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Home My WebLink AboutBLD2010-00104 S DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD10-00104 Received Date 4/8/2010 SITE ADDRESS: 21 E CEDAR ST Issue Date 8/4/2010 PORT LUDLOW, 98365 APPLICANT: CLARA P WALTON PHONE: 360-437-0254 21 E CEDAR ST PORT LUDLOW WA 98365-9740 28-29 SUBDIVISION: PARADISE BAY ESTATES Block: 4 Lot: PARCEL NUMBER: 983400424 Section: 22 Township: 28N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: OWNER, CLARA P WALTON PHONE: 360-437-0254 if different: 21 E CEDAR ST PORT LUDLOW WA 98365-9740 PROJECT DESCRIPTION: DEMO EXISTING 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 8/4/2011. REQUIRED INSPECTION: FinalApproval: 104 / LOT 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 BLD10-00104 SUILDING PERMIT APPLICAIIPN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00104 Received Date: 4/8/2010 SITE ADDRESS: 21 E CEDAR ST PORT LUDLOW, 98365 OWNER: CLARA P WALTON PHONE: 360-437-0254 21 E CEDAR ST PORT LUDLOW WA 983659740 PARADISE BAY ESTATES SUBDIVISION: Block: 4 Lot: 28-29 PARCEL NUMBER: 983400424 Section: 22 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION DEMO EXISTING M/H TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routi q,Date: — �y Type Arn unt Paid By: Date: Receipt: Permit $71.00 LYK 04/08/10 117531 APPROVED State Building Code $4.50 LYK 04/08/10 117531 /► 4 Au2010 Total: $75.50 Jefferson County Planninc &Building Department � .......,_ � 0 • • IC....:„ Olympic Region Clean Air Agency 2940-B Limited Lane NW sZt Olympia,WA 98502 Residential (360)586-1044•FAX(360) 491 6308 sal ... Port Angeles office(360)417-1466 ,44k, ORCAA Raymond Office (360) 942-2137 Demolition Permit www.ORCAA.org This permit valid only for residential homeowner residing in the dwelling after renovations AUG - 4 2010 Permit fee: $35.00 per structure. Non-refundable. PROPERTY OWNER Name: ` ! Phone: (3,e'a,?j�f.- fee49 Email: _ W i9/i7- 7i2 i/ _FAX: ( )379 5!7✓ Mobile: ( ) Mailing Address: City State: Z : Site Address: City: State: Zip: DEMOLITION CONTRACTOR[Artrerck if same as property owner information Busire=.--3'`T - -" Phone: ( ) Email: ....,- f•-a,•-••" y-j_ _ _ _ ' FAX: ( ) — Onsite Contact: Phone: (.2 /:6 S�/e' Mobile: ( ) • / 7 (1/��' FAX: ( ) Mailin2 Address: " Ci State: ?i,.,,,Ac.- DEMOLITION INFORMATION #of Structures being demolished: Start Date•j- -- Completion Dire: Asbestos present Yeses is Now. Survey attach4. Yes o_ Has all iden4ed asbestos been removed Yes.,. .... No_ . DEMOLITION PROJECT CATEGORY [ omplete 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. 1e„yam' `n ' iaer: 'a. Signature Date Ni ...Sf R V ICr..Sy1; Date Application Received Payment Info. �'�]`Approved Asbestos Permit JUL 0 2 2010 [ ] Cash [ ] Disapproved Permit# /0 ASBOO 3051 I r [ ) Check: # Demolition Permit [VJ�Crree�Cax t� Review date:2/?�)/I7j Permit"#16/DEM00(� ()RCM -` . Receive date/L./10 Reviewed by: Agency Use Only Agency Use Only Agencyljellia— Agency Use Only 09/19/08 OVER ri;,. ,ON —' c JEFFERSON OUNTY • • ' \g14' DEPARTMENT OF COMMUNITY DEVELOPMENT '' 'N 0 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax � p"� www.co.jefferson.wa.us/commdevelopment 87N Master Permit Application MLA: Lt n'1tJ ./ Project Description(include separate sheets as necessary): oYy4- Tax Parcel Number: �' "' " l��#TS" Property Size: �� 0 (acres/square feet) Site Address and/or Directions to Property: 2_ / ` ,6/7", s/® 70r4 Property Owner(s)of Record: (.A a wik rt-;i,_.) Telephone: 1437- U SS `` Fax email: Mailing Address: ;94 ( Ci rt Tcrf L i c'kv lA G �L,'j Applicant/Agent(if different from owner): 07 ( '..ir t-6; [- rn l-7( h} Telephone: > !"1,. fd x Fax:7#_,,, email: Mailing Address (C rD Da_ V1 r Ti,,l1.3--,-"-Y7+7 (.4 (-)f 31,-R What kind of Permit?(Check a box that applies 0 Lot or Road Segregation v.auilding 0 Critical Areas Stewardship Plan )gsDemolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) Ingle Family 0 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 ❑ Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** El Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane El 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). D , SIGNATURE ?.„../OWNER � 41' Date: By signing this application form,the Itnedagent 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 cation t he or she wants prior notice. Signature: _ — "4 �, Date: .3 / 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 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 disclaiSner and signs and dates it below. Signature: Date: ,3/`- / G:\PermitCenter\###FORMS###\DRD FORMS\Current DAD Forms\Master Permit Application 5-29-08.doc • a 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 as5umin9 the responsibility of the/General Contractor for the proposed project. /Signature; 7�- ' ' Date: �' ��, /"GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PFIONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ❑ Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System O Repair ❑ Masonry SEP Permit# ❑ 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 U• nderground Tank i Above ground Tank Size of Propane Tank: H• eat Stove 1 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: 2 Floor Heated Consistency Review: Other Heated Base fee: I Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: C , Other Unheated Pot Water Review fee: _____—_, Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: --,`` Other TOTAL: $ �c . Receipt Number: 11"'T! 1 Cash/Check Number: .7()-273.102 ESTIMATED COST(REQUIRED) Date: L� .Fair market value of all labor and materials foundation to finish l l U Initials: F G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • ''..k \‘'s i (C.) -, ) ‘\• .c.- N3 ciA ''.:1 f.,,•-, 0\-:, ) C' A ON L., "-\-‘ ..A.' ON,. ) 0 ,--,_ sZ, S a •-o o --.1 J ) _ . 1 Cil - , <m 11‘ , (".. . #1j1 Exisrikx,1 .,. . 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