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Home My WebLink AboutBLD2010-00072 • 0 DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD10-00072 Received Date 3/15/2010 SITE ADDRESS: 4372 S DISCOVERY RD Issue Date 3/25/2010 PORT TOWNSEND, 98368 APPLICANT: KARL JON JACOBSEN PHONE 360-385-2745 SANDRA J JACOBSEN 4250 S DISCOVERY RD PORT TOWNSEND WA 983689676 TX15-i SUBDIVISION: Block: Lot: PARCEL NUMBER: 001321012 Section: 32 Township: 30N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, KARL JON JACOBSEN PHONE: 360-385-2745 if different: SANDRA J JACOBSEN 4250 S DISCOVERY RD PORT TOWNSEND WA 983689676 PROJECT DESCRIPTION: DEMO SFR 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 3/25/2011. REQUIRED INSPECTION: FinalApproval: .? 1— (1 n5 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#BLD10-00072: 1.) A new residence constructed on this property will require a current code septic system. The existing permitted septic system may or may not meet code at the time of building application. I:\F_BLD_Permit_Propa ne.rpt 10/29/19 BBLDING PERMIT APPLICATI BLD10-00072 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00072 Received Date: 3/15/2010 SITE ADDRESS: 4372 S DISCOVERY RD PORT TOWNSEND, 98368 OWNER: KARL JON JACOBSEN PHONE: 360-385-2745 SANDRA J JACOBSEN 4250 S DISCOVERY RD PORT TOWNSEND WA 983689676 SUBDIVISION: Block: Lot: TX15 PARCEL NUMBER: 001321012 Section: 32 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION DEMO SFR 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: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: SEWAGE DISPOSAL: CON BANK HEIGHT: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: • Type Amount Paid---Bv —mate: Receipt: Approved/Date Permit $71.00 LYK 03/15/10 114013 APPROVEr State Building Code $4.50 LYK 03/15/10 114013 Total: $75.50 MAR(95 ZO?U Jefferson County Plannin, &Building Department • • 01ON. Olympic Region Clean Air Agency 2940-B Limited Lane NW Olympia,WA 98502 pl• (360)586-1044•FAX(360)491-6308 Residential �r Port Angeles office(360)417-1466 • ORRrA Raymond Office(360)942-2137 Demolition Permit , •xsra «a�ss�.e► www.ORCAA.org This permit valid only for residential homeowner residing in the dwelling after renovations Permit fee: $35.00 per structure. Non-refundable. PROPERTY OWNER N e:l \\ Phone: 040)385-2.7SS Email-4 " � U t Sg blet4 V AiCD\ISe_wr PAX: 1si4,, 301.3 5�'Me!•C►yn Mailing Address: ( ) Mobile:�p)301-3(�?�j Site Addre s: WA _N346 �4372$. ys ov�Y 1tyW1s$ State: 1 : "� R34 g DEMOLITION CONTRACTORheck if same as property owner information Business Name: Phone: Le �4 \Cuc, (3l VS"-yaao Email: U S �n FAX ( ) Onsite Contact o Phone: ( ) Mobile: ( ) FAX: ( ) Mailin Address: CiY0 I0W) `yore tQ stat A zip `t 335' DEMOLITION INFORMATION #of Structures being demolished: Start Date: ; '''-p Completion Date: � L. 3//S'1"o� dr Asbestos present Yes Nov'. ' `" '' ' - '•��a�. FZ�' Survey attacheu re No Has all identified asbesths u e, removed Yes— No— tYf DEMOLITION PROTECT CATEGORY [forComplete Demolition [ ]Training Fire—Fire Agency: [ ]Renovation,Alteration,Remodeling,Maintenance,or other Construction 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. 144 . tktizs Q A )1 Applicant Name 2,_Z`5 Signature Date RDate phc�tij 1.1.c eived Payment Info. Approved t t V�� [ ]Cash pp Asbestos Permit ] isapproved Permit# ASB00 [I Check: # g06'7 Demolition Permit FEB 2 6 2010 [ ]Credit Card Review date: 3/`Q/�� Permit# It DEMO() 151 7 Receive date:/ / IO Reviewed by: # Agency Use Only OVER e Use OnlyAgency Use Only 4w` ,SON c° JEFFERSON CO�NTY • ti kilo DEPARTMENT OF COMMUNITY DEVELOPMENT `4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax K4... ....... 44S �p . www.co.jefferson.wa.us/commdevelopment G Master Permit Application �� MLA: �.� Project Description(include separate sheets as necessary): PAs'sla„�'4.\ DQ.AAA\•�%mN Tax Parcel Number: 00 ( 321 o IZ, Property Size: .2.3, z o O{_ (acre quare feet) Site Address and/or Directions to Property: 4372. s. D\sc.oiretzy 12a.. ToR± lawt.asewcl Lox. g834 Property Owner(s)of Record: a\ 4 Sgp,aAA 3Aca\oSsa.3 g l�p Telephone:360—3.1"3 423 Fax: email:kqtra.IJ Ip t We,speQei. Com Mailing Address: '4z5c S. Dt3Celleia71 RA.l Poit7;„►ms...Ad, WA•g�3348 Applicant/Agent(if different from owner): 7 Telephone: Fax: Mailing Address: email: What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation C du' ing 0 Critical Areas Stewardship Plan Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home . 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address ❑ Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane ❑ Si n ❑Long Plat** y 0 Planned Rural 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* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment 0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Requires a tion Conference Please identify any other local,state or federal permits required for this propos/ala 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 an required ter ins tions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the icati that or she n pr r notice. Signature: AW.) `J_ O Date: 5j 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 wi I 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 „•mpliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tra rable spons•ility fo dher g o and complying with the ESA. The Applicant has read this disclai mer and signs and dates it below. Signature: k, �'ja ^ `D Date: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • 0 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 ssuming t e responsibility of the General Contractor for the proposed project. 1112.010 1 Z C l D Signature: PAl\ 3 N4D �.n Date: ! GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx:( ) ( ) EMAIL: MAILING ADDRESS: WAINS CONTRACTOR'S LICENSE NUMBER NUMBER: PHONE ( ) FAX:( ) ARCHITECT/ENGINEER: EMAIL MAILING ADDRESS' Shoreline: Type of Sewage Disposal: Frame Type: Bathrooms: ❑ pewer Project Type: ❑ New ❑ Wood Existing: Bank ❑ Community System ❑ Steel Proposed: ❑ Addition Total: _ Height: ❑ Individual Sy m -�9 ❑ Alteration/Remodel ❑ Concrete SEP Permit# 1-/...o(D ❑ Repair ❑ Masonry Bedrooms: Water Supply: X Demolition ❑ Other: Existing: Setback: ❑ Private well ❑ Two Party Proposed: ❑ Public Type of Heat: Total: Name of System: If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces: `•a Number of Parking Spaces: Current: Proposed: 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 1 Above ground Tank Size of Propane Tank: 1 Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this a fiance bein installed in a Manufactured/Mobile Home? Yes / No • - When, applying for and t distanll a ces fromane tank you must also submit a site the propane tank to all property lines,lan showing all of the buildings and septic buildings,all property lines, tank location and size, including the reserve area. Amount Revision quare Footage I Current Proposed For Office Use Only Review: EH Bid App 22 Main Floor Heated �J 2nd Floor Heated Consistency Review: Base fee: r ` Other Heated Additional Section: Mezzanine Heated Basement Plan Check fee: —-- State Surcharge fee: J'Zj Unheated Basement � - Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 1 LE 5D 911/Rd Approach fee: Decks Other TOTAL: $ \_I Receipt Number: ' ( ` (5 Cash/Check Number: C/, ') ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and materials foundation to finish Initials: mili— Nam- G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc . ,_ __ __ ___ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 t sou-Jo., 0.1.5covq.„ R,,,i4 ,, ,_ 43 31 tSJ 1 .,D �< 117, , ,s I 3 O z w+�{ea / a I vI 8�' 1.2%I / / g v1 1 1 // / z o a. 1 / I - - - - - - -' / z- - - I OcI / ce l ai D R �eJ I A y 6-kAlc,a*1 s�.\S.) w / °- a w � o.q ii 65 :::,(NI DRt+‘N - \ t �= O 19Z ' 15' /15 ��Q .9 I1-10�1g- A-0 VA. 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