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HomeMy WebLinkAboutBLD2006-00193 • • 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 #: BLD06-00193 Received Date: 4/21/2006 SITE ADDRESS: 420 FREDERICKS ST Issue Date: 5/1/2006 PORT TOWNSEND, 98368 APPLICANT: JULIAN L ARTHUR SUSAN K ARTHUR 1637 WASHINGTON ST PORT TOWNSEND WA 983686929 SUBDIVISION: COVE ADDITION Block: 17 Lot: 1-4+ PARCEL#: 945901701 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ BUYRITE HOMES PHONE: 800-654-1695 DEALER 3543 W ST HWY 16 PORT ORCHARD WA 98367 INSTALLER: BUYRITE HOMES BUYRIH*0840B Expires: 5/20/200E 3543 W ST HWY 16 PORT ORCHARD WA 98367 PROJECT DESCRIPTION: NEW M/H - KCB 68301 SER#27092 MAKE: KARSTEN YEAR: 2005 SIZE: 68'X30' THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 5/1/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY I YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, r PADS USED).-s/ Q6 Stormwater FINAL Approvalit., -/�fQ'o Blocking/Plumbing: 4. 0 Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: ( L. 10- -o(-) 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 # BLD06-00193 1.) The application was reviewed by the Jefferson County Department of Community Development staff on April 24, 2006 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: Level I Landslide Hazard Area and Susceptible Aquifer Recharge Areas. 2.) 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. 3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 5.) The property is located within a mapped geohazard area (Level I Landslide Hazard Area) The building area of the property does not contain any identified bluffs or steep slopes. 6.) A Declaration of Restrictive Covenant was recorded December 23, 2002 under AFN 463561 with the Jefferson County Auditor binding lots 1 thru of Block 17, Cove Addition for the purpose of meeting bulk and dimensional requirements and minimum land area. 7.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 8.) A septic permit(SEP02-00281)was finaled on December 19, 2005 for a system of 480 gallons per day. 9.) Fredericks St(C693419) is a local access road. The road approach is existing and an address of 420 Fredericks St has been assigned to the parcel. 10.) This parcel was created through the Cove Addition to the City of Port Townsend, filed of record September 27, 1889 in Volume 2 of Long Plat, page 27 with Jefferson County Auditor's office. 11.) A minimum of two (2) on-site parking spaces are required for the single family residence. 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 plan for a medium project 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.) This parcel is served by a public water system. 15.) 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. 16.) The applicant is proposing to create or add 2040 square feet of impervious surface and 2040 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal submit a stormwater plan meeting Minimum Requirements#1 through#5 of the Stormwater Management Manual for Western Washington. 17.) 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). i 18.) The site plan as submitted with the building permit application on April 21,2006 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 April 25, 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 19.) This approval is for a manufactured home 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. 20.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 21.) 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). 22.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 23.) Minimum setback from Fredericks St right-of-way is 20 ft. Minimum side and rear setbacks are 5 ft. 24.) The building height is not to exceed 35 feet. 2- V r 0a II tic ( Rig :r- rr f: ., 7•Ca i _0 'a fl & `ry C---- VIE 4...—Z....—re --41— ..4/ (iii I '8 4 .---4-xl lo ire - r � I e A _/ II .1 ' j 11 'ill LIMN 0....s. 1_,Ann -� f 1 J um .. , 2�Ox5D10 1 € 1 .0.1' al fig-, 41E) .e, el o Ll,_ .... 4.• (._ L .._..kvi . __ _ . . ----- Z. . zoo 2 KIabaS Sii -iia 09L9 199 09£ XVd £f- T ITH,I 90%£T,•the JACK WESTERMAN le Jefferson Onty Courthouse ASSESSOR PO Ilo. 1224._Port_Ton-nsend, 98368 (360) 3115-9 10 i MOBILE HOME INFORMATION FORM APR 21 2006 OWNER'S NAME/MAILING ADDRESS: NAME: J Vt-tAM 4 TuOR ADDRESS: 1 b37 W A 541t.1&TOt4 ST. ?OCT TOLOMS A4 b, W, 36$ PHONE NO.( o) g5,24tb A6-tir-rs 41- 310!). 385. 7Poo 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. 1)MOBILE HOME DATA: (A) MAKE I'A.STN (B) MODEL 4433OI (C) YEAR 2065 (D) LENGTH C9 t (E)WIDTH 30, (F) SERIAL # 27O9 2. (G) YOUR PURCHASE PRICE (Do not include sales tax) tpggop PURCHASE DATE Ce 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE Bocet1E ttoMe-9 ADDRESS 2cliftio's I wy lot , S&[th M, W A 4 z. (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes 45 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 ET.) (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: JULLP.4 Q.ThU , LOCATION ADDRESS AMAFD fzO_ REAL PROPERTY PARCEL #/DESCRIPTION 945 90 t to ign ure of ap irant THANK YOU FOR YOUR HELP! eR)sl-eQ JO COSSELL, Property Technician • MLA06-00184 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00193 Received Date: 4/21/2006 SITE ADDRESS: 420 FREDERICKS ST PORT TOWNSEND, 98368 APPLICANT: JULIAN L ARTHUR PHONE: 360-385-2410 SUSAN K ARTHUR 1637 WASHINGTON ST PORT TOWNSEND WA 983686929 SUBDIVISION: COVE ADDITION Block: 17 Lot: 1-4+ PARCEL NUMBER: 945901701 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ BUYRITE HOMES PHONE: 800-654-1695 DEALER: 3543 W ST HWY 16 PORT ORCHARD WA 98367 Contractor's License BUYRIH*0840B Expires 5/20/2006 INSTALLER: BUYRITE HOMES BUYRIH*0840B 5/20/2006 800-654-1695 3543 W ST HWY 16 PORT ORCHARD WA 98367 REPRESENTATIVE: PETER BONYUN PHONE: (360) 385-7800 PO BOX 1024 PORT TOWNSEND WA PROJECT DESCRIPTION: NEW M/H - KCB 68301 SER# 27092 TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: KARSTEN SETBACK: VALUATION YEAR: 2005 LABOR & INDUSTRIES APPROVAL? SIZE: 68'X30' BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: CITY BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 3 Total: 3 Total: 3 Routing Date: _ _ Type Amount Paid By: Date: Receipt: A p r eI.;.1. .` Permit $163.00 LYK 04/21/06 80981 MAY I Potable Water Application $55.00 LYK 04/21/06 80981 Total: $218.00 Jefferson County Planninc Building Department Co • • APPROVED STORMWATER PLAN . SON CQ e , VA JEFFERSON COUNTY APR 2 5 2006 g 1401 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 JEFFERSON COUNTY O 360/379-4450 • 360/379-4451 Fax DEPT.OF COM UNITY DF.VE MEN NC` http://www.co.jefferson.wa.us/commdevelopment/ SIGNATI RE. STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# Or, I��(-1 PROJECT/APPLICANT NAME: JULtA4 Al2-Ti-Mz. 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. Sl Ft.wl1 L\( R t OEOCE Om PACZ tl CLaAMti> S Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. StTe t tacSeortAktsi T W A %fE¢l/ S IAGt-1 r S.c4'E 10 Thee N e• 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. U t --ra t.D �4 UU l wa UlJSAow A PAFFiJttJD,At`1QWMAND =12- 4. Describe the existing soils. Indicate soil type on the site map. SottS ,&Q VerlY AIDE_ re.o4 SAND extg Sow ebsecec 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. fk -t t O (LS I PC D • (sib szAu OtIJC-W A`-c D2 Oot !fit!F,AJ DK1 oacit me,f4se. Cu ' - ' . SIYC (S msso �J t QQo P�Ll . is O v-QLI.a t ee + Add cat() PZq 6. Describe any excess levels of noise generated by the proposed use or activity: WA cG U JEFFERSON COUNTY CM,�F r- stormwater site plan template—rev.10/1/2003 ��� 5 • • 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. KO NE 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.). A =,4r( St DeMA 1 J W OF 91. t.E .tc.s j Ns skke• , kl O W J . SRSIT(J ) 42.ic. * (0.1 rt t t-t cl cWCt oe•J of A SL1 Nc D� o 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 the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. SMOnnwA C ,U- OE. cow-1 CI S ArAWD0 P&2 empTs .3c. I MO '7b Ntc-a\l Ue€ a[ it i w0SPe 1 OtSPse2.Sto0 PER_ SOAP T5• ID. 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.] N10 11. Describe the performance goals and standards applicable to the project. TO tkAger a.t,t. BoAP's ,&PPUcic$cE 12. Describe the flow control system. a % stormwater site plan template—rev.10/1/2003 6 • 0 13. Describe the water quality system. N/A --- 14. Describe the conveyance system analysis and design. t1/4)/A 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. k)oLJE. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. fN VA 17. Describe the proposed surfacing material. t.1►� iAt IS /4 -- SNcD ak-Sittir CyJEga 18. Describe methods for restoration of the site. 019-cuzio olcaicks Cu ct_c_ BE_ Cer5 DE0 /iLL• - ci AYb• -- 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 d 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. BMW( — cT. — tI, 1 stormwater site plan template—rev.10/1/2003 __v'f,ili'4 1 1 / • • 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. G.t is2tN` Lt MCtS 5E-40c10& OL SCE,R.AJs4 2. Establish Construction Access. ettS-rt►JC- 3. Control Flow Rates. N!l 4. Install Sediment Controls. Coo& 6e tos 5. Stabilize Soils. DtST) �L �1l ltro - Cal€:e1D dl/�U 25c P T't ,es�stor . 6. Protect Slopes. 7. Protect Dpin`nets. stormwater site plan template—rev.10/1/2003 8 • I 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. N© J 9. Control Pollutants. ANC 4&Pcus WILL- OE. Mal C- Z a,Wt i 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). Uwe__ Rat ease 11. Maintain Best Management Practices(BMPs). S I�t9�U- Fbtf• t� U R! ),eeir. 12. Manage the Project. ti.tx_WfAa_ an LL i/ PeeNlrirm7 J 0 t I g2E_ 6S GALL ALA__ 6MP`s 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). 0/A b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). KoUE- 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. K�kZ LMOJOSLC f } ,cNi i stormwater site plan template—rev.10/1/2003 9 • • ! b. Description of special requirements for working in or near environmentally sensitive areas. 1,)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). (4* 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). 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 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. I also certify that this application is being made with the full knowledge and consent of all o rs of the affected property. faro�� 4(20 C2C=0� NDO NER OR AUT •RIZED REPRESE TIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/1/2003 12 • 4)v- oo6. JEFFERSRCOUNTY 13 DEPARTMENT OF COMMUNITY DEVELOPMENT `' `4 621 Sheridan Street • Port Townsend "Washington 98368 360/379-4450 • 360/379-4451 Fax �qs o www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: do-BA Project Description (include separate sheets as necessary): MANUFAG-i 2ps) 4OME MIcrAt-I.,c-f]ON Property Tax Parcel Number: 'j4}.5 90% To 1 Size: 4-42.00 S . T. (acres/square feet) Site Address and/or Directions to Property: A9Pji-K .4 AmLe. S. dN PeEoE2ieS Sr. Wok SR z.o Property Owner(s)of Record: J tiLIAN AMU R Telephone:Card) 31%S5--241 D Fax: email: Mailing Address: 16,37 [ J( ON T. (ba-r rb(,4)A.s i.A)1 i4 9(R a Applicant/Agent(if different from owner): PETE(Z. eONYU N Telephone: CUP)31;3S•'7e00 Fax: email: pent/tthe p pQirp..6.ttet Mailing Address: (s7 GRV'ZO-1€Ee. ( O PO Z' Tot rq.smt WA gg366 What kind of Permit?(Check each box that applies) 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 ❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)** )(Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use 0 Long Plat** ❑ Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** gi 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: E� DESIGNATION OF AGENT I hereby designate �)� to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE}C Date: 4 1 l`7/06 By signing this appl ation 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 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 re 'red later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. 41 ti loc. Signature:x Date: 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 A•t:,,,i nt Iclinovy,:},es that he,she or it holds individual and non- transferable resp 'ity for adhering to and co lying wi he EFA;�Tl pplic. t s a tlri . claimer and signs dates it below. (Id 0 6 Signature: Date: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • 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 assuming the responsibility of the General Contractor for the proposed project. Signature:X Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Buy Rrr t-1o0.4 6 / JIB ar)S ($oo) 640-8' j (3(o)68t-.o78D MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE �/ WAINS , , NUMBER: V V R t 8+t��j NUMBER r W At N s c)2, 0 ARCHITECT/ENGINEER: PHONE ( ) FAX: ( MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: D Sewer ❑ Addition ❑ Steel Proposed: 3 Bank Height: ❑ Community System ❑ Alteration/Remodel Li Concrete Total: Individual System ❑ Repair ❑ Masonry SEP Permit#sepal-2$l ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: X Public Total: "A Name of System:e•tT/ o'fr fberwoosewp 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 ❑ Above ground Tank Size of Propane Tank: a Heat Stove ❑ Cook Stove 0 Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ 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 Current Proposed For Office Use Only Amount Revision • Main Floor Heated EH Bid App Review: I c 0 2n°Floor Heated Consistency Review: C`✓ C o Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: XJ Other Unheated Pot Water Review fee: 9e• 6 C) Garage/Carport SUBTOTAL 1st jQQ Decks 911/Rd Approach fee: ?RAI/Re-F—p Other ---------TOTAL: $ 4.1 • Receipt umber: , al I AR Cash/Check Number: 2006 )5ESTIMATED COST(REQUIRED) Date: l� •Fair market value of all labor and materials foundation to finish p(t, Initials: VEI pPecr+T / G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • RETURN ADDRESS LIST_r�"F7SHINGT0t\ MANUFACTURED HOME ir,UII'1AT1 ON � Drpnrlmrnr¢l APPLICATION ®TITLE ELIMINATION lIcEnsinG TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty DREMOVAL 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(VIN) 2005 KARSTEN 68 X 30 © LAND LEGAL DESCRIPTION ON PAGE REAL MANUFACTURED HOME WILL BE AFFIXED [J 945 REMOVED PROPERTYTAXPARCELNUMBER 45 901 701 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 1-4 17 COVE ADDITION © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS JEFFERSON 1 2 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER JULIAN L. ARTHUR NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER SUSAN K. ARTHUR ADDRESS CITY STATE ZIP CODE 1637 WASHINGTON ST PORT TOWNSEND WA 98368 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER MARINER BANK NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 211 TAYLOR ST 4TH FLOOR PORT TOWNSEND WA 98368 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: Signature of Registered Owner and Title, IF APPLICABLE C .�..�"---' /�'- ,.,-'i?'-- Signature of Additional Registered Owner and Title,IF APPLICABL�.Z�• /'7, a C.6�:� ♦ v► ,,• j �'�jit ekmP NOTARIZATION/CERTIFICATION FOR REGISTERED OW ER(S)SIGN. URE ttj State of Washington ,a Signed or -st:d G \�N. //i' tei I Count of- 1.U 1 ��? �� +0 Y befor: a e .n %cry: -(r• Y •,z f L / `IFF G : p . by a 2)-- .J e. I :0 C > ; i.- .1, ISTERED4V—/tu/ NER nature P �V NT NAME OF REG �. ! AR'.OR� ENT /,% 4, V OW' by 4.� /i 3_1g •Z`14, ~ P NT NAME OF REGISTERED OWNE •-INTED NAME OF NOT••RY -1,��� rE....... �`�` Title /A� ) County/Office No.OR yq I v AND: Dealer NoDate 1�C DEALERSHI POSITIO /AGENT/NO ARY Notary 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: fiii the manufactured home has been affixed to the real property as described. 0 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# BLDG PERMIT# SI N URE/POS lcA\i . UPLAA)414 _t.gf i PtarMA.1\.5 A.Pk. ,t DATE TD•420-7 MANUF EAPP //0 )OR(W)Pago a�l U -o 744 O m -1� --I-I D 10, '-DX Xi inj o .r .q tA -▪ re I �o O it, „„,. . 0. D '') 2 p, R 0 -Nos r p Z hir rTi VI g %el * t'4 0-, en ° -NI R,.. .7.26 �� t • (-----1/ 4111\1 , r Jc:e bi--)„ , I * --...,,, Mr fi Y , ,.\,('',4,..---, " j\____ In Ii ,i-- I $ ..\._,_ _Ti_ .s.„. i g vs Vtl of ie II „cr \• ¢ • z t ��(. TiN 03 70 ftl mIf 23 Viz M1 • , g ** 0 , , . 0-. llifr , z �-, 70 , ' •-:'--- ' x� o . SITE PLAN 13 rl'` APR 252.006 /11 1 * L ,:::. r N)k . JEFFERSON COUNTYFg ?-5 bEPT.OE, •MMUNIT D LOP k SI 1F o