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Home My WebLink AboutBLD2003-00629 NL. • , 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#: BLD03-00629 Received Date 10/3/2003 SITE ADDRESS: 100 MT JUPITER RD Issue Date 10/3/2003 BRINNON, 98320 APPLICANT: DONALD SILSBEE PHONE: LEA M SILSBEE PO BOX 362 • BRINNON WA 983200362 • SU3DIVISION: Block: Lot: PARCEL NUMBER: 502153004 • Section: 15 Townhip: 2'5N Range: 02W GUN I.<AC IOR: CENEX PHONE: (360)7'32-4585 • PO BOX 518 • AUBURN WA 98071-0518 Contractor's License CCOQCHSIN9790Z Expires 9/6/2004 OWNER, DONALD SILSBEE PHONE: if different: LEA M SILSBEE PO BOX 362 BRINNON WA 983200362 PROJECT DESCRIPTION: A9OVE GROUND PROPANE TANK INSTALLATION THIS t ERMIT IS VALID FOR GNE YEAR AND iS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 10/3/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApproval: (2aae e_.-Cf i 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 ea I:\F_BLD_Permit_Propane.rpt 10/29/19 • • 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 #: BLD03-00629 Received Date 10/3/2003 SITE ADDRESS: 100 MT JUPITER RD Issue Date 10/3/2003 BRINNON, 98320 APPLICANT: DONALD SILSBEE PHONE: LEA M SILSBEE PO BOX 362 BRINNON WA 983200362 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502153004 Section: 15 Township: 25N Range: 02W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CCOQCHSIN9790Z Expires 9/6/2004 OWNER, DONALD SILSBEE PHONE: if different: LEA M SILSBEE PO BOX 362 BRINNON WA 983200362 PROJECT DESCRIPTION: ABOVE GROUND PROPANE TANK INSTALLATION 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 10/3/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApproval: 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_Pe rm it_Propa ne.rpt 10/29/19 JEFFERSON COUNTY COMMUNITVELOPMENT,621 SHERIDAN ST,PORT TOWNSIOWA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN,TOOT THIS INSTALLATION 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 Nam jtAerreci- / (. N) ZIP `g3Z° 9 DIGIT PARCEL ID NUMBER b' 1 5-3 dO Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT \60k-1/41 -pd-- C N PHONE —73Z--115-85 MAILING ADDRESS PO g4i+6 -Lyc c f((tAtu4Afrk Vv, ZIP gC`3-z-S PROPERTY OWNER ►ZOO --11-9-1 C1 Olk VAeNc`{ PHONE eId 7 361- 64 4 c MAILING ADDRESS Po Obi. 27 g(I (N NON WA ZIP 't D J Zo CONTRACTOR M I"1 LV.t-Sf J l Qt+'tV PHONE 7 '' � ' 4$- P MAILING ADDRESS O 6 0/. 1-9 v A cirwA �A(AA4fr \, `�WV ZIP STATE LICENSE# r{S INyKs T? O 0 EXP.DATE �!"4-ZO6 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 ' ant's prope y or s ure shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE DATE /6 I 3 / FOR OFFICE USE ONLY BASE FEE RECEIPT# CONSISTENCY REVIEW CASH/CK# TOTAL DATE / / *Underground Propane Tank applications require additional information to be submitted. 0 V E R 11 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