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HomeMy WebLinkAboutBLD2006-00220 06 OPUILDING PERMIT APPLICAT N MRL viewTy 210 vpe Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00220 Received Date: 4/28/2006 SITE ADDRESS: 200 WILDWOOD SHORES BRINNON, 98320 OWNER: DON L SKANCHY PHONE: 253-631-9606 KAYLENE SKANCHY 26248 129TH AVE SE KENT WA 98030 SEEDS & REHE SHORT PLAT SUBDIVISION: Block: Lot: PARCEL NUMBER: 502142012 Section: 14 Township: 25 N Range: 02 W CONTRACTOR: ARMSTRONG HMS BREMERTON INC PHONE: 360-373-5061 2709 AUBURN WAY N AUBURN WA 98002 Contractor's License ARMSTHB307QL Expires 5/7/2007 REPRESENTATIVE: ARMSTRONG HOMES PHONE: 253-531-7020 TOM MALLORY 2709 AUBURN WAY N PROJECT DESCRIPTIOP NSFR W/ ATT GARAGE & A/C 100 GAL PROP TANK TYPE OF WORK RES , SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 279,852:6► . ADD'L:MAIN: 742 ( HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: # OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 532' SHORELINE: CONST TYPE: GARAGE: 700 SETBACK: 36 DECK: 1,066 BANK HEIGHT: 100 SEWAGE DISPOSAL: ALT WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 3 Total: 3 Total: 3 Routing Date: 6/,)/040oic Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $2,001.75 LYK 04/28/06 80997 State Building Code $4.50 LYK 04/28/06 80997 ;. ED Potable Water Application $55.00 LYK 04/28/06 80997 JUL 5 Plan Check $1,292.75 LYK 04/28/06 80997 Total: $3,354.00 Jefferson County Planning & Bailaing Department • • 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 #: BLD06-00220 SITE ADDRESS: 200 WILDWOOD SHORES Issue Date: 07/25/2006 BRINNON, 98320 Final Date: 4/7/2008 APPLICANT: DON L SKANCHY PHONE: 253-631-9606 KAYLENE SKANCHY 26248 129TH AVE SE KENT WA 98030 SUBDIVISION: SEEDS & REHE SHORT PLAT Block: Lot: 3+ PARCEL NUMBER: 502142012 Section: 14 Township: 25 N Range: 02 W PROJECT DESCRIPTION: NSFR W/ATT GARAGE & A/G 100 GAL PROP 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 THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 4/72008 I:\F_BLD_Occupancy.rpt 10/29/19 A 0 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00220 Received Date 04/28/2006 SITE ADDRESS: 200 WILDWOOD SHORES BRINNON, 98320 Issue Date 07/25/2006 APPLICANT: DON L SKANCHY KAYLENE SKANCHY PHONE: 253-631-9606 26248 129TH AVE SE KENT WA 98030 SUBDIVISION: SEEDS & REHE SHORT PLAT Block: Lot: 3+ PARCEL NUMBER: 502142012 Section: 14 Township: 25 N Range: 02 W CONTRACTOR: ARMSTRONG HMS 2709 AUBURN WAY N PHONE: 360-373-5061 AUBURN WA 98002 Contractor's License: ARMSTHT294KP Expires: 5/7/2007 PROJECT DESCRIPTION: NSFR W/ATT GARAGE & A/C; 100 GAL PROP TANK CALL IN FOR THE QUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: /(--/3.s� UFFER: Footing: �// / Founds on: Ole!)/CeM,�Jon5 ///30/0.4, Stormwater FINAL Approval: / Underground Plumbing: Underground Ins 'on: Shear Wall : w Sheathing:Framing: l)...- ,1 Fe - i-co,.cecA'��r—i Plumbing: .- X,2"7- "l 414.4. f2Aus i 44itu1E, ►yNLs ' Belme,e, S C Propane Tank/Lines: j 1�yy 4=; / Fart PL Insulation:Qt,A, � ' _�_�c:. 1y�1 Sheetrock: Septic Sytem Final Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy p Y Approval: e'te c.C9b'rtcxo� Lt.1-7/t9g HEALTH DEPARTMENT AND PUBLIC WOR S APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY - SEE REVERSE • SPECIAL CONDITIONS FOR CAA BLD06-00220 1.) 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. 2.) 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. 3.) 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. 4.) 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. 5.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 6.) 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. 7.) 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. 8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 9.) Not more than two (2) unlicensec.inoperable vehicles shall be stored on anyTot 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). 10.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 11.) Minium setback from Wildwood Shores right-of-way shall be 13 feet per approved administrative front yard setback variance.. Minimum side yard setbacks shall be 5 feet. Minimum setback from shoreline top of bank shall be 47 feet. 12.) Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 13.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 14.) The building height is not to exceed 35 feet. 15.) 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. 16.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 17.) The applicant shall fully adhere to all conditions and requirements of the eagle habitat management plan. I:\F_BLD_Permit_Buildng.rpt 10/29/19 MAR. 6 2006 2: 00PM AKM 1KUNG LUMdtK NU. bib r. Z • • z,t gg 11! V111L!LL1!Ih p 101 101 LI' 11 '4i ill ,. { D wilim •D D D r 11111:rall NFL: 4W r' ' -_,-. ----,-„.„---,,,, i,., ra. 3 _ C I a. i t MI ' i I A, '3'. s i MIA- ! -11 •' --Cs ? ' _ :-1 3 Katt l'il t : .. i- .10 ��Fri- iMIMMI1� ®IIr b•_� Pa M 1i,e. 1 i,0.,,w . all 1:2 h _glikm, ,i ; 1 r L I g! 42 ..‘ . 34 ; iii, ,r; t---4\4 i. 0'IIIII iii ---i,,,.. ; Jen: 0,77 1 16.4 : L�sij IZ•' — I = d 'I � �._... �__ aA ,l �� \l ' 1i U ' 4 k ri p j} \.. ill ,. , , 7 RI { a v a , I. I \ 14. ^1 �V-t7 Ni I '&� i ilktki 'q1 l : i-r' 4 9 �I f f if DODO 0000 1: _ f 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 thal they wEt be assuming the responsbility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx k n4 n� �> (215,5) 53/-7clo ( )53/`7OZl AILING ADDRESS: / /,.0 1 /ft C EMAIL: CONTRACTOR'S LICENSE - (,(! !rr``� q WAINS NUMBER: ,k2ML3�,,�t'.��I^l 11^K1' NUMBER ARCHrTECT/ENGINEER:' Q✓Jr✓1%V Iran(F.' PHONE(7.65)✓./Y 7a20 FAX:(453) l_7021 MAILING ADDRESS: )4g)0 U(e., EMAIL Project Type: Fral to Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ra"Wood Existing: 0 Sewer O Addition ❑ Steel Proposed: Bank Height: 0 Community System O Alteration/Remodel 0 Concrete Total: 1 '4 / l rvidual System O Repair 0 Masonry SEP Permit*r System ,....,,.., O Demolition ❑ Other. Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Pa 3yye ns w_. Proposed: 3 l q-Publc C� 13^ d IE/ee /VG- — Total: Z • G Name of System: t If this is a Commercial Protect you must answer the following: Number of Parking Spaces: Current: Proposed: Number ofA Parking Spaces: c {U ClIN2cO- �j3p� Number of occupants(indudes 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 th apply; O Underground Tank b'Above ground Tank Size of Propane Tank: 700 / +/ / No .75ti..+ O Heat Stove X Cook Stove 0 Woodstove 'Fireplace Insert 0 Hot Water Tank 0 Petiet Stove 0 Other et v(SIC') Cl , '�j.i ` Is this appliance being installed in a Manufactured/Mobile Home? Yes Amount-.• Re isle When applying fora permit to install a propane tank you must also submit a site plan showing all of the buildings,all propel lines,tank location and size,distances from the propane tank to all property lines,buildings and stop,f ystem comN en- includingthereservearea. A ne • I.E. Square Footage Current Pr±opoaed Ir- Main Floor Heated ie- L( -1�'„^�„C�sqr{p2 Q D 43a0v1 2"°Floor Heated / 4:Fl yam: n on Other Heated 'yz t°�° i� t 5 3 i5 Z. o) 15( a3,'0 a:�"fee: ,, - ar C101 . Mezzanine Additional`�lion: r I r! n I It ion: �'lN Heated Basement , PIAR C�1, rve: �n lLTIr (0. 131 ly?)o3.IA gg.3LF W Unheated Basement Ari,r2 f tr State Surcharge fee: 1, 56 oi qiithallxated C . 9 t> J�3Z , Pot Water Review fee: -q rageiCarport �a�3 SUBTOTAL -60 ` Decks . , H"` _ °911/Rd Approach fee: i-l0 997, s I a3,31353 L At5-ms-- other coCemedo mo2C'h 73, , 1 i13a.4° ___ • , • s . aai7•a) $ t . _ ReceiptNumbeV _, '1.1 (11/ Ow ?CAN,. . �j Q c, e 9��e ,n/Check Number. O 6&(, ESTIMATED COST REQUIRED �• Date APR 2 8 2006 "�'l 58`�/ ���J .Fah market value of all llaa aar�d materials founds •Viva.+' �- A I (og/0p 1 f1 Z o C✓ 333 15n�1''``ll!!ff *�R ttais' 2Do,Qeo,'� ,,vc1.0 MENT • _ Jul 24 2006 4: 13PM LASERJET FAX • p• 2 PERMIT 4 0!D i, . c \ JEFFE ' +011 COUNTY k., ' 0 2 2 0 ice' `. .4 DEPARTME T OF COMMUNITY DEVELOPMENJEEFE rCCRSON COUNTY DCP ,.r� 621 Sheridan qtreet• Fort Townsend•Washington 98368 cis, N��Q 360/379-4450 i 360/3 '9-44,51 Fax 'ITYhttp://www.co.j fferso 1.wa.us/comnxievelopment/ STORMWAT R S ITE PLAN SUBMITTAL TEMPLATE MLA# 04-2,1 0 PROJECTIAPPLI cANT NAME: K../illeild/r Please answer all of the following questi ns to tie best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either inoorpora the ek nnents 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 conditioi s of the site. Indicate position and relative size of proposed improvements on the site 1:p• A c-.1_, t,i)/k-t-ff:k-tv st.ci-vetici*., I cote-no-cher) Existing Conditions Summary 2. Describe the existing top9graphy. Indicate ;+., ,urs on the site map. r cek,r-l-t-Le. c2CDP.k. e „. PO ' ri_----*__WoX___;_ _*T.___/...__ p- trz-_%C.55" 3. Describe.,thhe existing vegetation. I irate r citive •tation areas on the site : /' ' rfl 4A •% .cs [ !'(71 ° . • a Describe the existing soils, Indicat soil tyj to on the site map. psi n f) -- tXoA- _71.- 5. Describe the existing site hydrotog (i.e.,d ainage;behavior of water on the site—above, below,and on the ground). Indicate existing stormwater drainage toad from the site on th1 site map. Depict separate drainage basins on the site map, if applicable,,54,Le.iap and Intl' to acres a off ach. (teen. . - 40 .6 r•Adra''t ice• —. ( e-PiSee-rz, -14r4.'4.0 u•-•,. _i_ficuA e, i . mit - i ri i r 6. Describe arty excess ails of nois genera:ed b the zroposed use or activity: . apn Ur\ a C l?flktr 716,orr APPROVED ' STORMWATER PLAN l °, JUL 2 5 2006 slrnmveter sits Nan temptate.doc-rev.10/1212003 , \ •tormWa B �s r t s -equire t i 1EFFE COI N t DEPT.OF T I P t ft SIGNATURE': . • Jul 24 2UO( 4: 13PM 0 LASERJET FAX . P. 3 7. Describe significant geographic fe• res a id critical areas (i.e„ environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Incl..:to 1 Lion on he site map- N� t B Litt, h VOI - f IWAlt- v) 8. Describe the general vicinity of the e, inc /ding adjacent land uses and structures,utilities,roads,and sensitivelcritical areas streams,wetlands,lakes,steep sl•.- ,etc ). 16 _ t? n A—t., P. 121 c�f, =ci'Z. �5 bra .`�ru col Me ..isLaywo on 05e-yr • of_-_01 istioutot) <A.c. A Agtrija_______ . pr. . i-,e._‘- ALOE_ t ne..,FFre_O or) -tile_. S efor -n 0 Permanent Stormwater Control P an This portion of the Stormwater Site Plan o nsists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place :. constr cation of the project is completed. `Medium'size proJects are requi •.r to ha,e the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating perviot s surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydro).•y, as proposed. Indicate whether stormwater will be fully dispersed(i.e., per BMP T5.30 in the Manual)or, if not,what • of stor ruwater flow control wil be utilized for the site or specific threshold discharge areas within the site. Locate these teats-:: on th, ,site plan and differentiate proposed taci ities from existing facilities. (qh'i rl '_, Roo E ti v1 o Fes- �>�`, f 2>K?-�- Red We_ct 5 10. If the project requires the use of str rnwate r treatment facilities,describe the types of stommwater treatment facilities proposed for use on the site. Locate these .: titles an the site plan and differentiate proposed facilities from existing facilities. [This Is normally for large"projects or proj: : that involve the potential for dispersion of contaminants.] I.LV /'C 11. Describe the performance goals and stand, rds applicable to the project. ILIA< 12. Describe the flow control system. _sgzipc.. etormwalOr silo plan lempla4adoe-rev.10/12/2003 e Jul 24 2006 4: 14PM 14110LRSERJET FAX • p. 4 13. Describe the water quality system. 14. Descrkie the conveyance system aratysis •wl design. Y1/4 15. Describe the source of fill material, physical characteristics of fill material,and deposition of excess material. 1\l/h( 1,VD. czcilnit 41:1-Pertt 16. Proposed methods of placement and con xaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Ildtng Code. 17. Describe � �d surfacing materiel. (/—# C) -z 18. Describe methods for restoration of h 19. An Operation and Maintenance Manual is r squired for each flow control and treatment facility. [This is normally required for large°projects only and only those for whit 'facilities are required to control flow or treat runoff I if included,list the Manuals here. 20. List here and include any special reeorts or studies conducted to prepare the Stormwater Site Plan. 21. List other necessary permits and approvals es required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or c rntain more restrictive drainage-related requirements,describe those conditions or rest'coons here. smrmwaler sue plan feaprafe.doe—rev_10/1212009 7 Jul 24 200G 4: 14PM • LASERJET FAX p- 5 CONSTRUCTION STO IMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment ar I erosion control during construction. The BMPs indicated by the applicant in The template that follows must be installed on the gro •nd during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to enviro'mentally sensitive areas and off-slte areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Managers tnt Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRAI NE 1. Construction Stormwater Pollution Plan :laments. Describe how each of the Construction SWPPP elements has been or wif be addressed. Identify the type and too Ilion of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptlo is of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction S WP'P tirdl1. Mark Clea'ng Limits. C? ``�" Grn C�► g-r- _ (2 2iPt' <.Of2.l��.'l 'ice Of- 4-- _ 2. Establish Construction Ac o. 3. Control Flow Rates. /Ylp-I 1`m m -en ( ' i IF L r,� t" I o✓1 A Q`- r n�C. 4. Instal Sedime Contr Drz. l O YZ 5. Stabilize Soils. r y 6_ Protect Slopes. 7. Protect Drain Inlets. stomwiate*s le plan lemplate.doc-rev.10/12f2003 8 Jul 24 2UUi 4: 15PM ,LHSERJET FRX P. S i2 Required Elements—Construction:'WPPP(continued) 8. Stabilize Channels and Outlets. tYPI 9. Control Pollutants. 11 0.- '` 10. Control De-Watering(the act of[xi nping groundwater or stormwater away from an active construction site). Anck&.\ort 11. Maintain Best Management P cti,rjs(BMPs)_ T n 12. Manage the Project (?'p er-rf"2-- mil 2. Adjacent Areas. a. Description of the adjacent areas thr i may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). b. Description of the downstream drainaf path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally set alive areas that are on or adjacent to the site. cditpat-tdt71 zto nrvvaiet slta plan tert,plale.doc—rev.10H2121)03 9 Jul 24 200G 4: 15PM • LASERJET FAX •_ p, 7 b. Description of special requirement t for working in or near environmentally sensitive areas. • rIk -1 n 4 c\ _ !A . 0 lagOLK -AAgri VA-Q-ut 4. Erosion Problem Areas. Description off)tential erosion problems on site In the context of the characteristics of the on-site soils(e.g.,erodibifity,settleability,penneab,ity,depth,texture,sod structure). 1\1/66- 5. Construction Phasing. a. Construction sequence c&A eiCk.TN—. 1t)G(‘.. AuCp. Cons) phasing(if proposed' 6. Construction Schedule. Wet season is tictober 1 through April 30(page 2-21 of the Manual). Provide a proposed� construct in •u /. f ta�� / -Y- 7 e neCtre i ' C-C li. 1 Wet Season Construction vibes. a. Proposed wet season co etruction activities. rrvre o PI'Y'.�_� n �-3n b. Proposed wet season co s°truction activities for environmentally sensitive areas. N/4tc 7. Financial/Ownership Responsibilities. - a. Identify the property owner respor Bible for the initiation of bonds and/or other financial securities. 1.1.5 r44. - 11 *...4-no14-7— b. Describe bonds and/or otter evil me of financial responsibility for liability associated with erosion and sedimentation Impacts. 0(..0 n t A. — 8. Engineering Calculations. Provide Desig i Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps, b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Cak a lations starrmeter site plan templete.doe—rev.10/12/2003 10 , .;iu1 24 2006 4: 16PM •LASERJET FAX • P, g Stormwater Site Plan Changes If the designer wishes to make changes o revisit is to the originally approved Stormwater Site Plan,the proposed revisions shall be submitted to DCD prior to construction. The st bmittal shall include substitute pages that hidude 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 :ysterns,treatment facilities,flow control facilities,or structural source control BMPs (not standard on-site stormwater management Btu Ps),the applicant shall submit a final corrected plan("as-twins')when the project is completed. These should be engineering drawir 1s (stamped by a licensed civil engineer)that accurately represent the project as constructed. IPPLICANT SIGNATURE By signing the Construction SWPPP wcrksheei I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also cer ify th this application is being made with the full knowledge and consent of all owners of t igtor per r.fOrej (LANDOWNER ORP)TFgRQED REPRESENTATIVE B THIS SPACE MAY BE USED FOR ADDITIONAL I IOTES,IF NEEDED: dornmeler site pion lemplatadoe—rev_10112/2000 12 0 ----le 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 a,.d'hal they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: o h nCp cols c ) 5 - 0 -0 ( )D 1-7a71 'MAILING ADDRESS: n F(( EMAIL: CONTRACTOR'S LICENSE I i WAINS NUMBER: A MTM1 2. /q 4 �/ fp NUMBER ARCHITECT/ENGINEER: `-filecri (P PHONE (7_55) /7 a 20 FAX:(Z )53r-74J 21 MAILING ADDRESS: A. EMAIL / Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New Wood Existing: 0 Sewer O Addition 0 Steel Proposed: Bank Height: 0 Community System O Alteration/Remodel 0 Concrete Total: '.; 490 / 0 ln'dividual System Li7 D` � O Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Pa Type of u.--•- Proposed: / (aPublic Jr! %�= _ TOT °3Z' Name of System: If this is a Commercial Protect 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 andlor Appliance Installation permit,mark all items below that apply: O Underground Tank W Above ground Tank Size of Propane Tank: Ara O Heat Stove Cook Stove 0 Woodstove Fireplace Insert ❑ Hot Water Tank 0 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 proper lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system componen including the reserve area. _ Square Footage Current Pro.oaed ,'.a aitn: , Main Floor Heated 919, _H Bld App Review: 2 °Floor Heated 74a �1g- Consistency Review: 3 j 7 . tU Other Heated , Y * r ;t y. ,. Base fee: \ i `- ; r F t - ^U o�r ©0 1 1� y'� Mezzanine r �'4 `•`'° g Additional Section: Heated Basement r , - i Plan Check fee: f� Unheated Basement z: State Surcharge fee: �( 56 t_ , ,:. ., ,.:. . ,: 1,, Other Unheated - Pot Water Review fee: �ste�_, r j 532 Garage/Carport 91 ��� ,�`��� SUBTOTAL 3i�`5 n I Decks r„�w }V "`� 3' 911/Rd Approach fee: �J 011 `M. s i a3 393. a Ac5a-m5.. Other Co) P pc)" 7 AD ` r'4'` Receipt Numbe. } ,n/Check Number: ESTIMATED COST(REQUIRED) Alum` DateAPR 2 8 2006 �8`�� .Fair market value of all labor an materials founda • to n sfi --' l 106 i Initials: 20a E0o,''D G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc g,SON c0 d. JEFFER1104 COUNTYIII Al +3 DEPARTMENT OF COMMUNITY DEVELOPMENT • `� ` `.4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ��q�,� �p'� www.co.jefferson.wa.us/commdevelopment APR 2 8 2006 Master Permit Application MLA: 0(o 'a kd Proje t Description(include separate sheets as necessary): f,t.IENT C�on�770 , F f2• &)� �'1 lii IBCArn. Tax Parcel Number. Property „ �0 Z- �42- 'O / Z Size: 9, �F /,/6ACiet(acres/square f Site Address and/or Directions to Property: CO W/1-Y) UJOQQ Property Owner(s)of Record: `POt L , i11 (,,�/Y� ' Y')Ci-)I-j Telephone: L 5 3 I - 1 C c Fax: email: nSk\nc=L 41ct,,�cast,vet Mailing Address: L.6)-`4 zf I"3-c1 AveEr- K.e,n"t. w A rim;C'i r Applicant/A ent i different from owner 1Dyy� /y)V-(...40 Telephone: Jr � �j/-7 v 0 __ Fax: L✓5'j3( ( email:rayoie i n15Ttroa,-h orso. Mailing Address: (p 0 I pi- J t ( 'L " l f �(n �}- ('0,r1" What kind of Permit?(Check each box that applies) cg Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]** 0-Single Fami 0 Discretionary"D"or Unnamed Use Classification VI,Garag=t'.St-ch-• Detached 0 Special Use(Essential Public Facilities)** ❑ Manufa 1 -i "ome 0 Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑ Commercial* 0 Binding Site Plan** ❑ Change of Use 0 Long Plat** ❑Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendment: -i Propane 0 Plat Vacation/Alteration** ❑ Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance ❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendmen ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate ./0 1At?i 4,rAci y i 'tio47 2,(10- to act as my agent in matters relating to this application for permit(s). � OWNER SIGNATURE r / / Date: 3- L. - u le ✓ 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 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 result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of applicati review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature:�lti 4.4_,3------ Date: 3— E) tf 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 pE 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 actic 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 r onsibility �ering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: -•- — l'! 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"'�' "`, r \� `.' +fir "'� SOILS APPLICATIUNWASTEWATER PANSSU \ ' � ON--SI TC 502-142-012 tJ� TAX PARCEL 863 CARL U WA09a382 1T . .. • SEa X 2. "' to ;,,, M FAX (360) G8 \ •-'\ do SHAl10W PRESSURIZED ,1 INT. SAND FILTER SK�,NCHY SYSTEM FOR DON do KAYLENE r PIS (360) 6Q3-6300