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HomeMy WebLinkAboutBLD2001-00479 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 #: BLD01-00479 Received Date 8/22/2001 SITE ADDRESS: 2481 ANDERSON LAKE RD#214 Issue Date 8/22/2001 CHIMACUM, 98325 Expiration Date 8/22/2002 APPLICANT: EVERGREEN COHO ESCAP RETREAT PHONE: (360)344-4292 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: (360)344-4292 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 08/22/2002. REQUIRED INSPECTIONS: [ ] 0Line/Appliance: [97 FinalApproval: ©)� , F-36 - 0 t 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_Perm it_Propane.rpt 10/29/19 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00479 Received Date: 8/22/2001 SITE ADDRESS: 2481 ANDERSON LAKE RD#214 CHIMACUM, 98325 OWNER: EVERGREEN COHO ESCAP RETREAT PHONE: (360)344-4292 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 REPRESENTATIVE(S): HELEN J SMELCER 2481 ANDERSON LK RD #214 CHIMACUM WA 98325 PROJECT DESCRIPTIO 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_ Plat Conditions Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $48.00 MAM 08/22/01 30310 Total: $48.00 JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 PH: (360) 379-4450 "e"--0 INSTALLATION PERMIT APPLICATION WOODSTOVE PROPANE TANK PELLET STOVE OTHER SITE ADDRESS: o�iL,9l LT�y. e-2tr1� I`al`L 911#/ROAD NAME °"4� «�i "...46? ZIP 9Ka - 9 79' 9 DIGIT PARCEL ID NUMBER CtO l • l 0 l • 0 3ct , Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM \ APPLICANT y% % ' / \�PHONE �'� �-� �-� 9� MAILING ADDRESS cqII/ . / G---/ e/,,. a.:___y7e_e2______,___e__v._.77____;sz.,s.....4.c::L. ZIP qga„,,t 9,n " - a PROPERTY OWNER t �_ PHONEo�Ze) - - / 9G MAILING ADDRESS t�gl Q�yL�.p � . e) / 1� ` 2 ZIP 9 F -02 5 - 9795 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 14. 7-t:--"" r - -t_ DATE / �/L 3` / FOR OFFICE USE ONLY BASE FEE �/,,� "" RECEIPT# ) _ / C CASH/CK# 6 4 >;S TOTAL (.../..„, U DATE r /:)--R. 6/ H:\HOME\PLNCNTR\FORMS\INSTALL. C10/99