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Home My WebLink AboutBLD2010-00191 • • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD10-00191 Received Date 6/3/2010 SITE ADDRESS: 6062 HIGHWAY 20 Issue Date 6/30/2010 PORT TOWNSEND, 98368 APPLICANT: BRUCE R BROWN PHONE: 360-385-2991 LINDA S BROWN 6062 STATE ROUTE 20 OFC PORT TOWNSEND WA 9836-89301 SUBDIVISION: OLYMPIC MOBILE VILLAGE Block: Lot: PARCEL NUMBER: 978706201 Section: 33 Township: 30N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, BRUCE R BROWN PHONE: 360-385-2991 if different: LINDA S BROWN 6062 STATE ROUTE 20 OFC PORT TOWNSEND WA 9836-89301 PROJECT DESCRIPTION: DEMO FIRE DAMAGED M/H &ATT GARAGE 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 6/30/2011. 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. SPECIAL CONDITIONS APPLY - SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS FOR CASE#BLD10-00191: 1.) Replacing the mobil home will require a current code septic system. I:\F_BLD_Permit_Propane.rpt 10/29/19 IlkUILDING PERMIT APPLICADN BL Revviewiew T Ty191 ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00191 Received Date: 6/3/2010 SITE ADDRESS: 6062 HIGHWAY 20 PORT TOWNSEND, 98368 OWNER: BRUCE R BROWN PHONE: 360-385-2991 LINDA S BROWN 6062 STATE ROUTE 20 OFC PORT TOWNSEND WA 9836-89301 OLYMPIC MOBILE VILLAGE SUBDIVISION: Block: Lot PARCEL NUMBER: 978706201 Section: 33 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE REPRESENTATIVE: PHONE PROJECT DESCRIPTIOI' DEMO FIRE DAMAGED M/H & ATT GARAGE 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: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: ADD r ed/Date Permit $71.00 LYK 06/03/10 117794 AP OVEI State BuildingCode $4.50 LYK 06/03/10 117794 Total: $75.50 JUN 201U Jefferson County Plannin, & Building Department • • i`jtEGIONC Olympic Region Clean Air Agency }ti1. • otiy � i,\ 2940-B Limited Lane NW j ce;, Olympia,WA 98502 n (360) 539-7610••FAX(360)491-6308 o/ Port Angeles office (360)417-1466 Demolition Permit ORCAA /� Raymond Office (360) 942-2137 \\ **-____IER �-�j www.ORCAA.org Qa Commercial Structure—Permit fee: $60.00—10 working day wait period [ ] Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice sVP p PROPERTY OWNER 11 3 Name: aeuce R. B.Rdi vrr> Phone: tire)3 a.99/ Email f FAX: ( ) Mobile:6‘0)30/a3/r Mailing Address: ity: State: Zip: ‘Oa,, s�eao 99 /o�uo Sc•�d RM. PO..?a> Site Address: City: State: Zip: &G‘a Sea 0 (Of4C-.) 1c r(0/41tis‘wb cif. 9P.?�� DEMOLITION CONTRACTOR [ ] Check if same as property owner information Business Name: /� Phone: 'O) '5-4i)OO Email: 2Fj9 vZ%T / eu.CK/k/. FAX: ( ) Onsite Contact: Phone: 0)3p5- V444 ZF/1 v/ iT �faOQ Mobile: ( ) FAX: ( ) Mailing Address: City: State: II--Zi /PO.�3ox /4?0 ,/)..eT%%'t/ocX _ J�1339 DEMOLITION INFORMATION # of Structures being demolished: Z Start Date: / �/a Completion Date: ?oZo/D Asbestos present Yes }( No Survey attached 4 Yes No Has all identified asbestos bee removed Yes No Ai DEMOLITION PROJECT CATEGORY x] Complete Demolition [ ]Training Fire-Fire Agency: [ ] Renovation,Alteration,Remodeling,Maintenance,or other Construction [ ] Emergency—Additional Fee of$50.00 (must be accompanied by Government Ordered Declaration-Commercial only) I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify that all identified asbestos has been removed and the information in this application and supplemental data described herein is, to the best of my knowledge,accurate and complete. Keet>=Z—Zsit2Jgari&t.60OS- 7- o/e. Applicant Name Signature� Date LI :E � tIVE ei ed Payment Info. Approved Asbestos Permit v [ ] Cash [ ] Disapproved Permit# ASBOO MAY 10 2010 ["A Check: # q0Or Demolition Permit [ ] Credit Card yn� Review date: S /10 /10 Permit# /0 DEM00&jD'/'i CRC 1 Receive date: 5/ /V/(0 Reviewed by: Agency Use Only Agency Use(9/nly Agency Use Only 10/21/08 OVER �. .,gON co JEFFERSOPOUNTY • .crO j DEPARTMENT OF COMMUNITY DEVELOPMENT "5 ` 1.4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �qs,IiING0$ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: JQ niv, tar-CA) Project Description(include separate sheets as neces1ary): (),C) .'0\ -� �3.k t. � 1(-( t \ V\ (tip w/A Tfi(-!/A ii-k qE Tax Parcel Number: 972 7 2 ' / Property Size:,yx6'c (acres/square feet) Site Address and/or Directions to Properly:- (��o(;z_; Ste (/)c- �;�( C. 1-1 (cc ri ,L;,,is il, l� ,- Property Owner(s)of Record: ., ./?el CL x/ 6'2QW/) / { Telephone: ; a— �-�99/ Fax: email: Mailing Address: 'yam t/;! t!,4,q9 p, 92 32a Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: h t kind of Permit?(Check each box that applies uilding Demolition Permit El Lot or Road Segregation El Critical Areas Stewardship Plan El Variance(Minor, Major or Reasonable Economic Use) 0 Ingle Family ❑ Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home El Modular El Discretionary"D"or Unnamed Use Classification I ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment 0 Address El Road Approach_ El Short Plat** 0 Home Business ❑ Cottage Industry El Binding Site Plan** El Propane ❑Long Plat** ❑ Sign ❑Planned Rural Residential Development(PRRD)/Amendments** El Allowed"Yes" Use Consistency Analysis ❑Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑ Temporary Use ❑Shoreline Management Variance El Wireless Telecommunication* El Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium El Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference El 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 right of entry will be assumed unless the applicant informs the County in writing at the time of the a�ion that he or she� wants prior notice. I l Signature: LI"C-e . Date: —/e5 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-trans ble responsibility for ering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: .7e / try!✓ Date: l:ZO—/deP 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: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: CI New LI Wood Existing: ❑ Sewer ❑ Addition ❑ 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 Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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: / 3 o c 6 2`d Floor Heated Consistency Review: , Other Heated Base fee: ,, a c1 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: V.S 01 Other Unheated' • Pot Water Review fee: / Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ / ��(/// 5 Receipt Number: I 1-11CN Cash/Check Number: flu t(4- ESTIMATED COST(REQUIRED) Date: _ rr ll •Fair market value of all labor and materials foundation to finish �J � '-1Y Initials: _ - ) _ r.' G:\PennitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 3.,0 Z a I �O.o r- o4a t • dw i) a 7/2 �/d vv•5a--0 .�.4)-,c J Qq �o v to m a . _ ) u/ lb r., Nr 4 :7z.'\ 6 ‘ C C4 o „k' N ct� ! 0sit...t3 x- . 1 q Ai. . , m -71 b O }, � so oti ,;t., `co \ —'v3 O . ,. ? �� p , $ Rt T C �. . Z a 3 m _ v 73 cn cn t-A•n R. 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