Loading...
HomeMy WebLinkAboutBLD2006-00218 MLA06-00205 PJILDING PERMIT APPLICATIuN Re view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00218 Received Date: 4/27/2006 SITE ADDRESS: 2090 EAST QUILCENE RD QUILCENE, 98376 OWNER: BROOKE WHITE PHONE: 206-784-2224 8061 28TH AVE NW SEATTLE WA 981174516 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701194007 Section: 19 Township: 27 N Range: 01 W CONTRACTOR: TIMBERLAND HOMES PHONE: 1-800-488-5036 1201 37TH NW AUBURN WA 98001 Contractor's License TIMBEH*2090B Expires 8/27/2006 REPRESENTATIVE: GRETCHEN REYNOLDS PHONE: 206-592-1824 3058 S 200TH SEATAC WA 98198 PROJECT DESCRIPTION NEW MODULAR HOME W/ DECKS / 43 asocr5L n P P ,� TYPE OF WORK MOD SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,562 VALUATION 15,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: ►��op/�:� OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: 866 SETBACK: BANK HEIGHT: 5 SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 3 Total: 2 Total: 3 Routing D te: ( Type Amount Paid By: Date: Receipt: Approved/Date Permit $421.55 LYK 04/27/06 81130 Plan Check $274.01 LYK 04/27/06 8'1130 State Building Code $4.50 LYK 04/27/06 81130 JUL23 2006 Potable Water Application $55.00 LYK 04/27/06 81130 Total: $755.06 Jefferson County Planning & building Department BUILDING PERMIT• Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00218 Received Date 04/27/2006 SITE ADDRESS: 2090 EAST QUILCENE RD Issue Date 07/25/2006 QUILCENE, 98376 APPLICANT: BROOKE WHITE PHONE: 206-784-2224 8061 28TH AVE NW SEATTLE WA 981174516 SUBDIVISION: Block: Lot: TX9+ PARCEL NUMBER: 701194007 Section: 19 Township: 27 N Range: 01 W CONTRACTOR: TIMBERLAND HOMES PHONE: 1-800-488-5036 1201 37TH NW AUBURN WA 98001 253-939-8803 Contractor's License: TIMBEH*209OB Expires: 8/27/2006 PROJECT DESCRIPTION: NEW MODULAR HOME W/DECKS �,, 4 , ipi 4 - CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT'. 1j SETBACKS: 60 /D/i4164 Oar A.seaur,, UFFER:J/, Footing: 0 /if..4 Foundation: ,L(-8'-QC0 Stormwat FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Sheathing: Framing: Plumbing: Propane Tank/ Lines: C.ct L.kAi Z.( - , Il'11 IN,WO iti(i— �-)/C 2 2 1 .C 7 t.,, ' Insulation: Sheetrock: Septic Sytem Final Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval:Final/Occupancy Approval: 'VIA.-.V 1 A 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 10.) Not more than two (2) unlicenseer inoperable vehicles shall be stored on any ot 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). 11.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 12.) Minimum setback from East Quilcene Road right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum rear(shoreline) setback shall be 13.) 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. 14.) 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. 15.) The building height is not to exceed 35 feet. 16.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. 17.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 18.) 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. 19.) 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. 20.) 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." 21.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 22.) 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. I:\F_BLD_Permit_Buildng.rpt 10/29/19 SPECIAL CONDITIONS FOR CAS, BLD06-00218 1.) 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. 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.) 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. 4.) 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. 5.) 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. 6.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 7.) 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. 8.) 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. 9.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 05/24/06 17:40 FAX 206 373 3039 NORDSTROM PR . . 014 PEINff # IID ., . . ; :,,r:. ► c . . . :, JEFFERSa4 MY--BCC - c "4 - DEPARTMENT OF COMMUNITY DEVELOPMENT tiq _.... JEfFERr', r„ 4,. -621.Sheridan Street• Port Townsend-.Washington 98368 L -._ C��_UIl�� . • s .. 3.60/379-44.50.360/379-4451 Fax -_...... oil .. . .... '`., httpJ/www.co.Jefferson.wa.us/commdevelopment/. . STORMWATER SiTE PLAN SUBMITTAL LTEMPLATE • rviA# 0(0—. 2_J . • PROJECT/APPLICANT NAME: UJ "{)yuk • l 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 stomiwater site plan map. • Project Overview -• • .1.• Describe the proposed developed conditions,of the.site. Indicate position sand relative size of proposed improvements on the • . site.map. . . - "Th.L_ L p r ilki c ()co V1 Yr t t t Si-m. CO O ly I�'ic t� C r .,..-fit_ WAD �eszs►d1,11Ci. t� , ��� (al✓tJ�. 14to • • on-thL.. t3,n t .hic4 1&: �xu`s p P�Q �' z sum Existing Conditions Summary • . • •. 2. 'Describe the existing topography- I Icate contours on the site map. u - n De ve(�.. po►"E O'r) lot Ss , Ul w �o tlortAk_`�i�k. 'crfom (d n .aro -� �c- P � �. P icrun� .(� �' �xk. (zL.r'� `�fi1�.�-n do',�n -fin?-�`�- . 3. Desc Ibe the existing vege '•on. Indicate native vegethtion areas on the site ma.. -�ar,n-���16 -n L �a. 01 C.�re.O�. )0 •4.i� `- h2:Gcv _„ i : sszt- . 4. Describe the existing soils. Indicate soli type on the site m . C �. � r. - . - kg rite. . q Learn .. & . 1foL.1 n L 5 cx . 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 inchoate acreage of each, \\5 . t' - laid u 'Dean ..-m rn trr,.44 ., . + --to . tinA i , we - • J t Lire. ►off- O i n darter p . 6. Describe any mess levels of noise generated by the proposed - o a , y. V .\0 eYC, noZ (Lve Lt 11 ' <�'P0►.0.. I fill . rear % 1 �: -- _�;_ A Ii� Stormwater : ''s ' JUL 2 5 2006 Required i 1 SVi,/..I,J. sammwmer Wig plonwmplam—rw.ran2oa9 • ` JEFFERSO r .OUN • 5 • DEPT.OF Co.id,, 1 1 •VEL'-PM.NT SIG ATCRE. 1111 A Air A_ 05/24/06 17:40 FAX 206 373 3039 NORDSTROM PR Z 015 • r I 7. Describe significant geographic features and critical areas Ile., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. indicate location on the site map. t - • - - . • • p. Cam. rl ovL I\ b u-Cct o tR9• 11111, • rig. 5' IbV- 1 Ca hr . uD **TIM Mign• /Wilr•A• ~- Sloe. c.,n adt 4 'ID' d Duofl -4-cc) A SS P - Q )._--1 i,� 8. Descn a the general vicinity of the site,including adjacent land uses and structures,u ii ities, roads,and sensitive/critical areas (streams,wetlands;lakes,steepAlopes,etc.). neS:.4 Vrtfte-r-b et› -olV5 Q,e-MAArtM. mat. s 01/4.r1 *AO_I 7.4 p e 0Ti ANNL Spa z✓✓L •YIOt- JL • • Permanent Sfonfwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation..otthe appropriate stormwater control BMPs and facilities to remain in place after construction of the project Is completed. • - • :"Medium°size projects are required to have the.totals calculated of all-Impervious surfaces. pollution-generating impervious surfaces, and pollution--generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydrology,as proposed. Indicate whether stormwater will be fully dispersed(i.e., per BMP T5.3O .in the Manual)or,if not,what types of stormwater flow control will be utfiized.for the site or specific threshold discharge areas within the site; Locate these facilities on the.site plan and . erentiate proposed facilities from existing facilities, 'O V)A Ositz.D �. ' , -i a � s�n csin 1 - o- . n‘.1 a.t ue (slat -tea ezikAt'x etrv\ ` C 4.4Lt� criS el— i'GE.o to Y rnP T6►3a Sr i ' o ccrl i rg. NA/(1 env,st-._ 1_Icy pot,dt4- 611+ e . nroe-A-6 0, -Utley 10. If the project requires tie use of atormwater'treatmeht facilities,describe the types of stormwater treatment fa les proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normal fo "large' r ects or projects in oive the potential for dispersion ofcontaminant .] Pj.LI ti h COCA cal 1 —iz� oft � � 1,t7 d-t.CCU() -1/ ue i �..._ +mod �I o..�r;c.-��l-Ex,rr -i'��,t.y� �' r�� sad �rL� .eck \ vio rvtole--I an I' r d-czAuc A1 .c-ic et-toe sad 11. Describe the performance goals and standards applicable to the project. Y1'l t r,-Fi 8 r aceLCJ( (0 u✓t-h i 4 strth, wi rr v> A tT-c r au✓ o vtL KaYtk �- 1 tv ' 1) t t( + e c-i-J7 r)-Pr tt is 12. Describe the flow control system.y Cox, o � e C�I,t-iW' -t o do uxn cpo u is void, �o ate;n fir, k1'�t c� -'cc dirk U3e-Uk • • • • stormwater alto plan template—rev.15t15009 6 05/24/06 17:41 FAX 206 373 3039 NORDSTROM PR �1016 q. �1 L• v �. 13. Describe the water quality°s tem. 5et-- co-( "&i(CIA-‘ Mud COY-kre e\--riAdur-e. on p(co . • 14. Describe the conveyance system analysis and design. ex-- . Srnl° 51 o tee- -kg__ 15. Describe the source of till material,physical characteristics of fill material,and deposition of excess materiaLl i•NnAtd 0.-ek-A• .- ----(jkg,Cd14,_ M6±-46 CAA l.,Undkr VIC)atk- —OW TOtt u -110 d6) CL,s t1 a\\ vyno� ��0 -tc cii r1 2Vistic *tDi � S Qrtq Soy\-t-Q -I4.0.4d .0-n Srfk• (to►xc.,•ca ccor-cle L 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. .. Pipe c& tI . ru4e5 $ rre. .tda i_0,0 . 17.. Describe the �•C3t'��l'lne. 1 roc osedi surfacing material. 611' ow-lye vim. J (Dr) &t,t, ct1 1& _C'.o 18. Describe methods for restoration of the site. -1 .. %t�1 AO n ctS�P S c 1 sic�.�lxr \o �2!Z �G�v l d(i veu, hct-oe_ v C �Lrc [6 DJp - try t-o - recre ,e • ` \ ��\5 Ld �uoVeN I e s-t n -Rcitiaer 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. noiAL �K c5Lr\4 -to remove cte..k)rit, mans -t-v rrr o.>te_ I U Q it 3 t iL'Y1C.n ®►mod --,�' . -- 20. List here and include any special Veports or studies conducted to bmpare the Stormwater Site Plan.- nc)ram._ k u . r 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. 7 amwalerene ap template—rev.1a120W ror 05/24/06 17:41 FAX 206 373 3039 NORDSTROM PR U 017 CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP The Construction SWPPP addresses sediment and erosion,control during construction. The BMPa indicted by the applicant In the template that follows must be Instated 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 theConstruction 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 bean 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,lustily 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 Cleating Limits. Ssl�e O���. - • • 2. Establish Construction Access. T - • 3. Control Flow Rates. A. Install Sediment Controls. • Oro, Ua _ 5. Stabilize Sols. ' • • O. Protect Slopes, • • • 7. Protect Drain Inlets. p (o_n . • • • • stormwaier alto plan template—rev.15'1I 3 B _ 05/24/06 17:41 FAX 206 373 3039 NORDSTROM PR - Z 018 ~ 12 Required Elements—Construction SWPPP(continued) .. -( ued) i 8. Stabilize Channels and Outlets. 1. elt: _ 1 .. 4.. Control Pollutants: _ A --1r Cal ( -- hc ;oNuN4 ColeA Fb, unil . .. 10.-Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site), uc.c5) rl brs� Coin A , . 11. Maintain Best Management Practices(BM��Ps). &_. .rq - . 12. Manage the Project_ `WIr _OY\4711iX, CDrtifrA__C-40r a. DescOption of the adjacent areas that may be affected by die-disturbance (e.g., streams, lakes. wetlands, residential are - ry a r i ` r J ea..)-(-) b. Description of the downstream drainage path leading from the site fo the receiving body of water(minimum'distance of 400' 3. Environmentally Sensitive Areas. a. Description otenvironmentally sensitive areas that are on or adjacent bo the site. . 'V)0-6.4/' '1 t-2 -41:? loe pi a ad, - alcrmweter site plan Ie r41ale—rev.10'12003 9 05/24/06 17:41 FAX 206 373 3039 NORDSTROM PR Z 019 • b. Description of special requirements for working in or near environmentally sensitive areas. • 1111 4. Erosion Problem Areas. Description of potential erosion problems on'site in the Context characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). • • 5. Constriction Phasing.a. Contra ' n sequence ) t n u)t flA .165 cbni 12n�u, s-tt��wt_ t�kta ix r-c r-o uD - D b. Construction phasing(if proposed) � & Y y S l-cc • co '-m. e .. ( S rY 1L f n � . 6. Construction tehedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. • IL • Wet Season Construction Activities. • a. Proposed wet season construction activities. • b. Proposad wet season construction activities for environmentally sensitive areas. • • '7, Financlai/Ownershlp Responsibilities. • a. Identify the property owned'responsible for the initiation of bonds and/mother financial sec it' 6oro® t�Kttt_ 8b0! - `r`' Avt i3 l&O (,� /8 (1 7 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. ,5 how r on 5;2 b. Diversions. • c. Waterways. • . d, Runoff/Stormwater Detention Calculations swmmvater site plan torrclale—rev.10/1/2003 10 05/24/06 17:42 FAX 206 373 3039 NORDSTROM PR [Z021 • Stormwater Si#e 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.DOD,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 Ms-bunts')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, 1 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 $' of the affected prope • OFI AIJnioruzp A ATIVE$1aNATURE) (bATE) • THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: i 1r'L �Li Ji• • A 2006 • JEf HERS N MINTY OVI • • • • • etotmwater alto pl an template—rev,1 Wl/2003 12 , ON c. ,4� O JEFFERS.,I'COUNTY -- Tt `fig } DEPARTMENT OF COMMUNITY DEVELOPMENT Y . 4 � i ' • '4 621 Sheridan Street • Port Townsend •Washington 98368 t' 4360/379-4450 • 360/379-4451 Fax q�, N�20� www.co.jefferson.wa.us/commdevelopment APR Z ZQds Master Permit Application MLA: O(p-9(f 1 Project Description (include separate sheets as necessary): 70 1 !9 (,1 D0 7 Property Tax Parcel Number: Size: (acres/square feet) Site Address and/or Directions to Property: c©9v 6 a_/Ce.ze... Q1 lane._ / 9 0 37=> Property Owner(s)of Record: a ro OVA L ) 1 f3z. Telephone: "U(' 70y-Z - 4 Fax: .2S3- Z /tjcf 3 email: �t%fs i enisr).corr Mailing Address: 41 O1 - Z Au/WV Applicant/Agent(if different from owner):/ 6'rei - Q Heim�m(�{� Telephone: o00(1,v9 /$Z7 Fax: ?53-/,F6,Z I c/415 email: 12 iniitS(fa ?flis').6 Mailing Address: 30S6 6 zC ``- c ,& um C?R(g 8 What kind of Permit?(Check each box that applies) NoCuilding ❑Variance(Minor, Major or Reasonable Economic Use) Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** Se Single Family ❑ Discretionary"D"or Unnamed Use Classification Ii Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment )gModular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address [l 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: GNATION OF AGENT I hereby designate '`1C- Jact as my agent in matters relating to this application for permit(s). OWNER SIGNATURE le ,( C ./ Date: L�/z0/c. , 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 attorney's fees and expenses which may in any way accrue against Jefferson County as a reswt of or in consequence of the granting of this permit. I further agree to p vide access and right entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and an fired ter inspecti cess a rght of entry to this property shall be requested and shall occur only during regular business hours. z/ Signa re: Date: C///2Jl The action or actions Applicant will un ake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to 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 a of violate the ESA. Any in.' '.ual,group or agency can file a lawsuit on behalf of an endangered species regarding even ifyou ar9 p g g your action(s) �. : plia,:- wi h the Jeffe►�• ounty development code. The Applicant acknowledges that he,s or it hol s individual and non- transfe .• - -4 n•.e .• -.herig t. :r•. complying wi.h t • ''. The Applicant has read this disclaimer Ms it below. Sign �i .I�A J .//,/Ae' Date: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • I 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: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: i/rn her/awl hiz7ncce /nc. ( 2 7 55I�s (a-s EiGt/Vii3 MAILING ADDRESS: A a r-n Lk.)A- EMAIL epr4S Vct A &Ise), Cetail CONTRACTORS LICENSE WAIN // NUMBER: T < -'- °c(, NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: t ' New Pc Wood Existing: _ ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: C p3'Individual Systelg ❑ Repair ❑ Masonry �J SEP Permit# 7 s7 Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 1kr Private well ❑ Two Party T of Heat: Proposed: a- 11 Public Type of �r Total: Name of System: If this is a Commercial Project you must answer the following: 2+ Number of Parking Spaces: Current: Vt Proposed: O Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current P-- Proposed el a. 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: f /y ❑ Underground Tank ❑ Above ground Tank Size of Propane Tank: ; c:'1c .\ I ` ❑ Heat Stove ❑ Cook Stove I i Woodstove -A Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? CI, 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 Bld App Review: 2n°Floor Heated Consistency Review: I �-, o, • Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: 1-1 61 Unheated Basement State Surcharge fee: 463 Other Unheated Pot Water Review fee: 90 •a° Garage/Carport SUBTOTAL Decks z669/ _ (3ff1'1 l 62 1/Rd Apprroaac � .. Other �f t.J + TOTWL: $ 1 Wg Receipt Number: .31 I t I a)J atcio°1 c Cash/Check Number: CC�� eri 0 l� 1 CAM tv161 ESTIMATED COST(REQUIRED) Date: �(�OJ��� ���� .Fair market value of all labor and materials foundation,to finish 101 ',C�1-' (i\cw,, ` - Initials: i f,603,w toiknAtd -(--------e5:: ::> G:\PermitCenter\FORMS\DRD FOS\Master Permit Application 12-30-05.doc 1r .CA ate c=, r),9C8 -Apo co cv lk 112:;11111 2 l's W 0 I -'i L_...• a Co 0 -,.‘..---- - VV\`-_-.2f4 0 LI_ Li. 2 1. t N ----------, _ i, , i -d-- , T3, . .* .. , - ' 4 ..9 5h1 %, v 0 ,-.., N,,,s? i , 4) r,i cifri. ,,t 7 .5 3 .. ..0 z_-.) I 4-“?" ' 1, i 9 (`-) 0 tc) -S.0 — t-1 --8 Af rtN2 sy.) , 1— - -I , ...1v1:4k-T-. -5 C V) I Ca CO 4 0A is ---- _ ;,..,. �41 (� 4. s I ... `t-‘, ____.4...,_ _ _ 57:••• , ,___(,• ..,____ --..-1 ) : -i. k8 c. .. , -----F. „,_ _. , ,L, (- j, , , N ir, 1,..,.-.0_2+ ific, 4 6 , „ ,,„16 _e-1 1. ) §A ' oi ,s_ r..;. .: :,. , t,s_ ,_. id, 8 / k ' .;,4 f g,,--,v--' L -2 , I.e , , , ( .- e 'r‘ fy.%) r: 8 V° c, ig pc_ ‘.1>,1. ;5-zl--- - 1-- ( x 3 '6' ti :.5-• r ik, ..2_,0 Ady , , ilit. t ca.--)- ' 4 i C:e‘str ; -..i ti , : i _,., ti, ".' 1441k 1 , ,,\ ,_,..!.. ._._.1,..,„ 's,------*, '2--;61 I." t ,g, .....- ' .?-:)`/-- /Or—( D'\ -.:).1 i •, i2 © F o r ri ? , cr'j ua 1 Lf ' c' ''ido. ' `-) , ,oni _ nQ, z -,3 it 0 i;i4----4 0 — 9 \ ` ,,, ir._ ,. le V, Pib ay `� 1,,ft 0 C se.--- { 1 . j R , \ ,, IK 1 I'd d , --* , ...----- _--T)1 eA ') J / ,m.R4P --\\cPrf----------------- ' s� . mayc.- ) .......„ 1--ti --a __c _ • -a) u-- ro(___ .6 `• ca) 4 '- .., 2 A(...):--cy,,e- 0 co a at_ ls, s ,mot (,o', 1 ,. V ‘.0 iii g SHIAIOH CL_NI- vrr-i[ :TC Et ifr\TIT , 4° <t zill Lij <le § . i I I 1 II I,_, V 1 flu 9 • - wg 0 1— Li -ct 3W wcikiljalill % 4 tit or.: 2 / al 0 . 0_ 41) _I to to 0 a Ci/ ...r, 1 --'1 ' --- &g) Efg F ; . - aowesii Qi g 5:-.; i .M41 1 =mm im mom vimmo Iii.. g0 qill'` %1 8 9 li,r n I r, 6 r;,--1 N.-, F ,-, , rtp--: _ 2 aa :S•, ii 1 711ree3.ar 1 1 11 'i '. •• gROgiN 4, .," • 1 " rh-ict ---_-- • =J L==: .,tC-r--- ,/ --,.., W. __ I 0 -I .94... - A I V -... / ,e I ---/- ..z.X, . I ,6,9.1 \ 2...„ „. ain ems \ kQl 1 2t(1 e I . .•., I k i— . — . 2 I / r-s / AOd.OL -il- 10 ZIIIV I / " $- / / 'NM Mal ii, • ."I • .S•X \\\\ ‘XN ' / ' ........y. 4.. L... ., .. ..., ' - . 4,' • - ir I \ ...44 $ 4,....., Luk.o. • I. ., I I 4 • 051 I I 4, •• • . .._ab / h ' .. A I I I / : . •74,W.1. 41 .kAl. '\ ‘ \Xv, ''it g)?Ct.. I I ,, . dr."N • - r- • 41 ...-...,-'7,A I I I - it 4. • : • .. 4 - III it 4,d1' 4,!4•.> -,411 • -I I-_-_-, 6 i..:_Q 1/1:j_i ,., ,p , , • ' .144, • • • s- .4 0 : • •-t. • ' • '• 4, : . -- - -I r-1- • ," it.,_ ,• 4. • , -.- I 1 P 4 .V.‹.. ON. ' * • . Z / . . __I L I 4 i 4 040 0 t . . I: , I :— Ll: : ,. 41, ' V:(11-.) ; , _7 J L__ . • . 4A *4 4 _÷- _ • $',1 -1---1 r-— . t.-... •• :s...), (. • <,... ,..4 • , 4., - 4.. ..;44•10, / 4,., tr ir .1,.. I- lel ' , 1 1 : • 14C44 ----- i .'Ve/.44 I __II • ',%.40.1tot __ .... A.'A 4, _ _ III - q i . r -1 1 , I---1 -- . 1 i I I 1 Lj_14.1____1_ 1 I "rr T--r- 1.):: 1,, 11/ --,1 %-t• 1 1_74----;'N 1 I 1 1 1 .,..0 g, i 14 CI „PR I ca zi II 1,-',Iiil I I I I— $-- _- I - --I / / I__ I 35P..] L go11 L__1 /kih 7 r -'-,,.... • 1 0 r——tir-a'- 9 I gi Si fi t l 1): - x;-\-- • u igt Li ,_dL,,_klL la,4 fi...„ .,. .. ,,..d, -7 - ., e d 1 I LIJI / 1 1 . , 1 -, I 2 1 I / ,-- ki. • / / ,..7,0 c)t.. I I / / / - / // ‘ / I I 1 :t //// / / /// I > o 0 El c4(") I,/ / Y / /// /I / I / . , 2 , ... 1 • . . , • 1 \ , 11111111•111 ii,---- I I I li IP • OS' 2\ / S 6 / , / \ itr-j):d ) ,..,',, 1 r.„-i ,' -=*-=:-6 .- 24 ---- IRII 1% I w - \ I D s. ,- I D2 kt& 14 \..,,,li I li 0, _ c :ON\-, k- • ..., , A PO VO1 V II' Li e i r 1 151i L JO El3r; o e- \••, Ill ,,, . . z.------ .—.. =.- 6 0 'i 1 I 1 0 es 1 - CH 1 " 11 1-9 i 4 ! I ; z1iih i It , . I I I I I I I I I I I I I I I I (_) 1111111 I 11111111111111 I , R I ! ! ! ! 1, : ri ! ! 1 : ! : Iiiit 1 1:‘ .... ii cc , ., L. Ca_ ul LT1 4) .0.49 0 0 tCa 114-% rII? IIM .. 111 mizioesci--IX -__. 1 C vo r 1 LI • 1 ,,---..--._ ._ ,,_,---: ---: