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HomeMy WebLinkAboutBLD2005-00005 S UILDING PERMIT APPLICAON MLA05-00p Review Type:: i Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00005 Received Date: 1/3/2005 SITE ADDRESS: WATERHOUSE LN PORT LUDLOW, 98365 OWNER: STEPHEN J MINER PHONE: KAREN MINER PO BOX 9 KLAMA WA 98625 SUBDIVISION: LUDLOW COVE DIVISION 1 PHASE 1 Block: Lot: PARCEL NUMBER: 968800001 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: PORT LUDLOW ASSOCIATES LLC PHONE: (360)437-2101 70 BREAKER LN PORT LUDLOW WA 98365 Contractor's License PORTLAL994L8 Expires 5/2/2006 REPRESENTATIVE: JEFF EVANGER, PLA PHONE: PROJECT DESCRIPTION NEW SFR & A/G 120 PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 437,011.00 MAIN: 2 742 CODE EDITION: 2003 ADD'L: 409 HEAT TYPE: HTP OCCUPANCY: R_3 HEAT BASE: 1,634 HEAT TYPE: PRO OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: DECK: 345 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: LUDLOW PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: 2 Prop: 3 Seismic Streams Total: 2 Total: 3 Flood Way Floodplain Routing Date: / �, F&W Landslide f �� Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Permit $2,886.55 BAC 01/03/05 68876 State Building Code $4.50 BAC 01/03/05 68876 APPROVED Potable Water Application $53.00 BAC 01/03/05 68876 Plan Check $1,041.38 BAC 01/03/05 68876 FEB - $ 2005 Plan Check $0.00 CJZ 01/05/05 Jefferson County Planning Total: $3,985.43 4 & Building D partme • • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 PERMIT #: BLD05-00005 SITE ADDRESS: 113 WATERHOUSE LN Issue Date: 02/8/2005 PORT LUDLOW, 98365 Final Date: 6/12/2006 APPLICANT: STEPHEN J MINER PHONE: 360-437-8152 KAREN MINER PO 65221 PORT LUDLOW WA 98365 SUBDIVISION: LUDLOW COVE DIVISION 1 PHASE 1 Block: Lot: 1+ PARCEL NUMBER: 968800001 Section: 17 Township: 28 N Range: 01 E PROJECT DESCRIPTION: NEW SFR & A/G 120GALLON PROPANE TANK THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes no� THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 6/12/2006 M =•. �• ng Official S'•. •:ture Date I:\F_BLD_Occupancy.rpt 10/29/19 • Stormwat °s APPROVED Requir STORMWATER PLAN ) JAN 2 4 2005 JEFFERSON COUNTY STORMWATER MANAGEMENT SMALL PARCEL EROSION AND SEDIMENT CONTR L /l �� ®uNTy 1J1 EROSION AND SEDIMENT CONTROL WORKS !�P E. 0 ii���fi��l . Property Owner: Port Ludlow ASSOC i ates Telephone: 437-2101 Address: 70 Breaker Lane, Port Ludlow, WA 98365 Assessor's Parcel Number. 3t O- 0 D/ Building Permit or Septic Permit Application Number(if applicable): Brief Project Description: New Single Family Residence W/ attached garage. Site Location: . e z t 4 t«e 617 e IL--z(€zo'410 / G0 er,3 S Person Responsible for BMP Installation and Maintenance:Jeff Evanger Address: Same A ahnve Telephone:Same as above. 1. Describe/check the Best Management Practices (BMPs) that you will implement during land disturbing activities or construction to control erosion and prevent sediment from entering water bodies (marine waters, streams, rivers, lakes, or wetlands) or impacting adjacent property or roads. Please check the measures you plan to implement and show their approximate location on the site plan.You may also propose measures other than those listed. Attach additional sheets,if more space is required. [1 Stabilize construction access route. Limit construction vehicles to one route, if feasible. Provide a stabilized construction access by applying quarry spans, ballast,or crushed rock to minimize tracking sediment onto roads. (See attached illustration from Stonnwater • Management Manual.) If sediment is transported onto roads, they will be cleaned thoroughly. [1 Minimize the extent of land disturbing activity and preserve existing vegetation. Preserve buffers of well-established vegetation between disturbed areas and property boundaries, roads, water bodies, and designated critical areas(wetlands, fish and wildlife habitat areas,landslide or erosion hazard area,etc.). SPESC Instructions—Short Form Revised July 17,2002 3 • : EROSION AND SEDIMENT CONTROL WORKSHEET [] Phase clearing so that only areas that are actively being worked are uncovered. [] Start and complete land disturbing activities and stabilize the site between April 1 and September 30. Stabilization means that disturbed areas will have well-established plant cover or be landscaped to minimize erosion. [) Stabilize exposed soil Exposed and unworked soil will be covered within 2 days between October 1 and March 31 and within 7 days between April 1 and September 30. [ ] Cover exposed soil with a minimum of 2 inches of straw or hay or other material approved for this purpose. [ ] Cover soil stockpiles with plastic sheeting and locate away from water bodies, roads, and property lines. [] Place gravel base on roads,driveways,and parking areas after.clearing and subgrade preparation. [f Protect adjacent properties and water bodies from sediment deposition: [] Place straw or hay bales in ditches and drainage ways down slope from areas. of land disturbing activity to filter runoff before it leaves the project site or enters water bodies.(See attached illustrations from Stormwater Management Manual.) [] Install a filter fence down'slope:from areas of land disturbing activity to filter runoff (. before it leaves the project site or enters water bodies. (See attached illustration from Stormwater Management Manual.) [A Regularly inspect and maintain all BMPs especially after storms events. [] Describe other erosion and sediment control Best Management Practices. Be specific as to design and specifications. Site is very flat with sandy soils. So I helipve the above. measures will be sufficient. - SPESC Instructions—Short Form Revised July 17,2002 4 JAN - 3 2005 i i 4 14 EROSION AND SEDIMENT CONTROL WORKSHEET areas will be permanently stabilized(seeded,landscaped,apply gravel base 2. Describe how disturbed to roadways,etc.) eas that are distrubed will belandscaped with natural type vegetation an awn to proper 3. Describe how runoff from impervious surfaces will be.controlled(disperse to vegetated areas to mute runoff to existing drainage facilities,etc.). infiltrate,dry well,infiltration trench, - , f^rP wi 11 hP r11n to roof drains and ,• . catch basins as designed into the plat requirements. SPESC Instructions--Short Form Revised July 17,2002 5 • • g`'T J EROSION AND SEDIMENT CONTROL WORKSHEET -. 4. Specify your construction sequence. Describe the timing of all land disturbing activities (clearing and grading, construction, installation of drainage facilities, landscaping, etc.) and Best Management Practices.Describe proposed maintenance of BMPs. After excavation the soil piles will be covered and. silt fence will be installed. Silt fence will be left in Place until we are ready to landscape and all roof drains/ - catch basins are. in. Landscabing .wf11. be installed as early as possible on the exterior of the building when all exterior concrete work is complete : . The Best Management Practices proposed above will be implemented to control erosion, sediment, and stormwater o notify the Jefferson County for inspections as required. . _ (in 1 .1:kk. 1 ?_iit Signature of Owner/Agent . V Date �� .l SPESC Instructions—Short Form . . Revised July 17,2002 ., i, ;lli.;.i 6 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00005 Received Date 01/3/2005 SITE ADDRESS: 113 WATERHOUSE LN Issue Date 02/8/2005 PORT LUDLOW, 98365 APPLICANT: STEPHEN J MINER PHONE: KAREN MINER PO BOX 9 KLAMA WA 98625 SUBDIVISION: LUDLOW COVE DIVISION 1 PHASE 1 Block: Lot: PARCEL NUMBER: 968800001 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: PORT LUDLOW ASSOCIATES LLC PHONE: (360)437-2101 70 BREAKER LN PORT LUDLOW WA 98365 Contractor's License: PORTLAL994L8 Expires: 5/2/2006 PROJECT DESCRIPTION: NEW SFR & A/G 120GALLON PROPANE TANK CALL IN FOR THE REQUIRE INSP FIONS THAT APPLY TO YOUR PROJECT. SETBACKS: CS/C .S/ aS UFFER: .Syl`/GSP Footing: e1'Irl/n.rd'E'L 57//Z Foundation: eri.:93 /, TEgice LFk.3/W S, z c'�i14 /�� e#1.11 Stormwater FINAL Approval: Ok G/3/'5 / Underground Plumbing: Underground Insulation: Shear Wall : OK Rtz,ilos Framing: _ Die G1_5:, Plumbing: O/S ///D�7/JS fitrisbok �ite.>yAo6%, all ,, Propane Tank/ Lines: ex /6/ 45 Lc ! r"l p iuE LN.1ESc6K 1if 2 15 p Insulation: /gtR Vettt,rAn L1Lz 5 Ok /05/ds/if Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: ��11 Final/Occupancy Approval: OK 4? y 6�/t Od 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 NSPECIAL CONDITIONS FOR CA BLD05-00005 • 1.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 2.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 3.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 4.) All construction activities shall not encroach upon the landslide hazared area buffer. This includes the storage or preparation of materials. 5.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 6.) 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. 7.) 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. 8.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 9.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: 1. Installation of a flow meter. 2. On-going well monitoring for chloride concentration. 3. Submittal of monitoring data to County. 10.) MANDATORY MEASURES FE#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. 11.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 12.) 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. 13.) A Stormwater Site 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. 14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 15.) 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). 16.) Maximum lot coverage is not to exceed 45%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 17.) The building height is not to exceed 35 feet. 18.) Minimum setback from Waterhouse Lane right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum rear(shoreline) setback shall be 30 feet or landward of the building setback line as depicted on the face of the recorded subdivision. 19.) 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. 20.) 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. 21.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 22.) Per MPR Code Section 3.17, Accessory dwelling units (ADU's) shall not be allowed in the MPR-SF zone. 23.) Motor vehicle parking between new structures and the Ordinary High Water Mark (OHWM) is prohibited. 24.) No fence, wall, hedge or barrier greater than 42 inches in height shall be placed or enlarged nearer to the water than the building set back line (BSBL). No fence, wall or similar structure shall be placed water ward of the Ordinary High Water Mark (OHWM). 25.) Mechanical apparatus rather than chemicals shall be used for brush clearing maintenance wherever practicable. 26.) Herbicides used for maintenance along roads and drainage systems shall follow the performance standards outlined under"Chemical Application" of the "Forest Management" Section of the Jefferson County Shoreline Management Master Program". 27.) Lot owners shall be aware that Jefferson County has approved the Habitat Management Plan (HMP) dated June 6, 2003 and should be aware of the contents of the HMP. 28.) As delineated in the filed by orange painted 1"X 2" stakes, no earth disturbing activity shall be allowed in sensitive areas unless witnessed by Larson Anthropological/Archeological Services (LAAS). 29.) In the event archeological items are discovered during construction, builders and lot owners shall observe the following protocol: STOP WORK. DO NOT FURTHER DISTURBE THE AREA OR REMOVE ANY MATERIALS THERE FROM. NOTIFY IMMEDIATELY THE JEFFERSON COUNTY DIRECTOR OF COMMUNITY DEVELOPMENT (360) 379-4450. THE DIRECTOR OF COMMUNITY DEVELOPMENT WILL IMMEDIATELY NOTIFY THE WASHINGTuN STATE OFFICE OF ARCHEOLOGY AND HISTORIC PRESERVATION ("OAHP"), (360) 407-0752. PROTECT THE AREA FROM VANDALS AND COLLECTORS. OBTAIN SERVICES OF A QUALIFIED ARCHEOLOGIST TO EVALUATE THE SITE AND MAKE RECOMMENDATIONS FOR FURTHER WORK IN THE AREA. IF FURTHER EXCAVATION OR DISTURBANCE OF THE SITE IS NECESSARY, OBTAIN THE APPROPRIATE PERMIT FROM THE OAHP. PROCEED ONLY IN COMPLIANCE WITH THE TERMS AND CONDITIONS OF SAID PERMIT. 30.) Construction of housing units within 10 feet of an adjacent housing unit on these residential lots shall be built with "one-hour"wall construction. 31.) Existing asbestos cement sanitary sewer pipe across Lots 1 and 5 and Tracts A and C have been pumped with grout and abandoned in place pursuant to Jefferson County Health District requirements. 32.) Lots 1 through 7 of said plat shall have an equal and undivided 1/7th ownership and maintenance responsibilities for the guard rail located within Tract"A". Refer to Declaration of Conditions, Covenant's and Restrictions for Ludlow Cove Division 1 Phase 1 for further information. 33.) The proposal was reviewed for consistency with the Shoreline Management Master Program Section 3.402.5 and found to be consistent. The proposal is (1) a single family residence, (2) does not exceed 35 feet in height, (3) does not involve over-water construction and is located landward of the OHWM, and (4) meets all required setbacks as set forth in said SMMP and the MPR Code. 34.) APPLICANT AND/OR CONTRACTOR SHALL CONTACT JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT (DCD)AT 360-379-4457 TO SCHEDULE A SITE VISIT WITH THE PORT LUDLOW DRAINAGE DISTRICT, DEVELOPER/OWNER, AND DCD PRIOR TO ANY LAND DISTURBING ACTIVITY BUT AFTER FOUNDATION IS STAKED. I:\F_BLD_Permit_Buildng.rpt 10/29/19 __________, _. . _ . I c.ir ,,,, • ... •... _ . .. ..„, zr%-ii - — P - --_ " ks �- i 00 i a / - - - -t14i4TXL _ :_ 1 • i.'.4tt°* —-—-' i ' s --`--7 .: ':-. N - ,,,,: . , . , .. ,. ,e.a, . .::- - /1 li - \ \ ... _ . am _-tal... 1 err � -ri :; •, / : / 1-'01?_.tl . ,.. N.g-K,Fr 01.-1 .-is.,. , .� / ./7 7/.404-:_gyp-� , ,,-.--r--- -. ,„. , if, -A, \ - . , • .7 f - 1„ *1.1-4- til M : , y agj Ail Requir--� �� �.H� �.�r : � � .. ,., ,.�. -�' APPROVE ,2.,. ,, . � ?2, , ,, SITE PLAN -_ glv -- ' ' � JAN 2 4 2005 )-94.' c r uNTY � ��3 - DEPT.OF r• 1 I) °t‘� ') E .PMENT SIGNATU• '. 11��.��10,, 1 A e ` i 1 e. .wnrir— , " i "arc€l 96'- koo-oof _ ... . ... _. _ _ : .-x64-1411\ 1-1 - -( 1 _-_ s i_ 1 ____. _ _ Lai. _I 1,02w u7,/ NI i NI 1 . . _ . ,_ _ lqiuel04- -----.)f,tv4t,.. - • r.Z-filV64#14-t-. ' kxrF, rti)_ 14- . ... . L. _ — iOWNER BUILDER STATEMENT III I The signer of this statement does herebyrer certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they to assuming `Are I N -the General Contractor forthe proposed project. J:1 Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Por- Luo/%uc nssoc•a/es LGG (36o ) y3 7- 2/0/ (36° ) Y.3 7- 2S2 2 MAILING ADDRESS: EMAIL: 7D A�/PQ6P/f C���/ /��c�LudCou�, CONTRACTORS LICENSE Lve 983G S WAINS NUMBER: PQ,e 7LAL NUMBER - ARCHITECT/ENGINEER: c._/OhnS/rr) Se/r&A.e p// //)G. PHONE (.2o )8y2-9993 FAX:(2.4. ) gyz-966�p MAILING ADDRESS: /75 ,4 ,/t aq/ S•z. /50 EMAIL t3a%/2 6'-, c /s., Wt 9 8/vO Proms Type: Type: Bathrooms: Shoreline: Type of Sewage Disposal: • New d Wood Existing: -0'- [ewer ❑ Addition ❑ Steel Proposed: 3 Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: 3 Height: 0 Individual System 0 Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: -e' Setback: 0 Private well ❑ Two Party Type of Heat: Proposed: 2 V-Public Total: Z fleaf /hum — Name of System: OfvSL /rolmne re/o/ece- _ If this is a Commercial Project 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 IY Above ground Tank Size of Propane Tank:—/20,9 ❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit 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 h:2 ' � �.ia'�., A� Current Proposed 1 °N ;,� /x s • o 41 ,. < w / V?.-,-• =; 41 , ::,--,-,,* �t a.S. ```'I�,,.e c ...7'J� + Si m°/ ,� ��,: v 9 q ,�„ 1 �, .t ,-, �.t" it' iis;.r -%'a;;Wirth .r'f.��•,' mayjr .. 3w Floor �_ q, i. z n w wa *ts jam. }',0. am„ 'stial 1. a r Ft l r �.ze. �, Mezzanine: �_ $_ �'w{{} �-a`�.,;.,�1'�''-��� E m Q-. ,se�i�' �v.F *�4 � g`� � K�j �i•k` Heated Basement '., ' •� 7. Y x� ` -, ; ' . ` -,y Unheated Basement -` ? 1r - ,t 4,.Y� ilk R.97 a ,w 44,1 . t v =L t3-I-- a2-t% ;;: Wi . ; r-,. ` ,kt 0 ram` �` --. `•'1,1.- `+L s': '.., - ,�+ •` P t a s to t :•. . :awl cir-12,t5 il.ri .ort i •, Other Unheated �_ -� ti 7 -. . s r C aired Garage/Carport ; , 't: " " t ` Y-.4 . 1 ` .4 ,�; i$_ 4,< , t , ♦ c a , :,. r , L ,! , ? vv '44 ( •:� w .:u.es .w• r 3;x 4 r.lv M y?_p Decks w f ., ; { + � b 3i y 5 r. y\ t !..rt r " t � t io " � S • g Other r dig . i ',,,Tr *� a d I`' 3 "'i �y C•• itar .: F, k9y l�z�. *rte�i- M1{9Ty4�,„ s , - ,..... 1 4 FS ESTIMATED COST(REQUIRED) t i ,7 r4 b 'r ie r ;,r; "f '�k '�a�. 3^} 'Fair market value of all labor and materials foundation to is f � st t#% ��, j,;k f -� i M / <p r ,' 5- ,o r ©� ._:x. ..s,' .i .', ;4 .x't. sue. g.,, §`;,41 G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc i C06 JEFFERS",COUNTY /- / afYI `�� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 983f82605- �_,' ,_ 360/379-4450 • 360/379-4451 Fax "' p� www.co.jefferson.wa.us/commdevelopment BINS Master Permit Application MLA: (J5' 3 Project Description(include separate sheets as necessary): (o 1)S 71i-a c L� 2 4ew /e 76 it y IP.p deuce Tax Parcel ✓ Property Number: 9‘8 g00 - 2O/ Size: �J/S 3 (acres square feet Site Address and/or Directions to Property: 7 a/a Zet-4'o .SP One 1 /"or t Zie alto w, i O,} 9(f3� Property Owner(s)of Record: 5fe✓ell 71 /(gren 70/;?e4. Telephone: email: Mailing Address: /9.BOX 9 ,'/Qr-,/Q/l`,�/2 986.25 Applicant/Agent(if different from owner): o rf Luc/4W /ccoe,a 1e,S- 44 C Telephone: 136o')5/3 7- 2/0 / Fax: (260) 5'37-2522 email: Mailing Address: ?o ,Area/e (une, A - ' Luc/0W', 1-09 '7k3a WJat kind of Permit?(Check each box that applies) ff 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 larage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** D( ddress [4/Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** t ropane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑ Stomiwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance 0 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: �� �� �j DESIGNATION OF AGENT I hereby designate t 17 t�j to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ✓'�' Date: /040 iJ 206 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 attorneys 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 9ccess and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any regriir\ later inspections.Access and right of entry to this property shall be requested and shall occur ly during regular business hours. [ Signature: � /� / Dater61(."/ 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-transferable e ponsibility(or adhering to and complying with the ESA. The Applicant has read this disdaiyner�nd si(:i/ `ns and dates it below. Signature: ;__ i / Date: U 1 ( G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc