HomeMy WebLinkAboutBLD2001-00109 Zi
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 #: BLD01-00109 Received Date 2/21/2001
SITE ADDRESS: 2481 ANDERSON LAKE RD#605 Issue Date 2/21/2001
CHIMACUM, 98325 Expiration Date 2/21/2002
APPLICANT: ED GULDEN PHONE:
PO BOA 427
LA PINE OR 97739
SUBDIVISION: EVERGREEN COHO ESCAPEE RESORT Block: Lot:
PARCEL NUMBER: 901101039 Section: 10 Township: 29N Range: 01W
CONTRACTOR:
&C-:-)A\-C4
OWNER, EVERGREEN COHO ESCAP RETREAT PHONE:
if different: 2481 ANDERSON LAKE RD
CHIMACUM WA 983259795
PROJECT DESCRIPTION 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 02/21/2002.
REQUIRED INSPECTIONS:
( ] Clank/Line/Appliance: J' — "Z-2T-° -
( nalApproval: (Dt Z-27—0 L.
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 #: BLD01-00109 Received Date: 2/21/2001
SITE ADDRESS: 2481 ANDERSON LAKE RD#605
CHIMACUM, 98325
APPLICANT: ED GULDEN PHONE:
PO BOA 427
LA PINE OR 97739
SUBDIVISION: EVERGREEN COHO ESCAPEE RESORT Block: Lot:
PARCEL NUMBER: 901101039 Section: 10 Township: 29 N Range: 01 W
CONTRACTOR: PHONE:
PHONE:
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: 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:
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
—Proximity - Flat conditions
Type Amount Paid By: Date: Receipt: ApprovedR ate
Propane Tanks/Stoves $48.00 PRB 02/21/01 38122
Total: $48.00
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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 2 (/ 4 A/D x-7°-S 0,1-) t'05—
C PI/� 6S .Y ZIP gr 32)
Cr`9 DIGIT PARCEL ID NUMBER 0 t /01 d 39
Legal Description:
Subdivision Name Block Lotls)
j7 Section Township North, Range WM
1 APPLICANT G✓L.-) Fi/2,/ PHONE
MAILING ADDRESS Tp�c 6 0 >L 5',,7
�. P/A/t5 " p ji,.i 04 ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR 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 4( DATE 07. l ICE/ l z 00 J
FOR OFFICE USE ONLY
;BASE FEE RECEIPT#
CASH/CI(#
TOTAL • " DATE /
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