HomeMy WebLinkAboutBLD2022-00270-01- Permit Application, Issued Permit, Certificate of OccupancyDemolition Permit 1
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street, Port Townsend, WA 98368
Tel: 360.379.4450 | Fax: 360.379.4451
Web: www.co.jefferson.wa.us/communitydevelopment
E-mail: dcd@co.jefferson.wa.us
DEMOLITION PERMIT APPLICATION
Steps in the Permit Process:
-Review required submittal items to ensure all information is completed prior to submitting application.
-Make an appointment to meet with the Permit Technician by calling 360-379-4450.
-Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued.
For Department Use Only Receipt # Date:
Related Application #s: Payment #
Demolition of any structure requires the applicant to Olympic Regional Clean Air Agency
( or 360-338-6419)
prior to obtaining a permit from Jefferson County Dept. of Community Development.
Required Submittal Items
from ORCAA.
Complete Site plan - Please refer to the site plan checklist to ensure all items are on the site plan.
If applicant is different from owner, written authorization from property owner to demolish structure.
Building Information
Site Address:
Assessor Tax Parcel Number(s):
Present Zoning:
Present Use of Property:
Type of Structure to be demolished:
Residence Garage Shed Commercial Other
What existing buildings will remain?
Is there any water on or adjacent to the property?
NO YES Marine Creek Pond/Wetland Lake Other
Sewer disposal method: Onsite septic Public Sewer - Provider
Septic Case #
Wastewater - Sewage Disposal
Is there an existing Septic System on the property? Yes No
Will you be reconnecting to the existing septic system? Yes No
Is there an existing well on the property? Yes No
Do you plan on decommissioning the well? Yes No
Received 05/09/2022
Demolition Permit 2
Property Owner
Name:
Address:
Phone #: E-mail Address:
Please contact Authorized Agent/Representative with project info.
Property Owner Signature: Date:
Applicant / Contractor: Authorized Agent/Representative
Name:
Phone #: E-mail Address:
License #: Expiration 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 making any issued permit null and void.
I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in
compliance with all applicable federal, state and county laws and regulations and I 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.
for visits related to this application and subsequent permit issuance.
Signature: Print Name: Date:
A final inspection must be scheduled once structure is removed to close out case
OFFICE USE ONLY
Building Permit Fees
Demolition Permit Fee $.00
Environmental Health Review $1 .00
Project Scanning Fee $2
Technology Fee 5% $1
Total Fees* $2
*Additional fees may apply
Received 05/09/2022
Asbestos in
Your Home
Helpful Hints &
Project Planning
• Include the appropriate fee
• Ensure the Start Date is after the 10-
day or 14-day waiting period
• Include the complete survey for
demolition projects
ORCAA offers many of its pertinent
documents and forms through its website:
•
Inspectors and Contractors
• Link to NVLAP Accredited
Laboratories
• Do-it Yourself Resources
• Removal Instructions for various
materials
• Program Forms:
Asbestos Notifcation
Amendment Request
Before demolishing a structure…
An asbestos survey and ORCAA
If asbestos was detected in the
survey…
The asbestos material must be abated
requires an and
See Asbestos Projects below.
Projects are considered “Asbestos
Projects” if…
The project includes more than 48
square feet or 10 linear feet (pipes) of
with ORCAA at least 10 days before
work begins unless the project meets
end dates noted, as well as the location
ORCAA can waive the 10-day
Contact ORCAA Compliance Staff for
details.
Homeowners wishing to remove
asbestos should…
Review ORCAA’s three guidance
documents for the most common do-it-
To determine if there is asbestos…
If a structure is being demolished, a
If the structure is not being demolished,
submit samples to a National Voluntary
Laboratory Accreditation Program
Find a link to a list of these at
www.ORCAA.org.
Residents who want to do the
abatement work themselves…
Owners of a single family residence
documents are available at
Olympic Region Clean Air Agency
2940 Limited Lane NW
Olympia, WA 98502
(360) 539-7610
Best practices for
planning your home
improvement projects
Received 05/09/2022
Received 05/09/2022