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HomeMy WebLinkAboutBLD2012-00028 • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD12-00028 Received Date 1/31/2012 SITE ADDRESS: 11811 CENTER RD Issue Date 2/21/2012 QUILCENE, 98376 APPLICANT: VERNON E MAHRT PHONE: 206-547-0776 3919 LATONA AVE NE#C1A SEATTLE WA 98105-6864 T 17+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 701061010 Section: 6 Township: 27N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, VERNON E MAHRT PHONE: 206-547-0776 if different: 3919 LATONA AVE NE#C1A SEATTLE WA 98105-6864 PROJECT DESCRIPTION: DEMO EXISTING 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 2/21/2013. REQUIRED INSPECTION: FinalApproval: 5/02_ /C 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 liOLDING PERMIT APPLICATIO BLD12-00028 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00028 Received Date: 1/31/2012 SITE ADDRESS: 11811 CENTER RD QUILCENE, 98376 OWNER: VERNON E MAHRT PHONE: 206-547-0776 3919 LATONA AVE NE#C1A SEATTLE WA 98105-6864 SUBDIVISION: Block: Lot: T 17+ PARCEL NUMBER: 701061010 Section: 6 Township: 27 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: MEGAN RUKKILA PHONE: 360-531-3494 11811 CENTER RD QUILCENE WA 98376 PROJECT DESCRIPTION DEMO EXISTING SFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM 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 WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $74.00 LYK 01/31/12 131412 APPROVED State Building Code $4.50 LYK 01/31/12 131412 Total: $78.50 FED a l Zj:? Jefferson County Planning. & Building Department 00,gcliun :-, Ol,iupc Region Clean Air Agency 4 � `' 940-B Limited Lane NW • °vim � Olw.upia,WA 98502 c (360)539-7610•FAX(360)491-6308 t..Fs ;1 Pon Angeles office(360)417-1466 Demolition Permit Qi&c ,, . Raymond Officc(36o)942-2137 fir. „ � www.ORCM org [ ] Commercial Structure—Permit fee: $60.00—10 working day wait period )4 Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice" _PROPERTY OWNER Pl o e 1 4�— uf Rmai}. Nariel ` 0.�tr FAX: ( ) Mobile ( ) Mailing Address: ` State: • Zip: ?)1111 1 ona .1 T.. C ale.. .e k . . .clg.1cv Site Ads: Gitp: , state Zii DEMOLITION CONTRACTOR OCheci if same as property owner information Business Nam= �T"" Phone ,-1 k4 f Email. FAX t'V( ) kec0.b116 i-4,5et- Onsite Contact n Phone: ( ) Mobile: (90) 1- 441 Mesy.s. Kukk&N FAX ( ) A s: State • t t�}fir �.:C� . C6 c. l`t Ur ik %H-4 DEMOLITION INFORMATION #of Structures being demolished Start Date Completion Date: Asbestos present Yes X No _ Sorvey attached Yes _No• Has.all identified asbestos been f e v 1 c - c tt1 _ciTLeas removed Yes —,_.eta DEMOLITION PROJECT CATEGORY • • [ ]Complete.Demolition [ ]Training fire—Fire Agency: L— ' [ ]Renovation,,Alteration,Remodeling,Maintenance,or of '" U •V _,-c • \ • I I Emergency—Additional Fee of$50.00(must be acooa led by Government OrdOrderefl Declaration-Commercial only) I have read and will abide by the.conditions set iamb in this permit and any addend4 hereto, I do hereby-certify that all identified asbestos has been removed and the information io this application aitcl.suppletaeuta l data described herein is, to the best ofmylrnowledge,accurate and rorn slrn., _ i • f1 . ,u r+i,2 i) r�'-r (1-C(1""; Irvn .'F1 n M NT Q.E, I•ko!ivet ---)uvh-7--- . Applicant Name Signature Date , RE F1VFD A _ . Date Application Received . Payment Info. IJ4 Approved Asbestos Permit JUN 01 Z011 { J Cash { ] Disapproved Pexmir#._.AS800 - - [O Check; # -L / Demolition Perm: � ORCa [ ] Credit Card Review date 6 /�i�/�/ Pezmit# 1 1 DE vi00. .' [4O Receive datnLt /9 / 11 Reviewed _iener Use 00• Agency rise Only _ end•Use On/r _4Aenc; Us:O0• 10/21/08 OvR.R . Ox co w 6 JEFFERSON COUNTY • _. w1V� •rik DEPARTMENT OF COMMUNITY DEVELOPMENT t 621 Sheridan Street• Port Townsend •Washington 98368 .40 360/379-4450 . 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment BIND Master Permit Application MLA: KO CcJ\ Q€C Pro Description(include separate sheets as necessary): mc. 15Thi--- Tax Parcel Number: ' tOI t cj`© Property Size: j j. (o c,c- -e s (acres/square feet) Site/Address and/orT} DirectionsJ/ to Property:,I `+ '/1// Cq, •e//K' / QN., Ica_Y,t 1 w�1 Property Owner(s)of Record: Viz n.. Ma--it(- Telephone: 26 b -3 F/'7 -& / 1 4, Fax: Sc.i e_ email: rc ntu -t 1 k c Q if, &.u' iikiililiy:,c ii;:a. 3 Y / 5 4;1-fuY, %1_t7, , /tih At Al ,sc> j�'/rj LUIi: yam/o —•'APplicantJPc ./;s a�a. F ..nor); K�C: 4 e . Telephone: _ - - Fax: cef// 3 /i •3 y 9 y' . email:rM.e.yc:.,1': t-:,,,s 02 ern ie,•-y te..1 Mailing Address: /12 i/. ce.,Te,.-/t'd, QQQw, Ic „pi u),, %fr316 coj„ W at kind of Permit?(Check each box that applies 0 Lot or Road Segregation 7 ilding 0 Critical Areas Stewards ' _ Demolition Permit 0 Variance(Minor, Major t Rya n- ofili ❑Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),!oiC]**--- ❑ Manufactured Home .0 Modular • - - 0 Discretionary"D"or Unr,iamed Use Classification ❑ Commercial* 0 Special Use(Essential Pubfic Facilities)** ❑ Change of Use 0 Boundary Line Adjustm 3 1 2012 ❑ Address 0 Road Approach El Short Plat** I j El Home Business 0 Cottage Industry 0 Binding Site Plan** I I ❑ Propane 0 Long Plat** JEFFERSON COUNTY ❑Sign - 0 Planned Rural Reside ' iitlditni4ntiPRRD3/lArnfai1#gments * ❑Allowed"Yes"Use Consistency Analysis ❑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 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: f —1 DESIGNATION OF AGENT I hereby designate /11 c yan R /kR. le, to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 4—' t Date: b //- /i/ '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 the County in writing at the time of the application t h;a or she wants p�tice. � �' Signature: : -1��� Date: //'z/i, 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 you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual wand non-transferab p9nsibilit�adh ing to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 6. ,� O'/ Date: 4i// 7// 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 re the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assumin kkq-... eeesponsibility of the General ontracto for roposed project. a Signature: "� ' �����?-—e— ate: - //.e 71/ GENERAL CONTRACTOR OR MANUFACTUR D 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# )5, Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ 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: 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 rOffiice Use , .' . t-0. t' ,`Revtsion ..Main Floor Heated SO EH Bld App Review: W 2nd Floor Heated Consistency Review: Other Heated Base fee: 711 i' Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: J-1-- Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL `7g . 50 Decks 911/Rd Approach fee: Other TOTAL: $ 178.f Receipt Number: q iZCash/Check Number: 611 ,1 ESTIMATED COST(REQUIRED) Date: _�If •Fair market value of all labor and materials foundation to finish 1^5"v-A" - a ;, u e Initials: _ G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc v t° o Y O o n 0 H 1H WW '' N LL 06 N- c\1 O a- 4Z c ONN b CD ccoo N F- a) co ) N-- oCL cn a) O CO ' � , 1 0 -c c 7 `) .- C. 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