HomeMy WebLinkAboutBLD2010-00224 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD10-00224 Received Date 6/21/2010
SITE ADDRESS: 111 AST Issue Date 6/23/2010
PORT HADLOCK, 98339
APPLICANT: LAURIE A CRAWFORD PHONE: 360-531-0888
RICHARD CRAWFORD
111 A ST
PORT HADLOCK WA 98339-9547 T 147
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901021025 Section: 2 Township: 29N Range: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, LAURIE A CRAWFORD PHONE: 360-531-0888
if different: RICHARD CRAWFORD
111 A ST
PORT HADLOCK WA 98339-9547
PROJECT DESCRIPTION: DEMO EXISTING SFR FROM FIRE DAMAGE
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 6/23/2011.
REQUIRED INSPECTION:
FinalApproval: �f/ "(b -�t 1
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#BLD10-00224:
1.) No plumbing has been reviewed or approved for this project by Jefferson County Public
Health. Additional requirements may apply if plumbing is proposed.
2.) This permit is to demolish a fire damage home. No review of the function or adequacy of
the existing septic system was done. Any new or replacement residence will required
compliance with current code.
BLD10-00224
BUILDING PERMIT APPLICOION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00224 Received Date: 6/21/2010
SITE ADDRESS: 111 AST
PORT HADLOCK, 98339
OWNER: LAURIE A CRAWFORD PHONE: 360-531-0888
RICHARD CRAWFORD
111 AST
PORT HADLOCK WA 98339-9547
SUBDIVISION: Block: Lot: T 147
PARCEL NUMBER: 901021025 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: VANESSA ESCENE PHONE: 541-980-3198
PROJECT DESCRIPTION DEMO EXISTING SFR FROM FIRE DAMAGE
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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total
Routing Date:
Type Amount Paid By: Date: Receipt: Ap rov / eE
Permit -$71.00 LYK 06/21/10 117883 APPOSJDR
State Building Code $4.50 LYK 06/21/10 117883 201U
Total: $75.50 JUN L
Jefferson County Planning
&Building Department
E1E/21/2010 14:15 360417. 67
III PAGE Eli
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i Olympia,WA 98502
g. (300)539-7610'FAX('3469 49145308 3 '.� �' .
' f Yon Angel a {re(36n)417-1466 aolti.on Permit
'.:.0. ORCAA Raymond Office(350)947 2137
,tha 41\2 -NIAA . . i-.'jam-\9Y ..
[ I commercial structure_Permit fee:$60.00—10 working day wait period
`f,Q. Owner occupied residential dwelling—Permit fee:S35.00—prier Notice
FROPFRTX OWNER
I Nanlq —Pbonor ( o)G3i -Osrgg Email:
i c_.1~..r~ 1-41.0 c;c„. C av t"cc:i 'FAX_( ) Mobile: ( )
Matlis► A,9.d.ress: � l b^ State:
Sit Addrert: Seam
Zip
DEMOLITION CONTRACTOR Utl Check if same pr property owner,infOrmarion
Business Name: Phone: ( ) mod;
FAX; ( )
Onsite Contact; Phone! ( ) ^_y Mobile; ( )
FAX: ( L.
Mailing Aridness; C _ ' —
� Site Zip:
DEMOLITION INFORMATION
IT of Structures bring demoti shed: Start Date. I Colnplc .
n Date: .
Conviction
i AAbeatnm pr6senc Yee ,`$,No Same)?atrurbed , ,Yea __No Has all identified mob otoo teen
L. __- r ____ removed ..Yes No
DEMOLITION PROJECT CATEGORY
Complete Drrtolitian
I Training Fite—Fire.Agency:
[ l Reitnv.ric n,Alteration,Rempdeliog,1Viaintenante,or other Construction 4
Enter en t-Additional Fee of 550.00 Smuer be aeaopapaoieel by Government Otdtred Dectamelon-Commercial only)
.X bent read and w171 abide by the conditions set forth in this permit and any addendum thereto. X do hereby cerdiyp
that all identified asbestos has been removed and the lrafbrmstlnn la this application and supplemental data
. described herein is, to the beat army lbnowlrclpe.accurate and complete.
'4{ a.L6.urh,dam pb U r•' _ «--•-f' C,'„-- n -_ V- 0.-}0
Applicant Name Signature Date
0 icier! Payment Info. 1 ki,AliproVed Aetbeeeee Peanir
[ 1 Caeh ) Dieappeoved Permit# �,,SSBOO
JUN 2010 [ )1 Check:Credit Card Review date
R Demolition Permit
eceive Lintel !�/21/_�P Reviewed by: C'/f 4//S
_gPnZ}cl[1a " jlre Oa envy Urr On =Ltnq Ute 01# I
1 O/2l/o8 OVER
I
•
feriliok°14- 6, JEFFERSOfOUNTY
�' DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�qS, p� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: " - �') � -E 1
J.
Project Description(include separate sheets as necessary): -.
ktYo ( e t; )L`c,I kroo' 11
Tax Parcel Number:(10 10c1-1 0 5 Property Size: : )( Oa. 101- (acres/square feet)
Site Address and/or Directions to Property:
ikv A Q-A vtif\ `k% t
Property Owner(s)of Record: t , `
Telephone: — Q , Fax: email: ' • -061
Mailing Address: k,i f O (1 Y 1
Applicant/Ag_e t(if different from o�wner): c,sw,ifr, y
Telephone:` ) \.S- 3\ iN Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
uilding 0 Critical Areas Stewardship Plan
demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single 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* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 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 ❑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 r-_.' -d later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli . ion hat he/3or she wantsprior no
Signature: 1 �✓ + Cr4 Date: �` - 1V 1 1
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 u e in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transf able r sponsibj fg tity cadheri to a onnplying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ..ram- 1/ (., �, v`�'� Date: -J�' (r;
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 response ility of the General Contractor for the proposed project.
\
�,, ',Signature:.; -s-.1 _,, Date:
J
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: 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 ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ 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:
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 Bid App Review: j C;C
2`d Floor Heated Consistency Review:
Other Heated Base fee: / (-.
Mezzanine Additional Section:-
/
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: y� -(..1
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL /' ✓v
Decks 911/Rd Approach fee: _ _V
Other TOTAL: $/ . 0
Receipt Number: i I1\ -`�)
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: (_ _) _
'Fair market value of all labor and materials foundation to finish `c-'.S y I IQ
Initials: �^:...
,C
G:\PerrnitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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