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HomeMy WebLinkAboutBLD2012-00238 • ! DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD12-00238 Received Date 8/2/2012 SITE ADDRESS: 4900 CENTER RD Issue Date 8/7/2012 CHIMACUM, 98325 APPLICANT: FLORA C MACE PHONE: 206 499 7103 JOANN KIRKPATRICK JTWROS 4725 37TH AVE NE SEATTLE WA 98105-3014 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801033001 Section: 3 Township: 28N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, FLORA C MACE PHONE: 206-499-7103 if different: JOANN KIRKPATRICK JTWROS 4725 37TH AVE NE SEATTLE WA 98105-3014 PROJECT DESCRIPTION: DEMO EXISTING SHED & BARN 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 8/7/2013. REQUIRED INSPECTION: FinalApproval: 4^-- ".--1- t3 ✓/ 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 \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 8/7/2012 itILDING PERMIT APPLICAT BLD12-00238Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00238 Received Date: 8/2/2012 SITE ADDRESS: 4900 CENTER RD CHIMACUM, 98325 OWNER: FLORA C MACE PHONE: 206-499-7103 JOANN KIRKPATRICK JTWROS 4725 37TH AVE NE SEATTLE WA 98105-3014 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801033001 Section: 3 Township: 28 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr DEMO EXISTING SHED & BARN 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: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: otal: _ � Routing Date:3-1 -- -- Type Amount Paid By: Date: Receipt: Approved/Date Permit $74.00 LYK 08/02/12 135069 APpR 0VE7'...1 . Total: $74.00 AUG tr 2012 Jefferson County Planning & Building Department \\firJcmorIAr1oM\fnrmo\F RI fl Ann PIA n+ RYL9f119 1'J(,)V 14f, i!I! 1i Tip 1 I ; OD, Mi UFi1, ,P, l't:_ f i , h!_I4!-N-i-I ,-, i_III1 {„...2_,) jIyi, rapit Region Clear,Ai/4ger,c?' • ° 7 Olympia,WA 98302 (360)539-7610•FAX(360) 491-6308 3x�Ql t�Qx1 Permit . t: -: Port Angeles office(360)d 17-1466 Q R CA A ' Raymond Office(360) 942-2137 �¢�k°�•4tegS a6 • vw.ORC'.AA.org S - - - . . C [ ] Commercial Structure-Permit fee: $60.00-10-working day wait period Owner occupied residential dwelling-Permit fee; $35.00-Prior Notice t 4 PROPERTY OWNER d Name: �n Phone: (24) , �'J '.$ + Email: g*rr 1,4 t-e3F t t' CkC f ►M 1- Ok t'it FAY (.246) 5141" $1.,. Mobile: (z I-Vrl''rtO.1 M dIing Address: City: Scat= Zip: 4°775- . ' e, i w getic)5' Site Address: Cite State: Zip t�� C.e ear Chi rn. _ W Pt 9 5W DEMOLITION CONTRACTOR�Check if same as property owner information Business Name: Phone: ( ) Final- .Onsite Contact: • • Phone: ( ) _ _ .T , Mobile: ( ) - - . FAR: ( ) Mailing Address: City State: ZAP: DEMOLMOR INFORMATION . - . 3 #of Structare6 being iiema3ishecl •1 Start Date: .� Completion Da J _ vii)10� doti all t C3Q Asbestos present _Yes o Survey attac e TT:7—Np I•• triNd;VB been r--\) (...L*--.--.ei*r.ved ___J_Me!s o DEMOLITION PROJECT CATEGORY • 1 1' 1 - toit Complete Dtmatitiou • ! - 2 2012 . [ ]Train Fire-Fire Agency _.. -'1 - [ ]Renovation,Alteration,Remodeling,Maintenance,or other C.onstzy�on\1 . _ .. • [ I Emerf eeu y-Additional Fee of$50.00(muse be accompanied by!GovcrnmenifOft d®G}elararion-Commercial amok') DEFT.or cor+7T1Nrr DPEI OPMENTf' I have read arad win abide by the conditions scr forth Diu MI5 permit and any-addendum thereto- I des hereby wet - that allideatdi'ed oshestas halts been femared and the I nnation in this art Iicaeian.And.supplemental delta described herein is, d the best ofnpkric wJedge,accurate and cornpie i,._ • .. _ ... . ..... . . - sc C, . KkAc.e. tAtok --f' - itl t 3,-AceI I Applicant Name Date Iped Payrrenr Info. A.pprarcd T Asbestos Permit III� sa '#+i K-r [ ] Cash )4[ ] Disapproved Permit#- ASBOO NOV ( ] Check: # Demolition-Permit \ 0 gill [ zedit Card' . Review dacelL/ .,{ J 2 Permir# l_t_TaEMO(!� . Tr.1"1 A. A sr ppaasra rinrt• 1 I / " a/ i i R Rsrimenprl 1-yr... he ir) • -PeArr x'i+#1 I Derw,od 30563 �,�•5pN Cps •• 4 JEFFERSON UNTY r ' r� DEPARTMENT OF COMMUNITY DEVELOPMENT _ 1-5 ` '4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ��S pip$ www.co.jefferson.wa.us/commdevelopment 81N Master Permit Application MLA: O ; ` )1( ect Description (include separate sheets as necessary): ,..7.j.). Tax Parcel Number: fic,1 Q33 op ‘ / __ Property Size: 46 - (acres/square feet) Site Address and/or Directions to Property: '- c o ('ten\-tor- 'Rd Property Owner(s)of Record: "Ft cNCA N\WE - ..::)tit KickerAl- LK Telephone: 2CYD ' `V 9c\ -P11 Cib Fax: email: Made W 3 -V me__©9 inc,1 „ch Mailing Address: "VA 72S 3'7 Vl E ea \e V\itl- c c oc5 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies ❑ Lot or Road Segregation B ilding3 0 Critical Areas Stewardship Plan Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional U a ❑ Manufactured Home 0 Modular ❑ Discretionary"D"O'll (Ba 7 i•:,•�• ❑ Commercial* 0 Special Use(Esser tiaf Publi�-Fa • Change of Use 0 Boundary Line!Adjtastment O Address 0 Road Approach_ 0 Short Plat** ' " AUG - 2 2012 ❑ Home Business ❑Cottage Industry ❑ Binding Site Plan** ❑ Propane ❑ Long Plat** Li ❑ ago ❑ Planned RurallResid **�EFF U /Ame dments** ❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration 0 Stormwater Management ❑Shoreline Master-RR • • s** ❑ 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 ❑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,cou 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 gr nting of this permit. I further agree to provide access and right of entry to Jeffers. •• ty and its emplo,ee representatives r agents fo e sole purpose of application review and any required later inspections. Staffs ac ss and ight o -• " will be .ssu d nless e a • n orms the County in writing at the /meofthecationthathan7o CI G' Date: apt O(.11 a , ad t The action or actions Applicant will undertake as a result of the is-uance • this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an end:ngere. species as those terms e defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County malfes no a Z,. - •-s to the applicant that t e actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,gro.• • a•-n can file a lgNsuit n behalf A an endangered species regarding your action(s)even if you are in compliance with the Jefferson County d-velop :n d T,ffa Ap li c nowledges that he,she or it holds individual and non-transferable res or dheri to and complying ith the : • . T e p scant has ead this disc aimer and signs and dates it below. ' Date: L1C1 ZL7 Z_ '�Signature: _ I ,. . , ,i ......•in.u1111 ern r�nw«`\/`_._ r\n 11 T:_ _\A T).._..... A...-.1:—.. — o0(IR.7..." • Bt.DER STATEMENT The signer of this statement does hereby certify that they re Ow er ar I r rented h , at they are not licensed contractors and that they will be assuming the re ility of the Ge ral C n ra t r f th pro s d of t. \ Signature' D te: _ GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PFICNE: 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: C New C Wood Existing: C Sewer C Addition E Steel Proposed: Bank 1 Community System C Alteration/Remodel C Concrete Total: _ Height: C Individual System C Repair C Masonry — SEP Permit# _ Bedrooms: Water Supply: Demolition � Other: pp Y: Existing: _ Setback: C Private well ❑ Two Party Type of Heat: Proposed: C 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 1 Above ground Tank Size of Propane Tank: i Heat Stove 1 Cook Stove 1 Woodstove i Fireplace Insert 1 Hot Water Tank 1 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: / 2`d Floor Heated Consistency Review: Other Heated Base fee: i7 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: • Other Unheated Pot Water Review fee: Garage/Carport _ SUBTOTAL 1 fJ l Decks 911/Rd Approach fee: Other TOTAL: $ \ -a " Receipt Number: I -2 „p�.JI)LT R Cash/Check Number: ESTIMATED COST(REQUIRED) Date: _ *Fair market value of all labor and materials foundation to finish --' 11111 Initials: ._. .. ,1.uur-l.r,.«ulau\r-vnr,r-r.r„mx C.._____rinrl n ..\lk r it,_._:. .A__c.......,..C 00 nQ a..,. i a CP 7C e.. C- -4 I:7 \ •IV:2• __... ...,,, 0) 0 T-s .. IJI C?... 1` ....) — ••,..,7) I -y-- > < rri I -.-_,.-_-- '7 .... . .:.,-.,-. 04 Ail • • , ..._-, , c,... . ,. r,..6 IL'"\ x) a . a * In 2 , i rrl 111 ,._ ›. 1 , • C3 1,1 G...., a 03 . 1 1111 • 7\-) c= .• ri C - No r....) r-I [ill. 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