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Home My WebLink AboutBLD2009-00034 BLD09-00034 UILDING PERMIT APPLICACN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00034 Received Date: 2/10/2009 SITE ADDRESS: 250 JANSEN RD NORDLAND, 98358 OWNER: CHRISTIAAN P MEYER TRSTEE PHONE: 602-920-9375 STEPHENIE M MEYER TRSTEE 32531 N SCOTTSDALE#105 SCOTTSDALE AZ 85266-1519 OLSON & HAMBLETON'S SUBDIVISION: Block: Lot: 3 PARCEL NUMBER: 977700090 Section: 4 Township: 29 N Range: 01 E CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080 TODD HULBERT PO BOX 100 CHIMACUM WA 98325 Contractor's License TOLLEBI977N9 Expires 3/15/2009 REPRESENTATIVE: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080 TODD HUBERT PO BOX 100 PROJECT DESCRIPTIOr DEMO EXISTING GARAGE (720SF) TYPE OF WORK GAR 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: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0 Total: 0 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date APPROVED � Permit $55.00 LYK 02/10/09 105365 R®V E D State Building Code $4.50 LYK 02/10/09 105365 Total: $59.50 MAR 2009 Jefferson County Planning & Building Department I DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD09-00034 Received Date 2/10/2009 SITE ADDRESS: 250 JANSEN RD Issue Date 3/23/2009 NORDLAND, 98358 APPLICANT: CHRISTIAAN P MEYER TRSTEE PHONE: 602-920-9375 STEPHENIE M MEYER TRSTEE 32531 N SCOTTSDALE#105 SCOTTSDALE AZ 85266-1519 3 SUBDIVISION: OLSON & HAMBLETON'S Block: Lot: PARCEL NUMBER: 977700090 CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080 TODD HULBERT PO BOX 100 CHIMACUM WA 98325 Contractor's License TOLLEBI977N9 Expires 3/16/2011 OWNER, CHRISTIAAN P MEYER TRSTEE PHONE: 602-920-9375 if different: STEPHENIE M MEYER TRSTEE 32531 N SCOTTSDALE#105 SCOTTSDALE AZ 85266-1519 PROJECT DESCRIPTION: DEMO EXISTING GARAGE (720SF) Directions SEE DIRECTIONS& MAP IN FILE 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 3/23/2010. REQUIRED INSPECTION: FinalApproval: 4- 1- V 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 FEij/1 /7009,1.E. On' 34 FM OPEIA FAY No. 3604916? 8 P. 001 8\ • Olympic Region Clean Air Agency • /4 2940-B Limited Lane NW Olympia,WA 98502 a '+� Port3 )586 1044.FAX(360)491-6308 Residential 1^ Angeles office(360) 417-1466 '- QRCA � i. Raymond Office(360)942-2137 Demolition Permit '�°. iR,v •a° www.01RCAA.org This permit valid only for residential homeowner residing in the dwelling after renovations • • Permit fee: $35.00 per structure. Nonrefundable. • PROPERTY OWNER Name: Phone: (4 4720 54" Email:. cG"h`". 7-.1'.°'� - t.V' F.�.X: ( ) Mobile:( ) Mailing Address: $+4454 G.'L+h c' es&ic c.c.) Oci c City; State; Zip: c cr,-fe. c sc 43a l c..o.t., tv oe Site Address: ed`S Z 5-c--) City: State lip; DEMOLITION CONTRACTOR I ]Check if same as property owner information Business Name: Phone: (3 0'73 z, Ka$ro Email: r2s t( $4,,, C v ae+- AX ) 'Todd+�mit �Sra.75.wr1+rS.cex ,Onsite Contact Phonc: (Zac 533/--_3 7 c( Mobile: ( ) 'Todd t-Iu Il,c,..-I-- FAX: ( ) Mailing Address: P I pj rua City: ` crate Zip: m,4c..n... 54s3 Z S' DEMOLITION INFORMATION . _ #of Structures being demolished: l Start Date: ' Completion Date: vu ce--tAL !4 r c..-may all Asbestos present Yes NoY' Survey attached Yes No tics all identified asbestos been tenxoved Yes_ No• ' DENTOLITION PROJECT CATEGORY [,C]Complete Demolition ( ]Training Fire—Fire Agency: L 1 Renovation,Alteration,Remodeling,Maintenance,or other Construction , • I hare read and hill abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify that all identified asbestos has bun removed and the information in this application and supplemental data described herein is, to the best of my knowledge, accurate and complete. ___,.. .e-:). :41___=___ 'V�..tfcf 1-14.-1kr Applicant Name - 2/e i a Signatt re • Date • Dat c • Payment Info- �� ] Approved • Asbestos Permit �.. • [ ]Cash [ ] Disapproved Permit# _,A.SB00 FEB [ ] Check # 1 8 200 Credit Cat /1 C J Demolition ermit .. �y7 tL Review date: / I_.` Permit# DEM00 D iC) � Receive date/\7/Oet Reviewed by: /C tit'o '5 A Agent'Use Only 4e1mcy Usa Onby 44gemy Use Only 09/19/08 OVER 1�: -- I l Th-so ( sc i c OI JEFFERSDOUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT 1- ` '4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �qS et() www.co.jefferson.wa.us/commdevelopment NG Master Permit Application MLA: y. _ , e._,C Ck I Project Description(include separate sheets as necessary): �G'-'+n ei(. (- e?Cr'STi l... OeirSc Le_d to ,✓.., Tax Parcel Number: 5 ?7,--4, oc,c, qo Property Size: 5 see- (acres/square feet) Site Address and/or Directions to Property: 2 —v )c v.Ce-4e. t2 O+Ae4"o-( Imo.Kc1 -wA Property Owner(s)of Record: LL.r.sy-i'c e,N wtcyrt/^ Telephone: Coo 5 2.4) •53 3 6` Fax: email: Mailing Address: C.? Iti >~ i?‘...cc..., .-4.1 wyso , Lc.vet-v.eeK .47_ 'K6 3?1 Applicant/Agent(if different from owner): Tr,c%..( J4 /6.L,.-i Telephone: 34o-s t ) 3l'-1 Fax: 3 bo 7 3 . '-/vbc- email: Mailing Address: Po bo+lc too c LItie►u,c 4.+N., 'A iv 3.a g Tchcfef 6"roLILc-.Scm15."'(ti-t e Cc► What kind of Permit?(Check each box that applies ❑Building ❑ Critical Areas Stewardship Plan ,k Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑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)** ❑ Change of Use ❑ Boundary Line Adjustment O Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane ❑ Long Plat** ❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use ❑ Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium El Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate 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 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 a% iat-hebrsh�wants prior notice. Signature: L Date: Z/ 4//v5 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 lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the i "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 i mpliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transom ra respo ib' y�er adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: �,1 Date: 'c f/`•?//C, 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 !"g+h onsibility of the General Contractor for the proposed project. Signature:,/) / Date: Z/ '5 tc ct GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: —1-cJ// .4 i, a u t't01.ti-S ,r_vt c �1 (34d)?Z 2-�a isv (340)7-312 £-!ems( MAILING ADDRESS: eo So /W 4.(,�,✓hS Gvd„N. (,✓4 it 3 a-EMAIL:-r-.j di) t0,//Q4 in c ,l( y'faG.--S. c -. CONTRACTOR'S LICENSE WAINS NUMBER: DUI I E tar C77 u ti NUMBER ARCHITECT/ENGINEER: 1e-•fr'Ne."1 (-ic(r.bSN PHONE (340)3ffs Zc 2t.., FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: I1 New Iilk..Wood Existing: v L1 Sewer Addition CISteel Proposed: _—er— Bank I Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ,E--Individual System Repair Masonry 3 ❑ El Permit# y(1—Demolition ❑ Other: Bedrooms: Water Supply: Existing: CU Setback: ❑ Private well L i Two Party Type of Heat: Proposed: 11 Public Total: 0 a:S` Name of System: If this is a Commercial Proiect 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: Lk)\1A ;:\f)(_-) 2"tl Floor Heated Consistency Review: w/C-ik e ,, ,i Other Heated Base fee: 5.�• Mezzanine Additional Section: _ Heated Basement Plan Check fee: __. _ Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: l��W Garage/Carport J SUBTOTAL 2 Decks 911/Rd Approach fee: Other TOTAL: $ ,-)(1,>0 Receipt Number: •Cash/Check Number: �`� �5- ESTIMATED COST(REQUIRED) Date: I` Q4� •Fair market value of all labor and materials foundation to finish I Initials: ____ _ D G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc —J