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Home My WebLink AboutBLD2013-00326 BLD13-00326 BUILDING PERMIT APPLICA!ON: Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98388 PERMIT#: BLD13-00326 Received Date: 10/21/2013 SITE ADDRESS: 295553 HWY 101 QUILCENE, 98376 OWNER: RUSSELL A SMITH PHONE: LORENA SUE SMITH PO BOX 57 QUILCENE WA 98376 TRANQUILCENE MH PARK SUBDIVISION: Block: Lot: 1-4 PARCEL NUMBER: 702231023 Section: 23 Township: 27 N Range: 02 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOII DEMO OF LAMPLIGHT ,,,,\‘31 1-- IN SPACE #15 TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM VALUATION MAIN: 980 CODE EDITION: 2012 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: SEW WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: 0 Prop: Prop: 0 Total: Total: 0 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $76.00 MEB 10/21/13 145474 Total: $76.00 Mirlomar4\rla+a\fnrmc\G PI fl Ann RIA,n+ 1f I I)f 1 i • A c- Gm,CL d,. Olympic Region Clean Air Agency ��`I* \ 2940-B Limited Lane NW ti , G'\;, Olympia,WA 98502 r"' ! (360) 539-7610•FAX(360) 491-6308 •, e4�' Port Angeles office (360) 417-1466 Demolition Permit ''''4)3•,,O RCA A /7 Raymond Office (360) 942-2137 '°°4•JfffER54N•1ARSON•,0�`• www.ORCAA.org Xr Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice-Nonrefundable Other Structures—Permit fee: $60.00—10 working day wait period-Nonrefundable [ ] Emergency Fee$50.00—must be accompanied by Government Ordered Declaration(other structures only) PROPERTY OWNER Name: AleT' fiN 1:4,4,....-- G Phone: .(2y/R6ul—Z�- Email: G ezr-fSSue ,e,la)/Qo%cah, Fax: ( ) Mobile: ( ) Mailing Address: City: State: Zip: ?D B4X .s17 Ou u LeEN,E wA- 418376, Site 4 5 f-/- ul y 1 O / Cqu/L GENE State: VV A- O 3 ! S. DEMOLITION CONTRACTOR 4Check if same as property owner information. Business Name: Phone: ( ) Email( ( j� /J Fax: ( ) I lJ 1 E—• lJ t/ LE--, �' Onsite Contact: Phone: ( ) obile: ( ) Fax: ( ) OCT 11 2013 Mailing Address: City: - 4te: Zip: J JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT DEMOLITION INFORMATION #of structures being demolished: Start Date: Completion Date: Asbestos present? H Yes 1><No Survey attached? j Yes fl j No Has all identified asbestos been removed? ri Yes fl No N DEMOLITION PROJECT CATEGORY Complete Demolition fl Training Fire—Fire Agency,Contact,Phone: fl Renovation,Alteration,Remodeling,Maintenance,or other Construction I do hereby certify that all identified asbestos has been removed and the information contained on this form and supplemental data described herein is, to the best of my knowledge, accurate and complete. Applicant Name Signature Date Date Application Received Payment Info. [ ] Approved Asbestos Permit [ ] Cash [ ] Disapproved Permit# ASBOO [ ] Check: # Demolition Permit [ ] Credit Card Review date:_/_/ Permit# DEMOO Receive date:_/_/_ Reviewed by: Agency Use Only Ageng Use Only Ageng Use Only Agency Use Ony 02/13 OVER D�18131%�3p Munn 1 !HTd Cano 100 p.14 III z . I;) ASSOCIATION ot :,,,,::::* ..,7f.t,i-.;:.-1-4..sc,..,4 .15.=1,' b v .. ..6 . „:„,.., ;.::,.;.,..,.,,,..,:,. ..t. „,,....,,,,,,,,.„ .,....,., ,,.,...,,, •:,,,,,t.:,-.10,.... tt,$ .•• .1. vitrlericiaaoe i 9714 228t-1 St. SE, BotheH WA 98021 (425' 48 -6g80 .. � ' . • . ____ ___-_-_ __�_ - Oct 18 13 12:22p Munn Broth Hood Canal iQ-765-21OO p.13 Summary of Inspection: This survey includes all areas of inspection with report results from Northern Industrial. Hygiene,Inc. Sample#1: 12"x 12"Floor tile with mastic.Various locations.Brown wood pattern. No asbestos detected. Sample#2: Hallway and bathroom floor vinyl with mastic.Tan and gray stone pattern. No asbestos detected. Sample#3: Homogeneous ceiling material. No asbestos detected. All asbestos containing building materials with a reading greater than 1%is considered a hazardous material if disturbed. If removed a certified abatement contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency. During demolition it is possible that additional suspect ACBM may be found. Should such suspect material be discovered an AHERA certified inspector will have to sample and test the material to prove it is of non asbestos. Northwest Asbestos Consultants is not responsible for identification of bidden materials that are not identifiable with reasonable diligence. Thank you, Bob ob {Witheridge, F.M. Oct 181312:22p Munn Broth Nood Canal • 76521OO p.12 215 SW 153rd Street Burlen,WA 98166 OFFICE:(206)988-1746 FAX:(206)988-1978 i I�iVLAP Lab Code:200511-0 •rseaeae irseer.e:mrarrawie.wogs. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number. 1300648 406 Reed Street Client Job Number. Port Townsend,WA 98388- Turn Around Time S Day C Project Location: 295553 Highway 101,Quilcene, WA Samples Analyzed: 3 White paint on light-brown fibrous compressed material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: • No Asbestos Detected 85% Cellulose 5% Filler and Binder 10% Paint Sampled by Bob Witherldge 101912013 Received by: Fermin bribe 1011012013 Reviewed by: Rachel Melgoca 10116/2013 Rachel Melgoze,Analyst Page 2 Oct 181312:22p Munn Broth Hood Canal 410-765-2100 p.11 215 SW 153rd Street Burien,WA 98166 OFFICE: (206)988-1746 FAX:(206)988-1978 ill' NVLAP Lab Code:200511.0 [ 141 NYOIENJOE. Ma. Bulk Asbestos Analysis Report Northwest Asbestos Consultants Nil Batch Number. 13-00649 406 Reed Street Client Job Number. Port Townsend,WA 98366- Turn Around Time: 5 Day C Project Location: 295553 Highway 101,Quitcene,WA Samples Analyzed: 3 Client Sample Number. 1 Lab Sample Number:13.00649.0001 Client Sample Description: 12'X 12'Vinyl and Mastic-Brown Wood Grain Pattern Client Sample Location: Various Locations Sample Comments: Checked If Sample Not Analyzed Layer 1 Brown/tan n vinyl covering over beige vinyl with clear adhesive Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fbrous Components: No Asbestos Detected 5% Filler and Binder 70% Vinyl Filler and Binder 25% Aggregate Comments: Materials distinguishable but inseparable Layer 2 Brownlyedow mottled vinyl with tan fibrous backing and yellow adhesive Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 20% Cellulose 36% Flier and Binder 5% Synthetic 15% Foam • 25% Vinyl Filler and Binder Comments; Materials distinguishable but inseparable Client Sample Number. 2 Lab Sample Number 13-00649.0002 Client Sample Description: Floor Material-Brown and Gray Block Pattern Client Sample Location: Hallway-Bathroom Sample Comments: Materials distinguishable but Inseparable Checked if Sample Not.Analyzed (] Whiteyellow/gray pattern vinyl with tan fibrous backing and yellow adhesive Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 20% Cellulose 35% Filler and Binder 5% Synthetic 20% Foam 20% Vinyl Filler and Binder Client Sample Number. 3 Lab Sample Number 13-00649.0003 Client Sample Description: Ceiling Material-White Client Sample Location: Homogenous Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed [J (Sample results continued an next page.) Sampled by: Bob Witheridge 1019/2013 Rived by Fermin verb, 1011012013 '" Pt "a`" Reviewed by; Rachel Melgoza 10/16/2013 Rachel Meigoza,Analyst Page 1 Oct 18 13 12:22p Munn Brothers Hood Canal 410-765-2100 p.10 Asbestos Bulk Sample Data NORTHWEST ASBESTOS CONSULTANTS Surveys. Inspections. Sampling AHERA Building Inspector/Mgmt Planner EPA Certification WAMOA-0042 406 Reed St.Port Townsend,WA 98368 northwestasbestoscon sultants@cablespeed 360-385-0584 To Northern Industrial Hygiene,Inc. Date: 10/9/13 Job location: 295553 Hiway 101 S.#15 Quilcene,WA 98376 Owner: Art and Sue Smith 295553 Hiway 101 S.#15 P.O Box 57 Q uilcene,WA 98376 Sample#1: 12"x 12"Floor tile with mastic.Various locations.Brown wood pattern. Sample#2: Hallway and bathroom floor vinyl with mastic.Tan and gray stone pattern. Sample#3: Homogeneous ceiling material. Inspector: Bob Witheridge AHERA-Building Inspector I Management Planner WAMOA-0042-1019201202 Expires- 10/19/13 Oct 18 13 12:22p Munn Broth,Hood Canal 40-765-2100 p.9 Scope of Work: 1) Good faith inspection for asbestos containing building material(ACBM). 2) Survey,sample and record suspect materials. 3) Report to owner with results of testing by Northern Industrial Hygiene,Inc. Inspection Report: The inspection stared with a visual survey looking for ACBM. Single wide mfg home, approx. 980 sq.ft.had carpet and vinyl floors, Wood and electric heat.Fiber glass insulation.Metal clad windows. Metal and wood siding. Metal roof material. Sample results are as follows: Sample#1: 12"x 12"Floor tile with mastic. Various locations. Brown wood pattern. Sample#2: Hallway and bathroom floor vinyl with mastic. Tan and gray stone pattern. Sample#3: Homogeneous ceiling material. Samples were sent to lab. See results. Oct 18 13 12:22p Munn BrothHood Canal 40-765-2100 p7 • PLEASE MAKE A NOTE OF YOUR FEE. Applicant name Date tArt Smith I 110/17113 By checking the box and clicking"Submit'at the bottom of this form,you hereby certify that all identified asbestos in the project area has been removed and the information contained on this form and supplemental data described herein is,to the best of my knowledge,accurate and complete. agree II Oct 18 13 12:21 p Munn BrotoHood Canal ,O76521OO p.6 PROPERTY'OWNER Name Mailing address :Art Smith I IPO Box 57 City ZIP State puilcene I 198376 I iWA Site address City ZIP 1295553 US Ivvy 101 } 1Quilcene I 196376 FAX Phone number Other contact number Email I i 1509-961-2551 1509-952-0317 I iartlsue2 @aol.com uci+nvu i evir wr i Cr check the box if same as property owner information Susinessiconbrctor Name On-site contact E-mail Mailing address City ZIP I I I Phone number Other contact number 1 I I DEMOLITION PROJECT INFORMATiON Number of structures being demolished iZ � r � 1 Start date Completion date is asbestos present? 110118/13 j 111/29/13 1140 1 Attach your asbestos survey below � 1 Iias all Identified asbestos been removed Nee i EiviOLITlOii PK0,16.7 CA EISCAY Complete demolition i ! Trainino fire-(complete fields below) Renovation,alternation, remodeling, maintenance or other construction If training fire,provide fire protection agency name,point of contact and telephone number I i J Owner occupied residential dwelling-Permit fee:$35.00-Prior Notice-Nonrefundable ❑ Other Structures-Permit fee:$60.00-10 working day wait period-Nonrefundable ❑ Emergency Fee$50.00-must be accompanied by Government Ordered Declaration(other structures only) Attach declaration below f f Oct 1613 12:21p Munn Brotil Hood Canal •0-765-2100 p.4 '' — - ' otryin aitc.; , 2,40 R, inited 1.!Pi' NAV $.;F"'..4'-‘'-i."'.4i; ot.riz11; `A.A4:.`,15(1.2 F.:. :',;;;:i,..;ri .- PRCAA .. iii......_ : :.-".:.:ii;--I.:,2-56.2 I * ;;b:), ORCAA Permit Application Status Permit Status 0 Approved a Disapproved Notes 1 ,Your permit to demolish the mobile home at 295553 Highway 101 South#15 is approved. 1 0/1 7/1 3 Reviewed R Moody Review Date by 13DEM003611 Permit# Expiration Date 1 1/29/13 Application Received 1 0/1 7/13 $35. Amount Due 00 LI Cash Cl Check la Credit card 1 0/1 7/13 Additional notes or permit conditions Oct 18 13 12:21 p Munn Brot.Hood Canal 00-765-2100 p.5 Olympic Region CleanAirAgency(ORCAA) 2940-B Limit d Lane NW Olympia,WA 96502 360-539-76101 FAX 360-491-6308 Port Angeles Raymond Office Office 6 0-942-2137 ORCAA wwworcaa,orV • • DEMOLITION PERMIT APPUCATION • Demolition and renovation protects within Clallam,Grays Harbor,Jefferson,Mason,Pacific and Thurston counties REQUIRE A PERMIT and require that the following permit conditions be met prior to demolition or renovation. Olympic Region Clean Air Agency(ORCAA)regulations define a demolition project as the wrecking,razing,leveling, dismantling or burning(by a Ike department for training purposes)of a structure making the structure permanently uninhabitable or unusable.Renovations include the removing of load bearing structural members,but not to the extent to make the structure uninhabitable. The following information is merely a reference guide and not a substitute for agency regulations. 1.A good faith asbestos survey must be conducted by a certified Asbestos Hazardous Emergency Response Act(AHERA)bolding inspector. Qualified contractors and inspectors may be found In your local Yellow Pages,through the Washington State Department of Labor and Industries,or on ORCAA's website. 2.Asbestos samples must be sent to an NVLAP laboratory(National Voluntary Laboratory Accreditation Program)per 40 CFR 763.87, A list of labs can be found on ORCAA's website. 3.The start date on other structure demolition must be at least 10 working days from the submission date of the complete application and payment. 4.It is the responsibility of the property owner and/or demolition contractor to ensure there is no asbestos-containing material present in the structure to be demolished. 5.Any and all structures on the same parcel of property that are not proposed to be demolished must be identified as such. 6.A copy of the asbestos survey and approved Demolition Permit,as well as any subsequent amendments,must be kept on site and available for review by Agency inspection personnel. 7.Use the Completion Notification and Amendment Form to make changes to the original permit B.The original demolition permit will expire on the Completion Date.To change the completion date,a Completion Notification and Amendment form must be received PRIOR to expiration.If the permit expires and the project is not compete,you must submit and pay for another demolition permit Under no circumstances will a project be extended beyond 1 year from original start date. ADDITiONAj,,�REMEN TS In addition to Agency requirements,most building departments require a demolition permit(separate from ORCAA's Demolition Permit).The Washington State Department of Labor&Industries may also require notification for asbestos removal projects. "Owner Occupied Residential Dwelikug"means any single family housing unit which le permanently or seasonally occupied by the owner of the unit This term includes houses,moue homes,trailers,houseboats,and houses with'mother-in-law apartment'or a'guest room.'This term does not include structures that are demolished or renovated as part of a commercial or public project nor does this term include any mixed-use building,structure,or installation that contains a residential unit,or any bunting that is leased or use as a rental,or for commercial purposes. Oct 181312:22p Munn Broil Hood Canal •o76521oo P.8 NORTHWEST ASBESTOS CONSULTANTS Surveys. Inspections.Sampling AHERA Building Inspector/Mgmt Planner EPA Certification WAMOA-0042 406 Reed St.Port Townsend,WA 98368 northwestasbestosconsultants @cablespeed.com Serving Western Washington 360-385-0584 Date: 10/15/13 Job location: 295553 Hiway 101 S.#15 Quilcene,WA 98376 Owner: Art and Sue Smith 295553 Hiway 101 S.#15 P.O Box 57 Q uilcene,WA 98376 Subject: Demolition Inspector: Bob Witheridge AHERA-Building Inspector/Management Planner WAMOA-0042-1.019201202 Expires- 10/19/13 II I •tranceN ■ fl1 t gYnNaY 1 �* \Utility Pole- i Well House„ rd , ter Well Mobile Home L I I. , :. t Approximate Route,_ , 'Sew\ /20 of Driveway Loop ? Tarp Mobile •H1 ' - Home ,, 1 Access Risers Parcel Boundary t k installed to-grade ��.,tic Tank with lids,Fall 2012 RV i Septic Tank Mo�IJ MH2 — '''-• RV2 #_ , Access Riser ,%...,,,,-------,y . installed to-grade , `4. / RV ti Mobile • \with lid,Fat 2012 /space �., iii Home Driveway Tank p>,, /SeptIc RV1 o.9 r Spaces 6&7 RV—... -•---"'�t RV� Sho I / ` /•7 j Reserve 1 /j ,/ " lam.`<'�*f N'/ Drainfiieid:Two - // Septic - k / 3k4lY Gravel r /- / r1,-)Vile t. Trenches / �� - fir- 0EaVE D-Box ,f' "-....W. de +'Iy — V ,, Survey 1-_ OCT z 1 2013 Survey marker ...,.. marker 0 at SW corner `3 _ l I , ._.----_ < 12- ( JEFFERSON COUNTY ` DEPT.OF COMMUNITY DEVELOPMENT 0 .m. 80 160 Ft Drawn by Everett A. Sorensen, P.E. Streamline Environmental, inc- Site Plan with Septic System Layout,As-Built 715 Grant street Tranquilcene Mobile Home Park Port Townsend, WA 98368-2405 Russell (Art) & Sue Smith 360-821-9960 295553 Highway 101 January 23, 2013 Quilcene, WA 98376 JeffCo Parcel 702231023 �,� �� EP12 Parcel 4.75 acres (� �-1520 Oct 1813 1220p Munn Brothers Hood Canal 360-765-2100 p.2 III • . . • . Nit, .,. JEFFERSON COUNTY Cit'b( 7,-- 1) 2-‘ ,1. . --, - DEPARTMENT OF COSMIUNITY DEVELOPMENT rit 441i.. '. 621 Sheridan Street-Port Townsend•Washingibn 98368 , •-. . . 380/379-4450• 360/3794451 Fax wantcojeffersonma.usicananderelopnlent Master Permit Application MLA: Project Desoiption(include separate,.jheeits as ' • N L i J 4 ' ' i eel.4 4 * - 1 ' 4 ot * • )i TrucPwoel 1 , •,r: i I - -dif . •. •— . Sew I •t i''' ..,., ' Site Address andlor Directions to Property: /Ire f 1 al . _ • Properly Owner*el Recant ff? Tehaphoner 71 - , - — .. •Se.41 -q ' - 03 1-ems Cts-ii 5 tor e:240cte i.coini , Malang Address: 'PC 2i'Ix"s-i7, i.t_Li 1-p.ti i iii f 4 q R49 4 . ApplimmtlApent Ofdiffetent hoar owner) Telephone: FaX emelt • Mailing Adthess: What kind of Permit?(Check each box that emotes 0 Critical Areas Slawardthip Plan 17 • • • Permit 0 Variance(Minor,Major or Reasonable Economic Use) • Single Family 0 Garage Attached I Detached 0 Conditional LiselC(*,C(c1),or " 0 Manufactured Home 0 Modular 0 Discretionary*D"or Umtamed 771.1'.% 0 Conwriercial" 0 Spedral Use(Essential Pubic .1". .);La GEIVE- 13 Change of Use 0 Boundary Line Mushier/sit • • 0 Address 0 Road Approach_______ 0 Short IPlat" 0 Home Business 0 College industry El Binding Site Plan' 0 Propane CI Long Flat" 1 (po ii()Cjuvinialuel3 0 Skin 0 Planned Rural Residential I: -ati, . 0 Mowed-Yee Use Consistency Analysis 0 Plat VacationfAlleration" 1 It 0 Stommater kliartagentent 0 Shoreline Master Program — .,•• "-, - '-- —''-a* a Ske Mail APixeral Advance Determination(SPAN))• 0 Shaven.Management;-. .•----., :',. DevatoprtitelifftSON COUNTY • 0 Temponay Use 0 Shoreline Mimeo:men,V, ', •‘ DEPT OF COMMUNITY DEV OP ENT 0 Wireless Telecormaunicalico" 0 Comprehensive Plan/UW.4mnd Use l''.1 O Forest Practices AM/Release of Sir-Year Moratorium 0 Jefferson County Shoreine Master Program Amendment *Slay require a Fee-Applicelfen Confeertair 0 Tree Vegetation Request "Reeerres a Pre Appeases"Conewence Please identify any other local,state or federal writs required for this proposal,IF known: • a k_r 4A DESIGNA )hereby designate act as my agent in matters relating to this application for permit(s). Omen SrarAltirm - By signing' this Oppecation form,the ovateriagent attests that the infounallan provided herein,end in any eneohmeres le hire and COMA loth&heat of his,her or Its knowledge. Any material falsehood or any omission of a materiel fact made by the ovmerragent wit)respect te the oplicaton pocket may result In tirls name being nee and void. I hatter agree to sem indemnity and hold harmless Jefewson County rgatest at Sabilities,judgmen*coat owls.reasonable mammal?5 teen sad expenses which may in any way accrue easiest Jefferson Counly as a roma of or in consequence of the granting or ells permit. I nether agree ter provide access and right of as to Jefferson County and he employees,representatives warrants for Me sole purpose of wharf= review and any required tater Inspections. staffs access and right of enhy wit be assumed unless the applicant intern*the County boating at the tine of the eoplict ha ot aheeMsor; S t... _lfrz Ignatunt Ai Date: alia..._ The action or ectkers Applicant will undertake ass reset of the issuance arse permit may negatively impact upon one or more threatened or endangered species and could lead to a polentid lake-of an endangered species as those terms we defined in the federal lam knees as the "Endangered Species Ad'or'ESA'Jefferson County melees no assurances to the applicant that the actions that wit be undedeken bemuse this panne has been issued wit sort visite the M.Any individual.Omen or WPM'can the a Weed on behalf of an endangered species rekordina your actionert men If you are In compearme with the Jettanven County developmers code.The Applicant acirmovriediges the he,six*cc it holds Inekedusi . 1 and restrampattle respon ., and compiying with the ESA.The Applicant has read thin disciainer pod signenti dates it below. Signature! ...../.2_.4, Date: /D//1 j 4.3 GAPearrieCtuteNW#1201)19#01ADIADFOIMISVihreat Parke Appiketioet 5-29-Mike Oct 18 13 12:20p Munn Brothers Hood Canal 360-765-2100 p3 • • ., . BUILDER STATEMENT The signer of this statement does hereby osiffy that they are the 01101410 tithe gamer referenced hereirs,dad they are not licensed=tractors and that they will be Ihe the Contractor forthe proposed ptoject. Signature: Date: /ir)//,',/13 GENERAL CotintscTort OR MANUFACTURED NOME INSMLER: PHONE fanx tititiNGAO0fiESS: Etat.: CONM4C1Xst'S UcessE WAIN Ancterscrffamarest: PHONE( --j------„ FAx:( ) MALMO ADINIES ' Ewa. ........... Proillef TYPO:- Frame Type: Bath. -Shorelbse: T • of Seviraga 8 • - : 0 New II Wood 0 Addition 3 Steel B O AlteralioniRerriodel 3 Concrete • • H a -, ' .:I - - C Repair 0 Masonry -,- • Permit 1 ' Dernolition 0 •, ,. Bedroams Wtar SWOP • 4 Oar edetkilT: — • '-' ° Frivaka siren U Two Patty Type of Herd: 4 Lli Pi tfll I i tri P .'. ':Totak — • 0 Public . St DecitiC - - PrigtellZseri: ,....i__..,... ;,,.... ,.... ,.., _ _1-...L. '...L. 1..1:4_L I'. Number of Parking Spaces: « - Proposed: Number of Parking Spears: Number of occuPards(inductee osmers, - , employees,etc) agreed Proposed IBC Occupancy; IBC Type of-,. -, ,•.,- : Will you have Food Service? Yes I N0 T, 4'l.... ... .... _L t I-... ..,_1'L' ._111 1 tt.__I I Underground Tank I Above ground Tank •- of Propane Tanic 1 t Heat Stove i Cook Sieve I •--- -• I Fireplace Insert -• Water Tank 1 Pellet Sieve 1 Other J_.. .!....i'.._.1...". .../1... LII 11 11 r t IL..." ,i'J.I, 1.-..111. es i No Wigan applying Sore: .' rk•install a propane Ian*yen most also •, a site plan shoarbag suet of the buildings,all fuoperly lines,tank , - , and eke,cadences from the propane tank to ell• •. , belldlltgs and septic system cosponent4 "no,' area. F4.., ,o. • , ' .., , ' " = ' * Current _ .._, Floor - — EH Bid App Review: 21-6 Floor Heated . , Other Heated Base fee: - tC34 Mezzanine Additiortal Section: Healed Basement .., 4,-4- ' Plan Check fee: -;„.., Unheated Basement -1::- '-'7 Stale Surcharge fee: Other Unheated I- 4:,'",ii Pot Water Reviewilae: GaratideaMorl . SUBTOTAL ., --- Dedis '-`--- ' - ' 9111/Rd Approach fee: Other c10 TOTAL $ I 5-7_f Receipt Number: I i't r 41-14. %...... CashiChack Number: i EST1MATEITabritT(Rir:QUIRED) Date: ar-airmadarr vat.or all tabor and nortarels founciation to nide* V 0 t• Initials: • GAPennitCeiverVilAWORMSN#ADRD PORUANtasterPeanit Apprxidion 5-29-08.doc 44,-ON oG JEFFERSON COUN d,tt, • DEPARTMENT OF COMMUNITY DEVELOPMENT 2,y`rKl N 4,„ Date: 0 I4Time Received: am/pm Mon. Tue �� We.. Thur. Fri. Date: BLD: 1 3-- OTY3, .. Contact Name: -1 Owner: ,! [ Contact Number: -'' 0-Emu ZSSt Address: .d'R +7OXIL. 11 206 Notes: I " .i► t 1 y. I _ : i1 • ,1 14 AI i1 ■ ^LJ CV Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00326 Received Date 10/21/2013 SITE ADDRESS: 295553 HWY 101 Issue Date 10/23/2013 QUILCENE, 98376 APPLICANT: RUSSELL A SMITH PHONE: LORENA SUE SMITH PO BOX 57 QUILCENE WA 98376 1-4 SUBDIVISION: TRANQUILCENE MH PARK Block: Lot: PARCEL NUMBER: 702231023 Section: 23 Township: 27N Range: 02W CONTRACTOR: OWNER, RUSSELL A SMITH PHONE: if different: LORENA SUE SMITH PO BOX 57 QUILCENE WA 98376 PROJECT DESCRIPTION: DEMO OF LAMPLIGHT MOBILE HOME IN SPACE#15 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 10/23/2014. REQUIRED INSPECTION: FinalApproval: BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Perm it_Propane.rpt 10/23/2013