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HomeMy WebLinkAboutBLD2004-00558 MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD04-00558 Received Date: 9/2/2004 SITE ADDRESS: 43 N VICTORY AVE Issue Date: 10/7/2004 PORT TOWNSEND, 98368 APPLICANT: LESTER N MANEVAL DIANNA L MANEVAL PO BOX 551 PORT HADLOCK WA 98339 SUBDIVISION: IRONDALE Block: 141 Lot: 16-19 PARCEL#: 962114105 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ DEALER INSTALLER: HAI PHAM VAN CONSTRU DWt(1 WIC*999PP Expires: 10/17/20( W/HERITAGE HOME OF SEQUIM LACEY WA 98503-7975 PROJECT DESCRIPTION: NEW MANUFACTURED HOME MAKE: MARLETTE YEAR: 2004 SIZE: 68 X 40 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRAI1ON DATE IS 10/7/2005. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): �J = yp -FDA Stormwater FINAL Approval: _Lie S— 179.4C w Blocking/Plumbing: _ 6LpckC T Lo vi_jA_ -AO-0_'S_i Propane Tank/Lines _ Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED 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 SPECIAL CONDITIONS APPLY- SEE REVERSE • • SPECIAL CONDITIONS CASE # BLD04-00558 1.) The setback from N. Victory Avenue right-of-way is a minimum of 20 ft. The setback from Andrew Avenue right-of-way is a minimum of 20 ft.. The setback from the alley right-of-way on the south side of lots 19 and 28 is a minimum of 20 ft. The setback on the north side of lot 16 is 5 ft. from the property line. The setback from the east side of lots 32, 33 and 34 is 5 ft. from the property line. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on September 27, 2004 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Special Aquifer Recharge Protection Area (SARPA). 3.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 4.) A Medium Stormwater Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 5.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1) All Industrial Land Uses (2) All Commercial Uses (3) All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4) All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 6.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 7.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 8.) The applicant is proposing to create or add 4,000 square feet of impervious surface and 6,880 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires the project applicant submit a stormwater plan meeting Minimum Requirements #1 through #5 of the Department of Ecology Stormwater Management Manual for Western Washington. The stormwater plan shall address measures to control stormwater, erosion and sediment during construction and shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 9.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i). 10.) The site plan as submitted with the manufactured home installation application on September 2, 2004 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated October 6, 2004 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 11.) This approval is for a manufactured home installation only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. • 12.) Outdoor residential storage s all be maintained in an orderly manner and"3fiall create no fire, safety, health or sanitary hazard. 13.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less than one-half acre unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Unified Development Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC, and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area (ESA). 14.) Maximum lot coverage is not to exceed 25%. Pre-existing legal lots of record less than one acre in size in Rural Residential districts are subject to the stormwater requirements in UDC Section 6.7 and must meet the "Area of Impervious Surface Coverage"to the maximum extent practicable as determined by the Administrator." Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 15.) The building height is not to exceed 35 feet. 16.) N. Victory Avenue (P493) is a private road. A road approach (RAP04-00223) was approved on October 7, 2004 and an address of 43 N. Victory Avenue has been assigned to the parcel. 17.) A minimum of two (2) on-site parking spaces are required for the single family residence. 18.) A septic permit (SEP04-00173) was approved October 6, 2004 for a capacity of 360 gallons per day. 19.) This parcel was created through Irondale, Division 6 under AFN 30490, recorded June 28, 1910, Volume 2, page 139 with the Jefferson County Auditor's office. 20.) These parcels are legal non-conforming parcels designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 21.) A Declaration of Restrictive Covenant was recorded August 12, 2004 under AFN 488123 with the Jefferson County Auditor binding lots 16 through 19 and 28 through 34 of Block 141, Irondale No. 6 for the purpose of meeting bulk and dimensional requirements and minimum land area. FFERSON COUNTY ASSESSOR (- )(ckINEsititikti PH IIIFJEFFERSON COUNTY COURTHOUSE - - — ASSESSOR PO BOX 1220,PORT TOWNSEND WA 98368 (360)385-9105 11,1 2 MOBILE HOME INFORMATION FORM • ,,n , • , OWNER1114A144 7=MAiii NG ADDRESS: THIS IS NOT A TAX STATEMENT f , NAME: /Z. )1 4 F / The purpose of this questionnaire is to obtain information regarcing either the current location of a mobile home or the ADDRESS: previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County_or if it has been moved to this county from another area. Please see reverse side for TELEPHONE NO: Co 0)— 4 1./7/5 addtional information. 1) MOBILE HOME DATA: (A) MAKE 1T) /2. (B) MODEL L. ‘;‘ e EZ, (C) YEAR c-,Voti (D) LENGTH 4,1 (E) WIDTH d7 (F)SERIAL NUMBER 71(G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) /AO( 43 (.0 . C: (H) PURCHASE DATE 9. 7 e 064 2) PREVIOUS OWNER / LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE MOBILE 1*-W / /9 4."1 OPP "4': !,) ; ADDRESS 5 /9/.0 ; /A ti 2I .": (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO,WHAT COUNTY? IF YES,WHAT WAS PREVIOUS ADDRESS OF MOBILE? 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES NO (B) IF LOCATED IN A MOBILE HOME PARK: NAME et ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK: • NAME OF LAND O r-WNER: / • n ety,' / , LOCATION (ADDRESS) I) Ore...9 Aug_ REAL PROPERTY PARCEL NUMBER/DESCRIPTION OQj 94.211 4/ 106 t,000r-i Z.:,1141 07 r)0 09(.0 I I / / J i 1_0±5 25x/00 /4. -19 aF-29 30 - 3<4 ( THANK YOU FOR YOUR HELP! . SIGNATURE ULeS,.4 .) KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJtCT TO AUDIT VERIFICATION. MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATIONMLA04-00525 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD04-00558 Received Date: 9/2/2004 SITE ADDRESS: l} 3 N VICTORY AVE PORT TOWNSEND, 98368 APPLICANT: LESTER N MANEVAL PHONE: (360) 265-4715 DIANNA L MANEVAL PO BOX 551 PORT HADLOCK WA 98339 SUBDIVISION: IRONDALE Block: 141 Lot: 16-19 PARCEL NUMBER: 962114105 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ HAI PHAM VAN CONSTRUCTION PHONE: (360)455-4158 DEALER: W/HERITAGE HOME OF SEQUIM 6642 5TH WAY SE LACEY WA 98503-7975 Contractor's License HAIHC*999PP Expires INSTALLER: HAI PHAM VAN CONSTRUCTION HAIHC*999PP (360)455-4158 W/HERITAGE HOME OF SEQUIM LACEY WA 98503-7975 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MFH TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: MARLETTE SETBACK: VALUATION 121,806.00 YEAR: 2004 LABOR & INDUSTRIES APPROVAL? SIZE: 68 X 40 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUD BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO Exist: Exist: AREA Plat Conditions Prop: 3 Prop: 2 Wetland Erosion Total: 3 Total: 2 Seismic Streams Flood Way Floodplain Routing Date: 9/ 7/JO d F&W Landslide T Shoreline Aquifer PERM,' a Type Amount Paid By: Date: Receipt: Manufactured Homes $154.00 KAS 09/02/04 67609 OCT - 7 2004Add. Manufactured Home $32.00 KAS 09/02/04 67609 Potable Water Application $52.00 KAS 09/02/04 67609 Jefferson County mnninp & Building Department Total: $238.00 CoI:Q.+«m oL 41. 1 iiii 01V CO�� JEFFERSON CITY --_.___ ' DEPARTMENT OF COMMUNITY DEVELOPMENT- a -li INti ''; 621 Sheridan Street• Port Townsend •Washinge f;"L8 ``- I/ \J } 360/379-4450 • 360/379-4451 Fax 1 ' it �1,, 0� www.co.jefferson.wa.us/commdevelopment f,t. i 1 j �, 1 SEP :',2 2004 l Master Permit Application I MLA: _, Project Description(include separate sheets as necessary): u[ o I �C�?=PT. OF Ci7tvii�fia�hi�'UEVELOFh1El•�l 11Fu.,, _,� L, Ac-i'vpF01. -id, 4.- Tax Parcel 00° 96 2//H/U2- Property • Number:000 9 42 ii /i45 0604:L..'f11 Yf0 T Size: ,27 5OO 5F, (acres/square feet) yz Site Address and/or Directions to Property: h . Y,...I-4.l A vt, o Cr Prs esc , it. X4 bi Pf, Property Owper(s)of Record: ,.E�tt 0, W l A I4�il4 1 0 AI h if 4 I-. A-t l F L/04 i Telephone: pi,o) 1.5— 417/ S Fax: email: Mailing Address: P.O. cix- 45 t eop_f I-},4 ott o cS4- art • l'-33' Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) N Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification G Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** )(Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** El Change of Use ❑ Long Plat** [7 Address ❑ Road Approach El Planned Rural Residential Development(PRRD)✓Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre-Application Conference **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 it's 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 attomey'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 acrpcs 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.A and right of entry to this property shall be requested and shall occur only during regular business hours. �J{q y�� �r Signature: ,L,�/� r ' . i y Date: a "1 L —v 4 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 lake"of an endangered species as those terms are defined in the federal 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 and non-transfe/pb`' l-ponsibility for adhering to d complying with ti ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: �`y` knet Date: '5 "/1. "014 G:\PemritCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc iOWNER BUILDER STATEMENT IP The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be In the responsibility of the Gen I Contractor for the proposed project. Signature: N. 9'‘y Date: gt''"/L" .'°. )'7 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Hetle.l'tg € H dvrltGs Qf S Sri A.% (31,o) Z $ 3 -L81 i ( ) MAILING ADDRESS. G} ✓ S£ ' EMAIL: ��' r �7 1�� Vdhc CONTRACTOR'S .LICENSE r a 9yJ WAINS r f� NUMBER: X !7 4/ PNG 599 PP�" NUMBER OA/rvS 0 /! L, ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Ice New X Wood Existing: 2 0 Sewer Addition ❑ Steel Proposed: Bank ❑ Community System Alteration/Remodel ❑ Concrete Total: Z Height: Individual System Repair ❑ Masonry S P Permit# p y'�73 Demolition ❑ Other: Bedrooms: Water Supply: Existing: 3 Setback: ❑ Private well ❑ Two Party ope of Heat: Proposed: XPublic , tact 4 AI, . Total: 3 Name of System: P.U.Q- / fis is a Commercial Project you must answer the following: nber of Parking Spares: Current Proposed: Number of ADA Parking Spaces: fiber of occupants(includes owners,tenants,employees,etc) Current Proposed Occupancy: IBC Type of construction: Will you have Food Service? Yes / No s is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: Iderground Tank ❑ Above ground Tank Size of Propane Tank: at Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other ;appliance being installed in a Manufactured/Mobile Home? Yes / No applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property tank location and size,distances from the propane tank to all property lines,buildings and septic system components, ing the reserve area. S uare Foota a Fr ce Use Only ;i ; • Current Proposed . • Amount 001- Conslstleiicy tev : - Base fe .._.____— — ___. - k SW • L tt --,., .., .„,:nc . . ..r,/3E13 _ 2 20u t I fee: x"r t ,1-1` t r0 z1r a . , ,i seated 911/ad .o .s c fee ti +,, a 7,' intro: + • If wK " C c g :fi fq .y r Vt ti- g: hr 3 st3. S-:. E1:: k�s;,yi+.,y arport TOTAL: $ r F airs_ -7Y r Receipt Nu mb r `' Yj fir( 1��. \�- S.U.s. � C Cash/Chock'Number: 1`7k,.�, 44-,. s,, '; ED COST(REQUIRED) - z + Date: j # 5 R, i , value of all labor and materials foundation to finish ��,�` -' . t \FORMS\DRD FORMS\Master Pemut Application 7-8-04.doc • RETURN ADDRESS Flt st Federal Savings & Loan P4':). Box 351 Port Angeles. WA 98362 h STATr OF WASHINCTON ANII��.., i ��� HOME - ��+ S- 7� MANUFACTURED ®TITLE ELIMINATION licEnsinG APPLICATION DTRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty REMOVAL FROM REAL PROPERTY of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VI!V) Ei LAND LEGAL DESCRIPTION ON PAGE REAL PROPERTY TAX Pp 1 OE7 N'M 0 B F,$ MANUFACTURED HOME WILL BE MI AFFIXED [� REMOVED 962-114-105 CKJ LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 16/17/18/19/2 8 141 IRONDALE B GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 16 2 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER LESTER N MANEVAL NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER DIANNA L MANEVAL ADDRESS CITY STATE ZIP CODE P 0 BOX 551 PORT HADLOCK WA 98339 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER FTRST FPT'Rj2 A r SAVINGS AND LOAN ASSOCIATION OF POR'1 ANGELES NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE P O BO X 351 PORT ANGELES WA 98362 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF HIS VEHICLE AND THIS INFORMATION IS ACCURATE: a r Signature of Registered Owner and Title, IF APPLICABLE - r. t-'L/1r•r..��'-2./l'c- /1 ; Signature of gElfttdlhbll/Rpniptered Owner and Title, IF APPLICABLE r, /a• 1r. �.x1 /4 r A : NOT A"\X tpliti P r /4.. NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE to of WashingtonAAdee.7.7 Signed or attested ��/�NOTARfr County of befor e on 'Q cn !Exp. Oh-15.05li y=,.-`r`,1`t;L.KLt . i'�.n ilA t;1 i Signatur %% T .^I t A 'I 2INT NAME OF REGISTERED OWNER CRY O -7� V e L(G ` \ i �JOTARY OR AGENT i cc\ ... ,ihki` x i, a I\.Y\,9 `_. i',\i,,,,LI FI I c•! /�rl' Ted•t�� ��/ / Qh�• AS" A���\ss PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY wA s County/Office No.OR ///////1lIIIIIN��\\`I Title _") k-4'I"t'1 AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notar;Expiration Data �S 43 0 TITLE COMPANY CERTIFICATION Q9 I certify that the legal description of the land and ownership Is true and correct per the real property records. NADAE(TYPED OR PRINTED) y��-�" TITLE COzg• ANY L7ANNY/7�P�HOON�E/NUUMMBER F '7 SI y :`/POST I� • I, 1� �r 'u"� `'l ram.-t.c �V i j?6+I322_ . I *AI rr -8 �I!1inalize thistr.' n Ith a Licensing Agent within 10 calendar days of the date Title Company Representative signs. EILBUILDING PERMIT OFFICE CERTIFICATION I certify that: the manufactured home has been affixed to the real property as described. a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME(r)PED 0 PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG P RMIT# A4. tL link, li�ttk / c13C4DYY1A—LHA-24) CA "VAS SIGN TAI E/POSITIOA F 1 ATE g TD-420-729 A U OMEA i PL(R/2/02)OR )Page1of2 r • MVIANUFACTIIRFD '-IOMF - FROM SECTION '' TPO'PLATENUMBER YEAR MAKE LENGTHNVIDTH(FEET) VEHICL IDENTIFICATION NUMBER(VIN) X /-1v 36iC,S 6 SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR LIMINATIO OF TITLE REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title, IF APPLICABLE - 't-'--- "ILA-( ' L t'�!L-�� , �CC ( Signature of Additional Legal Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP I NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE GUSH I State of Washington 0 n I I Signed or attested J_p QZ�Y T�jY \ County of +'1 ` \�.rY before me on I (I•� �► j ,� ��;, . ,c`� iCr cT,,�� ��ti .1L r� ignature • � ,ik•a�I y PR NT NAME OF LEGAL OWNER - T Y OR jJs-I1,7 ,J p�' - ZA L,,M 'r PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY * yy/` County/Office No.OR ' S). � 4; itle ('\ 1" - AND: Dealer No.OR D3i -D9 446 DEALERSHIP POSITION/ GENT/NOTARY Notary Expiration Date .I ;t D LAN' •. ••c • •= A legal description of the land can be obtained from the local County Assessor's Office LOTS 16, 17, 18, 19,28,29,30,31,32,33 AND 34,BLOCK 141,IRONDALE,AS PER PLAT RECORDED IN VOLUME 2 OF PLATS,PAGE 139,RECORDS OF JEFERSON COUNTY,WASHINGTON. SITUATE IN THE COUNTY OF JEFFERSON,STATE OF WASHINGTON. 0 DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT.THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN. ANY REQUIRED SALES TAX HAS BEEN COLLECTED. DEALER NAME(TYPED OR PRINTS ) • WA DE L R_NU,MdBER DATE OF SALE .J IIFR , 9 A (y 0 irl /Lj ri '--)Pot-4.f , �F.,-�5'�fi .2 ".2'1— (") P, HASE PRICE , L,P,' TAX JURISDICTION/TAXRATE DEALS A�y`�rHORIZE $IGNATU ,,✓'i,,., UUSE TAX EXEMPT Sale to a certified Tribal member on the reservation(attach notarized statement of delivery). 9 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents) I certify that the above application appears to have been completed correctly,and the applicant has sufficient documentation to proceed with the recording of this form. NAME(TYPED OR PRINTED) COUNTY OFFICENFS OPERATOR NUMBER SIGNATURE DATE 10 TITLE FEES FILING FEE I APPLICATION I MOBIL:HOME FEE ELIMINATION FEE `USE TAX SUBAGENT FEES TOTAL FEES&TAX IMPORTANT: Once the application has been approved by the County Auditor/Vehicle Licensing Office,take your application form to the County Recording Office. Retain proof of the recording fees paid. If the Recording Office retains your original application form,obtain a certified copy of the recorded form. APPLICANTS: Once recorded,you must return to a Vehicle Licensing office to file the Manufactured Home Application, paying all required fees.Vehicle licensing subagents charge a service fee. For full instructions on completing this form for Title Elimination, Removal from Real Property or Transfer in Location,see form TD-420-730, Manufactured Home Application Instructions. The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation,please cal(360)902-3600 or TTY(360)664-8885. TD-420-729 MANUF HOME APPL(R/2/02)O R(W)Page 2 of 2 .vSON JEFFERSON COUNTY Al DEPARTMENT OF COMMUNITY DEVELOPMENT iptzb. 621 Sheridan Street • Port Townsend •Washington 98368 ,r►,zle p 360/379-4450 • 360/379-4451 Fax "rt[1v http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# PROJECT/APPLICANT NAME: 1,...Ez4zji. n ` V 4 kin'r.th - Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. V1£L.Le M444 PAC-fattei hid rnr_,.. 02&v.) Existing Conditions Summary 2. Describe the existing topography. in contours ntours on the site m . 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. SAIAI ( c i,L 1MOs•E1 4. Describe the existing soils. Indicate soil type on the site ma . • 5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—above,below,and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. niA 6. Describe any excess levels of noise generated by the pr posed use or activity: i;\ 1 stormwater site plan template—rev.101/2003 �tL�� 5 t 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. ri//7 8. Describe the general vicinity of the site,including adjacent land uses and structures,utilities, roads,and sensitive/critical areas (streams,wetlands,lakes,steep slopes,etc . f£A A A-lit}.. PT. O F, '' .O cc.*, I)wl J rr_.Y�q IL�1 W t4 Ut Mies- t'� .- sj S �q 1 E f'�w,,.'I )4dsies 110 4Qv.S$z3seg rt v 510.4AwtS ,fl Lat.* A-b ,etV5 Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities And flow control facilities are not exceeded. g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed(i.e., per BMP T5.30 in the Manual)or,if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on t e site plan and differenti to proposed facilities from existing f lities. 10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of contaminants.) 171/if 11. Describe the performance goals and standards applicable to the project. h 11 12. Describe the flow control system. I �+v"ff'zs O d!��( tcl L a d' sp/4sLt d3Ori-R-4S stormwater site plan template—rev.1012003 6 13. Describe the water quality system. 14. Describe the conveyance system analysis and design. ll il/t4 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. h)1 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. n/� 17. Describe the proposed surfacing material. 18. Describe methods for restorat'on of the site. /��b/,L Tans s , itd p/vw€a,,s. s.h�,42.1. 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. ,, d 11 �`'l 20. List here and include any special reports or studies co ucted to prepare the Stormwater Site Plan. h /9• 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. 101//4- • AAA Vi stomiwater site plan template—rev.10/12003 00\ 7 t r CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.52 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits.Zia Ul) x`e• -•J- ate 2. Establish Construction Access. I rti. 0.r 3. Control Flow Rates. Vl A 4. Install Sediment Controls. C """`�-� 5. Stabilize Soils. 6. Protect Slopes. 7. Protect Drain Inlets. X\J\N 8 stowater site plan template—rev.10t1/2003 mt r t 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. 1� 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). Y 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). hDhf, b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). _ In IA 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. V\ 1A stormwater site plan template—rev.10/12003 9 f 1 b. Description of special requirements for working in or near environmentally sensitive areas. VI lA 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). J 1(.31i. 5. Construction Phasing. a. Construction sequence b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. II. Wet Season Construction Activities. a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the i '' tion of bonds and/or other financial securities. nA , - b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 0/4 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template—rev.10/1/2003 10 Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. 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