HomeMy WebLinkAboutBLD2006-00569 •JILDING PERMIT APPLICATIN MLA
06-00553
YID
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00569 Received Date: 10/3/2006
SITE ADDRESS: RAINIER LN
PORT LUDLOW, 98365
OWNER: STEPHEN R LAND TRUSTEE PHONE: 360-821-9672
CAROL A LAND TRUSTEE
222 CRESTVIEW DR
PORT LUDLOW WA 983658003 PORT LUDLOW NO. 1 AREA 4
SUBDIVISION: Block: Lot: 39
PARCEL NUMBER: 990400439 Section: 8 Township: 28 N Range: 01 E
CONTRACTOR: TERHUNE CUSTOM HOMES PHONE: (360) 681-8898
PO BOX 3125
SEQUIM WA 98382
Contractor's License TERHUCH984MA Expires 7/1/2008
REPRESENTATIVE: TERHUNE CUSTOM HOMES PHONE: (360) 681-8898
PO BOX 3125
SEQUIM WA 98382
PROJECT DESCRIPTIOI NSFR W/ATT GARAGE & A/G 125 GAL PROP TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 2,583
VALUATION 292,000.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: 1,002 SETBACK:
DECK: 349 BANK HEIGHT:
SEWAGE DISPOSAL: SEW
WATER SYSTEM: LUDLOW
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 4 Prop: 2
Total: 4 Total: 2
Routing Date:
31(140
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,912.15 LYK 10/03/06 85064 ;u s
Plan Check $1,242.90 LYK 10/03/06 85064 2 y,.
State Building Code $4.50 LYK 10/03/06 85064 NOV
2006
Potable Water Application $55.00 LYK 10/03/06 85064
Total: $3,214.55 J!I;fferson County Plannir,
Ruildino Oehartm-
i
• •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00569 Received Date 10/3/2006
SITE ADDRESS: 331 RAINIER LN Issue Date 11/8/2006
PORT LUDLOW, 98365
APPLICANT: STEPHEN R LAND TRUSTEE PHONE: 360-821-9672
CAROL A LAND TRUSTEE
P.O. BOX 65266
PORT LUDLOW WA 983658003
SUBDIVISION: PORT LUDLOW NO. 1 Block: Lot: 39
PARCEL NUMBER: 990400439 Section: 8 Township: 28 N Range: 01 E
CONTRACTOR: TERHUNE CUSTOM HOMES PHONE: (360) 681-8898
PO BOX 3125
SEQUIM WA 98382
Contractor's License: TERHUCH984MA Expires: 7/1/2008
PROJECT DESCRIPTION: NSFR W/ATT GARAGE &A/G 125 GAL PROP TANK
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: ? ' fi 8/a 171
U F F E R: dik /i/ aG ,
Footing: ; /z s*,
Foundation: OiZ- o/moo 4
Stormwater FINAL Approval: /'ndnmz C lt6HTLfu&01 :ereO
Underground Plumbing:
Underground Insulation:
/Shear Wall : 1.0,at0 4L1jc7
Sheathing:yf2-`2-? b'?
Framing: u/Fhie I �7v'0..j
Plumbing: -2*()1 V✓\
Propane Tank/ Lines: Ili iit LATgD
Insulation: Fie Seams a,L s.3 47 -'%' LiNLcS 4 eti'i 6K [cM ,w5 /2.q/,7y
Sheetrock: An- C/jB sNEwily/Sus' 40, 3 f v aog At 5 .1e f /
Septic Sytem Final Approval MUST be obtained before final of structure can be ttempted.
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: eV -Por c o. yjaRerHEALTH DEPARTMENT AND PUBLIC WORKS APPLIRED 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
1
• •
SPECIAL CONDITIONS FOR CASE t BLD06-00569
1.) 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.
2.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
3.) 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.
4.) Minimum setback from Rainer Lane right-of-way shall be 20 feet. Minimum side and rear
yard setbacks shall be 5 feet.
5.) 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.
6.) 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.
7.) The building height is not to exceed 35 feet.
8.) Maximum lot coverage is not to exceed 45%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
9.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
10.) Per MPR Code Section 3.17, Accessory dwelling units (ADU's) shall not be allowed in the
MPR-SF zone.
11.) All stormwater from patios and/or sidewalks shall be dispersed of on site. The driveway
shall be at such a grade as to allow the stormwater to enter into the county road ditch and
shall not be allowed to drain onto neighboring properties.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
• i •
14 \-A �bA '4NOV Q 6 Al
a '
0
m •
� ` ` O0
A�tttO fAtti
0
Lc)
o F
rc� C
z lu
•
ti
0
A�
Q vr'y-6 kklet�k d
eock-
PERMIT # BID
/21, tea. .. h
EFFEBSUN a.; != BC1.
M` iY C +YrCvytC- {rbuS�
S ( .11erstw APPROVED
- < 3� — J IZ ItSTORMWATER PLAN
O lnin A- 1. 6. 6.0.6 is -'r
r ,,� � � Fo 0 NOV - 7 2006
pc
"C"'4o JEFFER O U TY
DEPT.OF ('C .� DF: ti
SIGNATI;RE-
Ed WHSS:90 900c L0 '60N bSLS L2h 092 : Oh! dNOHd um f'10iuni 1 d : WO;�d
i IP
OWNER BUII.PEt3 STATEMENT
l"
The signer of,tht§statement does treby certify that they acre l vyners the parcel referenceeherei at they are not licensed contractors and that
they will,bd assuming the responsibility of the General tractor for propose�r project.
�u
Signature:
GENERAL CONTRACTo PHONE: FAX:
.•V 4Lu I'l. _ (.1_ , �--ti:!. Y Ili,'N *- AiN 04 - ' afG 0 )(CZ t- mil-`? (C.a)c�� , - t t';
MAIUNG ADDRESS: C �''
.p('�.�GX BIZ-= �.�'Ca�1_u� L,��L:. �� ,�Z
CONTRACTOR'S LICENSE WAINS
NUMBER: , -Y tA,ULC_V-V—lC)'l I'lu-1 NUMBER 710 b
ARCHITECT/ENGINEER: PHONE ( -,(.)) r Ax:(? )
MAILING ADDRESS: 31U) EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New ) Wood -•Misting: _ _ A Sewer
J Addition u Steel Proposed: Bank u Community System
Alteration/Remodel u Concrete Total: / Height: u Individual System
7 Repair ❑ Masonry SEP Permit#
Bedrooms: Supply:
7 Demolition U Other. ;' Water Su
Existing: Setback: u Private well u Two Party
Type of Heat:,, Proposed: -t Public
1 1C'c'`.{ 1 't,�pL:17 Total: i i ___` Name of System:
If this is a commercial Project you must answer the following:
Number Parking_Spaces: 1current: —- / Proposed:_ / Number of-ADA Parking Spaces:
-' Numbe if occcup'ants(inclu s owners;tenants,employees;etc) Current J_- Q/oposed— 1
IBC Occc panty: 13-C Type of contruction: �"Will you have&o d-Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tank c ove ground Tartk* Size of Propane Tank: ;. c : ( i, `t
1 Heat Stove 1 Cook Stove 1 Woodstove AQFireplace Insert 1 Hot Water Tank 1 Pellet Stove Al.Other r)-e
Is this appliance being installed in a Manufactured!Mobile Home? Yes ("Flo•
When applying fora 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 Fur Office Use Only Y` xar' �' --
Current Proposed tint -iu i
Main Floor ,:I y1z,9.CIT rsistency Review:
210D Floor Base fee: [CI VS74
3 Floor A4* al Section: 4.
Mezzanine: - Plan Check fee: - - -_
Ott �
Heated Basement / State Surcharge fee: J Jet 51)Unheated Basement Pot JVater Review fee: (` 0
Other Unheated 911/Rd Approach fee:
Garage/Carport I CO l ( , ----TOTAL: $ - -- � •t 1
Decks �a Z .6ZS � Recaipt Number: j
Other 31210. Casa/Check Number:
Cbli C,\ CSC
ESTIMATED COST(REQUIRED) 2 j-I Date:
FFair market value of all labor and erials ff 'n to tmi' (0.
CF �-, CC�1 Initials
C:\Documents and Settings\mocha\Desktop\Master Permit Application 7-8-04.doc
0 •
- JEFFERSON COUNTY
e i ADEPARTMENT OF COMMUNITY DEVELOPMENT
t
``f 621 Sheridan Street• Port Townsend•Washington 98368
360/379-4450. 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
L•jMaster Permit Application MLA: �b� �
Project Description(include separate sheets as necessary):
ax Parcel
1 . Property
T Number. �dl C' LA C.C.` 1. ? Size: '., = -' ('(acreslsquare feet)
Site Address and/or Directions to Property: -A.-L\1\-r. ' ` rr
Property Owner(s)of Record: "; ��l^O ►mil «. 1/ 1i " t Yll.l ��2
Telephone: )„" F G t ` k 1�2r Fax: email:
V(U Mailing Address: - UC` `
A (e'Z:.�Ze>' W d A-- \7-:�\o L l-kxi U . ci air-5
Applicant/Agent(if different from owner): -1- V milk , C_L,Lc7Z'i v\ -\c Ole_`�
Telephone:?.0 -(ceL';1-- S '``t`1€` Fax: ,f:�#)—(_.P,t---1'.I email:
Mailing Address:T'(-- 'P). (' ?C 53 i Z`: `x`'-(;�LL,k $t VI r lr. .NC l• --IF 307.
What kind of Permit?(Check each box that applies)
}d6uilding U Variance(Minor,Major or Reasonable Economic Use)
U Demolition Permit U Conditional Use[C(a),C(d) or CJ**
.k'Single Family U Discretionary"D"or Unnamed Use Classification
Ott GaragecAttachea/Detached U Special Use(Essential Public Facilities)*"
U Manufactured Home U Boundary Line Adjustment
U Modular U Short Plat**
U Commercial* u Binding Site Plan**
u Change of Use U Long Plat**
*I'Address JtRoad Approach U Planned Rural Residential Development(PRRD)/Amendments**
fist Propane U Plat Vacation/Alteration**
U Allowed"Yes"Use Consistency Analysis U Shoreline Master Program Exemption/Permit Revisions**
AI Stormwater Management u Shoreline Management Substantial Development'*
U Site Plan Approval Advance Determination(SPAAD)* u Shoreline Management Variance
U Temporary Use u Comprehensive Plan/UDC/Land Use District Map Amendment
U Wireless Telecommunication* U Jefferson County Shoreline Master Program Amendment
U 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 tnie 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 iced later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. f--
Signat4: Date: "" -
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if are in,00mpkance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-I bltrr—op brlity for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: 1. Date: e� '0(O
C:\Documents and Settings\model\Desktop\Master Permit Application 7-8-04.doc
• •
, ON
101PV, JEFFERSON COUNTY
ki it
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend • Washington 98368
Iszaw
0 O 360/379-4450 • 360/379-4451 Fax
http•//www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMP
LATE
MLA# OCP" PROJECT/APPLICANT NAME: t_
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.
-toe.. S i..4-e v::*_GLY1
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
--t-bi-r3LS 6 T aL(fv_eikci. -79-civvv-PAA_-t-- 46 Lckcie____.
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.
Ala-1,-
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.
6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
STORMWATER PLAN
PERMIT # RD
stormwater sae plan template—rev.10/1/2003 + +. �': JEFFERS C U, TY
JEFFERSON �(I DEPT OF , 1 Y I EVE OP ENT s,
SIG\ATURt ( -
• •
-
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.).
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.
n- rvo• -rva c_, c'vi 4 9£
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.
11\
12. Describe the flow control system.
PERM1T .# RjP
°.c ;)
JEFFERSON C UC
6
stormwater she plan template—rev.10/12003
• •
13. Describe the water quality system.
14. Describe the conveyance system analysis and design.
ally a a E, O■ ►mac
fib 4 • - •_A....1 =1_
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
• -WPM •
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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. l
/
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.
Iv t:
0
JEFFERSON COMMf OCR
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
wilt 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.
se e i.-4e. -Fk-0—A/1
2. Establish Construction Access.
See_ S A--e_ �Lc�.�✓�
8V a u-e 9 w C-
3. Control Flow Rates.
p /�-
Q�
4. Install Sediment Controls.
5. Stabilize Soils.
6. Protect Slopes.
7. Protect Drain Inlets.
8
stommwater site plan template—rev.10/12003
•
•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
Alb
9. Control Pollutants.
t �
10. Control De-Watering(the act of pumping groundwater orstormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
•
IMP
1 1 �� � v AEI >i
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.
JEFFERSON Clitr
stormwater site plan terrplate—rev.10/12003
9
• •
b. Description of special requirements for working in or near environmentally sensitive areas.
N f(� .
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).
N--) ( iv
5. Construction Phasing.
a. Construction sequence
V
b. Construction pha ing ' r po ed)A-
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule. ���� ` Zo�-'--1
kc0 -\ N 6V 2 -Ft 11
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
/1\--
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
; >� k C'o...,v O k Lc
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts. .
i ,..\,_,
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/fraps. ER '
b. Diversions. f •
mu
C. Waterways.
d. Runoff/Storrnwater Detention Calculations
JEFFERSruiw 666 ii 11 b
10
storrnwater site plan template—rev.10/12003
• • •
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 stomiwater 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
that the information provided herein is true and
By signing the Construction SWPPP worksheet, I as the applicant/owner is st made with the full knowledge and consent of all
correct to the best of my knowledge. I also certify that this applicationbeing
owners of the affected property.
(91
(LAN OWNER AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
PERMIT # BLD
0 6r 5 6 q
JEFFERSON COUNTY DCE
12
stormwater site plan template—rev.10/12003
.SON c
• •
44 i6A JEFFERSON COUNTY
�\ d- h DEPARTMENT OF COMMUNITY DEVELOPMENT RE C E rr
. . 621 Sheridan Street•Port Townsend•Washington 98368
•�YssNcoa 360/379-4450.800/831-2678 .360/379-4451 Fax
www.co.jefferson.wa.us/co.mmdevelopment T , `
Master Land Use Permit Application Form
PROPERTY INFORMATION
Tax Parcel Number. DDILI� E E �' (
Subdivision Name: 1 t r it L.-A-(-, U L' 1 1' 4 �F
k.!_ Lot Number:
Property Size: -3—S3 Efes/square feet) Existing Use of Property: VC. 0L11 1-
Site Address and/or Directions to Property: -4 v 14 1 Cc, k ' Oa . tA)i.'55-{ C v 1 AN L1_ LC C t
L,V;f LL . K�01 -t te I L I 1 Li'_L I�.k i k L Lk_ .L.- v Ii.i 1z[ C L' ,
i 1 Li C Yt y , cIi,Cl
APPLICANT&OWNER INFORMATIONCil ``
Applicant(if applicable): l_L ti✓ Telephone: Z l Cl(L`l
► 1�-t1 �LIYL: �C1
Address: Y. O• e3C,/C (C`3Z L-k-
City: i :Y i L,LakiiLr State:. , ;':\ Zip Code``?C+ 'fj Email Address ('-
Applicant's Signature: / 9"'4) < C o in
Property Owner(s)of Record: Telephone:
Address: 1 1 b fit.
City: State: Zip Code: Email Address
I acknowledge that the applicant above is applying for a building permit on my property.
Owner's Signature:
I hereby designate to act as my agent in matters relating to this application for pemiit(s).
Agent's Contact Telephone: Address:
(PROPERTY OWNER SIGNATURE) (DATE)
DESCRIPTION OF PROPOSED USE OR ACTIVITY(include separate sheets as necessary)
C lc,Nt \;_J\y' LAC'_1 C.: L-‘ it %C\v c, N, 1 `7 - \/
CCU:.-a (y lb Gee f
[THIS SECTION FOR OFFICE USE ONLY]
Refer to the specific sections of the UDC referenced below for more information and further requirements. An asterisk(*)indicates
that a supplemental application or questionnaire may be required.
Type 1 Permits Refer to:
❑ Septic Permit/Evaluation of Existing System(EES) UDC Section 6.4.1 and Chapter 8.15 JCC
❑ Building/Demolition Permit UDC Section 3.2.1 and Table 3-1
❑ Allowed"Yes" Use Consistency Analysis UDC Section 3.2.1 and Table 3-1
❑ Home Business Table 3-1 and UDC Section 4.20
❑ Stormwater Management* UDC Section 6.7
❑ Road Access* UDC Section 6.8
❑ Boundary Line Adjustment* UDC Section 7.2
❑ Minor PRRD Amendments UDC Section 3.6.13.15
❑ Sign Permit* UDC Section 6.15
❑ Site Plan Approval Advance Determination(SPAAD) UDC Section 8.7
❑ Shoreline Master Program Exemption/Permit Revisions UDC Section 5
❑ Temporary Use(based on use may be Type II or Type III)* UDC Sections 4.38 and 4.39 (OVER)
MASTER LAND USE PERMrr.DOC REV.11/182003
r
Type II Permits • Refer to: i '
❑ Discretionary"D"or Unnamed Use Classification UDC Sections 3.2.1, 3.2.2 and Table 3-1
❑ Cottage Industry UDC Section 7.3 and Table 3-1
❑ Short Plat, Preliminary and Final* UDC Section 7.3
❑ Binding Site Plan* UDC Section 7.5
❑ Conditional (Administrative)"C(a)" Use UDC Table 3-1 and Section 8.8
❑ Conditional(Discretionary)"C(d)"Use UDC Table 3-1 and Section 8.8(Discretionary Permit
Review Process Determined by Administrator)
❑ Variance,Minor* UDC Section 8.9
❑ Wireless Telecommunication Ordinance 06-0712-99(UDC Appendix C)
❑ Shoreline Substantial Development(Primary Use) UDC Section 5
❑ Forest Practices Act/Release of Six-Year Moratorium for Single- UDC Section 4.16.5(c) .
Family Residence
❑ Appeal UDC Section 8.4.2 SEPA 8.10.12(b)
Type III Permits
❑ Conditional"C"Use UDC Section 8.8
❑ Long Plat, Preliminary* UDC Section 7.4
❑ Planned Rural Residential Development Preliminary Approval UDC Section 3.6.13(must be in conjunction with an
(PRRD)and Major Amendments* underlying land division application)
❑ Plat Vacation/Alteration UDC Section 7.1.3(d)
❑ Variance,Major* UDC Section 8.9
❑ Reasonable Economic Use Variance* UDC Section 3.6.4(h)
❑ Wireless Telecommunication Ordinance 06-0712-99 UDC Appendix C
❑ Shoreline Management Substantial Development,Secondary Use* UDC Section 5
❑ Shoreline Management Conditional Use* UDC Section 5
❑ Shoreline Management Variance* UDC Section 5
❑ Appeal UDC Section 8.4.3 SEPA 8.10.12(c)
Type IV Permits
❑ Long Plat,Final UDC Section 7.4
❑ PRRD, Final UDC Section 3.6.13
Type V Permits
❑ Special Use(Essential Public Facilities) UDC Section 3.3.5
❑ Jefferson County Comprehensive Plan/UDC/Land Use District Map UDC Section 9
Amendment*
❑ Jefferson County Shoreline Master Program Amendment* UDC Section 5
❑ Appeal of SEPA UDC Section 8.10.12(d)
Other Local,State or Federal Permits
❑ Please identify any other local,state or federal permits required for this proposal,if known:
ACKNOWLEDGEMENTS [PLEASE NOTE THAT TWO SIGNATURES ARE REQUIRED]
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their
knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property.Any
material falsehood or any omission of a material fact made by the applicant/owner 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 required later inspections. This right of entry shall expire when the County (through the Administrator or the
Administrator's representatives)concludes the application has complied with all applicable laws and regulation Ac s and right of entry to
the ap�)ica t' p y III besequ�ste shall occur only during regular business hours.
1. ( f
PROP TY OWNE (DATE)
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened
or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as
the "Endangered Species Act" or "ESA." Jefferson County makes no assurances to the applicant that the actions that will be undertaken
because this permit has been issued will not violate the ESA. Any individual, group or agency can file a lawsuit on behalf of an endangered
species regarding your action(s)even if you are in compliance with the Jefferson County development code
The Applicant acknowledges that he, she or it holds individual and non-transferable responsibility for adheri g t 'and complying with the
ESA. The A' licant as read this disclaimer and signs and dates it below.
2.
PROPER 0 R ATE)
I
w
3r � . 7 +_
�< ....
A"D---_N..AiLLT_.---"-T-"--"-------,......,,,_____,
70 A,5E -.ON7; ETA wm
I T��CK ('C�� �V <
to �r— -I Z >
o rn
Z IF
U m
70 v 9-1r��cncn
tri_I < �, NmOOD-,n
i no�r� N1„H7„m> I
(7I OrnD<O Nz, O�w
rn -
� co� <n>z rn �rn���rnrn I I
I-� 3 n -CI C' 70 I- 2 c D 44
D •
I O rn D �T7 n• 1- ,�. I I U
70
m 70� #ODC) 1—
(� O
} = O O ID
CD OD_
�
CO �
-
r----'�CO _I Irn0 /I� 7Ornl,IO APORc 1' rn
to > `°< cnDwD
_ ( nN � �z
7 N _ �, p7C
O
n vi �/
�� rnI B1 DROO rn o
���� RESIDENCE r
cn
...- I
nun OE. LTr L
Z
77 3II I MM DECK
re p - D Z'
iii \\, 0 l t
i
to /' 16 ' 60'--0" - I VI-6'r non'
c*�
/' n 1,.1 1n
0 g a=
O
Z • r o ao<
/ I 7--- I Irn gno'nnco,
• I I w V
11�*'-p 3
I EXISTINN. STUB -DP g w g R.
OUT TO tiRAINAGE
PIPE I
n
I I
I 5' REAR 1'aA Ii SETBACK \
(TO EAVES: ,1 \ to,-
Nrn
�rn 5' UTILITY EASEMENT
. n < —
15 _1S '
- I— F i Imi
. _ �I_ ]Ti= L JL z
4D 1.2
y x
o I c4 � y or>, o
zz
o
<* >=
ZO (, rn p , ..! C)
D7' t13 1 I of ril ba CI)u 12 RI oc cri n
pzi
It r� m UCD
b II
_
1 Tug 1 I-1(f= �I o T "v 1 ' 1 CJ'mil oNmNu)O u) O ti.S? `�' :az c....: ;'),,4
-"'I yr7,3 . aomcn-.iK Roe'rri" L" �pr�* m 1ov = t� c_* fir. T:7111".111
00 a-'zo >o -n W MT: Uo -)Lo
r p L•- rD �
o Q rn amy;- C "
zorn��3o E ';a. tumuli
i f' 0.
e
i 12,4" ,2-6" F 2-6" 20'-10" 12,6"
tr-fr 5•-10" 4=13" 4'-17 4-4"--e5 0" 5'--a - 8,6" 5=2' T-4"
i
OD 'd Ewe aA
3..D.tal Ir GSIL T..SU.i V iL
Fatro D errO� t a Entae tier
9.e Oeta r(:JIL Tr Shp $era Dee/fa-CSIL Tr St.mr V
C d'Rc k.♦ ♦ , —.SIB --
ito
N\ Y4 ` vess io
i
eck04
Iv: mg_ rc norr.rab
111111
a`u / TBD m mte BBC! Stub rat
J
r- Nook bs B`-'�"lb TBD b
' Store- orb in
5'b5,.,Ewes. 13'-4• x 13'0' ••• Yx71O' Angle 3'r2'0• Angle
1 1 Hardwood Ib IUadaa Above Cba'10• Pic Above Above
N 3Ssdr CbCRc 3'bd'
u i0
U I i FrmtendPrapwte O ;�
o e✓ tAe
' Bedroom#3 - r___, eI I 4' aba boas e grew
17-0' x II'-0• Hdfd J DW I <i! i\ f r� /�`
8=1 T' 3'-r et
0 s�,' 2,17
ate, ' O•.. I $7'I Fist Soffit `^
II
_ — lima I X I X I Grov e i it ( \•
ri\ C Blrab 3� r I/ \ _E!i\I I a sl Great Room I Master Suite
RIS u OR 7 Pt
ml 1v-0' x rr o• c.wtI I3'-8• x T5 2 Hoed
` t* r..V ; itl,ti I Vaulted Ceding b l 1 I/2• dropped casing ( b
C ,ab�r -pee et al o I n
x, r0• ! it tii1
♦ I
i was 3'0' Kitchen i I
01
/ •
�. I I . t Hartle x rt-r of I `\\ r,° �/
ct
Hardwood a 3-3" Y4 Hardwwf
P N Ha a - 16,0" I 1 3 CP 4,4" t 10,2'
to ca? He.a� \ h —� rn �� O 7 3.0. 1 PLed sr Raf. ✓ a I I r7
, 2%t baring 7Q-- a 1 rrVsi:ad Celr� .\ I 3.0, Pk r�—el /F-
v B \ —�-- Flat Ceuta t ,♦ C
2.-er Y--tr 5,9" nor a
�,- C BRdd l ti
10 - Q
3'0' 3._8.. T._2„ _a, n t PLs b
8'-T' 1 9'-3' t '2 + 7C 1° n o I
i 1 �.- • Hardwood e O S o sY •°'.i
fo
•
floe s '0 3'O• ® 8 Keg Heats $a9 •
am
a r RtS Lambar TBD •j \
: °' _ Room - ► "� �
Bedroom#2 p s _ -Dining 5-6- r-+"I
T- 'V
• Q a •'; 14'-r z 1Y-3't-Hail O(.}er c LL iss N _1QI3'-O• x n'-0•+- I �g Drgged Cdrered Cal.g Hardwood e m Hdwd PLaw I /`ob InHardwoodo c . TBD = /• _ C
1 o= r:7mTP�.rr�a xCe'(23 �. ri)o
V
I
\ ` O®1 WWI Tap Temp i a) 3'O•
1 sp PYr.to Tip
"� _ 0 3'O' 4 1 v T�mPl.ta Pl.ts Temp P1 a' -
IV
iv J I 3' Vwg1 I 01 b Carpet _I
;17
as
I b
vow
� :. L e�,,..ti^^.1 }qa li = .. •I Yxcldr 1'>{err Z .al b r. of
b Carpet. En ® 7i 1 e 1
2 IQ J 2 r3•-0• x Y-0
o — ^ Covered Porch _0<
"' / d\ Rose la'atrap tap t ISf p..fe Fluff Correct. Rts RtS C
:o boom I/3's �C
I M 20 Yin,flee R-IO P.d --�-,
-\--� 5 Wok! �+ S Bddd rated door 24'x24Sa ' Cdu.n
b \ C b_ Psc r/T...... A.
1 RCS
I �S Post ( - an ..
7i/ o 1
N N% At Zlus7drap�n9-7i a_a) ® I groper T.Grade ® b
�r I
0
1 14'-0" IF-8"
ttac e
Accrue I\ /- •
I \ / I
l \ / Note:
3 Car Garage I \ / I
\ / I 9' Cning Hncht
2r-(' x 35'-0• IT-IO" Header` Ht. U.N.O.
Attar Truax Above ✓OSB nor 1 \\ i 6' 8" Door Height U.N O_
drop eating d Geroge 7 for I \ /
aux roam above l
2Gi l a.hilted floe rte..
trte..be wet
wen nor .n. 1.4• Id
\ /
coring ht. • garage S I F.,M a i n .tor Plan Scale: 1/ I" = 1'-0"
io
/ \ •
-
I / \\ j Squa e Fo.tagG. L_iv'ng 2582.E Garage IOOL5
io
I / 1 Io'
is I / ' \ N
✓ / I.\
" Type"X"Otte an I / 3l \
oil;
roan wdl. I/ � \I
V LL°
II 6
N
I \ //
\ /
/Io \,/ i.,
ra
1r / \
I / \\
I / \
Jo J� o
a i
�� N
♦ ♦ ♦ ---7. ,
- ♦
P 13) exeeh I P7
9'-r 3•-0" L •-0" 1 9'-9" ,1•-6', 3-B' v 3=6" v2'-6" { Y-0" 3'-a' 3'-2" f
•
v z5j=6^ 1r-a' 3'-a' L 9=z' L it-+^ v
6-Y t t