HomeMy WebLinkAboutBLD2003-00426 • •
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 #: BLD03-00426 Received Date 7/11/2003
SITE ADDRESS: 890 BERRY HILL LN Issue Date 7/11/2003
CHIMACUM, 98325
APPLICANT: LARRY E WILSON PHONE:
SANDRA K WILSON
1805 CONGRESS ST
LAFAYETEE IN 479051268 9
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901333014 Section: 33 Township: 29N 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, LARRY E WILSON PHONE:
if different: SANDRA K WILSON
1805 CONGRESS ST
LAFAYETEE IN 479051268
PROJECT DESCRIPTION: Above Grund Propane Tand & Heat Stove
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 07/11/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: 7 7 x o.4' 4 9.--e.,"45-c... /2.�/d s
[ ] FinalAppraval: 771)." K OA•'/ C- 71� ,03
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
1:1F_BLD_Perm it_Propane.rpt 10/29/19c
BLD03-00426
ILUILDING PERMIT APPLICAWN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00426 Received Date: 7/11/2003
SITE ADDRESS: 890 BERRY HILL LN
CHIMACUM, 98325
OWNER: LARRY E WILSON PHONE:
SANDRA K WILSON
1805 CONGRESS ST
LAFAYETEE IN 479051268
SUBDIVISION: Block: Lot: 9
PARCEL NUMBER: 901333014 Section: 33 Township: 29 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 DESCRIPTIOP Above Grund Propane Tand & Heat Stove
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 CJZ 07/11/03 58124
Total: $47.00
JEFFERSON COUNTY COMMUNJEVELOPMENT,621 SHERIDAN ST,PORT TOW,D WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION X
Underground PROPANE TANK* Above Ground PROPANE TANK HEAT STOVE 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):
•
Jct.{ //��/� ZIP Ro3 9 DIGIT PARCEL ID NUMBER 90/333 c/
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE 70,2 -D3 X�
MAILING ADDRESS> t Q`C�.
ZIP
PROPERTY OWNE aL PHONE
MAILING ADDRESS
ZIP
CONTRACTOR PHONE
MAILING ADDRESS
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 structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE DATE
�BASE FEE /7 a. FOR OFFICE USE ONLY 1 RECEIPT#
CONSISTENCY REVIEW CASH/CK#
TOTAL I f DATE / l /l l
*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.
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