HomeMy WebLinkAboutBLD2001-00004 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 #: BLD01-00004 Received Date 1/3/2001
SITE ADDRESS: 2481 ANDERSON LAKE RD. #542 Issue Date 1/4/2001
CHIMACUM, 98325 Expiration Date 1/4/2002
APPLICANT: EVERGREEN COHO ESCAP RETREAT PHONE: (360)301-3111
C/O HAROLD CLEMENT
PO BOX 929
CHIMACUM WA 98325
SUBDIVISION: EVERGREEN COHO 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 09/01/2001
OWNER, EVERGREEN COHO ESCAP RETREAT PHONE: (360)301-3111
if different: C/O HAROLD CLEMENT
PO BOX 929
CHIMACUM WA 98325
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 01/04/2002.
REQUIRED INSPECTIONS:
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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.
HOT LINE AVAILABLE 24 HOURS A DAY
is\F_BLD_Permit_Propane.rpt 10/29/19
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00004 Received Date: 1/3/2001
SITE ADDRESS: 2481 ANDERSON LAKE RD#
CHIMACUM, 98325
APPLICANT: EVERGREEN COHO ESCAP RETREAT PHONE: (360)301-3111
C/O HAROLD CLEMENT
PO BOX 929
CHIMACUM WA 98325
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 09/01/2001
ARCHITECT/
ENGINEER :
PROJECT DESCRIPTION: PROPANE TANK INSTALLATION
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 Flood Plane
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
—Proximity - hlat Conditions
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $46.00 MAM 01/03/01 37260
Total: $46.00
is\F_BLD_App_Bld.rpt 10/29/19
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE \C PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: r
911#/ROAD NAME k� ' -, E V6eZ6; L?(Yo r .? /
J,f I.f/�'r_' j�[� . ZIP J5/
9 DIGIT PARCEL ID NUMBER cto/ to t 03 I
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT ii4WAL /1/` 642 4V1 A// PHONE ( ( 1/
MAILING ADDRESS • /r2)("•3 `f,/�
VV1 des". ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR � N PHONE
MAILING ADDRESS
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 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 Oft / d / f
FOR OFFICE USE ONLY
BASE FEE RECEIPT# -211-.
2
CASH/CK# 4.3110 tt
TOTAL 4t� ! DATE l ! /O(
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