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HomeMy WebLinkAboutBLD2000-00245 • 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 (800)831-2678 PERMIT #: BLD00-00245 Received Date 4/19/2000 SITE ADDRESS: 2481 ANDEERSON LAKE RD#216 Issue Date 4/19/2000 CHIMACUM, 98325 Expiration Date 4/19/2001 APPLICANT: BEULAH M IMLAY PHONE: 2481 ANDERSON LK RD SPACE 121 CHIMACUM WA 98325 SUBDIVISION: L MCOHO ESCAPEE RESORT Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29N Range: 01W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 06/01/2000 OWNER, EVERGREEN COHO ESCAP RETREAT PHONE: if different: 2481 ANDERSON LAKE RD CHIMACUM WA 983258764 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 04/19/2001. REQUIREDINSPECTIONS: [ ] EI)Line/Appliance: [ ] FinalApproval: I'/ l/2S-'©v BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. Inspector's Phone Hours 8:00 a.m. - 9:00 a.m. SPECIAL CONDITIONS MAY APPLY - SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY E � BUILDING PERMIT APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00245 Received Date: 4/19/2000 SITE ADDRESS: 2481 ANDEERSON LAKE RD#216 CHIMACUM, 98325 APPLICANT: BEULAH M IMLAY PHONE: 2481 ANDERSON LK RD SPACE 121 CHIMACUM WA 98325 360 385-9017 SUBDIVISION: EVERGREEN COHO ESCAPEE RESORT Block: Lot: PARCEL NUMBER: 901101039 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: CENEX SUPPLY& MARKETING PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CENEXHS022NQ Expires 06/01/2000 ARCH ITECT/ ENGINEER : PROJECT DESCRIPTION: propane tank installation TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: ADD'L: HEAT TYPE: PRO OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: STORMWATER: YES NO AREA BEDROOMS: BATHROOMS: Wetland Erosion Exist: Exist: Seismic Streams Prop: Prop: Flooding Landslide Total: Total: F&W Plat Conditions Shoreline Aquifer Routing Date: Forest: Commercial Rural Proximity Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 LMB 04/19/00 27195 Total: $48.00 I:\F_BLD_App_Bld.rpt 10/29/99 JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450 INSTALLATION PERMIT APPLICATION WOODSTOVE PROPANE TANK PELLET STOVE OTHER SITE ADDRESS: 911#/ROAD NAME a Y a/ /( J4Q/Pgco7 L" 7N / ZIP 9 DIGIT PARCEL ID NUMBER D/ / 2/ 0 3 7 Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT Be_LC ht..AP7 J_kfT/ay / PHONE, Q 3)S—7c/ !� 7 MAILING ADDRESS i7 / #c o Soi L A'c C LA !i! • 4e /q ZIP 7 3.Z_5 PROPERTY OWNER , iA5:/� /17e cat ( 446 Re S"6Jc71-PHONE MAILING ADDRESS ZIP Cenex Harvest States CONTRACTOR PHONE 9315 Rhododrendren Dr MAILING ADDRESS Chimacum, WA 98325 ZIP STATE LICENSE# �,�� ' C�� A/ EXP. DATE ' rod 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. APPLICANT SIGNATURE DATE p //9/ t,d FOR OFFICE USE ONLY BASE FEE � R_; ��1� RECEIPT# TOTAL ' " DATE TIl/ / H:\HOME\PLNCNTR\FORMS\INSTALL.DOC 10/99