HomeMy WebLinkAboutBLD2008-00474 • !.
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD08-00474 Received Date 11/6/2008
SITE ADDRESS: 60 MAPLE DR Issue Date 11/12/2008
PORT TOWNSEND, 98368
APPLICANT: ANNE STOLTZ PHONE: 360-376-7528
SUSAN STOLTZ
3712 W TILDEN
SEATTLE WA 98199 18
SUBDIVISION: CAPE GEORGE VILLAGE DIV 4 Block: Lot:
PARCEL NUMBER: 940800018 Section: 13 Township: 30N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, ANNE STOLTZ PHONE: 360-376-7528
if different: SUSAN STOLTZ
3712 W TILDEN
SEATTLE WA 98199
PROJECT DESCRIPTION: DEMO EXIST M/H
Directions
To Site:
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 11/12/2009.
REQUIRED INSPECTION:
FinalApprovap 10-P
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
•
BLD08-00474
BUILDING PERMIT APPLICAMON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00474 Received Date: 11/6/2008
SITE ADDRESS: 60 MAPLE DR
PORT TOWNSEND, 98368
OWNER: ANNE STOLTZ PHONE: 360-376-7528
SUSAN STOLTZ
3712 W TILDEN
SEATTLE WA 98199 CAPE GEORGE VILLAGE DIV 4
SUBDIVISION: Block: Lot: 18
PARCEL NUMBER: 940800018 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: MARTIN KITHCART PHONE: 360-379-6652
PO BOX 1031
PORT HADLOCK WA 98339
PROJECT DESCRIPTION DEMO EXIST M/H
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP DEM
VALUATION MAIN:
CODE EDITION: 2006 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $52.00 LYK 11/06/08 102881 A1PR \JEIJState Building Code $450 LYK 11/06/08 102881
Total: $56.50 NOV Ia 2008
Jefferson County Planninc
& Building Department
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+1.c0. - • - Signature --6.-g30,----� Dale
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�L`r119iO$ , OVER
4„4, , cod,.a JEFFERSOrtUNTY .
, DEPARTMENT OF COMMUNITY DEVELOPMENT
~' ` `4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
qS,�,— •' ' www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: o '.b
Project Description(include separate she is ai necessary):
1 i 1',i.11l, C (1C,w0(
Tax Parcel Number: O4 6 S 000 l53 Property Size: (acres/square feet)
Site Address and/or Directions to Property: NOV - 6 2008 / j
('o Au p l c p vj vc- Ft, ),- -To try 0 J-c iw(
i
Property Owner(s)of Record: Alit vl G W- S h(i-7-- 1 ciA S G ti (--- S .t-) l v
Telephone: -27(00 • 27l10 • 752 Fax: '3(Qo- 311, - 152Z entail: 5ucdi.6 ch(i2Kau,CM-
Mailing Address: I '[-(0 Ovi j Ni. 6c4S}J0U6t4 WA `1' +S
Applicant/Agent(if different from owner):_ //.-.fit/j-77/X,C/c , X�,
Telephone: _..S 79-6(oSo2 Fax�...5Av /7(' email:/f :v7�?9/ -�/c, C.h)ylt +c)c�
Mailing Address: ��, t 7 /3 7� jc,2� /,tjk i�foc k. G %S � Cc>�t
What kind of Permit?(Check each box that applies
❑Building ❑ Critical Areas Stewardship Plan
X Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
0 Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
0 Commercial* 0 Special Use(Essential Public Facilities)**
0 Change of Use 0 Boundary Line Adjustment
0 Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
0 Propane 0 Long Plat**
❑ Sign ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
,/y� DESIGNATION OF AGENT
I hereby designate r/// i Zi j.i.) I 2-fre,tver—to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE cr, 4 j1 Date: a) ,(S' 0
By signing this application form,the owner agent atte s that the information provided herein,and in any attachments,is true and correct to the best of
his,her or its 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 access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he or she w is prior otice.
+Signature: I ` 1.3- S•
Y Date: /� �/ 0
The action oractions Applicant will u ertake a 'a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable responsibility for a Bring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ,t J'11 '- a{C Date: /0 •(c` 6 ST
II
G:\PermitCenter\##}#FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
• 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.
g l; ` � Date: �/., G UU
Signature:
r
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLE : PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New Li Wood Existing: 1 Li Sewer
il Addition LI Steel Proposed: \ Bank [i Community System
CI Alteration/Remodel Concrete Total: Height: Individual System
LI Repair ❑ Masonry SEP Permit#
Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 2- Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: \ )(Public
Total: \ Name of System:
If this is a Commercial Project 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:
i Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
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 Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bid App Review:
2n°Floor Heated Consistency Review:
Other Heated Base fee: ,-, --
Mezzanine Additional Section: O(
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: D
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL {{ a(� ��
l VrY-� ..
Decks 911/Rd Approach fee: .---
Other TOTAL: $ ( 0
Receipt Number: I D2 5N ,
Cash/Check Number:
i-11
ESTIMATED COST(REQUIRED) Date: • l '��^,�Q
.Fair market value of all labor and materials foundation to finish /� 08
Initials: /�
G:\PermitCentcr\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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