Loading...
HomeMy WebLinkAboutBLD2006-00439 • • MLA06-00428 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00439 Received Date: 7/31/2006 SITE ADDRESS: 192 OLD EAGLEMOUNT RD PORT TOWNSEND, 98368 APPLICANT: ROBERT J HOFFMAN PHONE: 360-477-0494 NANCY L HOFFMAN 192 OLD EAGLE MOUNT ROAD PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: TAX 9 PARCEL NUMBER: 901304006 Section: 30 Township: 29 N Range: 01 W CONTRACTOR/ PREFERRED HOME SERVICES PHONE: 360 808-1830 DEALER: 61 HOUSE RD SEQUIM WA 98382 Contractor's License PREFEHS981 RR Expires 12/19/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW M/H SER#AB75C44920R TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SILVERCREST SETBACK: VALUATION YEAR: 1988 LABOR & INDUSTRIES APPROVAL? SIZE: 60 X 28 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL — BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: `7) 1 kip - Type Amount Paid By: Date: Receipt: j� Approved/Dat Manufactured Homes $163.00 LYK 07/31/06 83865 `� k �/ Potable Water Application $55.00 LYK 07/31/06 83865 QCT Ii 2006 Total: $218.00 Jefferson County Planning - ±anent ' 0 • 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#: BLD06-00439 Received Date: 7/31/2006 SITE ADDRESS: 192 OLD EAGLEMOUNT RD Issue Date: 10/18/2006 PORT TOWNSEND, 98368 APPLICANT: ROBERT J HOFFMAN NANCY L HOFFMAN 192 OLD EAGLE MOUNT ROAD PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: TAX 9 PARCEL#: 901304006 Section: 30 Township: 29 N Range: 01 W CONTRACTOR/ PREFERRED HOME SERVICES PHONE: 360 808-1830 DEALER 61 HOUSE RD SEQUIM WA 98382 Contractor's License PREFEHS981RR Expires 12/19/2006 PROJECT DESCRIPTION: NEW M/H SER#AB75C4492CiR MAKE: SILVERCREST YEAR: 1988 SIZE: 60 X 28 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 10/18/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPL • OUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, LA: it PADS USED): r(f) -ZD-06 Stormwater FINAL Approval: t�'TI S w 4 TCt--L urh:2 ,(A 2 4 0`7 Blocking/Plumbing: BLDek;NG E-11,40/u,s /SK //14/t0/ WuA•t61N4 z k 04,7b7P-v Propane Tank/Lines �/ Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: 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 APPROVED • • Quadra Engineering STORMWATER PLAN 240 W. Cedar St. P.O. Box 2356 Sequim, WA. 98382 OCT 1 2 2006 (360) 683-7019 n Residence File #: 06-103 JEFF RS ' du Y DEPT.OF c , 1 gle Mount Road, Port Townsend, WA 98368 SIGNATURE: S AN RE: LA06-00428, BLD06-00431ERMIT # DLD ��, c1 9 z Design: mz Date: 10/12/06 0 € 0 4 3 9 . '�2,ST3347 c) �; , Revised: JEFFERSON COUNT %Y DL EXPIRES JAN 15, 2007 Stormwater Report This report and the detail sheet (page 3) addresses stormwater management for the construction of a single-family residence (manufactured home & deck) for the subject development. A site plan has been prepared by the owner and is on file with the Department of Community Development for this project. Project Overview Construction of a manufactured home (60'x28') with a contiguous wooden deck (12'x15') on a 7.7 acre parcel. Existing Conditions Summary The 7.7 acre parcel is on the easterly downhill slope (15%-30%) of a forested area. Access to the site is via an existing private 10' wide gravel surfaced driveway (10%± max grade) from Old Eagle Mount Road. The building site is a terrace cut in the side of the hill where the existing slope was 16%±. The cut face is 8' max height and the fill face is 12' max height. The terrace is relatively level and is 130'± long and 77'± wide. The terrace has been cleared of vegetation and is gravel surfaced for use as a building pad. The entry to the building pad at the driveway (south side) has power and phone service and a well (tags ALJ148 & AHR318) is on site. The septic system is under construction on the north end of the building pad and uphill to the west. A curtain drain has been built at the toe of the cut face and captures both surface and subsurface drainage across the face of the cut, carries it around the edges of the terrace and discharges into the forest via two ADS pipes. The outlets into the forest are both heavily vegetated and show no obvious signs of erosion or sediment buildup. The cut face is eroding slightly. The fill face of the terrace does show signs of riling and erosion. It is heavily vegetated on its face. Small longitudinal cracks exist within 1' of the top edge of the fill face indicating possible sloughing may occur. Landslide Hazard The entire parcel is depicted on Jefferson County Critical Areas C:\Documents and Settings\mich\Local Settings\Temporary Internet Files\OLK31\06103 SWM Report.doc Page 1 of 3 • • Quadra Engineering 240 W. Cedar St. P.O. Box 2356 Sequim, WA. 98382 (360)683-7019 Map as lying within a Slight Landslide Hazard Zone per the US Department of Agriculture Soil Conservation Service Soil Survey which identifies a severe soil limitation for dwellings without basements within this sites' Beausite-Alderwood (BdD) complex soil type when slopes are greater than 15%. This building site has been keyed into the slope creating a relatively flat area for development. There is no visual evidence of landslide activity in the surrounding areas. No seeps were found in the area. Recommendations: • The existing curtain drains are critical to keeping the building pad dry. The existing drains are incomplete. The swale below the cut face has exposed curtain drains that needs to be properly capped at the ends and covered with rock spoils as other areas of the curtain drain have been improved. Install 2 cubic feet of rip-rap at each curtain drain outlet to protect against future erosion. • Collect stormwater runoff from new roof surfaces via gutters and downspouts and carry via closed conduit a minimum of 10' beyond the toe of the fill face into the forest and vegetated slope. Do not connect this system to the existing curtain drain. Install 2 cubic feet of rip-rap at the discharge point to promote dispersion of the stormwater and minimize erosion. • Building foundations shall be extended a minimum of 12" into undisturbed soil. Do not place foundation footings or slabs on uncompacted fill. • Finish grading shall be 10' @ 5% minimum slope away from all building foundations • The west limits of the dwelling shall be a minimum of 20.0' from the toe of the existing cut slope. The east limits of the dwelling shall be a minimum of 30.0' from the top of the existing fill slope. The proposed open deck may be constructed to within 15' of the top of the fill slope. No other building structure is recommended within 15' of the top of the fill slope, specifically the creation of impervious surfaces. • The owner shall inspect and repair any rivulets that may appear on the building pad and the cut and fill slopes on a yearly basis. Immediately repair any concentrated stormwater flows and disperse the flows to as broad an area as possible. Utilize least invasive equipment possible (i.e. hand tools) to minimize soil compaction. • Permanent ground cover shall be established on all disturbed surfaces PERMIT # BID 06 - C4T C:\Documents and Settings\mich\Local Settings\Temporary Internet Files\OLK31\061 '9 5M .dJ UIJNT1 DO Page 2 of 3 411 • LEGAL DESCRIPTION That portion of the below-described Parcels A and B, lying westerly of the following described line : LINE DESCRIPTION: COMMENCING at the Southwest corner of the Southeast 1/4 of Section 30, Township 29 North, Range 1 West, W.M. , Jefferson County, Washington; thence Easterly along the South line of said Southeast 1/4 , a distance of 543 . 55 feet; thence Southerly perpendicular to said South line of said Southeast 1/4 , a distance of 209 feet to the South line of below- described Parcel B and the TRUE POINT OF BEGINNING; thence Northerly perpendicular to the South line of said Southeast 1/4 , a distance of 627 feet , more or less, to the North line of below-described Parcel A, being the Northerly terminus of this line description. PARCEL A: That portion of the Southwest 1/4 of the Southeast 1/4 of Section 30, Township 29 North, Range 1 West, W.M. , in Jefferson County, Washington, described as follows : BEGINNING at a point on the Section line between Sections 30 and 31 of said Township and Range where the West side of Eaglemount Road Right-of-Way (as existed on March 06, 1911) intersected said Section Line; thence running North 417 . 42 feet along said Old Eaglemount County Road Right-of-Way; thence West 1, 043 . 55 feet; thence South 417 .42 feet ; thence East on said Section Line 1, 043 . 55 feet to the TRUE POINT OF BEGINNING (Tax 2) . PARCEL B: The North 209 feet (as measured from the North line thereof) of the Northwest 1/4 of the Northeast 1/4 of Section 31, Township 29 North, Range 1 West, W.M. , in Jefferson County, Washington, lying Westerly of Old Eaglemount County Road Right-of-Way. Situate in the County of Jefferson, State of Washington. 1' ECEJIVET JEFFERSON COUNTY OCR 0 SPECIAL CONDITIONS CASE # BLD06-00439 • 1.) The application was reviewed by the Jefferson County Department of Community Development staff on August 17, 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: Type 5 stream; landslide hazard area 1. 2.) 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. 3.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. 4.) The applicant is proposing to create or add 1827 square feet of impervious surface and 4030 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require the project applicant submit a stormwater plan meeting Minimum Requirements#1 through #5 of the Department of Ecology Stormwater Management Manual for Western Washington. The stormwater plan shall address measures to control stormwater, erosion and sediment during construction and shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 5.) 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. 6.) A Stormwater Plan dated October 12, 2006 prepared by Quadra Engineering 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. 7.) 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). 8.) The site plan as submitted with the building permit application on July 31, 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 October 12, 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 9.) This approval is for a manufactured home and deck 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. 10.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 11.) Not more than 2 unlicensed vehicles shall be stored on any lot 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 Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor vehicles is prohibited except in those districts where specified as an autormobile wrecking yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter 18.18 JCC, and such storage shall meet the requriements of JCC 18.20.100, Automobile wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor vehicles be stored in a critical area. 12.) Minimum setback from private ingress/egress easement rights-of-way shall be 20 feet. Minimum setback from western property boundary is 145 feet from the adjacent commercial forest lands. Minimum setback from north property boundary is 50 feet from adjacent commercial forest lands. Minimum east property boundary is 5 feet(site plan depicts 356 feet). 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.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 17.) The parcel has been designated as RR 1:20 under the Jefferson County Comphrensive Land Use Map effective August 28, 1998. 18.) An address of 192 Old Eaglemount Road, Port Townsend has been assigned to the parcel. The parcel has direct legal access from a private easement off of Old Eaglemount Road. A Declaration of Road Easement and Maintenance Agreement has been recorded on March 17, 1998 under AFN 408816. 19.) The parcel is served by an individual on-site well. Well review was finaled under USR06-0065 on August 23, 2006. 20.) A septic permit (SEP05-0281)was approved on November 2, 2005. A well review (USR06-0065)was finaled on Augusat 23, 2006. A building permit(BLD06-0440) for a deck will be issued with the manufactured home permit. 21.) On October 18, 2006 the Development Services Manager, Stacie Hoskins granted a reduction to the forest lands. The western reduction to commercial forest lands is 145 feet and norther reduction to the commercial forest lands is 50 feet. Applicant states in a letter dated October 17, 2006 that they acknowledge forest activities and do not consider them to be a nuiscance. 22.) The parcel is subject to a Declaration of Road Easement and Maintenance Agreement recorded on March 17, 1998 under AFN 408816. 23.) PRIOR TO FINAL BUILDING OCCUPANCY, PROPONENT SHALL SUBMIT A WRITTEN LETTER FROM QUADRA ENGINEERING STATING THAT THE STORMWATER FACILITY HAS BEEN CONSTRUCTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE "STORMWATER REPORT" DATED OCTOBER 12, 2006. Escrow No.: 72166KC EXHIBIT "A" LEGAL DESCRIPTION That portion of the below-described Parcels A and B, lying Westerly of the following described line: Line Description: Commencing at the Southwest corner of the Southeast 1/4 of Section 30, Township 29 North, Range 1 West, W.M., Jefferson County, Washington; thence Easterly along the South line of said Southeast 1/4, a distance of 543.55 feet; thence Southerly perpendicular to said South line of said Southeast 1/4, a distance of 209 feet to the South line of below-described Parcel B and the True Point of Beginning; thence Northerly perpendicular to the South line of said Southeast '/4, a distance of 627 feet, more or less, to the North line of below-described Parcel A, being the Northerly terminus of this line description. Parcel A: That portion of the Southwest '/4 of the Southeast 1/4 of Section 30,Township 29 North, Range 1 West, W.M., in Jefferson County, Washington, described as follows: Beginning at a point on the section line between Section 30 and 31 of said Township and Range where the West side of Eaglemount Road right-of-way(as existed on March 6, 1911) intersected said Section line; thence running North 417.42 feet along said Old Eaglemount County Road right-of-way; thence West 1,043.55 feet; thence South 417.42 feet; thence East on said Section line 1,043.55 feet to the True Point of Beginning(Tax 2). Parcel B: The North 209 feet(as measured from the North line thereof) of the Northwest 1/4 of the Northeast 1/4 of Section 31, Township 29 North, Range 1 West, W.M., in Jefferson County, Washington, lying Westerly of Old Eaglemount County Road Right-of-Way. Situate in the County of Jefferson, State of Washington. Streamline Legal Description-Exhibit"A"Rev.4/3/2008 2:25:00 PM .JOCK WESTERMAN III Jefferson Count, Courthouse ASSESSOR • PO Box 1220. II Townsend. WA98:1611 , (:hill) :185-91115 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: f • / • ADDRESS:- •��.►�:..�.�iii� , Prianfra �.�._ �..�.:....�.-�..��....��.'�-_:..- PHONE NO. 99 - 0/9ff ©YI old L-aJ 'p' ouht , 9' 2 6 g 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 whethe t; -4 ot w "tfr' already on the tax rolls in Jefferson County or if it has been mov 1� i is coun y om another area. 10MOBILE HOME DATA: (A) MAKE S IN eY C Y St (B) MODEL JEmmmBSQN COUNTY '}CII (C)YEAR 9 S" / / Ai )cC T7 Lo[oR (D) LENGTH 6D (E)WIDTH_ 2 (F) SERIAL # l' (G)YOUR PURCHASE PRICE (Do not include sales tax)pj;OuO PURCHASE DATE.0 _ 2► PREVIOTS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE ADDRESS 9'1 O ca o Pori Ainge.)es ‘,u�. cyp 3C,Z(B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUN LAST Y'IEAR? Yes If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. G M i I ea_tit 3)WHERE MOBILE HOME IS TO BE LOCATED: (A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBIL Hq M_ E PARK: NAME OF LAND OWNER: Kbi7tY1 N coo C• of 'C'lX.Al LOCATION ADDRESS 1q O L' cx(3) e"-tb AM-1oQ.1, `O(1".law iuSek REAL PROPERTY PARCEL #/DESCRIPTION 9 1 - 3 Oti O O ohQdL9 Signature o pplic THANK YOU FOR YOUR HELP! Cn JODI COSSELL. Property Technician LEGAL DESCRIPTION That portion of the below-described Parcels A and B, lying westerly of the following described line: LINE DESCRIPTION: COMMENCING at the Southwest corner of the Southeast 1/4 of Section 30, Township 29 North, Range 1 West, W.M. , Jefferson County, Washington; thence Easterly along the South line of said Southeast 1/4, a distance of 543 . 55 feet; thence Southerly perpendicular to said South line of said Southeast 1/4, a distance of 209 feet to the South line of below- described Parcel B and the TRUE POINT OF BEGINNING; thence Northerly perpendicular to the South line of said Southeast 1/4 , a distance of 627 feet, more or less, to the North line of below-described Parcel A, being the Northerly terminus of this line description. PARCEL A: That portion of the Southwest 1/4 of the Southeast 1/4 of Section 30, Township 29 North, Range 1 West, W.M. , in Jefferson County, Washington, described as follows: BEGINNING at a point on the Section line between Sections 30 and 31 of said Township and Range where the West side of Eaglemount Road Right-of-Way (as existed on March 06, 1911) intersected said Section Line; thence running North 417 .42 feet along said Old Eaglemount County Road Right-of-Way; thence West 1, 043 . 55 feet; thence South 417 .42 feet; thence East on said Section Line 1, 043 . 55 feet to the TRUE POINT OF BEGINNING (Tax 2) . PARCEL B: The North 209 feet (as measured from the North line thereof) of the Northwest 1/4 of the Northeast 1/4 of Section 31, Township 29 North, Range 1 West, W.M. , in Jefferson County, Washington, lying Westerly of Old Eaglemount County Road Right-of-Way. Situate in the County of Jefferson, State of Washington. ���,goiv cow JEFFERSONL`OUNTY t �, L • tiDEPARTMENT OF COMMUNITY DEVE:LOPMENfi C L in li Jr f ) - 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax kgs 0� www.co.jefferson.wa.us/commdevelopment I. : j0 Master Permit Application A FifS0 �a��h • d - LI .25 Project Description(include separate sheets as necessary): l u PA040Ueca_tt)•( t-st `f b fl e..., _ Tax Parcel p Property � Number: l Q / ••- 'S O� rJ 0 0 Size:7. 0 I (acres/square feet) Site Address and/or Directions to roperty: 9 0ti"t' Property Owner(s)of Record: ` 1Q\ -Q-r 1— a cA Ho-f�/�1G.k) • Telephone: — of 9 t( F : I email: Mailing Address. 7g4 e. ,e Applicant/Agent(if different from owner): 517f1 O Ai / /rAi/f-fr-1 , JQk-iToo/V E e -,. Telephone: Fax- -email./ 7' 4 Mailing Address: What kind of Permit?(Check each box that applies) l] Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑Saerage Attached/Detached ❑ Special Use(Essential Public Facilities)** Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** 1 Propane ❑ Plat Vacation/Alteration** tJ,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* Cl 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: \ 1 ESIGNATION OF AGENT 1 I hereby designate to act as mut a ent in ers relating to this application for permit(s). OWNER SIGNATURE t7` ` Date: dlf)- = 3-`o 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 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 application review and any required later inspections.Access and right of entry to this prope sttall be re sted and shall occur only during regular business hours. " vX4e-� I#,- , a- '.,,,- Signature: Date: 0 q - -- -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 lit 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 .....ion(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-trans rable responsibility for he'n to a d complying with the ESA. The Applicant has read this disclaimer nd signsigl and dates it below. Signature: t .ter. , Date: - f), 3 ` a ..-7,,,leizic")/vt7r. " ` G:\PermitCenter\FORMS\DRD FORMS\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:;o traetc,s and that they will be assuming the responsibili of the Gen ral Contractor for the proposed project. /] / Signature: 0 /Date: - 3 0 -( GENERAL CONTRACTOR r MANUFACTURED 11 ME INSTALLER: PHONE: FAX: J '�I.� �� MAILING ADDRESS: / EMAIL: CONTRACTOR'S LICENSE = ��L:'.s L H.S'0 Lf/4f.3 WAINS NUMBER: NUMBER / 5-3 ARCHITECT/ENGINEER: i PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: fi 1 ew iVWood Existing: ,+ ['newer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ,, ' ❑ Alteration/Remodel ❑ Concrete Total: 'L Height: [1 Individual System, t b7 ❑ Repair ❑ Masonry SEP Permit# zh\i ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: 3 Setback: ,Private well fwo Party Type of Heat: , Proposed: ❑ Public E 1 t c_1Y r; c. Total: .3 Name of System: Wao cJ 1 7 A If this is a Commercial Proiect you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: !�, ❑ Underground Tank ❑ Above ground Tank Size of Propane Tank: Li Heat Stove 11 Cook Stove LI Woodstove ❑ Fireplace Insert II Hot Water Tank ❑ Pellet Stove ❑ Other �./A„ Is this appliance being installed in a Manufactured/Mobile Home? Yes / No •( When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage For Office Use Only Current Proposed e-fi3Lciet.9dilount cos Main Floor Consistency Re iew: 2N0 Floor Base fee: 3rd Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: co w Other Unheated 911/Rd Approach fee: Garage/Carport r� O) TOTAL: $ � 1 Decks Receipt Number: 2 3? 65 Other Cash/Check Number: ! 6 8.6 / ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: C G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc RETURN ADDRESS Robert J.Hoffman and Nancy L.Hoffman 192 Old Eaglemount Rd Port Townsend,WA 98368 L1 2,74T yaEM1n4, sH,NaTON MANUFACTURED HOME PLEASE CHECK ONE I/icEnsinc APPLICATION co TITLE El ELIMINATION IN LOCATION TION ❑REMOVAL FROM REAL PROPERTY Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imirisonment,or both. (P,CW 46.12.210) MANUFACTURED HOME ^� TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VTN) +512657 1988 Silvercrest 60/28 A1375C4490R © LAND LEGAL DESCRIPTION ON PAGE 3 MANUFACTURED HOME WILL BE ®AFFIXED 0 REMOVED REAL PROPERTY TAX PARCEL NUMBER 901 304 006 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION Ptn SW SE 30-29-1W SE © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Robert J.Hoffman NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Nancy L. Hoffman ADDRESS CITY STATE ZIP CODE 192 Old Eaglemount Road Port Townsend WA 98365 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Washington Mutual Bank NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 3050 Highland Parkway,Suite 500 Downer Grove IL 60515 GRANTEE NAME Robert J.Hoffman and Nancy L. Hoffman 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: p � Signature of Registered Owner and Title,IF APPLICABLEvo Signature of Additional Registered Owner and Title,IF APPLICABLE f. �I,�' '�`� �•%-.�4 ' N1AI�Y SIAIyORrST41/IP1. NOTARIZATION/CERT/ ( \ \ T TION FOR R GIST^•E' OWNS' GNAT ' at c'Washington Signed or sted Notary Public r� County of Jefferson befor eon I Stet.Of Washington by robert.1.Hoffman Signature RC LORI A MURRAY ii.INTED NAME OF REGISTERED OWNER TARP OR AGENT My Aopolntmrnt Ixplr.s Jun 9,2012 ' �/A by dlgncy L.Hoffman v 4INTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY w County/Office No.OR. Title Notary Public AND: Dealer No.OR,TC/1e q 420/a DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 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 Jefferson Title Company (360)385-2000 SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative s!ns. HI BUILDING PERMIT OFFICE CERTIFICATION I certify that: ® the 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. E(TYPED OR PRINTED) BLUG PERMIT OFFICE PHONE# BLDG PERMIT# [�l` �� A C��� 360 379 4450 06-00439 \slutATURE POSITI js. D TE TD-420-729 MANUF HOME APPL(R/2/02)EXT(W Page 1 of 2 RETURN ADDRESS Robert J.Hoffman Nancy L.Hoffman 192 Old Eaglemount Rd. Port Townsend,WA 98368 141STATEm f SHINGTON MANUFACTURED HOME PLEASE CHECK ON licEnsinc APPLICATION x TITLE ELIMINATION ❑TRANSFER IN LOCATION ❑REMOVAL FROM REAL PROPERTY Anyone who knowingly makes a false statement of a material fact is guilty 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) I Z_(�I 1988 Silvercrest 60/28 AB75C44920R LAND LEGAL DESCRIPTION ON PAGE REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE x AFFIXED 0 REMOVED 901 304 006 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION // ® GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 I NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Robert J.Hoffman NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Nancy L.Hoffman ADDRESS CITY STATE ZIP CODE 192 Old Eaglemount Road Port Townsend WA 98365 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Washington Mutual Bank NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 3050 Highland Parkway,Suite 500 Downer Grove IL 60515 GRANTEE NAME Robert J.Hoffman and Nancy L.Hoffman 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 Signatu,rsmO dit M))egistered Owner and Title,IF APPLICABLE. ..<*/ , ; R•,,Y Y 014 //!� NOTARIZATION/CERTIFICA ION FOR RE ISTERED ER S)SIGNATURE \` A,X\ ,,.•••••••• X. /�State of Washington Signed or attested , 1 ��(/ ,• `A County of Jefferson ,-fore i -on 9 `•. Y•••. ' • •• ♦ig Robert J.Hoffman10 [� ! •02�1312,,n • PRINTED NAME OF REGISTERED OWNER ••ARY O• G 00 NA Ex PUB`�G . 0. „sip."' Nancy L.Hoffman f+,IN 9J, C1 � ••••••..... 0 P INTED NAME OF RE64S�ERED OWNER ••INTED NAME OF NOTAR OF W PS�\�`,* County/Office No. S R }� �� , AND: Dealer No.OR I / /////8/11t�ttt��\\\\\\ Title L.�' 1 C DE L SHIP POSITI N/AGENT/NOTARY Notary Expiration Date © 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 Jefferson Title Company (360)385-2000 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: M the 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. NAME(TYPED OR 15h t- Sc-h e ii K r BLDG PERMIT� # BI•D�FERMI SIGNATURE/POSIT�N h J\ '7 50 1�'/yl[J DATE (1,Ni ,k LtypC I�-�1AIL � fed rn i n Ctei K LI)a t-I-lo?c TD-420-729 MA HOME APPL(R/2/02)EXT(W Page 1 of 2 MANUFACTURED HOME—FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) —� �s ski&+ �o X1 Y+1-1 .C:1�(1ZZL 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 REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of Jefferson before me on by Signature PRINTED NAME OF REGISTERED OWNER NOTARY OR AGENT by PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 011 LAND DESCRIPTION(A legal description of the land can be obtained from the local County Assessor's Office.) AS FULLY DESCRIBED IN EXHIBIT"A",ATTACHED HERETO AND MADE A PART HEREOF. al DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT,THE VEHICLES 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 $ El USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). ggi 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 OFFICE/VFS OPERATOR NUMBER SIGNATURE DATE ® 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 call(360)902-3600 or TTY(360)664-8885. TD-420-729 MANUF HOME APPL(R/2/02)EXT(W)Page 2 of 2 - 28'-0" `n _— 'n ern w x 0 o_ m N m - 4.rj X _ — 4 1 _. tJ r- ,_ r- h co X D (7 -i o = - O 73 ) i et X r m W - cn r Fri 0 'n o o° `° z n z c o coO k _ 0 cn Zen _ �h 7-1 -o 3 ; D ? _ Z r ? __ s C C-L1 x T 1 7.1 o Z o n ,- 11 —1 0 _ o ▪ C b p o 71X Z : m - _ 6 O al0 03 cnm � D 0' m u' , = c °° z 8 73 r 6 m A -1 _ x ; z = ? W O m C° D x- p - m m O N 03 = D \ 2 CO N 0 Z J M X -1 ' X X 00 ;U —' rn CO `� oo Q og n r0 K Nm w .0 -{ 4O x 73 _ n 6 = mi _ _ 547.62 11 m Fri53 < ra u J L J • ''L'.J .y C: O m> '-'-J 11, _) 1 r- �. O� � "Y� 4 t f 73 �� � -NE m nYSI/b 3NI1)OV8J S 113M OO - \ f� CO < �; bJ, p7l ��� E` r, .► �L O ONOd ,_/'�' .6 e��/ �' I �'� .��s� ,••NV r, //'/f� 1, 0, ``' �� ,�� �bs '���' sadoa�3nda . Mo��d s `:iiNi `.��/ api , › / , i 0m 1` ,• IJ. ', ti CO m m ONOd \\ e s rn �� SECTION LINE O ` t+ O ,', \(c a� ---- __-J- jr - 3NIlHOd813sll3M,OOL . �' m r zN = CD 4/��i rn--I l i X v W cis 1 ,, CI 4, _ D N Z CO 2J3n1n0 / c \ (7;26 o O <-r; i - '' l Z e...‘Xl c=71 C) * m-0 rxr ic„ 4111!!! v Co -1 r-- / 1 \‘‘ z m m! r A D O "C C / 4 OO N I C M ( , . \ 0 E to Dm �. © / i I� fl X73 rn D + n n�o m n o�1 ci, ', rr _ �>' _ D CO rn /� r an d 0--o - m 1 J I --. -' z, x _ U �o? m O �1 I � E �t C C, C D m o m 4 o 7 �, D m T� Q w u) c . c0.O �,. O z a) I R,i�- - D r -. 1 D ;o° �r -I . joh = m -i \ O o cy-. �m D -� \, \ a5, i - r OrrX1f�m, ').....____::..,.....________.f.0. •\P °(1) ‘ o\ K--- . - NJ M CO 1 . I , t %.1•r, ( %, , .:\__,) \ -Jr" .,t rn CD r ..•.', NI\r A 1 # \ \ *--4 , >4 --.-.4 -0 i 1 . yaw 1 ci„......-. _,,,„.-• , 1 :s.,0 91 i I i a 16,e_ cL‘,_-11:-.C)I- \ (A) -z rr1 --I 1-3 'It ord. til i. ` \ t\ O H \ 8 4 —. 1, W RT p y‘ o \\ IV o Oc \ - - •- _ --_ \.. - --- �r-_._. ! N .�_•._ -------r s-_ , �-wa,�i Win,,use J �ti a5� 08'LOb to I ,�; .a lr dr.. , 86 �ZE t�Zg �� 8 t s \ J < ` ; Z M 7, `rw e -' O _ - • `� 0; I — - - + [.''� m.t rin LT -oCD 2pp'o C"3 r d C) m / I�1 _ \ / h ;c> ri mrn mo m>O m O / 4y,, �c�i» c�'i»� � � ,TmJ /�-, ll D7mpm ,/ \ c� C0 � � ' cn0nm mtz� v ce,5 °-DID-IT pQm rn CZ / C'r1` M u m � rnD � -4 \ pcnoo � XXmy 70n ri 73Z / z -i -I - � h. \ O Zc� cn O O � h mC� / it- 'rl0 OC / s(--ii( ^\ mo � � I i\Ii ; po o=zDZ GCp D � cn�cn cn m O Z / G �r• C- C;72 \ �� oDorC �mZ f�it� 0I .Z�I --I / • • XS� I JC� - . _ 32'. \\ ID ��y� �O D - / • / n '1 �t _� cn 1 2 r-- .-0 \Ivo, W' V" . . j 0 m (,) 0 r.- I c rn Z O73 0 C C77 I id. / w r/ri { o n Z ...-• h: ' ' O o m w� ADO � Zmo co r0 r� � g • g Q � � _ .b...-11 Q, 0 o v cn CI) � < 0 m z H Z .A y [�7I I -� N �wj .�Ib'�5' F-- i CD zCO 0) % i\ $_� It, p- " i 2 X '-• II zx � 4D l r i Z* * El * -‹ -I Q 1o1zg q r / N D Z o Np $5 s'S 4 \ A / z illz co WI) \ „;, 1'- T. \--' P-\--P 6. NW \ ✓ . \ / co . m \ - - .1______,.. -"A ° _ .... / NORTH PROPERTY LINE J II •` ,.0