HomeMy WebLinkAboutBLD2003-00633 03-00633
• BUILDING PERMIT APPLICATION BL Review
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00633 Received Date: 10/6/2003
SITE ADDRESS: 60 BAY VIEW AVE
BRINNON, 98320
OWNER: DONALD SILSBEE PHONE:
LEA M SILSBEE
PO BOX 362
BRINNON WA 983200362
SUBDIVISION: OLYMPIC CANAL ADDITION 3 Block: Lot:
PARCEL NUMBER: 980700503 Section: 21 Township: 25 N Range: 02 W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr 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: 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 ZAN 10/06/03 60169
Total: $47.00
0 0
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 #: BLD03-00633 Received Date 10/6/2003
SITE ADDRESS: 60 BAY VIEW AVE Issue Date 10/6/2003
BRINNON, 98320
APPLICANT: DONALD SILSBEE PHONE:
LEA M SILSBEE
PO BOX 362
BRINNON WA 983200362
SUBDIVISION: OLYMPIC CANAL ADDITION 3 Block: Lot:
PARCEL NUMBER: 980700503 Section: 21 Township: 25N Range: 02W
CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
OWNER, DONALD SILSBEE PHONE:
if different: LEA M SILSBEE
PO BOX 362
BRINNON WA 983200362
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 10/06/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: _ r i" ia7j
[ ] FinalApproval: �'3 (-'O�
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 10/29/19C
JEFFERSON COUNTY COM•TY DEVELOPMENT,621 SHERIDAN ST,PORT TIOSEND 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 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):
t.N WO ZIP g L3 316
9 DIGIT PARCEL ID NUMBER Q 8d 7 00 s(/l
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range two
APPLICANT Lit S t tS .�. PHONE '7 c3G-Lto y Z D62 �o
MAILING ADDRESS Pia 1? 4 ?E,2-
eg /Jo0 ZIP `n Zo
PROPERTY OWNER y.�� )i I Sim€, PHONE %,°' Li 0% li
MAILING ADDRESS
ZIP r�
CONTRACTOR CA.Pitt,X 14Ct rV.e-„ l�- 5 ',1-�
.}- .�j PHONE %3 L'Li 5 c
MAILING ADDRESS ?d 0O' ` ,�J 51(
C�1,v�A t°.(,�.V"., V° J ZIP oN3z.J
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 a ' nt's propertyuctur- ,.II be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE AY ! DATE IC) / & /
?-
FOR OFFICE USE ONLY /�
BASE FEE RECEIPT# (/
CONSISTENCY REVIEW ® CASH/CK# lia
TOTAL If 1 f10 DATE (iL/10___03
Underground Propane Tank applications require additional information to be submitted. 0 V E R I►
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