HomeMy WebLinkAboutBLD2011-00142 DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD11-00142 Received Date 6/8/2011
SITE ADDRESS: 251 RIVER RD Issue Date 6/13/2011
BRINNON, 98320
APPLICANT: JEFFERSON LAND TRUST PHONE: 206-356-6162
1033 LAWRENCE ST
PORT TOWNSEND WA 983686523
TX 2
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502172007 Section: 17 Township: 25N Range: 02W
CONTRACTOR: MITCHELL CONSTRUCTION PHONE: (360)796-2060
4246 DUCKABUSH RD
BRINNON WA 98320
3 -796-4379
Contractor's License MITCHC"1010E Expires 4/9/ 0 13
OWNER, JEFFERSON LAND TRUST PHONE: 206-356-6162
if different: 1033 LAWRENCE ST
PORT TOWNSEND WA 983686523
PROJECT DESCRIPTION: DEMO EXISTING STRUCTURE OVER M/H
Directions Decommission well and septic also.
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 6/13/2012.
REQUIRED INSPECTION:
FinalApproval: L / (erp
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_Perm it_Propane.rpt 10/29/19
BLD11-00142
MILDING PERMIT APPLICATI iV Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00142 Received Date: 6/8/2011
SITE ADDRESS: 251 RIVER RD
BRINNON, 98320
OWNER: JEFFERSON LAND TRUST PHONE: 206-356-6162
1033 LAWRENCE ST
PORT TOWNSEND WA 983686523
SUBDIVISION: Block: Lot: TX 2
PARCEL NUMBER: 502172007 Section: 17 Township: 25 N Range: 02 W
CONTRACTOR: MITCHELL CONSTRUCTION PHONE: (360)796-2060
4246 DUCKABUSH RD
BRINNON WA 98320
Contractor's License MITCHC*1010E Expires 4/9/2013
REPRESENTATIVE: MITCHELL CONSTRUCTION PHONE: (360) 796-2060
R MITCHELL
4246 DUCKABUSH RD
PROJECT DESCRIPTION DEMO EXISTING STRUCTURE OVER M/H
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP DEM MAIN:
VALUATION
CODE EDITION: 2009 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Proo:
Total:
Routing Date: - --------
Type Am Date: Receipt: Approved/Date
Permit $71.00 LYK 06/08/11 123569 APPROVED
State Building Code $4.50 LYK 06/08/11 123569
Total: $75.50 JUN 13 2U11
Jefferson County Planning
& Building Department
APR/22/2011/FRI 09:13 AM OROAA• FAX No, 3604816301 F. 001/002
N 0:444, Olympic Region Clean Air Agency • •
��
44 2940-B Limited Lane v'
Olysrpin.W,A,9850' r F•C; F a V LE
p (360)639 7610-F ail, , , •v..•
e s 11 .Uri Permit
Port Angeles office t.,• 17-1466
' . ORC•A.A. Raymond Office(3�t1 21377
JUN - 8 2011
te,g, i iso�, " www:ORCAA.org ,
• . s i 1 • - _._. .
VI Commercial Structure-Permit fee:$60 • .
Owner occupied residential dwelling--Permit see:S35.00.-Prior Notice •
PROPERTY OWNER
Name ' 'Fre
er 7A1 LaA //''t J . Phone (34437 9 7 o/ _Ftnal:5-i144 i aSaiek
d.
J FAX; (33c 37 q �I'e 9 Mobile( )_ er
Mailing Address:O fi tn/ J/ - City: -L Q�,�jl/ ,, State:�A Zipr 8 C
33 Z YC� _ ��' � 98345
Site Address: City:•�./A1h4 State Zip:
,A.57 KtVer. Rce. •
DEMOLITION CONTRACTOR[ ]Check if same as property owner information
Business Named 4 Phone: S3k)79C 'f 606— Ftnsit J
5-tt ioa4 ^ I (jd°R Rot S 61 '/ 591 Cv 7l FAX (se ) a n /s?`,'l oSiei,.totr'7'QR gfc ' ,
-Onsite Contact pi; /G`, w< •/ �Qr our (• ) Mobile: (20�}�00 0� ! "M
. Maella Dt-/ct6Js . R-1• - citrg-i;►in/o,,/ -St'7MA • ZiP9$3420
DEMOLITION INFORMATION --7 l I,• 3 o i t Ci)
• #of Structures being demolished Start Date Completion Date:
1
Asbestos present ✓Yes _No Survey attached _Yes „ No Has all identified•as a been
removed __Yea _No •
D. �OLITION PROJECT CATEGORY
• �1 Complete Demolition . - . .
[ ]?raining Fite—Fire Agency:
j ]Renovation,Alteration,Remodeling,Maintenance,or other Construction •'_ -
I 1 Emergency--Additional Fee of$50.00(must be accomjauied by Gcvewmeut Ordered Declaration.Cammercial oty) .
•
',have rend and will abide by the conditions set forth in this peccaitand any addendum thereto. I do hereby cerai r
that all identified asbestos has been remored and the in orxztativu,in this application and stippiemerttai data
• described herein is,to the best army-knowledge, accurate and complete. _ -
% /kA A Ye c✓ , 7' - "7,./.44.,'
4.-. ....."/ aa- ,zo
Applicant Name Sagaature - • • D .
Date Application Received Payment info. Approved- Asbestos P q� t
• - _ [ 1 Cash1 Disapprc ved Permit# 11 SBOA � 3
m Check # I a"79 . - ( ' Dettoliti malt •
_ .: [ J Credit Card Review date tG/�I Permit it# j i DEMO()Qq(
• -'03_d3
Receive date` / - Reviewed by: .
Aga*tJ,tr - Any Use Only 'tT*0n4 - tire Only.
10/21/08 OVER
t�rat, -- t k nc p er— r �
$4Ormil °1\T
cO JEFFERSON�UNTY •
a DEPARTMENT OF COMMUNITY DEVELOPMENT` 621 Sheridan Street • Port Townsend •• Washington 98368
360/379-4450 • 360/379-4451 Fax
(Q/ www.co.jefferson.wa.us/commdevelopment
�`SFIING''
Master Permit Application MLA: OD ( A- 12 Fr"
Pro' ct Description(include separate sheets
)
sheets as necessary):
ci-V re_ OVEt 11)/(--1
Tax Parcel Number: —bZ 11-_i G 0/" Property Size: 5-1 t-16/ qcAus..9 (acres/square feet)
Site Address i/or Directions to Prope •
a51 R
w c 9 i-i/10) (tea_ q S'32
Property Owner(s)of Record::� --cF t S77r (,ENO rit-'Sr - (2,(((_ itq NZ,k,S)k&- Sr ,yrzpS WitA cTca___.
Telephone: 7V V- ) - I )I Xr 165 Fax: -37-1 g q email: a'NI,h5/ffr o.SAvE L pd,r D•cat'
Mailing Address: I I T?t (fir c-`i-- 2afer-rm,NS&Aibr ttiA cili2 S
Applicant/Agent(if different from owner): ie.
0
&7 ,I lie
Ele-I1 ISL, fri larsT v'i)ck)
Telephone: 6C 790 2 ex[7 Fax: �{ email: d ,c
kct�:s P�rar+ Fbr►�r: 'L
Mailing Address: �/.L9G / .tC�, -/ 13���/ )0!4 fe/if 'i. yii// ej�"_;,� <"'.
What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation
P l" uilding 0 Critical Areas Stewar(ship-Pien--`-
�' Demolition Permit 0 Variance(Minor, aI' r->_••-:I
❑ Single Family 0 Garage Attached/Detached 0 Conditional c • r
I ❑ Manufactured Home .0 Modular 0 DiscretionaryID IdUnnamed Use Classificati.
❑ Commercial* 0 Special Use Es e�tial Public Facilities
0 Change of Use 0 Boundary Line1A jty'tmen(UN 0
0 Address 0 Road Approach ❑Short Plat** i 1
0 Home Business 0 Cottage Industry 0 Binding Site PI
El Propane 0 Long Plat** IrrrrRSfN COUNTY
❑ Sign . 0 Planned kural ,esidentiat Development( endments**
❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication* ❑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 ❑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 "ILL- 5-rEt-,M2t + Ka9,PA lrct�;LL to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE tin ni4 IN wk..-JT �S RIP '�rti eraYL Date:+0 E (a,Zo I I
By signing this application form,the ner gent 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 application that e or she wants prior notice.Signature: Date: t£ (o,U( I
The action or actions Ap licant 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' compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable re nsibility r adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: 1 Date: , 1 ..4(,z.c I 1
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:
•
( /Ie'/ C j krS-2X ve to'✓ `1 p ((3,,1,0 79e -,c: fl ( ) .s�.1 ',T
MAILING ADDRESS: .�?tti`- `J' i,r jri7F�Li5/-f 4 I4 i !S',��/s..'7/' ' .. dLq:/Cciia. lC.1' -1 -Jule/44r1.lr '
CONTRACTOR'S LICENSE WAINS
NUMBER: A) f / c A(C X/C%lam NUMBER •
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New >8. Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: Bank ii Community System
❑ Alteration/Remodel 0 Concrete Total: _ Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit# '74-174
X[ Demolition 0 Other: Bedrooms: Water Supply:;72-L.Z
Existing: Setback: L7 Private well 0 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 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,
includin the reserve area.
Square Footage 1 Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review: < .
Y ,i, J
2`°Floor Heated Consistency Review:
Other Heated Base fee: r
Mezzanine Additional Section: f
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ I S( '
Receipt Number: '��J V pCi
Cash/Check Number: 3024
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
Initials: �—
G:\PermitCenter\###FO]3MS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc --
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