HomeMy WebLinkAboutBLD2001-00555 • • •
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 #: BLD01-00555 Received Date 10/3/2001
SITE ADDRESS: 2481 ANDERSON LAKE RD#724 Issue Date 10/3/2001
CHIMACUM, 98325 Expiration Date 10/3/2002
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 09/06/2002
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 10/03/2002.
REQUIRED INSPECTIONS:
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[ ] FinalApproval: ii--&2__>(._
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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 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00555 Received Date: 10/3/2001
SITE ADDRESS: 2481 ANDERSON LAKE RD#724
CHIMACUM, 98325
OWNER: 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 09/06/2002
REPRESENTATIVE(S): MAVIS LARAMORE
2481 ANDERSON LAKE RD
#724
CHIMACUM WA 98325
PROJECT DESCRIPTIO NO MLA REQ'D — propahe ' v' '- 1ns-f d II 44 1-1'ov\
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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Stream s
Total: Total: Flood Way Floodplain
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
Proximity - a •.d. .•■
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 MAM 10/03/01 41507
Total: $48.00
JEFFERSON COUNTY COMMUNITY DEVELOPMENT, 621,SHERIDAN ST, PORT TOWNSEND WA 98368 PH: 1360) 379-4450
INSTALLATION PERMIT APPLICATION
WOODSTOVE PROPANE TANK PELLET STOVE OTHER
SITE ADDRESS:
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eirp.x...../YI,ce_.0_./.6,-/-7/ /v az-' 73S2�s ZIP
9 DIGIT PARCEL ID NUMBER - 1 0 l - (0 I. ' (D3 ci
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT fi _ a1-1,iys j PHONE ,.',G�/ J - 3 d (O ,j(j
MAILING ADDRESS rr
17/ IV c iL, 4i,&,--7, )/
14,1...,//x-2 ti�7I j. ZIP
PROPERTY OWNER PHONE
MAILING ADDRESS
ZIP
CONTRACTOR CCA `,2/ 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 1 v/a/ Ar1 iJ j%2 6/a -C-e}'ez_P_ DATE /C2 ! O,9 / . /
FOR OFFICE USE ONLY
BASE FEE Id 3 . O v RECEIPT# 4 t.5 i7
CASH/CK#
TOTAL L . 0-0 DATE t 0/ 3 / i
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