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C I T Y O F P O R T
T O W N S E N D
DEMOLITION PEILVIIT APPLICATION
9~ar- i~
FOR DEPARTMENT USE ONLY:
Plan Review fee of $ Paid on
Receipt Na. For Clerk-Treasurer
A demolition permit is required to ensure that your structure is removed from the Assessor's [ax rolls and [ha[ the site is left in a
safe, sanitary condition. Under Section 4409 of the Uniform Building Code the Building Official may require submittal of plans and
a schedule for demolition. When such plans are required, no work shall be done untii the plans or schedule, or both, are approved
by the Building Official. When plans or other data are required to be submitted, a plan review fee shall be paid at the time of
submitting plans and specifications for review.
Property Owner(s) Name ~1-e-d W ~!. ~ l~~ ~-' Phone
Mailing Address 9'7d P ST 'i~ ~^ ~r p
Contractor's Name ~,(f ~ LSC~ ~ ,/1~ [ C ~G ~ Z/~l. , Phone ~ z p J ~'S ^ ~~y Q 7
Mailing Address ~ 9, f ~.¢ j/[/ ~'
Property Street Address 9 yU ~ ~ ~~E~T
roperty Legal Description Addition, Block Lot(s)
~,cTr~~' ae s ~vv ~o~ E
Work to begin S I ~~~ y and be completed by ~- y
The use of all existing and proposed buildings and strucmres on site is: '
Materials from the demolished site will be transported to ~te ~~ ~` ~~ ,/U)~ '{e ra''a ~S r`
stn GtJ~ Z o
and used for ~'Gf!
Is the site in the Historic District? _ YES _ NO (If yes, please refer to Attachment A regarding design review)
SITE PLAN REQUIREMENTS: To help ensure timely review of your application, please submit two copies of an
accurate sits plan drawn to scale which include the following information:
1. Scale used and a marker showing the direction of North;
2. Location and dimensions of all property lines;
3. Location and dimensions of all existing and proposed buildings and structures on the site, showing distances from
property lines;
4. Location and name or number of all streets and alleys adjacent to the site;
5. Existing buildings scheduled for demolition or removal must be indicated.
ch plan shall be dated, shall clearly indicate the nature, extent and purpose of the work and shall list the location of the
,rk, the name of the owner and the name of the person who prepared the plan. '
Do you wish to abandon any existing utility services? _ YES _ NO If yes, please indicate disconnect date:
'Note: Monthly utility charges will remain in effect unless service is abandoned. If either water or sewer, or
both, are to be abandoned, you must submit a written request, prior to demolition, for City approval. Yo
will continue to be charged your current stormwater rate unless you notify the Utilities office of a change.
After you have obtained your permit, you must meet the following requiretneats:
o Whenever demolition interferes with pedestrian travel, demolition work may not begin until the required
pedestrian protection structures are in place;
o Remove all floors, foundations, footings and basement and retaining walls down to 18 inches below grade.
Basement sections below this must be broken into pieces not more than 8 inches in any dimension;
o Fill excavations and other cavities with noncombustible, inorganic material smaller than 8 inches and cover
with dirt or gravel so that broken concrete is not exposed;
o Grade site so that surface is smooth and water will run off. Be sure grading conforms to existing
neighboring grades of all sides of lot;
o During demolition, use water to control and reduce dust and its impact on neighboring properties;
o Leave the site clean and in a safe condition.
I certify that all information given above and on accompanying plans is complete and accurate m the best of my
lmowledge; that all information given above and on accompanying Plans will be relied upon in granting permits and
that if such information is later found to be inaccurate any permits may bewithdrawn.
The undersigned hereby saves and holds We City of Port Townsend harmless frpgt.any and all capses of action,- .
judgments, claims, or demands, or from any liability of any nature arising from any non~:ompliance with
restricficjos which may have been established by parties other than the City of Port Townsend.
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Signature of pli or Authorized Representative Date ~
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