HomeMy WebLinkAboutBLD2003-00603 S
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#: BLD03-00603 Received Date 9/25/2003
SITE ADDRESS: 260 APPALOOSA DR Issue Date 9/25/2003
BRINNON, 98320
APPLICANT: FRED ANDERSON TRUSTE PHONE:
KAREN ANDERSON TRUSTEE
149 BOWMAN RD
CHEHALIS WA 985329605 22
SUBDIVISION: LAZY C RANCH DIV 1 Block: Lot:
PARCEL NUMBER: 966900021 Section: 34 Township: 26N Range: 02W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CCOQCHSIN9790Z Expires 09/06/2004
OWNER, FRED ANDERSON TRUSTE PHONE:
if different: KAREN ANDERSON TRUSTEE
149 BOWMAN RD
CHEHALIS WA 985329605
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 09/25/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: D¢ K E-x-r ,/A.rgS ///e'
[ ] FinalApproval: ,0%l for 6/e ,0-9/
f
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.c
BUILDING PERMIT APPLI TION BLD03-00603
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00603 Received Date: 9/25/2003
SITE ADDRESS: 260 APPALOOSA DR
BRINNON, 98320
OWNER: FRED ANDERSON TRUSTE PHONE:
KAREN ANDERSON TRUSTEE
149 BOWMAN RD
CHEHALIS WA 985329605
SUBDIVISION: LAZY C RANCH DIV 1 Block: Lot: 22
PARCEL NUMBER: 966900021 Section: 34 Township: 26 N Range: 02 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CCOQCHSIN9790Z Expires 09/06/20C
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI 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:
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 ZAN 09/25/03 60088
Total: $47.00
JEFFERSON COUNTY COM•TY DEVELOPMENT,621 SHERIDAN ST,PORT TtSEND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* N Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK
WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE
OTHER(Please Specify)
Is this applia ce(htg stove, h water tank,furnace, etc.)to be installed in a Manufactured M bile Home?
4
&-1- .,,y icd --cam u.A yvc_ — YES NO
SITE ADDRESS(911#/Road Name):
0260
g f ovs j12
z/✓vn/or,1 C /I ZIP
/
9 DIGIT PARCEL ID NUMBER qc10 {G
o 0 o
Legal Description:
Subdivision Name dZy I�_ Block Lot(s) ,21 £ -v
Section Township North, Range 7 WM
APPLICANT / (jeY,�� PHONE3b(O 7 0 _6/47
MAILING ADDRESS //7 Bot1 i4k.- ' 1 p i
Che it aiCt s (A)4- ZIP g53v
PROPERTY OWNER /-Y��� A('�y6 U PHONE
MAILING ADDRESS /Lf 7 (OC'il - AO
. h ll , evk ZIP L0 /e—
CONTRACTOR ' e'7Z- PHONE 3 7 (-) 6o
MAILING ADDRESS 0 I v(C14141/ GU✓f
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 en,9 to.Jeffers o y 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 .pf t' o or structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE 1' DATE , 7 / 25T 6_3
.60 FOR OFFICE USE ONLY
BASE FEE RECEIPT# 00 gq-
CONSISTENCY REVIEW CASH/CK# S b
tt
TOTAL i1 `6° DATE 6 /25/ 63
*Underground Propane Tank applications require additional information to be submitted. 0 V E R III
Please contact our office at 360-379-4450 if the back of this application is blank.
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