HomeMy WebLinkAboutBLD2004-00298 0 BUILDING PERMIT APPLICIION BLD04-00298
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD04-00298 Received Date: 5/7/2004
SITE ADDRESS: 2481 ANDERSON LAKE RD#311
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**979OZ Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NO MLA REQ'D -AG 120 GAL PROPANE TANK
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: 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 $48.00 CJZ 05/07/04 64407
Total: $48.00
• •
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 #: BLD04-00298 Received Date 5/7/2004
SITE ADDRESS: 2481 ANDERSON LAKE RD#311 Issue Date 5/7/2004
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 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 120 GAL 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 05/07/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: r) ,t S11�
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 10/29/19e
'I I' op E �' o , o` li
..11Afrl.. /
["."-U D124!➢J El/ - AsE.M 1.vr' / %iLOT N4. -
�. �ialillil'i 7
; % .
U1PROVEfr
.: \ \ PERMIT
'6..... ,fcRe-il- y
1�
0. , ,._. .,. ..
I
-4;7. 12)1'• 1, \
F
--GI. �t rye .� �..
CO
p
r / T-------i \t,...
!C X (6 vv 1(:f (C
0 Pe 3 xtorvlOc.D
RD op b - . P
LOT tvidfrteNT_.-.... . 40..0 0 .
,_ . . R 7-\.? scot., l``=1
ci
.t.0GE OF PAVEMENT.14
-
APPROVE P 1' . • •• • p ' - • z.
4 r
, . LY
JEFFERSON COUNTY COMM.DEVELOPMENT,621 SHERIDAN ST,PORT TO•ND WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
�' 0 i
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK /`K
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):
acf 8f AN,DLe-c0,41 -1k,. ,D Z31/ eg/N4 ca/kl , 1,1/>1
j (� ZIP
9 DIGIT PARCEL ID NUMBER ? 0 fJJ!//O ` 0
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT /149/ ST C PHONE r- O` /
_. "
MAILING ADDRESS e 0. LOX 7-7 M640 ett Wr9
.r 'S ki 'e,
ZIP Vf r2
se
PROPERTY OWNER S'/1 47 E PHONE �'�5 r U . -s 6 t
MAILING ADDRESS JB v 1 e _crect
ZIP
CONTRACTOR CF/v E (� / PHONE J U ` p777,? 4',�1 S
MAILING ADDRESS PO g�� t-8 L A� 4 ( iif'J1 / tvil - qQ 3,2 3-
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 access and rig o ntry to Jefferson o it' mpl ees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry t applicant's prop r r ha uested and shall occur during regular business hours.
APPLICANTS SIGNATURE 'e DATE / 7 /
FOR OFFICE USE ONLY
BASE FEE $48.00 RECEIPT# 4 al
CONSISTENCY REVIEW $24.00 CASH/CK# +1' 4
TOTAL Cl 2( ' DATE / /v 4
* l
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.
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC