HomeMy WebLinkAboutBLD2011-00157 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD11-00157 Received Date 6/20/2011
SITE ADDRESS: 294983 HWY 101 Issue Date 6/29/2011
QUILCENE, 98376
APPLICANT: CHARLES H THRASHER PHONE: 360-765-4717
7450 COYLE RD
QUILCENE WA 98376-9677
1+
SUBDIVISION: CAMPBELL'S JOSEPHINE ADDITION Block: 6 Lot:
PARCEL NUMBER: 937500602 Section: 24 Township: 27N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, CHARLES H THRASHER PHONE: 360-765-4717
if different: 7450 COYLE RD
QUILCENE WA 98376-9677
PROJECT DESCRIPTION: DEMO EXSITING DECK, RAMP & STAIRS
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 6/29/2012.
REQUIRED INSPECTION:
FinalApproval:` ? )3—1 I
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
IJ ILDING PERMIT APPLICA BLRD1e 00157
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00157 Received Date: 6/20/2011
SITE ADDRESS: 294983 HWY 101
QUILCENE, 98376
OWNER: CHARLES H THRASHER PHONE: 360-765-4717
7450 COYLE RD
QUILCENE WA 98376-9677
CAMPBELL'S JOSEPHINE ADDITION
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 937500602 Section: 24 Township: 27 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION DEMO EXSITING DECK, RAMP & STAIRS
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP DEM INDUSTRIAL:
VALUATION MAIN:
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: ALT NUMBER OF EMPLOYEES:
WATER SYSTEM: 1 PWELL
BATHROOMS:
Exist:
Prop:
Total
R utinp Date:
L) -9C � I
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $71.00 LYK 06/20/11 123607 /�/\ P P R O't \
] E
Total: $71.00 �l V
JUN 2011
Jefferson County Planning
&Building Department
GIOn Cit
�Y.�ti�1� i��i: •• Olympic Region Clean Air Agency
o`�. 2940-B Limited Lane NW
1.:�, Olympia,WA 98502
'k..F.-
(-) (360) 539-7610 •
FAX (360)491-6308
Port Angeles office FAX
(360)(3 0 66
Demolition Permit
�:t� R CA A ;� ` Raymond Office (360) 942-2137
,aar. Ftm- ;: www.ORC_AA.org
Structure—Permit fee: $60.00—10 working day wait period
[ ] Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice
PROPERTY OWNER c w�_d
fWq . CerYi
Name: r _ L , Phonj)76 517(7 Rmail-
C 'I*Z ( e•](
crab(,! FAX Mobile: (-
l Address: Cite � �t�
Site Address: , ity:
J-CFLE Cf el S - ,4:kwoLy 6 I tah
DEMOLITION CONTRACTOR [ ] Check if same as property owner information
Business Name Phone: ( ) _ - - �
FAX: ( ) I ��, 0- � I�, ,\
Onsite Contactiii)
/ Phone: ( ) IP ;, Mobile: ( )
FAX
�
Mailing Addr : City Sfate� 2311
JEFFERSON COUNTY
DEMOLITION INFORMATION 61 sl- hecoC 9 P 1 ! .y )-1/ t_ p F. 1
# of Structures being demolished: c, Q Completion Date:
Asbestos present Yes �o Survey attachedYes o Has all identified asbestos been
removed Yes No
DEMOLITION PROJECT CATEGORY
[ ] Complete Demolition
] raining Fire-Fire Agency:
Renovation,Alteration,Remodeling,Maintenance, or other Construction
[ mergence—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.
C-hed-le_j-r-AVa. heh co.-AOutkj 6' 6 7)
Applicant Name Signature D to
DaEG
1 i WED d
Payment Info. [I Approved Asbestos Permit
[ ] Cash [ ] Disapproved Permit# ASBOO
JUN 0 8 ZO'r yi Check: # I 0 Demolition Permit
fj Credit Card Review date: /00 //) Permit# /I DEM00 1
�oR44
1
Receive dater/�/i ( Reviewed bc: �
I_ -42enr; T _4g,enn Use Only _ _42enr; Use On/i I _4zenc; Use On/i
1 i;f7i triP �zr, ,
-
tONL' •
wow �oL JEFFERSON NTY
' DEPARTMENT OF COMMUNITY DEVELOPMENT
"� 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
p"� www.co.jefferson.wa.us/commdevelopment
81N
Master Permit Application MLA: N)b MLA Q1?Q ►_I\
Project Description(include separate sheets as necessary):
1-C—Cf7 vE PEAAot eX b -, it Nb NFW tX7r-c lz- DES. I is
Tax Parcel Number: q 37 tj D 0 .6 C-Z_- Property Size: 2. 2. /91-12'c (acres/square feet)
Site Address and/or Directions to Property:
'2-9 ¢ e7 13 f�i /b/ Au/ 9 Y 376.
Property Owner(s)of
RRecord: (/II a;t/e S -7f/1 h4c.5`i eh
Telephone: 76 7 7/ 7 Fax: / email:C_ { Lei-'SW4�Vp/YnQ
Mailing Address: 7��O C cc/A ?0 cLc( r a cc( e ki 48 576 . c O'-?-j
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
*3uilding 0 Critical Areas Stewardship Plan
tksDemolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
Ingle Family 0 Garage Attached/Detached ❑Conditional Use[C(a), **
❑ Manufactured Home .0 Modular - 0 DiscretionaryD"or Un am )
0 Commercial* ❑Special Us Essential u4I i:Ti v
0 Change of Use 0 Boundary Line Adjustm r�t
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan** JUN 2 0 2011
❑ Propane 0 Long Plat** !, 1 f
❑Sign 0 Planned Rural Residen iaj elo•ment PRRD)/Amend -- s
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** JEFFERSON COUNTY
❑ Stormwater Management 0 Shoreline Master Program ExerrgrniqqfPgrmitAtvrifOrwpt
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantia eve opmen
❑Temporary Use 0 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 right of entry will be assumed unless the applicant informs th County in writing at the
time of the applicat' n that a or she s prior no' .
Signature: lI
Date:
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 federal 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-transsffe�r�ablee es on bilit for d j rein to an,�cof 1 in with the ESA. The Applicant has read this disclaim ran signs and dates it below.
Signature: � i'y(GZQ y � f�lti 2--Y 9 Date: 6 �'1/
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced h rein,that they are not licensed contractors and that
they will be a (sung the/r pon e General ntractor r the proposed project./ �/
Signature:Cf'Y L����K�CJ Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
MAILING DDRESS: EMAIL:
CONTRACTOR'S LICENSE, , ' . • ,,. .i WAINS , . . . • •..
NUMBER: . • -- y ' NUMBER 7 9-�Q
ARCHITECT/ENGINEER: /V c` PHONE j�r`�� 7 I,c1 [O•�F :( ) ice,
MAILING ADDREss:j,0p� T1 z ,VII9-4Q-F `�/y aPlatt S evt/l'in vti ti et ((�'�vte _ Ana,
Project Type: -. • • 73 Frame Tape: Bathrooms:. Shoreline: Typep_Oewage Disposal:
O New 0 Wood Existing: 0 Sewer
O Addition ❑ Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
, lition ❑ Other: Bedrooms: Water Supply:
,_pemo 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 1 Cook Stove i Woodstove i Fireplace Insert 1 Hot Water Tank 1 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 _df r ice Use ' _ Ifou Revision
Main Floor Heated EH BId App Review. i
2nd Floor Heated Consistency Review:
- Other Heated Base fee: rf 1
Mezzanine Additional Section:
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: $
Receipt Number: 1V 0 7
Cash/Check Number: I
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
Initials: -------- --)
----L-
G:\PennitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc —_
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