HomeMy WebLinkAboutBLD2009-00147 •
11111
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00147 Received Date 5/13/2009
SITE ADDRESS: 110 N MAPLE ST Issue Date 5/28/2009
PORT HADLOCK, 98339
APPLICANT: GEORGE HODGDON PHONE: (360) 457-7488
322 LEIGHLAND AVE
PORT ANGELES WA 98362-9339
11-21
SUBDIVISION: IRONDALE Block: 40 Lot:
PARCEL NUMBER: 961804003 Section: 2 Township: 30N Range: 01W
CONTRACTOR: SHOLD EXCAVATING PHONE: (36)385-0480
PO BOX 179
PORT HADLOCK WA 98339
Contractor's License SHOLDI*224LT Expires 7/9 L(360 379-6892
OWNER, GEORGE HODGDON PHONE: (360) 457-7488
if different: 322 LEIGHLAND AVE
PORT ANGELES WA 98362-9339
PROJECT DESCRIPTION: DEMO SFR - NO MLA REQ'D
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 5/28/2010.
REQUIRED INSPECTION:
FinalApproval: . ,,--iI-{,Y)
✓'
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
/ ON car,. JEFFERSON COUNTY !_i, J f-' ,� ` ji
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wz ,�.� DEPARTMENT OF COMMUNITY DEVELOPMENT
-'I ` 621 Sheridan Street • Port Townsend •Washington 98368
K. 360/379-4450 • 360/379-4451 Fax ^i i 1.
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p� www.co.jefferson.wa.us/commdevelopment
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Master Permit Application L,FFFE cf.t�
MLA:
Project Description (include separate sheets as necessary):
De rll 0/,'t/,'c,,-, O-t A c,,,•-re. c..„.T //0 � o�, /'C J { � �o j fh! � . � c p� q�
Tax Parcel Number: c(6 I 804. _ 0 03 Property Size: I i.quare feet)__
Site Address and/or Directions to Property:
//O McA/7 7e .S-/. Povf He cI lc,c & 1. 4 cr8 33 et .
Property Owner(s)of Record: G o--� Ho<,ll do
Telephone: 60 1/5 7 -7�FR8 Fax: email:
Mailing Address: 3 2Z Z.e 0 ,/.,./0/ A VC no r i- A,1 l e /.s 6/X1 18 3 6'2.
Applicant/Agent(if different from owner): S•AoIcf L,cc:.ve.-frH 1•-. . �,,,1c,-iL,,, 4 `%o4,�,so-•-\
Telephone: 3 CO 3$5 04, c� • Fax: 60 3 x4 i Z
email: C«tro-,s610rd02/4,40-, - Gain
Mailing Address: PO- i3o,. /9d1 Pc,y-f I-/G c//o.. /( t✓A 9e S7
What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation •
ui ding ❑ Critical Areas Stewardship Plan
LE'Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]"
❑ Manufactured Home .0 Modular - - 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑ Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach ❑ Short Plat**
❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan**
❑ Propane ❑ Long Plat**
❑ Sign - - • ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed "Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration**
❑ Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ 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 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:
I hereby designate ItM3hnS� I� G, to act D�SIGNAT act OF AGENT
as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE # • th/1 1 Date. 14 t�
By signing this application form,the owner/agent attests 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 orin 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 wants prio,notice.
Signature:
Date:
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
-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 adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
G.\PerrnitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• •
BUILDER STATEMENT
r.- slink:,r,f t'us statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors anc tna;
:ray a 11 be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTORg OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
.571o /e..0 .E<CC-.VGA.-/'t'vj - e'c . (360) 395— Oaf8O (30) 3 - 68 7 a.
MAILING ADDRESS: pQ. /3ox / of Po�-'t H ci 10G k £J' 9fi553`1EMAIL: Cc,f-{o. 5 A a(c) 9 y . 4 c:, . co,
CONTRACTORS LICENSE _ WAINS
NUMBER: S j-10L 0I`F Z Zz{- LT NUMBER
ARCHITECT/ENGINEER: PHONE
( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
C New ❑ Wood Existing: ❑ Sewer
C Addition ❑ Steel Proposed: Bank ❑ Community System j
Alteration/Remodel 0 Concrete Total: Height: 0 Individual System
- Repair Repair ❑ Masonry SEP Permit# _
✓Demolition ❑ Other: Bedrooms: Water Supply: I
Existing: Setback: ❑ Private well H 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'Seriice? 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:
Heat Stove i Cook Stove i Woodstove T 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 I
lines, tank location and size, distances from the propane tank to all property lines, buildings and septic system components,
including the reserve area.
.~x ' 0
a�i ra 3
Square Footage _ Current Proposed "'For;Offic@ Use ?ni t s
� Amourit? Revision _ J
Main Floor Heated EH Bld App Review: 00
2''floor Heated • Consistency Review:
Other Heated Base fee:
. 7 1, o
Mezzanine r° Additional Section:
fsY�• , —,
Heated Basement r f , Plan Check fee:
Unheated Basement , '} State Surcharge fee:
4 . 50 _ .
Other Unheated x , Pot Water Review fee:
,
Garage/Carport SUBTOTAL //''
Decks `?�y i. 911/Rd Approach fee:
Other ,� TOTAL: $
lUg s�
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish
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