HomeMy WebLinkAboutBLD2004-00207 BLD04-00207
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00207 °i1 % Received Date: 3/31/2004
SITE ADDRESS: 2481 ANDERSON LAKE RD#124r
CHIMACUM, 98325
OWNER: JIM ANDERSON PHONE:
2481 ANDERSON LAKE ROAD#704
CHIMACUM WA 98325
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 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NO MLA REQ'D -AG 125 GALLON 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 =loodplain
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 CJZ 03/31/04 64164
Total: $48.00
• .
PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 9,3368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD04-00207 (nim,1701 Received Date 3/31/2004
SITE ADDRESS: 2481 ANDERSON LAKE RD#jZ Issue Date 3/31/2004
CHIMACUM, 98325
APPLICANT: JIM ANDERSON 'HONE:
2481 ANDERSON LAKE ROAD#704
CHIMACUM WA 98325
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 09/06/2004
OWNER, EVERGREEN COHO ESCAP RETREAT PHONE:
if different: 2481 ANDERSON LAKE RD
CHIMACUM WA 983259795
PROJECT DESCRIPTION: NO MLA REQ'D -AG 125 GALLON 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 03/31/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
['] FinalApproval: - -197
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_Permit_Propane.rpt 10/29/19�
. - JEFFERSON COUNTY COOUNITY DEVELOPMENT,621 SHERIDAN ST,PORT NSEND 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* SIZE OF PROPANE TANK/ 2%' /�/
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 NO
SITE ADDRESS(911#/Road Name):
E ( 0 J Lk ed. Yo y
w-(/4-�I tJ ilA./N ZIP 90 3 2 s'9 DIGIT PARCEL ID NUMBER q t i /Z)/ .S'4
Legal Description:
Subdivision Name Block Lot(s)
Section Township ) North, Range WM
APPLICANT ' n- %Srt>• V PHONE , rJ" _S-- S f 7
MAILING ADDRESS
5 � 3
ZIP
PROPERTY OWNER g'j''''l c-Q___ PHONE
MAILING ADDRESS
ZIP
CONTRACTOR eit),.ex PHONE
MAILING ADDRESS
gJA.1..M + -tom.." ,,� 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 a s and right ry ffer .n unty and it's employees,representatives or agents for the purpose of application review and any required later
inspections. Access and righ nt tot a plicant's pr e y
V� structure shall be requested and shall occur during regular business hours.
APPLICANT'S SIGNAT E ! ' _ 1L' "' - DATE / / / 0
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT#
CONSISTENCY REVIEW $24.00 CASH/CK#
TOTAL DATE / /
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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