HomeMy WebLinkAboutBLD2010-00041 • 41111
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD10-00041 Received Date 2/11/2010
SITE ADDRESS: 1771 OAK BAY RD Issue Date 2/17/2010
PORT HADLOCK, 98339
APPLICANT: ARTHUR E LARSON PHONE: 425-235-1984
JEANNE A LARSON
6620 112TH AVE SE
BELLEVUE WA 980066424 2
SUBDIVISION: SURACE/LARSON SHORT PLAT Block: Lot:
PARCEL NUMBER: 921073023 Section: 7 Township: 29N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, ARTHUR E LARSON PHONE: 425-235-1984
if different: JEANNE A LARSON
6620 112TH AVE SE
BELLEVUE WA 980066424
PROJECT DESCRIPTION: DEMO EXISTING M/H -SEE BLD09-397
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 2/17/2011.
REQUIRED INSPECTION:
FinalApproval:
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
0041
AIR
LDING PERMIT APPLICATIe BLD1 Type:Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00041 Received Date: 2/11/2010
SITE ADDRESS: 1771 OAK BAY RD
PORT HADLOCK, 98339
OWNER: ARTHUR E LARSON PHONE: 425-235-1984
JEANNE A LARSON
6620 112TH AVE SE
BELLEVUE WA 980066424 SURACE/LARSON SHORT PLAT
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 921073023 Section: 7 Township: 29 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr DEMO EXISTING M/H - SEE BLD09-397
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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
(N1H1— t o
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 02/11/10 113854 APPROVEP
State Building Code $4.50 LYK 02/11/10 113854
Total: $75.50 FEB l 71010
Jefferson County Planning
& Building Department
4) Yn U
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O' JEFFERSON COUNTY "�
1, . �j DEPARTMENT OF COMMUNITY DEVELOPMENT S�
''� s i� 621 Sheridan Street• Port Townsend •Washington 98368 � l �--
360/379-4450. 360/379-4451 Fax
0.
N4141N�� www.co.jefferson.wa.us/commdevelopment C,. 4F /() cl 9 S
Master Permit Application MLA: 09 -
Project Description(include separate sheets as necessary):
■I
r+RsCIO `r-./ , • . I . J/r T I it A.
•
Tax Parcel Number. q 2 I - 073-023 Property Size: 1.3 4 7 8 (acres/square feet)
Site Address and/or Directions to Property: 1771 - OAK SAY ROA D
PORT HADLOCK4 wA g8339
Property Owner(s)of Record: / RTHUR 4-TEANNE Lf)RSON
Telephone: '/25-Z35 - 198 q Fax: email: Larson 66200ooc. coir/
Mailing Address: 6620- 1 / 2rH Ave. S. E. 4 BELLEVU1=( WA 48006-C '74'
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
31filding 0 Critical Areas Stewardship Plan
` 0 Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
Single Family rage Attached)Detached 0 Conditional Use[C(a),C(d),or Cj**
❑ Manufactured Home_ .❑ - - 0 Discretionary`D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)''
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑Home Business 0 Cottage Industry 0 Binding Site Plan"*
❑Propane 0 Long Plat'* t1 r 9�nnn�qq
❑Sign .. .- • 0 Planned Rural Residential Det4gbpn�e (l tf )/Amendments**
❑Allowed`Yes"Use Consistency Analysis ❑Plat Vacation/Alteration--
❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development'"'
❑Temporary Use 0 Shoreline Management Variance
❑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:
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 ' ht of ent will be assumed unless the applicant informs the County in writing at the
time of the application that he or she wants prior notice.
Signature: OF Date: /2-/02/0 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 lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
'Endangered Species Ad"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 ian with theAefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable respo i il' rr adherj o and complying with the ESA. The Applicant has read this disclaimer,and sigi/s and dates it below.
I Signature: 71;%�
1 9 Date: /2 /0 /0
02/03/2010 12:20 3604171467 PAGE 01/01
FEB/03/2010/WED 12: 12 PM ORS FAX Na, 360491530 P, 001/00l
I
46—iibIoilei (r,\ Olympic Region Clcau Air Agency
,s�� ,.I"'VI" ?yam-B Limited r r
r` ., Olympia.WA 9S502
QR (3G0) 5a6 1c7A1a•PAX(360) 91-6UM 1
I ?Ott.Angeles office(360)417-1466 Dexxxo tx'-' Pe a't
ORCAA • %/ Raymond Office(360) 942-2137
I 1 Commercial Strt cture Permit fee:$60.00—10 working day wait period(xj Owxier occupied residential dwelling—Permit fee: $35.00—.Prior Notice 1
• PROPERTY OWNER
Name:
Phone: (Ng /7—o k / Fu,,,ii, r 3;fro
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-J7aL,�S Zip. ,
sit,Address Qd O/`iC .83 9
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DEMOLITION CONTRACTOR . C:heck if 6ane es m 33
Business.Name '- ttv owr:er Information.
t� �. �- !S�S Pbc'rc: � W7-0 F f :,,nail:
omit,Conasct FAX; 4 — Q i7% 5
Phone: ( � n_eo
Mailing Address: FAX: ( f F hP Molailc: OM
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DEMOLI'I'4ON INFOR SAjIOI� ,r T_ _ ..
#of Structures being
_ng derno1I hcd; Starr Due:
_ d �� Completion Date: -
Asbeswg present Yes ! Survey Ott 5 'Y��'No l flag 1 T
aG all ideri ed asbestos bseA
texneved 4ap No
DEMOLITION PRO ECG'CATEGORY
[kJ Complete Demo(iuoo _ _
l l Training Eire-Fire Agency: ._
I I Renovation,A.lterurion,Remodeling, ----
m Ivl�tintcnsl+�ee,or other Gt+nszructjcyr�E
-Additional Fee of$50.00(most be aecorn anted
.E Gn'*'c7meuc Oxdeccc[TJcelarada,a-Coinmterciak on
I bve marl and will abidc by ad,conditie4s set fardi in tbft permit And oily addendrtm cbereto. T do hereby.cer
tbar>4Dr'dextri.6'ed Asbestos has bean.tcmoved sad the Ln£armatian era this cacia I and su J
described basin is, to the best of fs+y/wow/ed P pp eane�vtaf damg'e,s�acutYtre surd complctic.
- "aar ,L. rSO r7
att.'Applicant Name � ,--._. Z ../
Signature
Date
Dat cation Received — P z n, T _ - __ ._ .
I'ayruent T . Approved
f ]Cash - PA �$be;toes 1�vmri�
RECEIVEDf J Cash f ) Disapproved Permit# i _ASB00.0911 j
l J Credit Card Itat�i 3 f,� Detnelitien Verrnir
rw Clare:.... / /� Permit #aLDp N11)0
FEB 0.3 2010
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