HomeMy WebLinkAboutBLD2002-00522 •
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
PERMIT #: BLD02-00522 Received Date 9/9/2002
SITE ADDRESS: 2481 ANDERSON LAKE RD#229 Issue Date 9/9/2002
CHIMACUM, 98325
APPLICANT: WILLIAM COE PHONE:
2481 ANDERSON LAKE RD
#229
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 9/6/2004
OWNER, EVERGREEN COHO ESCAP RETREAT PHONE:
if different: 2481 ANDERSON LAKE RD
CHIMACUM WA 98325-9795
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 9/9/2003.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance:
[ ] FinalApproval: %" )i; g )5-0-7
BUILDING INSPECTION HOT-LINE 379-4455.CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
is\F_BLD_Permit_Propane.rpt 10/29/19
I UILDING PERMIT APPLICA)N B RD�O w005pe22
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00522 Received Date: 9/9/2002
SITE ADDRESS: 2481 ANDERSON LAKE RD#229
CHIMACUM, 98325
OWNER: EVERGREEN COHO ESCAP RETREAT PHONE:
2481 ANDERSON LAKE RD
CHIMACUM WA 98325-9795
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 9/6/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP 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 Floodplain
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $47.00 MAM 09/06/02 49621
Total: $47.00
JEFFERSON COUNTY COMMUNI•EVELOPMENT,621 SHERIDAN ST,PORT TOWN*WA 98368 PH: (360)379-4450
v INSTALLATION PERMIT APPLICATION
WOODSTOVE X Above Ground PROPANE TANK PELLET STOVE OTHER
Is this appliance (htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home?
YES NO
SITE ADDRESS(911#/Road Name):
Cff/427/9C L//Y7 ! c/1// ZIP 9 5 3
9 DIGIT PARCEL ID NUMBER 1 0 / //0/ 0. 3 9
Legal Description:
Subdivision Name Block Lot(s)
Section Township North, Range WM
APPLICANT IN / L 69/71 !i C `�� PHONE
MAILING ADDRESS ✓f PIE R sON I /94t IP D_ // ,2
G / 2-779- f/9 ZIP 3
PROPERTY OWNER E frE 4(k- c %''o / .7.6s'oX? PHONE
MAILING ADDRESS
ZIP
CONTRACTOR c 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 vv�%�GL rt�l'1 4 DATE / / / �S
BASE FEE E C E o w E 7 1 T#
K#TOTAL 4 4- - SEP - 6 2002i I 9. / /
J I
H:\TOME\PLNCNTR\INFOBLDGIFORMS\INSTALL.DOC11/05/01 - ,4,y
DEPT. OF COMMUNITY DEVELOPMENT