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Home My WebLink AboutBLD2004-00778 • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00778 Received Date 12/10/2004 SITE ADDRESS: Issue Date 12/14/2004 APPLICANT: ADMIRALTY CONDO'S#1 PHONE: HOMEOWNER'S ASSOC 6016 NE KESWICK DR SEATTLE WA 981052048 SUBDIVISION: THE ADMIRALTY Block: Lot: PARCEL NUMBER: 990300199 Section: 16 Township: 28N Range: 01 E CONTRACTOR: OWNER, ADMIRALTY CONDO'S #1 PHONE: if different: HOMEOWNER'S ASSOC 6016 NE KESWICK DR SEATTLE WA 981052048 PROJECT DESCRIPTION: DEMOLITION 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 12/14/2005. REQUIRED INSPECTION: FinalApproval: -9Qr C.1 0A5 147/ 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 I:\F_BLD_Permit_Propane.rpt 10/29/19 0UILDING PERMIT APPLIC ON MRAO-00689 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00778 Received Date: 12/10/2004 SITE ADDRESS: OWNER: ADMIRALTY CONDO'S#1 PHONE: HOMEOWNER'S ASSOC 6016 NE KESWICK DR SEATTLE WA 981052048 SUBDIVISION: THE ADMIRALTY Block: Lot: PARCEL NUMBER: 990300199 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt DEMOLITION TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM VALUATION MAIN: CODE EDITION: 2003 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 j.\-2.ç , Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Permit $48.00 BAC 12/10/04 68822 Total: $48.00 • 4110 a� 4NC 41014C LEA ORCAA �� R56N•1►A50'�•!� Notification of Demolition Permit It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos- containing materials have been removed from the area to be demolished. Work shall not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from ORCAA. A written application for a demolition shall include a certification that there is no known asbestos-containing material remaining in the area of the structure. Project Site Address: /06 m/ (c ,A . #42 ty,� Coun ot� City: "71% I- I feA) / �•��[. State: W/9- Starting Date: /,Q• — Completion Date: /a -AP *(There is a 10 working day advance notification period from receipt of permit application) e Owner: n n n; /�TSb c Property riY /� ��'� � Telephone:014G?- 75-5=,Z.35 S Fax:21,1AS,�71- fi.A.6- Mailing Address: (r0(Co I.e c-. bite/ , City: £f f-�-(r State: to 4 Zip:'3 /L S Demolition Contractor: /4. Is.L,(L.7 ( iG t y State License#: 14>4 4i,T.arzs-l'tJ Mailing Address: t`f& I44 4pi o /4't vt t City: State: Zip: Contact Person: Telephone: Fax: NO Demolition by Wrecking or Dismantling? ($25.00 fee)check# Training Fire Demolition? (If yes, attach fire department request for training fire) Renovation,Alteration, Remodeling, Maintenance, or other Construction? Asbestos found or suspected* *An ORCAA"Notice of Intent to Remove or Encapsulate Asbestos"form and appropriate fee must be submitted prior to any asbestos removal work. Asbestos removal p-ojects involving demolition must be preformed by a Certified Asbestos Contractor and all friable or potentially friable asbestos must be removed before any demolition begins. Refer to ORCAA Regulation 1 Article 14 for additional requirements that may apply. Asbestos Survey Completed by AHERA Certified Inspector &Jo St); Certification#- J44 044-1 CQ 1 This approved permit must Enclose$25 Certification of the Asbestos Survey must be available at the job site Processing Fee accompany this form 2940 B Limited Lane NW,Olympia,Washington 98502 360-586-1044 * 800422-5623 * fax 360491-6308 homepage:www.orcaa.org * email: info@orcaa.org Rev.07/11/02 • OWNER BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTUR I. t {,1 �p„f�M��risTPEL'ER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: P Shoreline: Type of Sewage Disposal: 0 New Wood Existing: D Viewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑repair 0 Masonry SEP Permit# �f Demolition ❑ Other: Bedrooms: Water Supply: Existing: 107-- Setback: 0 Private well ❑ Two Party Typq of Heat: Proposed: ublic ../2G, Total: Name of System: If this is a Commercial Prolect you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑ Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank 0 Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes /GNp When applying for a permit to install a propane tank you must also subnilti site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage .F' ce'UseTOnly A . � ,: Current Proposed - "q" r: t f' ` Main Floor a Re i b -- 4k get.- 3 3 "s �4. a I l d' , .{2""Floor m R` 'f,,L"s e; N ' 3 Floor 1di9n* on: • Mezzanine: i, Plan r f Heated Basement t.'' w StateISurcharge fee f _w r i,, i -4,x f'4 Unheated Basement ' 0 � , ' EC Pot W ales Revl�ey� � .��-� � �,> �� v� I Other Unheated � � 911/Rd Appn « �� ,A"y s� S��+lf1t�'1 �;jl* Cl , _.. l'�r r 'Ta i J.�t r. Pw[[•Y„ . .n,*xf et'�, zzy- Garage/Carport wi LI'(TWO,:O,: f" F i s p �.� yt 3YE a .fityw Decks ..Av , Receipt Number t, Z - t n` ? � - psi �, �4 ZF s4ik Other Cash/Check Number rpAL.�¢, � ESTIMATED COST(REQUIRED) *t '� ,4__k Date ,4,,t4 f ' x . }., U? r ' ,mot5, 2 ' r, •Fair market value of all labor and materials foundation to finish '. `� T.�?' 6' `��''' -�, 1�' �, a,;,.�' � ;o Initiai c �,' f *, ;«7 s r, -:. "'r ' , ..Ye.. L a=i fir. :.. u44"p S "?max _4 i+ Y. G:\PexmitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc o» /zl(D(,) , ' 0 RI/ w``$ cod. JEFFERSOUNTY 4 1 '� ' \� DEPARTMENT OF COMMUNITY DEVELOPMENT �'� �' 1-41 621 Sheridan Street • Port Townsend •Washington 98368 �9/ 360/379-4450 • 360/379-4451 Fax �/�' �.q p� www.co.jefferson.wa.us/commdevelopment S 4/ NGZ NC 1 n lootcg-9 Master Permit Application MLA: 614 ' Project Description(include separate sheets as necessary): Tax Parcel 4��0UO �q Property / Number: !! /,' Size: ,� (acres/square feet) Site Address and/or Directions to Property: ! ki,,i ',f 141 1 U v cOWt vti`U S Property Owner(s)of Record: Pr0 S cinar-;l We 1. "..i Telephone: dE 7 S- =a. 3$. — Fax: email: S4 t J//5-6 @ 4-Tr.Np---- Mailing Address: 6001 (o 1U6r k<Cci,. ;ck ,)),Q ,c.¢,Pt4/L� 9cfr0s- Applicant/Agent(if different from owner): I4. 0 ct.ii,l107 CAowt pc,,,.y `. k(A 1r5,f-erf Telephone: -a 7/ -3 4/ 7.3 Fax: S/)s--7'7/- a-/?>r email:J n14n- ;s,{-t,e @ir�.p/1i u•,•/ , Mailing Address: / c4 t) j,-, pit_ ,a-vi• cc W per, e.-", W0i T,d e f'- What kind of Permit?(Check each box that applies) ❑ Build'ng ❑ Variance(Minor,Major or Reasonable Economic Use) O.emolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **Requires a Pre-Application Conference Please1C9 identify any other local, state or federal permits required for this proposal, if known: cc�� DESIGNATION OF AGENT I hereby designate '(-rC,S _ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent 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 acres and ri t of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required Ia(er i spec',ns. ccess and right of entry to this property shall be requested and shall occur only during regular business hours. 9 Signature. Date: /�' - c 7 The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could ad to a po tial"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or S "Jeff son County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued wil of olate e ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are/' plia with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable ,eons i' f r adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date:/�/ Ur G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: c, Shoreline: Type of Sewage Disposal: ❑ New Z'"V1/ood Existing: D fewer ❑ Addition ❑ Steel Proposed: Bank El Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑Repair ❑ Masonry SEP Permit# Demolition ❑ Other: Bedrooms: Water Supply: Existing: I;2-- Setback: ❑ Private well ❑ Two Party Txn of Heat: Proposed: Public eG_ Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current P Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: o Underground Tank I7 Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove LI Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes /4-14):, When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage For Office Use Only Current Proposed Amount Main Floor Consistency Review: 2NU Floor Base fee: 46 if':C 31"0 Floor Additional Section: - Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement DV Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ 4$ C Decks Receipt Number: ('i 22 Other Cash/Check Number: L{L,A -Z. ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish 1 2-1 1'-l f_ Initials: \(2P G:\PemiitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc ---"4--An..--•.4.......)) ,. \\1\\\\ ` . .o - 'y- • i�v/ ,) Q , , Cit , 4 ,, , T- ' 2 "4"•• (-,. 3� gi N -dd 9, E *- • (k../ --- _, ra �o %...•. , , , ..,,, , , • -,_ z , ,,,, v) v, ., t 41. \,....\:: 3CI1 M • PtclrA7ru1h-../ LDADrAiIn;Uin,s