HomeMy WebLinkAboutBLD2001-00288 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 #: BLD01-00288 Received Date 5/21/2001
SITE ADDRESS: 2481 ANDERSON LAKE RD ;;iy - Issue Date 5/21/2001
CHIMACUM, 98325 Expiration Date 5/21/2002
APPLICANT: EVERGREEN COHO ESCAP RETREAT PHONE:
2481 ANDERSON LAKE RD
CHIMACUM WA 983259795
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:
if different: 2481 ANDERSON LAKE RD
CHIMACUM WA 983259795
PROJECT DESCRIPTION NO MLA REQ'D - 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 05/21/2002.
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 #: BLD01-00288 Received Date: 5/21/2001
SITE ADDRESS: 2481 ANDERSON LAKE RD
CHIMACUM, 98325
APPLICANT: EVERGREEN COHO ESCAP RETREAT PHONE:
2481 ANDERSON LAKE RD
CHIMACUM WA 983259795
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: NO MLA REQ'D - PROPANE TANK INSTALLATION
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
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
—Proximity - Hat Conditions
Type Amount Paid By: Date: Receipt Approved/Date
Propane Tanks/Stoves $48.00 MAM 05/21/01 40119
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: 13601 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS: / `
911#/ROAD NAME �'-4`I ', 4, /\�()�jrS on Lk_.- (2_4()
ZIP
9 DIGIT PARCEL ID NUMBER 901 ' tot " O39
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT PHONE
MAILING ADDRESS
ZIP
PROPERTY OWNER aEI/ tiLl '4. 4dO 5.3 L �" PHONE 3 as- - �
MAILING ADDRESS a4LS/ .4n4D ..S 1 O NJ X A-K6- /e2) 40 T Q.7
cf-f m /L.N 4Y( ZIP 9Y 307J
CONTRACTOR PHONE 3 S
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 / 02/ / ROO
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H:A HOME\PLNCNTR\FORMS\INSTALL.DOC10/99 MAY 2001
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