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HomeMy WebLinkAboutBLD2006-00312 • • 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 #: BLD06-00312 Received Date: 6/1/2006 SITE ADDRESS: 5131 DOSEWALLIPS RD Issue Date: 7/19/2006 BD, 9 I gas- `�o3 APPLICANT: HOWARD E WINNEM /A PO BOX 49 BRINNNON WA 98320 �„ \act._ `-61(0 -'1 CV0 SUBDIVISION: Block: Lot: TX 6+ PARCEL#: 602302011 Section: 30 Township: 26 N Range: 02 W CONTRACTOR/ WASHINGTON HOME CENTER INC PHONE: (360) 427-6667 DEALER PO BOX 176 CHEHALIS WA 98532 (360) 426-8493 Contractor's License WASHIHC0770A Expires 3/19/2007 PROJECT DESCRIPTION: NEW M/H &A/G 500 GAL PROP TANK CLASSIC 4663T SERI/TBD MAKE: SILVERCREST Ci\C �`P.`G 11 YEAR: 2007 SIZE: 66X27 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 7/19/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Sacks/Footing (CONTJ.N000S FOQTINetf�—�, SLAB f or ADS USED): C Jn Stormwater FINAL Approval: Blocking/Plumbing: y�9-7_17-10Co Propane Tank/Lines /4 6,— 1_/; , i.j10-Y---y- "f J Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: kirting/Vents/Porches/Steps: G 4 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 2L HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:CO a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY- SEE REVERSE • • SPECIAL CONDITIONS CASE # BLD06-00312 1.) The application was reviewed by the Jefferson County Department of Community Development staff on June 14, 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: Conservancy shoreline designation; type 1 stream; elk/spotted owl/harlequin duck; seismic; landslide 2; flood; erosion; SUSC aquifer recharge area. 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.) A Type 1 Stream (Fish and Wildlife Habitat Area) has been identified on the subject property. The stream will require a setback of 150-feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat Areas shall also have Buffers and Building Setbacks established. 6.) Stream buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of vegetation may be permitted as long as the function and character of the buffer are not diminished. 7.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis), Shore Pine (Pinus Contorta), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar (Thuja Plicata), and Western Hemlock (Tsuga Heterophylla). Among native tree species which may be used includes: Vine Maple (Acer Circinatum), Big-Leaf Maple (Acer Macrophyllum), Red Alder(Alnus Rubra), Pacific Madrone (Arbutus Menziesii), Quaking Aspen (Populus Tremula), Black Cottonwood (Populus Trichocarpa), Bitter Cherry (Prunus Emarginata), Oregon White Oak (Quercus Garryana), Cascara (Rhamnus Purshiana), Pacific Willow (Saliz Lasiandra), and Scouler's Willow (Saliz Scouleriana). Among the native shrub species which may be used are: Sevice-Berry(Amalanchier Alnifolia), Red Osier Dogwood (Cornus Stolonifera) Salal (Gaultheria Shallon), Ocean Spray(Holodiscus Discolor), Indian Plum (Oemlaria Cerasiformis), Pacific Ninebark (Physocarpus Capitus), Red Flowering Currant (Ribes Sanguineum), Wild Rose (Rosa Nutkana), Swamp Rose (Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus Racemosa), Snowberry(Symphoricarpos Albus), Evergreen Huckleberry (Vaccinium Ovatum), Red Huckleberry(Vaccinium Parvifolium). 8.) 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. 9.) 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. 10.) 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." 11.) All construction activities shall not encroach upon the landslide hazard area buffer or stream buffer. This includes the storage or preparation of materials. 12.) The applicant shall permanently 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. 13.) 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. 14.) The identified Fish and Wildlife Habitat Area (Type 1 Stream), shall maintain a vegetative buffer setback of 150 feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to the proposed single family residence. 15.) An additional setback of five (5) feet is required from the edge of the stream buffer area to the proposed single family residence. 16.) A permanent physical separation along the boundary of the stream buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 17.) Stream buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to and during construction activities. The signs shall contain the following statement: "Buffer - Do Not Remove or Alter Existing Vegetation." 18.) The applicant is proposing to create or add 3010 square feet of impervious surface and 5860 square feet of land disturbing activities. 19.) 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. 20.) 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. 21.) 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). 22.) The revised site plan dated July 17, 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 July 18, 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 23.) This approval is for a manufactured home installation 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. 24.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 25.) 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). 26.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 27.) Minimum setback from Dosewallips Road right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum setback from OHWM of Dosewallips River shall be 150 feet plus an additional 5 foot building setback or total of 155 feet. (Site plan identifies a 226 foot setback from south property line to proposed structure). • 28.) Exterior lighting for residential uses shall not exceed twenty feet(20') in heighom the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 29.) 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. 30.) The building height is not to exceed 35 feet. 31.) 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. 32.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 33.) The parcel has been designated as RR 1:20 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 34.) The parcel is served by an individual on-site well. 35.) A septic permit(SEP92-0384)was finaled on June 2, 1994. 36.) An address of 5131 Dosewallips Road, Brinnon has been assigned to the parcel. Dosewallips Road is a county minor collector(C250008). • • MLA06-00286 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00312 Received Date: 6/1/2006 SITE ADDRESS: 5131 DOSEWALLIPS RD tsr • Aa5 —40' -49.-d APPLICANT: HOWARD E WINNEM PHONE: 206-396-7086 PO BOX 49 BRINNON WA 98320 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 602302011 Section: 30 Township: 26 N Range: 02 W CONTRACTOR/ WASHINGTON HOME CENTER INC PHONE: (360) 427-6667 DEALER: PO BOX 176 CHEHALIS WA 98532 Contractor's License WASHIHC0770A Expires 3/69/ 07-8493 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW M/H &A/G 500 GAL PROP TANK CLASSIC 4663T SER#TBD TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SILVERCREST SETBACK: VALUATION YEAR: 2007 BANK HEIGHT: LABOR & INDUSTRIES APPROVAL? SIZE: 66X27 SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL -- BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: t3LD (01 aIo�r C2 Type Amount Paid By: Date: Receipt: AP4 ,ed/Date Manufactured Homes $163.00 LYK 06/01/06 83453 G Potable Water Application $55.00 LYK 06/01/06 83453 JUL I 1 2006 Total: $218.00 Jefferson County Planninu &Building Department Cott 4942Ae\F y,.,�eIL4C-- 0 0 , ,,),,,, ,•7 s::i,,Ili..,.,'....,.,:, ...:. -.. . _ 4,‘• -.z. Washington Home Center .... ... 7: ^-,A.7 ,.....:$0,"- 4.1 -****6 '....*......*- www.washhome.com • Silvercrest Classic 4663T ... , . . ..:. . ..... . . . •. A.. • .:.... •• •••••100" .. • . ... il." .1''•!4 . At. -*; -..*:;:•••P's•:, • • ••'A• • • * .. • ''. :it;**:-, . , . '''' ..a t i •' ., .. ,C:•- , -- addiblib. - • '-1• - -* * . - ' ,-...."--..:="--2-7 *;•••• * ' 111 in in RIrga'm in In 111 tr'• 1 1 _ ........ . __..... _ . .. --- - ..0. _........___ .. ,. .„ ., ... .-.-.a., ,. ,., II • r-- ...., Chamoion •• , - • _ - . . ., . .. . .... r ....... , • .,.... - •..... ... - ., — - ,• . ..1 . 1' -, 1 ,• "Po 'I, : „ . 1 - - _ BEDROOM#2 DINING ROOM IN II LIVING ROOM MASTER BEDROOM 11'10"x 9'2" 9'10"x 6'10" 14 0"x 12'10" E NYC , BATH pi 5 Apr, HA IlLtgli 11 / M Ell. FREEZER• 1.• II . .;,".c..ag, INN:id_ __ / .__ . , 7,-L ....._ , i ... - II/- rt I UTILITY ISLAND - !E 1 I' . i! 5 BATH 'NMI• , KITCHEN MIN... FOYER- NM. lee' REM 0 SIELL: 1 n m 1 . • • ( ow mom ilem_ a - IMP'• !kw ., _,... ./ ENTRY — JACK %VESTERMAN I Jefferson ( t, Courthouse ASSESSOR PO Ilox 122l1. Port Townsend, U':t 98368 (360) 3115-910 i MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: } JUN — 1 2006 NAME: ,�D�t/ '� '/ivx/E, 1 ADDRESS: iaaSe /..L/A S ! /l16/ .' Aeei PHONE NO. a 26 ' 3 q6 - 774S'& - _ rLj trwT The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. l)MOBILE HOME DATA: 64, "� (A) MAKE -J/�l/ e c%eC S/ (B) MODEL -L SS7 l fi(C)YEAR 6e r/e (D) LENGTH (E) WIDTH a -" (F) SERIAL # T 27 (G)YOUR PURCHASE PRICE (Do not include sales tax) �e,G> PURCHASE DATE__ 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE /////j./. ADDRESS (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes KNo_ (II)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: //4 /1//) D /• / ' /ef LOCATION ADDRESS .o /.Y/ ;/} -9r f,j///�?�i z-1/c'S / 4 C> REAL PROPERTY PARCEL #/DESCRIPTION*1 Q� s?°' — // Alt z z r El' Signature of applicant THANK YOU FOR YOUR HELP! .IO COSSELL, Property Technician r lb g, o cirTh el � PERMIT # BLD JEFFERSON COUNTY ' i 4 ro. 1 1 DEPARTMENT OF COMMUNITY DEVELOPMENT 1 A ,, , 621 Sheridan Street • Port Townsend • Washington 98368 JEffER A -�U Y DCD O 360/379-4450 • 360/379-4451 Fax 81NO http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# ()Cc, 2. e PROJECT/APPLICANT NAME: Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. 1 ;,i`ra - -fir h 4. 4,,,-1 ate _-4c,�3 Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 4. Describe the existing soils. Indicate soil type on the site map. 5. Describe the existing site hydrology(i.e., drainage;behavior of water on the site—above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. APPROVED 6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN JUL 1 8 2006 Storrly� ef , ' p \ -j' JEFF Ci tic Required " DEPT.OF C , EN7, f� -: \ SIGNATtiRE: / ,, : stormwater site plan template—rev.10/1/2003 " \,.. S ""--T • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. • 8. Describe the general vicinity of the site,including adjacent land uses and structures, utilities, roads,and sensitive/critical areas (streams,wetlands,lakes,steep slopes,etc.). 4 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. g. 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. { it _jr/ �t' tl :..�,Y 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of contaminants.] 11. Describe the performance goals and standards applicable to the project. 12. Describe the tiow control system. re/4 . � 1 t stormwater site plan template rev.10/1/2003 6 • 13. Describe the water quality system. j — :.v � 14. Describe the conveyance system analysis and design. 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. f/ 17. Describe the proposed surfacing material. . 18. Describe methods for restoration of the site. 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. stormwater site plan template—rev.10/1/2003 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. I A 2. Establish Construction Access. O 3. Control Flow Rates. 4. Install Sediment Controls. n f 1 5. Stabilize Soils. 6. Protect Slopes. 7. Protect Drain Inlets. stormwater site plan template—rev.10/1/2003 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. JUN - 1 2006 9. Control Pollutants. -T 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. stormwater site plan template—rev.10/1/2003 9 • b. Description of special requirements for working in or near environmentally sensitive areas. 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). 5. Construction Phasing. a. Construction sequence b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). 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. and Describe bonds and/or other evidence of financial responsibility for liability associated with erosion a d 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 owners of the affected property. e(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: Ju _ ? Z006 stormwater site plan template—rev.10/1/2003 12 • • ,i,,S cad,. JEFFERSON COUNTY i W ' ,�..3 DEPARTMENT OF COMMUNITY DEVELOPMENT �) rc 621 Sheridan Street• Port Townsend • Washington 98368 U� 1 360/379-4450 • 360/379-4451 Fax 2006 gS, NG�pP. www.co.jefferson.wa.us/commdevelopment , Master Permit Application MLA: OP,'ir tte,;•:tp Project Description(include separate sheets as necessary): 1JE /LI a 14 u,Pe 77;y c c/ /1o14,c e_ Tax Parcel Property Number: G d z 3 D 2, O// Size: g rI,c ,4 (acres/square feet) Site Address and/or Directions to Property: , %31 /.�C�.S/l.�Qil/�7 S R0 t3rihn0 j tar_ Property Owner(s)of Record: /1E0ltier,,J U' e,,h ,p 1;2-1, Telephone: ZQG•- 39 _- -7 g6 Fax: email: Mailing Address: iqe9, E, v9 A •I Lyh e9 fJJq G1 23 2 r Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) 'Building ❑ Variance(Minor,Major or Reasonable Economic Use) LI Demolition Permit Li Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** } Manufactured Home [1 Boundary Line Adjustment ❑ Modular I. Short Plat** Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** Address I Road Approach L: Planned Rural Residential Development(PRRD)/Amendments ye:propane ❑ Plat Vacation/Alteration** ❑ Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** rl Stormwater Management ❑ Shoreline Management Substantial Development** 1-11 Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Wireless Telecommunication* ❑ Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 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 r later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: 4 �,.- Date: 7 -/ _0 6 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 re in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfer b responsibilit for adhering o and-complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: /e_ Q 6 C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc • • OWNER BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assu 'ng the responsibility of the General Contractor for the proposed project. Signature:_.-/ Y 113� Date: c/g---J 6 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: W� s�«SToii /A e c e nfP",---, (36o) 9z7-644.T (3L0)4IZG-1'73 . MAILING ADDRESS: S�� tu EMAIL: �5F f�yo�J Road ys/�o�, tuck EMAIL: b calf( - CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER C,e`50 LainNAS - «aa ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New F�_//Wood Existing: ❑ Sewer ❑ Addition LDS Steel Proposed: Z. Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: 2„ Height: tYindividual S tem ❑ Repair ❑ Masonry 0 SEP Permit# — ❑ Demolition ❑ Other: Bedrooms: Water Supply. Existing: Setback: ji- rivate well ❑ Two Party Type of Heat: A Proposed: 2- ❑ Public C S /�d Total: 2 Name of System: 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: I Underground Tank 4--Above ground Tank Size of Propane Tank: 6-0 Q 4eat Stove ?took Stove 'Woodstove I Fireplace Insert I-lot Water Tank I Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home?0/ 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 For Office Use Only / Current Proposed EH 62 Main Floor /7/0 O Consistency Review: ...J 2""Floor Base fee: i 3f0 Floor Wo Pl r1L 51. Ob Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: _o.y Unheated Basement Pot Water Review fee: (I` 0 Other Unheated 911/Rd Approach fee: i Garage/Carport j` g TOTAL: $ --5D\a Decks �T Receipt Number: 8 3-1 53 Other -.��_ Cash/Ch k Number:s 5 ESTIMATED COST(REQUIRED) ; Date: CONOG .Fair market value of all labor and materials foundation to finish 11 ey CO O Jl Nnitralt: [Vw 4el .ri _._! i C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc ' ,,J; .x av f J RETURN ADDRESS Lql ST�ArAY.(nrenf of •o WAs,i/NGTon' MANUFACTURED HOME PLEASE CHECK ONE EfiD ITLE ELIMINATION licEnsinG APPLICATION ['TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty EREMOVAL 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) y4, ! 3 Zvo7 c ,-ii' ZE X 4�, /430-3icE,n,g,���r� LAND LEGAL DESCRIPTION ON PAGE AFFIXED RE L PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE pr El �,L)•? `,3t'`)2 -Q/I LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SEOTION 3O T Z Cott i? 2-, © G NTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL REGIS IEf tED OWNER �� / DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER //c)w4RD LE) u/'/NN i=M NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 5 / / ,205 F .4 1, / Ps R /3/?/NA/oN t/2 'ts'3 Z0 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 Signature of Additional Registered Owner and Title, IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of before me on by Signature PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT by PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY 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 3the manufactured home has been affixed to the real property as described. ❑ a building permit has been issued for this purpose and the attachment will be inspected upon completion. TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# NY\vt c� ra� ` (,__(0G) — � i�� eA,DG6 -`31 )5FGNAT /POSITION DATE O 2 TD-420-729 MANUF HOME APPL(R/2/02)OR(W)Page 1 of 2 MANUFACTURED HOME - FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) X 6 SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title, IF APPLICABLE Signature of Additional Legal Owner and Title, IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE State of Washington Signed or attested County of before me on by Signature PRINT NAME OF LEGAL OWNER NOTARY OR AGENT by PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date D LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office) ��-tAi - 6, o / hc� s s w s7" // i, s9 01' 55c, 3c57- . PI i 7`GC a.7`c.c, />V "1/41^J? 9?c,-c>, El DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT.THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN. ANY REQUIRED SALES TAX HAS BEEN COLLECTED. DEALER NAME(TYPED OR PRINTED) WA DEALER NUMBER DATE OF SALE PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALER'S AUTHORIZED SIGNATURE ❑ USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery). 9 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents) I certify that the above application appears to have been completed correctly,and the applicant has sufficient documentation to proceed with the recording of this form. NAME(TYPED OR PRINTED) COUNTY OFFICENFS OPERATOR NUMBER SIGNATURE DATE 10 TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES&TAX IMPORTANT: Once the application has been approved by the County Auditor/Vehicle Licensing Office, take your application form to the County Recording Office. Retain proof of the recording fees paid. If the Recording Office retains your original application form, obtain a certified copy of the recorded form. APPLICANTS: Once recorded, you must return to a Vehicle Licensing office to file the Manufactured Home Application, paying all required fees. Vehicle licensing subagents charge a service fee. For full instructions on completing this form for Title Elimination, Removal from Real Property or Transfer in Location, see form TD-420-730, Manufactured Home Application Instructions. The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation, please cal(360) 902-3600 or TTY(360) 664-8885. TD-420-729 MANUF HOME APPL(R/2/02)OR(W)Page 2 of 2 ..,. '.'1 c- : m , ,)'",.,), r _1 z . 1 Fr9 C 0\1 .919 M""H"P"1 PT'S-95 C.03 u J M = 0) U i WI c.- IV ....-- .. ......„ = cv ti, i ri 73 = 1 1 ....4 rm. = --1, M V7 , e.= e -7:1 • RI V‘ iiz`AZ tri a ,C3‘-- s i? xi cn cn ''..0 r'cre5,- / -e) v / _ R . 1 P----Ta ..•0 _ / ; Ilk , , ACRES - rcel,t,e ,• 7 ,it' , 0 I IV 7 N ( 10i • 11\tit 4 i (1\\0, q • , , . i ' ii r- qt\i';,-.. m ikr 0.' . • 2 .5,44 L. 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