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HomeMy WebLinkAboutBLD2004-00759 RILDING PERMIT APPLICAT MLA04-00671 Review Type:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00759 Received Date: 12/2/2004 SITE ADDRESS: 230 OLD FERRY RD PORT HADLOCK, 98339 OWNER: DANA A STOCKS PHONE: (425) 891-4048 RICHARD A STOCKS 9550 172ND AVE NE REDMOND WA 98052-3229 SUBDIVISION: PORTAGE BAY PARK Block: Lot: 12-14 PARCEL NUMBER: 989100011 Section: 1 Township: 29 N Range: 01 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW MANUFACTURED HOME & A/G 250 GALLON PROPANE TANK (WOODHAVEN #GOORN26119) TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 95 BANK HEIGHT: 50 SEWAGE DISPOSAL: ALT WATER SYSTEM: PUD PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Floodplain Routing Date: I 74 F&W Landslide Shoreline Aquifer /r1l� Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $154.00 BAC 12/02/04 68735 A Add. Manufactured Home $32.00 BAC 12/02/04 68735 A 1 1' A, 'l f r— Plan Check $48.00 BAC 12/02/04 68735 Potable Water Application $52.00 BAC 12/02/04 68735 i`` Total: $286.00 Jefferson County Planning At_cc & B it ,ng g/73artmepti BUILDING P ERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00759 Received Date 12/2/2004 SITE ADDRESS: 230 OLD FERRY RD PORT HADLOCK, 98339 Issue Date 01/13/2005 APPLICANT: DANA A STOCKS RICHARD A STOCKS PHONE: (425) 891-4048 230 OLD FERRY RD PORT HADLOCK WA 98339 SUBDIVISION: PORTAGE BAY PARK Block: Lot: 12-14 Section: 1 Township: 29 N Range: 01 W PARCEL NUMBER: 989100011 CONTRACTOR: PROJECT DESCRIPTION: NEW MANUFACTURED HOME & A/G 250 GALLON PROPANE TANK (WOODHAVEN #GOORN26119) CALL IN FOR THE REQUIRES INS ECTIO S THAT APPLY TO YOUR PROJECT. SETBACKS: ak 1/24, 05 f UFFER: ,4k Footing: 54 dk L/' ,oic / 45 / Foundation: R[.nGklUG 4 -7;F - t'#so i 0k_ OAS.# Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Framing: Plumbing: OK 3/�!/OS Propane Tank/Lines: Insulation: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: .4'v- 0 0051i/ 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 FOR CASE t BLD04-00759 1.) The road approach permit (RAP04-00307) must be inspected and finalled by the Jefferson County Department of Public Works prior to the final inspection/certificate of occupancy of this residence. Contact Terry Duff at 360-385-9159 for the road approach inspection. 2.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 3.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 4.) The development will be serviced by public water and a well will not be utilized. If a well is required for potable water the applicant shall meet all of the Aquifer Recharge and SIPZ conditions. 5.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 6.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 8.) 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). 9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 10.) The building height is not to exceed 35 feet. 11.) Setback from Old Ferry Rd. right-of-way is no less than 20 ft., setback from Laurel St. right-of-way is no less than 20 ft., side and rear setbacks are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 12.) Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 13.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 14.) A medium stormwater plan haaeen submitted and approved by the Department of Community Development. Once the subject permit has been issL.ed 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. 15.) A minimum of two (2) on-site parking spaces is required for the single-family residence. I:\F_BLD_Permit_Buildng.rpt 10/29/19 E w` ,. w•40 _ w-80 ,/ 13'-1� W83;;W-83 • Opt.O13a•fireylate � '- w-at w.at '•6 E_ \ \ W-sa W-a1 W-81 Cu CII e<� — - ' \ ru�mLmGC sC. p •zL ^� 6hwCaN Ur c, 0,--g. m I� to � co C. C '.' be: of �'.�a•'" .: ' O '� O 1 _ I ShooI Om ILL m F \ _• , y o s i2 *i D6t Shell 1 Pei a m _TI \ ,,� OpL Dnor v X Opt.L•Tub b.4 i D m ' i11 - Opt.Hzr. hbe,1 01 Am" iwn- I'` in,�! Y_3-e - • `y. i w rs y w ■ >< III 1 r^ o F o M O �• ; - e/- rrv,�l is., o ��y1 —I tiio ( ` D .`- -----=ice eS f.i y" \ KIl P. v p 24 '= ;` I z O • m _ -\ ----- Z • O. g. b m' 111? 4=1. r. N F O mr \ 17. O 4. u O Opt.DOL Doors y 1-1 F m Z O £ E.,,.—_ —J - 4 co P MI um M "= x 3 O j� a ' ram` \) r• `r d I 1, •5 4 & C V. \ \ / II I. .. a • wa� w MIMEM W 81 F ••` m D d 0 O Shelve: <-0 LI O q: V I co {� c to c p '''----�--:ai r...--"..-7T T. j _ J_J —N,N W-85 w-83 W-83 w-85 JACK WESTERMAN III • Jefferson Cou4101'surthousc ASSESSOR I'O Ilox 1220, Pori Townsend, WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: R e,11 A tt J w 'D Ant 4 S13 c_k i ADDRESS: &30 C f d rev°Ey d Pcf•t II et d lac/( , it 9'339 PHONE NO. (igi) g y,-ya y S The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the 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. l►MOBILE HOME DATA: COPY (A)MAKE Go teLe; i,1 es 747 'teo (B)MODEL itiee d l Atiem-b 3 lad I t< (C)YEAR QUI 0 L (D) LENGTH (O b' 4E)WIDTH 14' (F)SERIAL# 9 (G)YOUR PURCHASE PRICE (Do not include sales tax)7 153 b 5.3 PURCHASE DATE ///08/41/ 2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) _. (A) FROM WHOM DID YOU PURCHASE MOBILE ADDRESS B WAS MOBILE HOME( 1 ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: th4i'd ,r .-Z1410 1 S`fcc/C4 LOCATION ADDRESS Z50 C /d r"eYo'y led , P,k-f kalici / a 1 9 335 REAL PROPERTY PARCEL#/DESCRIPTION k9/6 Q 4 1/ A41.41 4 S/Fe- tJ Signature of applicant THANK YOU FOR YOUR HELP! 4ely JO COSSELL, Technician OWNER BUILDER STATEMENT • 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 assumir e responsibility of the General Contractor for the proposed project. �� Signature: �Q,;yl 4( e6(v Date: ///'7 to-coy GENERAL CONTRACTOR OR MANUFACTURED HOME INST R: PHONE: FAX: ir'lCl'f✓� \j (.moo )• : ,1,, 350/ ( ) MAILING ADDRESS: 3./•i c/5 W'/ell d kiln( .f EMAIL: / Cc-s�rr�- � i�7A CONTRACTOR'S LICENSE WAINS p NUMBER: NUMBER o T 0 � ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New [Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: ,2. Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: 3k. Height: "1-Jndividual System 41. ❑ Repair II Masonry Li / � / SEP Permit# O V//0 0 ❑ Demolition ❑ Other: Bedrooms: Water Supply: fy.,,,,,„ F,-4•1,,; ° Existing: Setback: 0 Private well ❑ Two Party Type of Heat: .. r„ Proposed: e'Public ei et fr:e� Total: 9� P.�ti Name of System: If this is a Commercial Proiect 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: ❑ Underground Tank 1Above ground Tank Size of Propane Tank: 25-0 e4e-t1= i Heat Stove ok Stove ❑ Woodstove ❑ Fireplace Insert C ' `Water Tank 0 Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? (tJ/ No When applying for a permit to Install a propane tank you must also s bmit 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 -For Office Usfily W n�d Sr ' .S1w, Current Proposed pot a, "� Main Floor Cor s �:2eview: �y�`l ' s n-y apt a r :"'fit k y [,ia ,, k.. s. ,..*3 2rtu Floor } ,1 ,i Base fee J 1- 2 Z sF � , ; a; w,§,';3."i,, : i{v�; : ie t. :sib` 4? iF?)an.`a Mezzanine: DEC — 2 "plan Check fee' ' wit zxx-S`a,s�§ -L,4' 1"ro ',� ;,,� Heated Basement Mate Surcha a fee: `'t 3 Unheated Basement ' x f .4 .DY S ,r .�!: ... � .. _,. - ��.ateC'�Fy�ew fes<r� �' -,:'�;,B y 7'�` 'i h -�.. Other Unheated � �q }�i 2 fk 7 F c t 14 - fie. ,+ 91'1/Rd Garage/Carport ,6 ,4 n 4 Decks , , .;-�-' r x H,,�+� H .q;"ll i4�ba1 Y 'T`.` Pl4 , Y -jp } I y k'i�^ ; r ' 4 at' _ j t [,h i 1 l k .Z}» ` „3gfa , k , -,a ; eChe ' i , , x .Other .>.t r ESTIMATED COST(REQUIRED) Date; �, ;; l 1 • 1 - S ' .Fair market value of all labor and materials foundation to finish ,"� )444,5 . ? `. . 4 -Initials: �,� r � E ,X 40 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc ree,s0N—c..›.oe, JEFFERSONQUNTY A DEPARTMENT OF COMMUNITY DEVELOPMENT `4 621 Sheridan Street• Port Townsend •Washington 98368 DEC _1 2004 360/379-4450 • 360/379-4451 Fax 44 O, www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: . 1.' . .07-1 ( Project Description(include separate sheets as necessary): A ne-e ) Pifir fn-c AP' J A,..,.n ,./ 13c old Fri.^y kd , ?cf�- W. d t if w s,wit Fir R..b•Stu c.- Tax Parcel `, Property Number: 7 g9/ 6 () 19 I / Size: , $ii .1-0• (acres/square feet) Site Address and/or Directions to Property: ,/3o C Id Fe,^r y gcl Art- h dIock , W A Property Owner(s)of Record: R.,kit iz,d r `1)Hd/l 5fcc.fs Telephone: Ala y') &?/ Ye 9 S Fax: email: 1)an 4..S146c..4 s elPS.d.c p in Mailing Address: a 3o old Feiry ,d• f 6,r7` /lac//oc k , Leg 'l3.1/-c2G•7.. Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ❑ Building ❑Variance(Minor,Major or Reasonable Economic Use) n Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** Single-Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** X Manufactured Home ❑ Boundary Line Adjustment El Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ 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 en-5't y f)/C C et'.c 4 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE `6 t, �7 e- G�L Date: /7 7�-4 (ejl By signing this application form,o the owner/agent attests that the information provided herein,and in any attachmen ;i 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 attorney'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 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.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: / l 1.L .-v el" Date: ////a/2 coy 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"take"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-transferable ponsibility for�adhering to and complying with the ESA. The Applicant has read this disdai er and signs and dates it below. Signature: /•'/4>N� ,,/ •�S'T:,c�,, Date: ///Z-/ZG'z)V G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc sow ' PERMIT # BLO rIVA JEFFERSON COUNTY -0 4 - 0 7 9 DEPARTMENT OF COMMUNITY DEVELOPMENT DEC — 252004 621 Sheridan Street • Port Townsend • Washington 983 . PERSON COUNTY OCD ,�+,,._..' O 360/379-4450 • 360/379-4451 Fax T�1� http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# PROJECT/APPLICANT NAME: 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. /,1C u.) //14*4 r'{a,¢fr y'� /4 r.,f 1 e .r1 L +f'JLt • Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. • 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 4. Describe the existing soils. Indicate soil type on the site map. 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. STOR W: TAR 6. Describe any excess levels of noise generated by the proposed use or activity: t' AN JAN - 2-05 JEFFF.R N-�."� 1)I;PT.OF(. , OtJNTY SIGNATURE: / 1)EVlil•Op •j, stormwater site plan template—rev.10/1/2003 w 4. 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. - " 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.). / C•� ' C( t'fk'/'/ oc d` oliil,Ut.' •- �J�°c. ' .7tj - fi'Il4f'a`: a.,'yj T S f QJ� R f A to 3'rd a=t i,'•, h 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. 9. 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 t e site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. GEf `tf'S CON/V{e "J c: O dr'1 . . 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.] • 11. Describer the performance goals and standards applicable to the project. �� 6 %A)xiR `"' 1. , . 1s' ' /r 4r,A City t/l `t 4i4*elsefayi./ 12. Describe the flow control system. \ 1.1 ,;,-., . ,, stormwater site plan template—rev.10/1/2003 6 a 13. Describe the water quality system. ETC -2 200A 14. Describe the conveyance system analysis and design. 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Unifqrm Building Code. 17. Describe the proposed surfacing material. Gi Aoel • 18. Describe methods for restoration of the site. 4 /)31,G5 „ r Ce'.S�Ydr�ri �1uuAi. • 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. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 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. • stormwater site plan template—rev.10/1/2003 7 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 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. seal ivd • • 2. Establish Construction Access. f[ A- V T' - n4 a.ee, 4 o== — w,I .A,r up' cti r,i i 1 1 L 02J0 p 1a r���'� A41• fir!iti t�c �l '<nr k 3. Control Flow Rates. 4. Install Sediment Controls. 5. Stabilize Soils. 6. Protect Slopes. 1/r- 7. Protect Drain Inlets. 8 storwater site plan template-rev.1O/1/2003 m 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. fFr 9. Control Pollutants. NA. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). 7-•-- 12. Manage the Project. -)ArvA 'iPc /I,ki4i ef 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. it yk._ 7` / p/tb.lPLi' stormwater site plan template—rev.10/1/2003 9 , b. , Description of special requirements for working in or near environmentally sensitive areas. jt1)-. 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). 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 initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 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 storrnwater site plan template—rev.10V12003 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-buns")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. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DA THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: 12 stormwater site plan template—rev.10/1/2003 RETURN ADDRESS r .�;� - o X 6 ?6'7 ��iinb.J ood, Lv/i 9�l o v tiT4Tr()FWA v HINGTON MANUFACTURED HOME PLEASE CHECK ONE APPLICATION TITLE ELIMINATION L4) IJ !i! 1f1G TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty ❑REiv30V,taL 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) VEHI LE IDENTIFICATION NUMBER(VIN) 2Db 2— pawood �� x I a Ci © LAND LEGAL DESCRIPTION ON PAGE R L� eERTYTAX PAR8v r s o MANUFACTURED HOME WILL BE ❑ • AFFIXED REMOVED / t LOT6a,t3 BLOCK PLNAMESECTION/TSHIP/RAN QUART / W+ � ` )14 r(.+ � ( . GRANTORS)REGISTERED/LEGAL OWNER(S) AIDITIONAL NAMES ON PA E F '' 'yl;. COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF GAL IM i.NERS rl 1 l� �, u )))� "pf,e ^y11 7.O F R GISTErRED WNER `_1 / �/ i0/0E14AECOUNTNUMpER if a N E OF ADDDITIONA REGISTD WNER DOL CUST t'R T NUMBER COD / CIT Al STATE ZIP O E j(Tj 0/G Fe '•YL� RO6vt , 6 (-/ 14a4 off' 'i / .R -5l2 NAM OF LEGA WN 7 DOL CUSTOMER ACCOUNT NUMBER &Aiuk_. NAME OF ADDITIONAL LEGAL OWNER J DOL CUSTOMER ACCOUNT NUMBER CI Y pRV S box J 6)/ `- " 1 ty/ (/?LT� � 'f / L-l.�/ ( STATE ZIP CODE, LLS GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Q� , Signature of Registered Owner and Title, IF APPLICABLE 1i �r- t-�! � Signature of Additional Registered Owner and Title, IF APPLICABLE ;'lut. aljk:S ea--e NOTA: 24Wi1=f- -.P NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE ��'le T ARC State of Washington '� p,�� Signed .r attested u K— �.��' NO '�Y 'L�� County of\ �IG ✓t • ire me on `I C� by ilf✓Y rd ►G{.t- Sig atu - , `�`1�07 PRINT NAME OF REGISTERED OWNER I 1Ti •r Y � N'''` ` by Pa i`ttr 5 _ I�� ,/L k .,'�� 9).. �°C18L,G �A, PRINT NAME OF REGISTERED OWNER PRI TED •ME OF NOTARY t�l. County/Office No.OR F WAS,/ Title _.._ AND: Dealer No.OR 5/7/off' DEALERSHIP PO ITION/AGENT/NOTAHY Noial y Expiration Date 4 TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. © BUILDING 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(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE N BLDG PERMIT N 40\1 `0 hn�rSIvvk 5( 0) .1Ci`''LA O ‘ (-D -0015°1 SI URE/POSIT N • QATE W4ACIA .Per\XA �z.1 '.3WA\lamTD-420-729M NUFHO EAPPL(R/2/ (W)Page1of2 MANUFACTURED HOME - FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE i LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) . 2-00i Ct; Ooocl (a. x(-I/ - Qa o 2e 3 Na4Lt-4 6 SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR EL ATION CIFTITLE/REMOVAL.FROM ` O'M REAL/PROPERTY. • Signature of Legal Owner and Title, IF APPLICABLE 4 L`( 11 �6 /'Al ���C G J� Signature of Additional Legal Owner and Title, IF APPLICABLE('Q 'i VI/2 'S c6Ct// I, l/ • �-! 16 i NOTARIZATION/CERTIFICATION , - NOTA R STAMP FOR'LEGAL OWNER( IGNATURE �. :; :± : � Signed orat-1.� before the on ," 4 1 010,4„, rMyp,„ • PRI T NA OF LEGAL OWNER *+ by 0 G'l. S '."f��yy.. ��` PRINT NAME OF LE A OWNER PRINTED NAME OF NOI ARY Sk. +' County/Office No.OR l/,ib(4..) a./�•+"�` .y Title AND: yDealer No.OR W 4"1 t�\��� DEALERSHIP POSITION/AGENT/N -ARY Notary Expiration Date , D LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office) rc.(-4 s ion, l 3, cut-6) ![ D-' j (4-ge PPC k_ ( eCc rc.141,1 fc -4.4 p 144- -)14...e.re O-C re0.0fd.t 64 ;;,, V 0 ju -�- 3 D ' P t,4- s ; aC 4-ictt14 c (4 `>Ur �a -s w c-,1-1, 1f o.r ex-FireffIc iv) --1-i etc 4 D,,, . ' 0,-, sekel "Trdc2A Siv ye-k_rs (>4-1-zAf? )-r c..v_ ' GS ,`Y?1'1l1 8 DEALER'S RE ORT OF SALE Li 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 PRINTED) WA DEALE NUMBER DATE OF SALE C)IA 1% 1,0Ct,i -4-f-v-o C- :' 1/0 , 4;/3 6/6 Y 1/5 4 PRICE 3 .,`/ TAX JURISDICTION/TAX G RATE DEAL• ��I,Y�ORIZ ✓NAT /� '(i/q ❑ USE,TAX EXEMPT Sale to Certified Tribal member An the,es rvation(attach notarized statement of delivery). Q 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.OP ATOR NUMBER SIGNATURE '+ DATE 10 TITLE FEES FILING FEE 'APPLICATION 'MOBILE HUME 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. 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