HomeMy WebLinkAboutBLD2003-00233 • •
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 #: BLD03-00233 Received Date 4/11/2003
SITE ADDRESS: 2363 OLD GARDINER RD Issue Date 4/11/2003
SEQUIM, 98382
APPLICANT: EUGENE E HILL PHONE: (360)797-7290
DEANNE HILL
2363 OLD GARDINER RD
SEQUIM WA 98382-8704 2
SUBDIVISION: GATCHET SHORT PLAT#2 Block: Lot:
PARCEL NUMBER: 002352029 Section: 35 Township: 30N Range: 02W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CENEXHS022NQ Expires 9/6/2004
OWNER, EUGENE E HILL PHONE: (360)797-7290
if different: DEANNE HILL
2363 OLD GARDINER RD
SEQUIM WA 98382-8704
PROJECT DESCRIPTION: PROPANE TANK& LINE RELOCATION
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 4/11/2004.
REQUIRED INSPECTIONS:
[\,].-----(fank1&Appliance: to"::-/C' .5.;?/i CC�C
inalAgproval: 40/ C °- 4r MP
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
443
UILDING PERMIT APPLIC ON B Review
002 3
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00233 Received Date: 4/11/2003
SITE ADDRESS: 2363 OLD GARDINER RD
SEQUIM, 98382
OWNER: EUGENE E HILL PHONE: (360)797-7290
DEANNE HILL
2363 OLD GARDINER RD
SEQUIM WA 98382-8704
SUBDIVISION: GAT HET SHORT PLAT#2 Block: Lot: 2
PARCEL NUMBER: 002352029 Section: 35 Township: 30 N Range: 02 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 DESCRIPTIOr PROPANE TANK & LINE RELOCATION
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 04/11/03 56014
Total: $47.00
JEFFERSON COUNTY COMMUEVELOPMENT,621 SHERIDAN ST,PORT TOW•D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* J� Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify) 020 p, W.- 1 J9/U L `f' !.i Ape- , S e- Zoty i re__,
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):
a 3:3 OLD GAab 1 z RD
S�cc,,CIJ'a'L 1 ^( }R �l ZIP d 31S Z
9 DIGIT PARCEL ID NUMBER Q a ? 3 S 2 U 3
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE
MAILING ADDRESS
/_.J ,2 ZIP -/7
PROPERTY OWNER � 1 i/�/ft/e_ l//L�, /� PHONE '7 9/` — 2-9 o
�
MAILING ADDRESS )6 J OL- /2� j/ -l/Z., 2D•
S vL Q'..e/r-7 / 6u4 ZIP 2d :PZ
CONTRACTOR Ce-V e-X /7' '2 U e s 1 STATe-&— PHONE 7 3 2 "`vJ e-N
MAILING ADDRESS pc. 10 O-X '. Q
��Airn IS�,C,c.-i -> / [.,cam n: ZIP ?3 z-
STATE LICENSE# C e1ve-le//.(>le- WQ EXP.DATE U S f/6/e
FEDERAL I.D.# eT7d1— O?-3/0 9 S
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.
APPLICANTS SIGNATURE DATE / /
FOR OFFICE USE ONLY BASE FEE RECEIPT# 5 .0( `I
CONSISTENCY REVIEW 0 K#
TOTAL DATE C' /I I / 03
*Underground Propane Tank applications require additional information to be submitted. 0 V E R 0. (P-
Please contact our office at 360-379-4450 if the back of this application is blank.
g:\permitcenter\forms\bldg forms\install-revised 10-23-02.doc