HomeMy WebLinkAboutBLD2003-00176 •
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#: BLD03-00176 Received Date 3/20/2003
SITE ADDRESS: 2078 TOANDOS RD Issue Date 3/20/2003
QUILCENE, 98376
APPLICANT: WARREN F TYTLER PHONE:
PO BOX 805
POULSBO WA 983700805
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701223003 Section: 22 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, WARREN F TYTLER PHONE:
if different: PO BOX 805
POULSBO WA 983700805
PROJECT DESCRIPTION: INSTALL PROPANE TANK
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 3/20/2004.
REQUIRED INSPECTIONS:
[ ] 1 ine/Appliance: AA)i< .01ULY 0-7A41,
[ ] FinalApproval: O �a ar C�O 1/Z7 2
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
•
BUILDING PERMIT APPLIION B Review
u
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00176 Received Date: 3/20/2003
SITE ADDRESS: 2078 TOANDOS RD
QUILCENE, 98376
OWNER: WARREN F TYTLER PHONE:
PO BOX 805
POULSBO WA 983700805
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701223003 Section: 22 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 DESCRIPTION INSTALL PROPANE TANK
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: J �„ ^ F&W Landslide
"ZadQ �(�`/'-�R'-�`) Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 PRB 03/20/03 55962
Total: $47.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT,621 SHERIDAN ST,PORT TOWNSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE XAbove Ground PROPANE TANK PELLET STOVE OTHER
Is this appliance (htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Horne?_
YES NO
SITE ADDRESS(911#/Road Name):Z07 ' /a )2'9s /21
di..„ 44,i e ZIP 9_5.7ka
9 DIGIT PARCEL ID NUMBER 7O/- , '2- Oo 3
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT , //2 .'it.) 2-. ..
�c l` OJ `
/ , PHON� -ry' 9�C�- 4/2.'
MAILING ADDRESS �. // S
/"'. a-- ,6 / ZIP 9g870
PROPERTY OWNER Ci.)149 ...11 i .- f2 PHONIC 2!9 t V
MAILING ADDRESS / i) '/22X �>!'�� �e
ra 0 / �ti ZIP � z376
CONTRACTOR PHONE 73Z- 4 5 /
MAILING ADDRESS / OO i ,1 Gib' �-?lam.- .,(.--/ � -1
f� , /4 ZIP er 2
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.
?........**/7
APPLICANT SIGNATURE ,=Csy?0; j-'t_...7 DATE 3 // / 7
FOR OFFICE USE ONLY
BASE FEE 47.00 RECEIPT# 559 ,Z
00 CASH/CK# CASE t--
TOTAL 47- DATE /!—/03
H:NOME\PLNCNTR\INFOBLDG\FORMS\INSTALL.DOC11/05/01