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Home My WebLink AboutBLD2009-00211 • 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 #: BLD09-00211 Received Date 7/9/2009 SITE ADDRESS: 2481 ANDERSON LAKE RD#714 Issue Date 7/9/2009 CHIMACUM, 98325 APPLICANT: JACK& SANDRA CLARK PHONE: 360-624-3848 2481 ANDERSON LAKE RD #714 CHIMACUM WA 98339 SUBDIVISION: EVERGREEN COHO ESCAPEE RESORT Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2010 OWNER, EVERGREEN COHO ESCAP RETREAT PHONE: if different: 2481 ANDERSON LAKE RD CHIMACUM WA 983259795 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK& LINES Directions To Site: 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 7/9/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: S'1-1-0(1 i 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 •UILDING PERMIT APPLICAJN B Review 1 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00211 Received Date: 7/9/2009 SITE ADDRESS: 2481 ANDERSON LAKE RD# CHIMACUM, 98325 OWNER: rfr (7)rY/ �Ci ("I Ka PHONE: 360-624-38:_ 2481 ANDERSON LAKE RD #714 CHIMACUM WA 98339 EVERGREEN COHO ESCAPEE RESORT SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION A/G 120 GAL PROP TANK & LINES TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2006 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: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing D Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $142.00 LYK 07/09/09 11)8734 Total: $142.00 • • C g • d f� _4- 42 61 CAI ) art( ) A.? 1 co� JEFFERSO UNTY41, DEPARTMENT OF COMMUNITY DEVELOPMENT `-' `4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax p. www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: kDQ 11YLA e ,�,, Project Description (include separate sheets as necessary): IN STALL ' I'2A PROPANE 7-4NK Tax Parcel Number: '0 11( GI Property Size: (acres/square feet) Site Address and/or Directions to Propert . 4 y8/ And ersv n Lk •., 071 chi main , Wfj J U L - 9 2009 Property Owner(s)of Record: _ n AL ^I1 Telephone: Fax: email: Mailing Address: ,2y8J Anderson Lk, RA., el,j ma e-wm, WA /8325 Applicant/Agent(if different from owner): Sack ¢ Says h a C/aril Telephone: 3b0- L.2y- 3ey8 Fax: email: Mailing Address: 78��hder�r r, / Rd, /t J/y (2Aimacga/n 10A 98.915 What kind of Permit?(Check each box that applies ❑Building ❑ Critical Areas Stewardship Plan El Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑ Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address_ ❑ Road Approach ❑ Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** X Propane ❑ Long Plat** ❑ Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development** 0 Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate Sandra, C1arK to act as my agent in matters relating to this application for permit(s). ,, OWNER SIGNATURE ✓�•-t• / a i.e- ,1-,..:y Date: 7 "3 c'- By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent 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 its employees, representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicption that hel or she wants prior notice. Signature: r-t f'f Z_a-1v1A% Date: -`+ -C i The action or ctions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if yo are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl respo sibility for h to and complying with the ESA. The Applicant has read this disclaimer an signs and dates it below. Signature: (/, /c.V Date: ' G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 11, BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: CONTRACTOR'S LICENSE WAINS NUMBER: C Q e NUMBER ARCHITECT/ENGINEER: ti PHONE ( ) FAX:( ) MAILING ADDRESS: ��C �vA EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 1 New C1 Wood Existing: ❑ Sewer Addition [1 Steel Proposed: Bank I Community System Alteration/Remodel '] Concrete Total: Height: I] Individual System ri Repair ,I Masonry SEP Permit# F Demolition Li Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well i Two Party Type of Heat: Proposed: PI Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank ''A6ove ground Tank ) Size of Propane Tank: l 2.0 i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines, buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2fa Floor Heated Consistency Review: Other Heated Base fee: , I Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL I2 Decks 911/Rd Approach fee: Other TOTAL: $ I C Receipt Number: l 0r(5. Cash/Check Number: 7 ,�� ESTIMATED COST(REQUIRED) Date: �1 b •Fair market value of all labor and materials foundation to finish l 'v ' Initials: /—. -- i G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc