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HomeMy WebLinkAboutBLD2003-00152 • • 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 #: BLD03-00152 Received Date 3/11/2003 SITE ADDRESS: 82 NICHOLSMITH LN Issue Date 3/12/2003 BRINNON, 98320 APPLICANT: DAVID C SELLMAN PHONE: (360)796-9954 SHERRY R SELLMAN PO BOX 172 QUILCENE WA 98376 GV'T1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 602231007 Section: 23 Township: 26N Range: 02W CONTRACTOR: ALL SEASONS GAS PHONE: PO BOX 2069 BELFAIR WA 98528 Contractor's License ALLSEG*024L3 Expires 11/26/2003 OWNER, DAVID C SELLMAN PHONE: (360)796-9954 if different: SHERRY R SELLMAN PO BOX 172 QUILCENE WA 98376 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 3/12/2004. REQUIRED INSPECTIONS: [ (110? Line/Appliance: 9///,0 3 lel ( ,'-!J / A(e.. /e?.ttNrJF.4c 7 e)i7 E--17 Ne9/✓&` z_f r %C, Dee) F�"..T 7 . nalApprov ®lC 54/l7®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 03-00152 LD 41UILDING PERMIT APPLICAON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00152 Received Date: 3/1B1/2003 SITE ADDRESS: 82 NICHOLSMITH LN BRINNON, 98320 OWNER: DAVID C SELLMAN PHONE: (360)796-9954 SHERRY R SELLMAN PO BOX 172 QUILCENE WA 98376 SUBDIVISION: Block: Lot: GV'T1 PARCEL NUMBER: 602231007 Section: 23 Township: 26 N Range: 02 W CONTRACTOR: ALL SEASONS GAS PHONE: PO BOX 2069 BELFAIR WA 98528 Contractor's License ALLSEG*024L3 Expires 11/26/2003 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 03/11/03 55193 Total: $47.00 • JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEIVD 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 r FIREPLACE INSERT PELLET STOVE____COOKING STOVE i CP _1 OTHER(Please Specify) j -P is this ppliance.(l tg.stove, I l ,,,,, rna! .tc.)ta-1 .installed in a Manufactured/till ,bile Home? °YES NO SITE ADDRESS(911#/Road Name): 'aZ ,(//!/yo4 s/// )TA/ LAM/4- `3i/2//t/.f/O //e /V 90932 0 ZIP 94?-0 9 DIGIT PARCEL ID NUMBER e:a..2..3I 007 Legal Description: C) * TM X3/ Subdivision Name �' � 7 Seel'f/7_r9Z3 Y, Block Lot(s) I Section_ �.3 Township_____+-', ___North, Range it) WM A LICANT ,SMF.egy /l, ,S7.1Cl L/r?i42:4/ ---- PHONE ,"7l?_ 7 9 e . 99,5Y MAILING ADDRESS ,l7. 60K /72 N'atL_CAE//Z- �J Q y� ZIP 9C -77I D/72 PROPERTY OWNER /4 V I D C. -,/ //t.S/'E/,A J?LL 11 F 4/ PHONE t� -7 - 9(6---471 �T MAILING ADDRESS SAS 1 E 0 cFL .36.o•; �p • 0,2 3.j -FATAL AL -4 Alt Seas()VLS ZIP N LCONTRACTOR �G04/oilt /�i 7�4/G # Si4E6/ C/ PHONE ti MAILING ADDRESS CIP-7-5-3 -S' //4-T, Hay 3 /y f ,c9/e 1c,' %6°AV /to /- ZIP 9 dP 31 , STATE LICENSE# ag-4 40I© J c�CV 7 —__ EXP.DATE ?.'79.7�/ . FEDERAL I.D.# (/ .4,(1 (J�..5 / --- ---_ 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 t eff son 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 1 roperty or s ruct to shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATUR — ✓ DATE Ge',.. / 7/ / _/ BASE FEE Li OR OFFICEUSE ONLY RECEIPT# 55 19 3 _ CONSISTENCY REVIEW CASH/CK# . -OL5 TOTAL a- 0 0 DATE 3 '-1-1. /. v3 *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. 1111110 H:\HOME\P LNC NTR\I N FOBLD G\FORMS\I NSTALL.DOC 3(c0 3q O9 5 ii-