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Home My WebLink AboutBLD2004-00170 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 #: BLD04-00170 Received Date 3/19/2004 SITE ADDRESS: 2481 ANDERSON LAKE RD#227 Issue Date 3/19/2004 CHIMACUM, 98325 APPLICANT: EVERGREEN COHO ESCAP RETREAT PHONE: 2481 ANDERSON LAKE RD CHIMACUM WA 983259795 229 SUBDIVISION: EVERGREEN COHO ESCAPEE RESORT Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29N Range: 01W CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/6/2004 OWNER, EVERGREEN COHO ESCAP RETREAT PHONE: if different: 2481 ANDERSON LAKE RD CHIMACUM WA 983259795 PROJECT DESCRIPTION: 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 3/19/2005. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApproval: ' i4aNig (o-. -oyZ— 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_Perm it_Propane.rpt 10/29/19 UILDING PERMIT APPLICA•N BLD04-00170 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00170 Received Date: 3/19/2004 SITE ADDRESS: 2481 ANDERSON LAKE RD#227 CHIMACUM, 98325 OWNER: EVERGREEN COHO ESCAP RETREAT PHONE: 2481 ANDERSON LAKE RD CHIMACUM WA 983259795 SUBDIVISION: EVERGREEN COHO ESCAPEE RESORT Block: Lot: 229 PARCEL NUMBER: 901101039 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: C H S PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/6/2004 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr PROPANE TANK INSTALLATION 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: J 11'M F&W Landslide 3{ I 64Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 PRB 03/18/04 64102 Total: $48,00 JEFFERSON COUNTY COMMUNI•VELOPMENT,621 SHERIDAN ST,PORT TOWNS WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TOI THIS INSTALLATION Underground PROPANE TANK* / Above Ground PROPANE TANK* SIZE OF PROPANE TANK / 2c) HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) Is this appliance(woodstove, htg stove, hot water tank,furnace, etc.)to be installed in a Manufactured/Mobile Home? YES X NO SITE ADDRESS(911 #/Road Name): 2- / �¢NDtis'a� I- i 12o b� Z� LIAR 18 2004 11/fin Um t, frt04- ZIP gg3z, — 9 DIGIT PARCEL ID NUMBER gal lc9(O3 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT i�G,G'i40/ PHONE 3 yam' ZVg 4/- MAILING ADDRESS /Z�1j��J ' ‘ 4:-t-$ ,- Ct 3 2- PA.f 2vrn I N t/ ZIP g 9%0,6 G) PROPERTY OWNER PHONE MAILING ADDRESS a 5Y' ZIP ' CONTRACTOR /i't/t �/ Vh 7 Sr PHONE q MAILING ADDRESS f/ 1 dif f /1-C a rn j u'4- ZIP ! �3 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 t .G,44.)9 DATE _ / / / 4 FOR OFFICE USE ONLY L-� BASE FEE $48.00 RECEIPT# ([) l CONSISTENCY REVIEW $24.00 CASH/CK# 4 TOTAL 1Z• 00 DATE / (&/6 c-(- 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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