HomeMy WebLinkAboutBLD2003-00093 • 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 #: BLD03-00093 Received Date 2/18/2003
SITE ADDRESS: 327 PEAT PLANK RD Issue Date 2/19/2003
CHIMACUM, 98325
APPLICANT: CHERIE I PERRY PHONE: (360)732-4759
327 PEAT PLANK
CHIMACUM WA 98325-0303
T9
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901253001 Section: 25 Township: 29N 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, CHERIE I PERRY PHONE: (360)732-4759
if different: 327 PEAT PLANK
CHIMACUM WA 98325-0303
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 2/19/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: C -3//
[ ] FinalApproval: (. t"hrJqLGj7 -a,/7A'3
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 APPLIC•ON BLD03-00093
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00093 Received Date: 2/18/2003
SITE ADDRESS: 327 PEAT PLANK RD
CHIMACUM, 98325
OWNER: CHERIE I PERRY PHONE: (360)732-4759
327 PEAT PLANK
CHIMACUM WA 98325-0303
SUBDIVISION: Block: Lot: T 9
PARCEL NUMBER: 901253001 Section: 25 Township: 29 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 DESCRIPTION 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:
OTHER:
CONST TYPE: 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 02/18/03 54987
Total: $47.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNS ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE X Above Ground PROPANE TANK PELLET STOVE OTHER
0.
Is this appliance (htg stove, hot water tank,furnace,etc.)to be installed in a Manufactured/Mobile Home?
JEFFERSON COUNTY DCD YES NO
SITE ADDRESS(911#/Road Name):
3Z ??/17- Z .44k— ,'o
(71V/HA e'e J f.'w lv ZIP 9'6325
9 DIGIT PARCEL ID NUMBER 'eV-- 25 3 -az9/
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range �y WM
APPLICANT 6 ,�/- 1. .-/e,e PHONE 73lT 4/75 7
MAILING ADDRESS .27 P-k/9T / G- ill/ A2-t
L- h/l2 04i)i ZZ4 1W J L-L// ZIP /E1'Z 5
PROPERTY OWNER /2--/ / #Z, 7/ PHONE / -'' 5 45)
MAILING ADDRESS 3')-� Pi '
47' �.1/'I//� /? 0 C
3 7 -
°i1,/l1t7J X2t,-' JL-1/-� ?ZIP ?7
CONTRACTOR e, ,,T PHONE 42- Al U
MAILING ADDRESS /Ar > ,Lt�* 24 L/
( /,' e_44)2 J , Li) /Q ZIP 3 g Z
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 or structure shall be requested and shall occur during regular business hours.
APPLICANT SIGNATURE DATE / 13/ 3)
O FOR OFFICE USE ONLY G�
BASE FEE /T
v/� RECEIPT# ! �7
CASH/CK#
TOTAL 7 _CO� DATE d'14_11K7d 3
H:U-TOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC 11/05/01