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Home My WebLink AboutBLD2003-00324 BLD03-00324 BUILDING PERMIT APPLICA!ION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00324 Received Date: 5/27/2003 SITE ADDRESS: 3682 LINDSEY HILL RD QUILCENE, 98376 OWNER: HENDERSON JACK H & SHANNON P PHONE: ROBERT&VALLYN HENDERSON 7225 NE PEBBLE BEACH RD SUQUAMISH WA 983927300 SUBDIVISION: Block: Lot: T 14 PARCEL NUMBER: 701321017 Section: 32 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 09/06/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION Above Ground Propane tank and Hot water tank 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 Permit $47.00 CJZ 05/27/03 56355 Total: $47.00 • 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 #: BLD03-00324 Received Date 5/27/2003 SITE ADDRESS: 3682 LINDSEY HILL RD Issue Date 5/27/2003 QUILCENE, 98376 APPLICANT: HENDERSON JACK H & SHANNON P PHONE: ROBERT&VALLYN HENDERSON 7225 NE PEBBLE BEACH RD SUQUAMISH WA 983927300 T 14 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701321017 Section: 32 Township: 27N Range: 01W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 09/06/2004 OWNER, HENDERSON JACK H & SHANNON P PHONE: if different: ROBERT&VALLYN HENDERSON 7225 NE PEBBLE BEACH RD SUQUAMISH WA 983927300 PROJECT DESCRIPTION: Above Ground Propane tank and Hot water 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 05/27/2004. REQUIRED INSPECTIONS: [ ] Tank/Line ppliance: 6'T (-/Nx)te _ !'1--O� [ ] FinalApproval: / „/lJ Le' EJ 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 i:\F_BLD_Permit_Propane.rpt 10/29/19 JEFFERSON COUNTY COMMI DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND 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 x 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 NO SITE ADDRESS(911 #/Road Name): 8a i;),) 0(s // 6? wf i c //-e i 6)/ ZIP q 8j 9 — 73 O-6 9 DIGIT PARCEL ID NUMBER 7O(3 P 1 0 i 7 Legal Description: Subdivision Name Block Lot(s) / /Y Section 3 a Township 7 North, Range / 66 WM APPLICANT A'c) .e,^ t - /--4nrie /s C21--7 PHONE 360 - S_71? - 7 ee3 MAILING ADDRESS 7, s- Pe h /e ReG c4. / K 5" c.�o,��•`3 �, (A') ZIP 9 3 9 2 PROPERTY OWNER j, ..,, ,p PHONE MAILING ADDRESS ZIP CONTRACTOR C ./ek1 to PHONE MAILING ADDRESS ei,,j/.yt 0.C t.4.4.r.1 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's property or stru r all be requested and shall occur during regular business hours. APPLICANTS SIGNATURE E ,..-r- a0--7 DATE /..2 7 /Ca S BASE FEE (leo FOR OFFICE USE ONLY RECEIPT# 65 CONSISTENCY REVIEW -1 CASH/CK# tO 51 TOTAL 1 c U DATE /c 7,&0c 3 *Underground Propane Tank applications require additional information to be submitted. 0 V E R 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