HomeMy WebLinkAboutBLD2011-00301 • •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD11-00301 Received Date 11/1/2011
SITE ADDRESS: 4900 CENTER RD Issue Date 12/12/2011
CHIMACUM, 98325
APPLICANT: FLORA C MACE PHONE: 206-545-2838
JOANN KIRKPATRICK JTWROS
4725 37TH AVE NE
SEATTLE WA 981053014
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801033001 Section: 3 Township: 28N Ranqe: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, FLORA C MACE PHONE: 206-545-2838
if different: JOANN KIRKPATRICK JTWROS
4725 37TH AVE NE
SEATTLE WA 981053014
PROJECT DESCRIPTION: DEMO EXISTING 296 SF ADDITION ATTACHED TO SHOP/ART
Directions STUDIO
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 12/12/2012.
REQUIRED INSPECTION:
FinalApproval: l 4
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
PILDING PERMIT APPLICATIO BLD11-00301
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00301 Received Date: 11/1/2011
SITE ADDRESS: 4900 CENTER RD
CHIMACUM, 98325
OWNER: FLORA C MACE PHONE: 206-545-2838
JOANN KIRKPATRICK JTWROS
4725 37TH AVE NE
SEATTLE WA 981053014
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801033001 Section: 3 Township: 28 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION DEMO EXISTING 296 SF ADDITION ATTACHED TO SHOP/ART
STUDIO
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP DEM
VALUATION MAIN:
CODE EDITION: 2009 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: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0
Routing Date:
II- I-II
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $71.00 LYK 11/01/11 128295 APPROVE!
State Building Code $4.50 LYK 11/01/11 128295
Total: $75.50
DEC 12 '4;I
Jefferson County Planning
& Building Department
`" .��,�CggGiDR cr �pn-11�,ic R�iosl Clean Au;Agency II I "
v 't4p``� ..9-Kl-B Limited Lane NW
° �i' Olympia,WA 98302
(36ortO)ring>39-7610eiesoffice FAX(3GQ)(360) 491-6308417-14G5 Demolition Permit
l, .... / P
;N• O R C-A A ` Raymond Office(360) 942-2.137
;' amsofi•ao / war w.(7RCILA.org
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[ ] Commercial Structure-Permit fee: $60.00-10 working day wait period r,:
Owner occupied residential dwelling-Permit fee: $35.00-Prior Notice 1
g
PROPERTY OWNER a
Name' Phone: (2Ada} 5 '�s Email- �e.4"CY 1
L-eav4 M0.Cam. ocktI t 1K4C ekk ( FAX 6415".2g1.Z Mobile: (2Q6,LL94"710?1
j Mailing Address: 4 City Suite Zip:
447a5-- v kkke wilt 9, N 5'
Site Address: City State z�:
4C DO C c e�- all rACY-Beg_ _ ‘it)A .. 9f .3,I.rS
_DEMOLITION CONTRACTOR)Ched:if same as property owner information
Business Name Phone: ( ) 72itai1•
FAQ
Oasite Contact: Phone ( J Mobile ( )
FAX: ( )
Flailing Address: - City. State Zip:
-7 .
DEMOLITION INPOBMA.TIO]T .
3 #of Structures being demolished, t Start Date: - "r— Completion Da
xt
tgai AJoc. ' t 0
Pav
•
Asbestos present Yes o Survey attar a es ___,No Has all identified asbestos been
removed Yes _No
DEMOLITION-PROJECT CATEGORY •
TA Complete Demolition
[ ]Training Fire-Fire Agcncp -
[ ]Renovation,Alteration,Remodeling,Maintenance,or other Construction -
[ ]Emergency Additional Fee of$50.00(must be accompanied by Government Chatted Declarafian-Commercial only)
I have read and will abide by the conditions setforrb in this permit and any addendum thereto. I do hereby cersity
that all.iderna£iad asbestos been removed and the information in this ap Beat on and supplemental data
described herein is, o the best army lmoj ledge,accurate and complc
-- --- - .S'1-;(114444/'- filAkt1(4' 4'
Aite'Arri
Applicant Name --0.1-11rallirrDate
1. Pea ty" -tD'ed Payment Info. )4 Approved _ _ Asbestos Permit
[ ] Cash [ ] Disapproved Permit# ASBOO
NOVg
Z ] [ ] Check: # - Demolition-Permit
( zedit Cards, Review date:I I. / ./ 1 1 .Lennie#( t DEMO -15
r^N.L-i.4''1 A it R p,—.4,p oar,.. I i / ' ./ i i R -i�nari h;-
1:77.4.-r t.-(.Ill I Ti.......,_
1:?sON
c JEFFERSON UNTY
A DEPARTMENT C,�COMMUNITY DEVELOPMENT •
1- ''4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
,.....i
kqs y www.co.jefferson.Gva.us �r> ppt \
l Qrr v C, Y
Master Permit Application , ' , MLA: (" )(p
i .•,--
P oject Description(include separate sheets as necessary):
Md _FXt_5i 1IJci AMincy ,L/
Tax Parcel Number: So\ Q 33 ( JEFFERSON COUNTY Property Size: 11 O Y-•g\ (acres/square feet)
I- ) mrmi!IN!IY UMT-IiiVMFNI —
Site Address and/or Directions to Property: ---`
L\c O3 c_•e.Anke,r. rRc) C_V-)i. a Pi- 9$3
Property Owner(s)of Record: 4
Telephone: Qc kisc\— '7 l c Fax: 20 G., SLf s.-D..52,38 email: MRGE. 3 iREc_r m°`4.Cc
Mailing Address: VAS. — —4N'7 t\7)F SeaiNe kk)Pt cleknS"
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
Wh•t kind of Permit?(Check each box that applies 0 Lot or Road Segregation
ilding 0 Critical Areas Stewardship Plan
►:4Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family arage Attached Detached 0 Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home Acdular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 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 Ikurai Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration*"`
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑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
—Pt>rdbe identify any other luCal,state or federal pe I!Iita iequired GA this rnoposal, 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: �OL) /t O l I
By signing this application form,the own 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 acces and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he nts for I
Signature: /14 Date: Ve>0 /, 0151 L
The actio or ac ions 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-transferable responsi •" nn o mplying with the ESA. The Applicant has read this disci imer and signs and
dates it below.
Signature: Date: OL) /r c O /
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 assumi siblit of General Contractor for the proposed project.
Signature: CA....,"Date: 0o0 (. c O I (
GENERAL CONTRACTOR 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 a-Shock¢,.'{ xisting: ❑ Sewer
❑ Addition 0 Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: _ Height: 0 Individual System
O Repair ❑ Masonry SEP Permit# _
Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Propos-•: ❑ Public
Total: Name of System: •
If this is a Commercial Proiect 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 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 [urrent Proposed For Office Use Only Amount Revision
Main Floor Heated EH BId App Review:
2nd Floor Heated Consistency Review:
Other Heated Base tee: f
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: 1-1 — —
Other Unheated Pot Water Review fee: _
�� �►
�Garage/Carport aqI - SUBTOTAL �j
, Decks 911/Rd Approach fee:
•
,0a��S Other TOTAL: $ 5
Receipt Number: \ as. 15
Cash/Check Number: ^ 5`
ESTIMATED COST(REQUIRED) Date: I _ _
•Fair market value of all labor and materials foundation to finish --
Initials: ----- l
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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