1 CONSISTENCY REVIEW (,( CASH/CK# 2I%-vC_ TOTAL -J DATE I /14/ o3 *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. 1.11* H:\I-IOME\PLNCNTR\I NFOBLDG\FORMS\I NSTALL.DOC