HomeMy WebLinkAboutBLD2003-00647 4 . .
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#: BLD03-00647 Received Date 10/13/2003
SITE ADDRESS: 155 OTTO ST Issue Date 10/16/2003
PORT TOWNSEND, 98368
APPLICANT: MILES L SOSKIN CO-TRTE PHONE:
BARBARA F SOSKIN CO-TRTE
PO BOX 1331
PORT TOWNSEND WA 983680019 1-4
SUBDIVISION: EISENBEIS BAY VIEW Block: 34 Lot:
PARCEL NUMBER: 948603401 Section: 16 Township: 30N Range: 01W
CONTRACTOR: OWNER BUILDER PHONE:
OWNER, MILES L SOSKIN CO-TRTE PHONE:
if different: BARBARA F SOSKIN CO-TRTE
PO BOX 1331
PORT TOWNSEND WA 983680019
PROJECT DESCRIPTION: Heat Stove- Unit B
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 10/16/2004.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance j fD/2I a3,4 i/ '." /0s✓ArC0
1/4J teem 4 /q/•
[ ] FinalApproval: d/` 4?r c/a to/z//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
I:\F_BLD_Permit_Propane.rpt 10/29/19
BLD03-00647
UILDING PERMIT APPLICA . N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD03-00647 Received Date: 10/13/2003
SITE ADDRESS: 153 OTTO ST
PORT TOWNSEND, 98368
OWNER: MILES L SOSKIN CO-TRTE PHONE:
BARBARA F SOSKIN CO-TRTE
PO BOX 1331
PORT TOWNSEND WA 983680019
SUBDIVISION: EISENBEIS BAY VIEW Block: 34 Lot: 1-4
PARCEL NUMBER: 948603401 Section: 16 Township: 30 N Range: 01 W
CONTRACTOR: OWNER BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOt Heat Stove
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 CJZ 10/13/03 60240
Total: $47.00
JEFFERSON COUNTY COMMUN 8
EVELOPMENT,621 SHERIDAN ST,PORT TOWN*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 N
SITE ADDRESS(911 #/Road Name):
/s - �t/o 3 — - ',vi7 a
/ 2/2 (Gr)/11,7i'/ , ZIP ? 3 6
9 DIGIT PARCEL ID NUMBER 9W /i9.
Legal Description:
Subdivision Name Block Lot(s)
Section Township / North, Range �CWM
APPLICANT _ �k...!/L ` ! 4 fi��/ / PHONE 36C/�e� 7J 7
MAILING ADDRESS ta, 12> f 3 3/ /��� 51
kvi,g_ ?s-)_3ecp ZIP
PROPERTY OWNER f/qGird PHONE
MAILING ADDRESS
ZIP
CONTRACTOR f 0 PHONE
MAILING ADDRESS
ZIP
STATE LICENSE# EXP.DATE
FEDERAL I.D.#
By signing the application form,the applicant/owner attests t a the infor ation 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 it respect this application packet may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jeffer.on County ainst 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 co se.uence o e granting of this permit.
I further agree to provide access and right of entry to Jeff_rson County a d it' ployees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry to the applicant's.ope y r uc all be requested and shall occur during regular business hours.
APPLICANT'S SIGNATURE DATE / //.3 /03
QR OFFICE USE ONLY �,th
BASE FEE CI� RECEIPT# (,0(J `'r(J
CONSISTENCY REVIEW CASH/CK# /�5 5-16
TOTAL �_ DATE /il /)3 / 03
*Underground Propane Tank applications require additional information to be submitted. 0 V E R
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