HomeMy WebLinkAboutBLD2009-00385 i •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00385 Received Date 11/19/2009
SITE ADDRESS: 244 FRANKS LN Issue Date 12/17/2009
QUILCENE, 98376
APPLICANT: MARK C WILSON PHONE: 206-949-7572
DANITA R WILSON
23707 SE 221ST ST
MAPLE VALLEY WA 98038-8435 4
SUBDIVISION: SEAHOME Block: Lot:
PARCEL NUMBER: 992600008 Section: 36 Township: 27N Range: 01W
CONTRACTOR: BISHOP BROTHERS CONSTRUCTION PHONE: (360)301-1979
LOREN BISHOP
371 BISHOP HILL RD
CHIMACUM WA 98325
Contractor's License BISHOBC093D6 Expires 1/11/2011
OWNER, MARK C WILSON PHONE: 206-949-7572
if different: DANITA R WILSON
23707 SE 221ST ST
MAPLE VALLEY WA 98038-8435
PROJECT DESCRIPTION: DEMO EXIST SFR
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 12/17/2010.
REQUIRED INSPECTION:
InalAp%royal: t l'tS" totO
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
&UILDING PERMIT APPLICtON B RD09 00eview p385
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00385 Received Date: 11/19/2009
SITE ADDRESS: 244 FRANKS LN
QUILCENE, 98376
OWNER: MARK C WILSON PHONE: 206-949-7572
DANITA R WILSON
23707 SE 221ST ST
MAPLE VALLEY WA 98038-8435 SEAHOME
SUBDIVISION: Block: Lot: 4
PARCEL NUMBER: 992600008 Section: 36 Township: 27 N Range: 01 W
CONTRACTOR: BISHOP BROTHERS CONSTRUCTION PHONE: (360)301-1979
LOREN BISHOP
371 BISHOP HILL RD
CHIMACUM WA 98325
Contractor's License BISHOBC093D6 Expires 1/11/2011
REPRESENTATIVE: LOREN BISHOP PHONE: 360-301-1979
371 BISHOP HILL ROAD
CHIMACUM WA 98325
PROJECT DESCRIPTION DEMO EXIST SFR
TYPE OF WORK RES 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: Exist:
Prop: Prop:Total: Total:
Routinq Date: -
<< 7-3-09
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 11/19/09 111250 APPR®VEC
State Building Code $4.50 LYK 11/19/09 111250
Total: $75.50 DEC 11 i 11
Jefferson County Plannini
& Building De!artme
• •
•oN4,, Olympic Region Clean Air Agency
4 \ 2940-B Limited Lane NW
Olympia,WA 98502 Residential
(360) 586-1044•FAX(360) 491-6308
Port Angeles office(360) 417-1466EC uDemolition Permit
O RCA.A • � Raymond Office (360) 942-2137
www.ORCAA.org
This permit valid only for residential homeowner
residing in the dwelling after renovations
Permit fee: $35.00 per structure. Non-refundable.
PROPERTY OWNER
Name: �n Phone: (3�,o)30/ -/y`7 9' Email: Is 6;s'l o7 0__? E'M,(�a-X ma.I
/a r ,' IV, /s o i'7 FAX: ( ) Mobile: ( ) . Co.,l
Mailing Address: City State: Zi :
37/ /3,..5/0( f/// RO CA, rv74,( (-✓/� 3�s
Site Address: � / Ci State:' Zip;,
,2�L� /'rccn /cS /71/ Vu, i(en e w4
DEMOLITION CONTRACTOR M Check if same as property owner information
Business Name: Phone: ( ) Email:
FAX: ( )
Onsite Contact Phone: ( ) Mobile: ( )
_ FAX: ( )
Mailing Address: City: State: Zip:
DEMOLITION INFORMATION
#of Structures being demolished: / Start Date: Completion Date:
/2 -/S-O _ 4,2 -30 --o
Asbestos present Yes_ No Survey attached YesX No_ Has all identified asbestos been
removed Yes No
DEMOLITION PROJECT CATEGORY
[ ] Complete Demolition
[ ]Training Fire-Fire Agency:
[ ] Renovation,Alteration,Remodeling,Maintenance,or other Construction
I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify that
all identified asbestos has been removed and the information in this application and supplemental data described herein
is, to the best of my knowledge, accurate and complete.
frt1Vs-) ` C /
Applicant Name Signature Date
Date Application Received Payment Info. t 4 Approved Asbestos Permit
[ ] a [ ] Disapproved Permit# ASBOO
`.t y
[ heck: # I ( Demolition Permit
[ ] Credit Card Review date:/ / / /L?9 Permit# dl DEM00c- " ---
c
Receive date/ /0 I Reviewed by: vS
Agency Use Only Agency Use Only Agency Use Ony Agency Use Only
09/19/08 OVER
\� (Lc�� i 3- -,z; (1
4��• ON cod JEFFERSOUNTY •
w ' I-4 DEPARTMENT OF COMMUNITY DEVELOPMENT
" ` `� 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
�Yy y www.co.jefferson.wa.us/commdevelopment
SNO
Master Permit Application MLA: 09- 379
Pro escription(include separate sheets as necessary):
Tax Parcel Number: -! 9a,.. 600 Q0 P Property Size: 9
/��` 9 3 7 (acres/square feet)
Site Address and/or Directions to Property:
g y F�4 ` r 41,7G Qu;/cc•-)e ti/�9. 9,9376
Property Owner(s)of Record: /1,1nt"-k ,,-/,sa,-f
Telephone: ZOO 9 Y 9 7,y 22_ Fax: email:
Mailing Address:a,3 707 .S,F- .2.2/ s'` S>4: /Ll,/a/e /.�a//t�� 14/'l, 91yo,3,4p
Applicant/Agent(if different from owner): /.or't., / ,,5-47'
Telephone: <.36 0 30/—/9/7 9' Fax: email:
Mailing Address: 37/ /3, _5'�rax� , 7/ ,e!a C'4„y,Q t u,,,,,,/ �, -1 9' 5 3 7
What kind of Permit?(Check each boxl that applies ❑ Lot or Road Segregation
❑Building ❑Critical Areas Stewardship Plan
-Er Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family D Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑ Special Use(Essential Public Facilities)**
❑ Change of Use ❑ 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* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑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 i� f Date: // ----/7—o 9
By signing this application form,the owner/agent attests t at 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 want prior notice.
Signature: Date: /7 _/ 7 —6 9
The action or actions Applicant will undertak s 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 sponsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: // /? —0
G:\PermitCenter\###FORMS###\DRD FORMS\Current 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.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
5/5h, BrptXt s c,75 f o 30//9 29 ( )
MAILING ADDRESS: / y // �/7 EMAIL:
3 7/ ,�.s�io i .rara.�-�
CONTRACTORS LICENSE ` WAINS
NUMBER: 5 1$//06C 0 9 3 1 f7 NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: _ Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
X Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 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:
1 Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove 1 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 Bld App Review: LI 5F L
21.4 Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: ...________
Garage/Carport SUBTOTAL ,e_rt•5J
_,
Decks 911/Rd Approach fee: 6-x1 ST-WI
Other TOTAL: $ 13...50
Receipt Number: ` t 1 250
Cash/Check Number: 3'2q
RO
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish <1
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
73
L .
rn —
n
n it y
v
CO TU z c) to a ON -A vJ
w
h
ODZ n � (-) '-� o ► oo D
o O
71 0 9 Q.. < 1.11 (0 D 3 Ji• \l/• ..1 _x CO
0
# h -5 -� (� C rip
C ID
oUl r- 3 � � � m C O •
v0 -0 3 D r_F Q o fU TT
< o r0 n h ` \ N
o �- oh � Q n -5
msr � 3 iP
rp Q3 o
Q Cu
�RS>
ti -5Fm v
� (oQ
c+ Q- (p (0 X 10
• x -5 -5 -h vQ9 N
cf
P <-fp � n r
Q `0 -n
`�Fi Ti- X me!r h
o ro
lilli0
G) XNIA
-i
I-
m
- ( `u (fly
r Cr
0 4 CO ` Q •
spo,„. - *
CD
•• / \
vi
�
xtr--.I I _
Zri)
0 3 N .
m • £
COh
to
wu T C b (`� -o
m r X `\� a
O X 3
Z <-1-
Z
• Rl X 0
�- • 0 Q
_ •Z Z 0 •
^ P m O
" 0
-) ‘+ -5 x 3
•
5) O 0 Q ;�
' to �� X
Z �
�' O Q Q ri
O z- 0
3 4- X co
s' £
Q Q
\. •
•, 41 O 0
1 no
r
Q ro
} TCO., it,
-y -I-
.