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HomeMy WebLinkAboutBLD2010-00080 i . DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD10-00080 Received Date 3/24/2010 SITE ADDRESS: 261 S BAY WAY Issue Date 4/6/2010 PORT LUDLOW, 98365 APPLICANT: STEPHEN MARINKOVICH PHONE: 206-226-3736 LISA KARIN MARINKOVICH 8047 FOREST DR NE SEATTLE WA 981155230 53 SUBDIVISION: OAK BAY WATERFRONT Block: Lot: PARCEL NUMBER: 976800033 Section: 29 Township: 29N Range: 01 E CONTRACTOR: SHOLD EXCAVATING PHONE: (36)385-0480 PO BOX 179 PORT HADLOCK WA 98339 ((33660p1379-6892 Contractor's License SHOLDI*224LT Expires 7/912010 OWNER, STEPHEN MARINKOVICH PHONE: 206-226-3736 if different: LISA KARIN MARINKOVICH 8047 FOREST DR NE SEATTLE WA 981155230 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 4/6/2011. 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 MAR;'19/2010/FRI 11 : 30 AM ORCAA Ai F.-:: No. 3604916308 Ai F. 002 •_ _ 6 scorn Cti,i�;. OIympic Region Clean Air Agency '� !"' � 4.~ 2940-B Limited Lane NW �� ,. Olympia,WA 98502 Angeles 0•FAX(3 0)41 -491-6308 Demolition Permit �p�' Port Angeles office(360)417 146G 111 ;� ORCAA . / Raymond Office(360) 942-2137 3a"i0;iararFtiar•�oSaK' • www.ORCAtLorg _---.--- -` C ( Co r ` Structure Permit fee: $60.00 'n day wait period r,, , 10 A 9 ,6 td er occupied residential dwelling—Permit fee: $35.00—Prior Notice PROPERTY OWNER Name Phone: cos)<6�-6—La./k E:matoti 0,15t a'rr-t,,.,Cn,t�{ ,7/,--...i c._J-4 s s:.�k43.-.3.c FAX ( ) Mobile: ( ) Mailing Address: City: State: Zip: Site Address: 6f I (its.P;���X I State: I IS 34.- DEMOLITION CONTRACTOR[ ] Check if same as property owner information Business. : (3 ame: Phonebo)3 $'-tic-j, , Email: . :o/> _Sit...,e_ ' r, FAX: ( ) Onsite ontact: Phone: (760)3 c7'-ige, Mobile: ( ) ,-A_Le 5nc/ ' FAX: ( ) Mailing Address: ,, City: State: Zip: /A- 1 Pi,,,,,tee// # ro p/ k.. t.Ji9- `f633'1 DEMOLITION'INFORMATIONArri ite ()p p L-- #of Structures being demolished: Start D t . I / ° o �o I on Date:'{ �/ ' - I r -rL3 0 -.r.) A g Asbestos present Yes No Survey attached Yes _No Has at identified asbestos been removed X Yes No DEMOLITION PROJECT CATEGORY [X Complete Demolition [ ]Training Fire-Fire Agency: [ ]Renovation,.Alteration,Remodeling,Maintenance,or other Construction I ] Emergency-Additional Fee of$50.00(must be accompanied by Government Ordered Declaration-Commercial only) 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. 5:,,,,--c.- .tip -P� f Ll'i-. ,— 67 — Applicant Name Signature Date IiiIGHVEtteivetl Payment Info. 1)4 Approved Asbestos Permit [ ] Cash ,f [ ] Disapproved Permit# /0 ASB00 0-c/.P MAR 1.9 2010 ?i Check # 11O5't ,� C Demolition Permit ] Credit Card Review date; / /., 6 Permit# 10 DEM00 (Q Q 1 0 R Receive date:0) //7/ 1 t) Reviewed by: ►� ,l/�l ru I CS Azettcy use Only ,Agency Use Only_ Agency Use Only Agency Use Only 10/21/08 OVER - o/G-- 03 -23 -°c 2_ 52F10-1q 410�� oN Cod JEFFERSONC OTY&6Ic� 8� '� 1 �j DEPARTMENT OF COMMUNITY DEVELOPMENT 1' ' '4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4 p/ www.co.jefferson.wa.us/commdevelopment • Master Permit Application MLA: 00 (Yi-Q ,V j r j Project Description(include separate sheets as necessary): l �C. ol i1'7 ,n,---%/re_eviC)...;<-1 17L 7 Ir eA I./C. pP Tax Parcel Number: 9 -46 g©cio 3 5 Property Size: . S/9c tL (acres/square feet) Site Address and/or Directions to Property: a-6 1 5. a, `^�'Y ; ( ,r ; ---�' \,j/9. ,8335 Property Owner(s)of Record: ,' Telephone: .C-)6.,- 6 .1-6 -9,r2 i 6 Fax: email: S M/dn 13.4„-rr..,. 60 M Mailing Address: ' `tI !c S T (,f' N.).E ', SL..i 1(._L vJ4. 9 8//5 Applicant/Agent(if different from owner): //9 Telephone: Fax: email: Mailing Address: W :t kind of Permit?(Check each box that applies 0 Lot or Road Segregation i.'uilding 0 Critical Areas Stewardship Plan molition Permit 0 Variance(Minor, Major or Reasonable Economic Use) Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .0 Modular - 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 ❑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** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 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 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 'ri/'entry will be assumed unless the applicant informs the County in writing at the time of the appli ' that he or��h�e/yvants prio notice. +JLC / T Signature: _ ,. c '-Ci.i p,_ �,C Date: / . /C. -I 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 tederal 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 develiopment code.The Applicant acknowledges that he,she or it holds individual and non-transfer responsibil'ty f r adheri to and comp! ' with the ESA. The Applicant has read this disclaimer and signs and dates it below. /Signature: om; , 's t' Date: -/ ) -/Gi G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 0 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: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) 1 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 ❑ Concrete Total: _ Height: ❑ Individual Sys ❑ Repair ❑ Masonry SEP Permit# ( ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 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 Bld App Review: r--/-3r- 2nd Floor Heated Consistency Review: Other Heated Base fee: r'Z ( Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: / {jv Other Unheated Pot Water Review fee: , Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ )4-8 5 Receipt Number: I 7 t 7�`Ier)I Cash/Check Number: �� l _c----• ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish 5 Initials: r _ G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc goonnimmll / -----1> O /r /: O= 0 /II Z. / N cri ' rO CD O ED in / j rnQ z jO I / rn N G7 r .. // jO •nO rrnp _ rnI z p (11 rn � NNJ' (-I) Nz, r �-- z -i- / 1 / In'. rn ?1 '73/-N-4 n h t. q2 �' gni �/I `/ / 3'95r PROPERTYAv oviglir-7Ar Air'''''.:: 11'f' - . ill t .' 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