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HomeMy WebLinkAboutBLD2003-00401 • 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 #: BLD03-00401 Received Date 6/26/2003 SITE ADDRESS: 294752 HWY 101 Issue Date 6/26/2003 QUILCENE, 98376 APPLICANT: JULIAN S OEN PHONE: PO BOX 307 QUILCENE WA 983760307 1 SUBDIVISION: CAMPBELL'S H.W. ADDITION Block: 10 Lot: PARCEL NUMBER: 937201001 Section: 24 Township: 27N Range: 02W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2004 OWNER, JULIAN S OEN PHONE: if different: PO BOX 307 QUILCENE WA 983760307 PROJECT DESCRIPTION: ABOVE GROUND 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 06/26/2004. REQUIRED INSPECTIONS: -] Tank/Line/Appliance:----1;;04 nu� /gPpL/,tUcE-- 7 z #7j [tjr FinalApproval: d 'K 0 0-47 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 BUILDING PERMIT APPLI•TION B Review 00401 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00401 Received Date: 6/26/2003 SITE ADDRESS: 294752 HWY 101 QUILCENE, 98376 OWNER: JULIAN S OEN PHONE: PO BOX 307 QUILCENE WA 983760307 SUBDIVISION: CAMPBELL'S H.W. ADDITION Block: 10 Lot: 1 PARCEL NUMBER: 937201001 Section: 24 Township: 27 N Range: 02 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI98306 Expires 09/26/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION ABOVE GROUND 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: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: 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 ZAN 06/26/03 56431 Total: $47.00 JEFFERSON COUNTY CO ITY DEVELOPMENT,621 SHERIDAN ST,PORT 11INSEND WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN i TO THIS INSTALLATION Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) B /1 's ) (try i_t_4Y1, /n z_ p/'�) �`-> Is this appliance(htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home? YES 1/NO SITE ADDRESS(911#/Road Name): �f I ,_ Jo/ ' La-L.1UA'Ut/ L/ C I ' ZIP qt3 7CG' 9 DIGIT PARCEL ID NUMBER 1i3 -7 o I 00 / Legal Description: �1 Subdivision Name Cu !'n1,C'h t,Li /s A'et ..G L/1 ill Block /O Lot(s) / (P as-I /.2(0 Section 7 Township Mv z/ North, Range E.,,7 Ai ,-? Ct..! WM APPLICANT (t L.,..I Ci, . T-a r- `C1 e-41 e.r-p PHONE C (i �J G l MAILING ADDRESS Pv 1/vim-�. 1 J). 'SL & Bur 3 7 6)&AA..((.e✓l.i'i 1,13 l'A ZIP 9(37to c PROPERTY OWNER -J((!"lt lr( (1(2 11 PHONE 3(yO-7(i.5- 3't A MAILING ADDRESS B©',l JJ30 '7 t �)I.A.A. �c r r i ZIP 9 i ._ (Cs CONTRACTOR Y 0 (kin, „i-- P),-tg-I?G,"-rv-- PHONE MAILING ADDRESS 1.---- � ._„h p I(fl�nth ZIP STATE LICENSE# EXP.DATE FEDERAL I.D.# p am 2 6 2� '.-.J By signing the application Torn, the applicant/owner attests that the'informttion 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 applicarkovvnar.with respect to this application packet may result in this permit being null and void. I DEPT. OF CON,7,4Ul,,:r i i.v rLU ""11't.N I I further agree to save, indemrTR7'aria hoid` arm ess a gQri 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 r ular bu ?sss hours. APPLICANT'S SIGNATURE iL€CC r /7)0)tz ..t�.{„O7vLi 1 DATE / / c. / a) FOR OFFICE USE ONLY BASE FEE "f RECEIPT# 1 31 CONSISTENCY REVIEW � CASH/CK# (&5 CO TOTAL 4 1/' ( DATEi.ip_/ t0/ O *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. MIIM H:\HOME\PLNCNTR\I NFOBLDG\FORMS\INSTALL.DOC