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Home My WebLink AboutBLD2003-00297 UILDING PERMIT APPLIC ON BLD03-00297 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00297 Received Date: 5/13/2003 SITE ADDRESS: 2481 ANDERSON LAKE RD#515 CHIMACUM, 98325 OWNER: KATHERINE OLSEN PHONE: (360)385-3817 PO BOX 85 CHIMACUM WA 98325 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 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 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 JSA 05/13/03 56264 Total: $47,00 • • 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 #: BLD03-00297 Received Date 5/13/2003 SITE ADDRESS: 2481 ANDERSON LAKE RD#515 Issue Date 5/13/2003 CHIMACUM, 98325 APPLICANT: KATHERINE OLSEN PHONE: (360)385-3817 PO BOX 85 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 5/13/2004. REQUIRED INSPECTIONS: [ ] Tank/Line/Appliance: [ ] FinalApproval: 14, frN,pt, 5//47/4! 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 JEFFERSON COUNTY COMMUIJEVELOPMENT,621 SHERIDAN ST,PORT TOW ,WA 98368 PH: (360)379-4450 INSTALLATION PERMIT APPLICATION MARK ALL ITEMS BELOW THAT PERTAIN TOI THIS INSTALLATION Underground PROPANE TANK* _Above Ground PROPANE TANK HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE COOKING STOVE OTHER(Please Specify) Is this appliance (htg stove, hot water tank,furnace, etc.) to be installed in a Manufactured/Mobile Home? YES L/ NO SITE ADDRESS(911 #/Road Name): (_--h( 611 2 C i e r k 6 - ZIP 9 DIGIT PARCEL ID NUMBER q.'FJ/)D l(2 3 q Legal Description: Subdivision Name Block Lot(s) Section Township North, Range WM APPLICANT KQ--1-fi cw i Yl e, E,, 0 (se kt PHONE 6 O 3 9 - 3 J 7 MAILING ADDRESS g Or 13DSC b. CLiimk..c&co, Gil ZIP -JY_5'2-. -- PROPERTY OWNER PHONE MAILING ADDRESS ( / ZIP CONTRACTOR C�Y/,2,>5 S✓�,�j/V d .�lt(/'/<�,!-(nq PHONE (ICJ 7J ` -3�5- MAILING ADDRESS 9/.a. HO)4 <J7g CJ tLii 01 w li- . ZIP -ee)7i_ 051 STATE LICENSE# C Ic.N r X/.-{-`5 f7 2..2 iv q EXP.DATE D01,/-2, pp 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 a plicant's property or structure shall be requested and shall occur during regular business hours. APPLICANT'S SIGNATURE C DATE / /3 I n 3 FOR OFFICE USE ONLY BASE FEE RECEIPT# CONSISTENCY REVIEW CASH/CK# TOTAL DATE / / rgr nr iroRg7l apgMeet+as require additional information to be submitted. 0 V E R (aa� c@tadt our oific; a O9 t the back of this application is blank. t! danter\forms\bldg forms\install-revise _ 2 0 doc L MAY 1 3 2003 1 i 1- 3D Li 9 . , ipirtal __I 1---) . , _ ,`` d LAM-WENT