HomeMy WebLinkAboutBLD2006-00577 tILDING PERMIT APPLICAT!N MLA06-00558
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00577 Received Date: 10/4/2006
SITE ADDRESS: E MARROWSTONE RD
NORDLAND, 98358
OWNER: CYNTHIA J SCHNEIDER PHONE: (425) 347-5713
5622 108TH PL SW
MUKILTEO WA 98275-4654
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 921043003 Section: 4 Township: 29 N Range: 01 E
CONTRACTOR: SHOLD EXCAVATING PHONE: (36)385-0480
PO BOX 179
PORT HADLOCK WA 98339
Contractor's License SHOLDI*224LT Expires 06/30/2008
REPRESENTATIVE: ROBERT DOWNING PHONE: (425) 343-3866
5707 PARKVIEW LANE (425) 740-0232
EVERETT WA 98203
PROJECT DESCRIPTION GARAGE (STICK BUILT) TO ATTACH TO MODULAR HOME
UNHEATED AND NO PLUMBING
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 25,000.00 MAIN:
CODE EDITION: 2003 ADD'L: HEAT TYPE: UH
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER:
GARAGE: 936 SHORELINE:
CONST TYPE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
1D151o( (
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $391.25 KAS 10/04/06 85105
Plan Check $254.31 KAS 10/04/06 85105
State Building Code $4.50 KAS 10/04/06 85105 NOV Re
2006
Total: $650.06
Jefferson C ni'y Pi triirig
& t8uitr;inr Oeaartment
• •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00577 Received Date 10/4/2006
SITE ADDRESS: 1043 E MARROWSTONE RD Issue Date 11/16/2006
NORDLAND, 98358
APPLICANT: CYNTHIA J SCHNEIDER PHONE: (425) 347-5713
5622 108TH PL SW
MUKILTEO WA 98275-4654
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 921043003 Section: 4 Township: 29 N Range: 01 E
CONTRACTOR: SHOLD EXCAVATING PHONE: (36)385-0480
PO BOX 179
PORT HADLOCK WA 98339
Contractor's License: SHOLDI*224LT Expires: 6/30/2008
PROJECT DESCRIPTION: GARAGE (STICK BUILT) TO ATTACH TO MODULAR HOME
UNHEATED AND NO PLUMBING
CALL IN FOR THE R_EC�UIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: \/
UFFER: 1,0
Footing: 6-Li b )
Foundation: 9: et-) cP(_k ' .&_ IJ-(o- 2
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Sheathing:
Framing: ))-2—V-D
Plumbing:
Propane Tank/ Lines:
Insulation:
Sheetrock:
Septic Sytem Final Approval MUST be obtained before fiial of structure can be attempted.
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval:
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
SPECIAL CONDITIONS FOR CAS•BLD06-00577
1.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
2.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
3.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
4.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
5.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
6.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
7.) A Stormwater Site Plan has been submitted and approved by the Department of
Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
• .
9.) Not more than 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.
10.) Minimum setback from East Marrowstone Road right-of-way shall be 20 feet. Minimum
side and rear yard setbacks shall be 5 feet.
11.) 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.
12.) 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.
13.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
14.) The building height is not to exceed 35 feet.
15.) THE ROAD APPROACH PERMIT (RAP06-0205) MUST BE INSPECTED AND
FINALLED BY THE JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS PRIOR
TO THE FINAL INSPECTION/CERTIFICATE OF OCCUPANCY OF THIS RESIDENCE.
CONTACT TERRY DUFF, DEPARTMENT OF PUBLIC WORKS AT 360-385-9159 FOR
THE FINAL ROAD APPROACH INSPECTION.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
•
, • ,r.r . ,,, ,, --, --,,i
. .
letik
JEFFERSON COUNTY NOV 1 4 2005 L
DEPARTMENT OF COMMUNITY' DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368JEOM SON COUNTY
�O'� 36p://ww4450 . 360/379-4451 Fax DEPT. OF COMMUNITY DEVELOPMENT
h1ENT
�O http://www.co.Jefferson.wa.us/commcievelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
rtU1-0fp - ss0
MLA# 9�1 - 0 45- 063 PROJECT/APPLICANT NAME: S C N►N E=t]ea_
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.
S.rm s.5 4 u Dilvi P6o 4-1As aka,n.- .‘4• Acta.s CR450n4M tf .c sro E
A c> . s..csts rs 4 011 Pt cRcS AN - 'lelSao ,6,as
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
S E Ca R►.1 o c- S_CTf. bZaV AT].1t ) .1.:S 100' Ki 6 C-6141LIL SS, 1 I S s
1\1 W co i2►. .11. SAS I aS' S uJ cA Qt�a(L,yS f 3.0 \,11.I`Y14 A fine' S LoPE ')
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
2u►b H 1 'Dez-rDv►Ov►S P wsp 6\1t4-6 Z1Z-EXS
4. Describe the existing soils. Indicate soil type on the site map.
Sc i s Lo G. +• Ell At.u Pr bU PvcriNe.41410
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.
So_cz...s ( c &5 A T1gtNib
APPROVED
1.
6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN
NoTIE
NOV 1 4 2006
StormW2 f S
JEFFERSO C U T
Require DEPT.OF ,' Y MN LO MFNT
SIGNATUR j�7
stormwater site plan template—rev.10/1/2003 ` t 5
• •
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.
NOtrE
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.).
-Z,Esrb c�s Ili AS Tt CC 4-Pi NJ C�
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 W differentiate proposed facilities from existing facilities.
5 T rn aQ �.., Dc {2., �..cnF iOf ��A]DrS ALL A L,Law e0 TO F�ow
tv Pay.2.c L VO4 0-VF34:47bC(7 4f) sir. aQ m-1. - &Lig Pi:12
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"pro acts or projects that involve the potential for dispersion of contaminants.]
tyeNe:— t-Z���Q1✓'�
11. Describe the performance goals and standards applicable to the project.
J11 AINA&L flrtr. c,* c-biLM w A- a.
12. Describe the flow control system.
otAG 1\1 - 4Q
JEFFERSON COUNTY OCE JEFFERSON COUNTY OCF
stormwater site plan template—rev.10/1/2003 6
r .
. • •
. .
13. Describe the water quality system.
N A-MtLp Mi\IFI-T t Zoc
14. Describe the c nveyance system analysis and design.
N� Pt
15. Describe the source of fill material,physical characteri • of fill material,and deposition of excess material.
5T2.1.s.TU,&1)FL_ F�L.I. Atft£ . 154 �
Alip
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code. _
�1 -HL t�T 13 c r,do 1=SDP ..2A1+.,s AT C-of .Nez3 aC (30.u,r),M-
- - ;s iA,-f..\ % %.NoEva.z•lk-t A>ttoks w S 4- i- $krathL
17. Describe the proposed surfacing material.
-(L.
18. Describe methods for restoration of the site.
1t Lfl...i-v. oLit.►O cooE.2. ADO LA two SGf1P—Cv(r
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.
N.1A
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
S 6_1,1,s L 0 &s t S ig nZ p4.iA")
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. ^-P
jLi I iaiiirull lydllll�I , !Ail) 4 ,t. . >..a a. m ;Ju ,,a , , .T
stonnwater 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 sensit ve 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.
C. 1=42).ra—..N c.- L_1.-06 ss3 Pry C i �£ w Zilk-sN ( Ft="T a c 41rr;..l
'-"Pc c os�'O P+Q,EPg fl..� S te► (.Aa.� MR. 60.11\4 oC. S, ►3E L -
r,4 Go
2. Establish Construction Access.
c_c_ESS
3. Control Flow Rates.
'120, %6glf .ow 6,.1 t.,1 § e c.c..y' &4LLCO k SJ:`N 4 Orwi f riEtaN S�AA�
r(A)T 5.3D
4. Install Sediment Controls.
S.zL.- r F > Pywl S ra.N.4
5. Stabilize Soils.
—Pc..c Geis awl LbV - VJ L't cow` LEVE
6. Protect Slopes.
rt�l�svxL SLo()
7. Protect Drain Inlets.
t'vt) 1� SN1.�5� ( r► ••_
JEllERSON COUNTY DCD
8 stormwater site plan template—rev.10/1/2003
• •
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
auE a N Sj r
9. Control Pollutants.
y esl RILL K.JT
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
F N eZel.S PrO,.'i w L I tom+A�jL�2.L...�- w 1�,c. E "�i Q t*� �-., f D Pi' a-
-S2d -`'►-"T- 4.4 SISE cit 4._'%V — )v►tPo S6
11. Maintain Best Management Practices(BMPs).
.s S w-ELL oasttttfGo P -r rEtOG5 0 bit _1
mac. s. SLR G�- �Q ott r rf1(+�- , / ow&4611.
�mPY5 3o \4D.L (at- Aoftzize'O11)
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).
A nwE
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
4 Vv
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
• S
b. Description of s ecial 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).
ot.Er
5. Construction Phasing.
a. Construction sequence
C — C Ems -i cPat- s t4T d i 04A4 P 1*-)
Pt..P<.E mP►+JQi.4ar..NLE:0 14otrE -t• ,Q &42.fiesE
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
1. Provide a proposed construction schedule. ^�
CA+t *S1-0-V•c:atnv c 4- o N Six w V/�.�+ PC�.Lw S J. �tOtiPsitt. 6` .S.14��
'NQQ9.11\115a-13q Qc iT / NO—Wet Season Construction Activities.
a. Proposed wet season construction activities.
Ft‘'`V*4_11111-7D6NA 4 5t97�.
b. Proposed wet season construction activities for environmentally sensitive areas.
4ti+t
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
L,c . . C..E**40`c C.c.N N E.TQ
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps. N41 Ell
b. Diversions. NV:tosl
c. Waterways. N4*-)Z
d. Runoff/Stormwater Detention Calculations ___SA,wEf
' l
stormwater site plan template-rev.1 W12003-LEI-BISON co 1 Y D C o 10
I
•
#
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 ;. fining 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.
10CP OC(,
(LANDOWNER OR AUTHORIZED REPRES AT SIGNATURE) (DATE
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
PERMIT # BID PERMIT # BID
p 5 7 706 - - 5i 6
JEFFERSON COUNTY CrI JEFFERSON COUNTY DCD
stormwater site plan template—rev.10/1/2003
12
_ •
• a J� IN -4( `111 lf n
4w N t^o6� JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT ,
" `4 621 Sheridan Street• Port Townsend•Washington 98368
360/379-4450 • 360/379-4451 Fax
sztry:
q www.co.jefferson.wa.us/commdevelopment j J� - '
n
Master Permit Application MLA: l.C)_ 55a
Project Description(include separate sheets as necessary):
A a,cu A TVP1CAED sTa1. 600zr (Athis
Tax Parcel Property
Number:J s 1 043 0o3 Size: 4,g 1 ft,square feet)
Site Address and/or Directions to Property: E Ii‘AQQo .sroN5.6 -2•1) 1.1oa.1)0.#,,o W \ < ' 3S8
Property Owner(s)of Record: CA U' - SGHI.. ..ax)1 1.
Telephone: 9 AS -347-5-7(3 Fax: email:
Mailing Address:S4 a.a. IO8"~ p( , Su...)
Applicant/Agent(if different from owner):{moo €.T --4 ou•�. .$..6"
Telephone:44 as- 343-3 gvo Fax: 41S_-74b- 3 , email ADAN1x .0 o II1
Mailing Address:s-7O1pA`L .UfLa4 L"PfNE N iiILM \isi A Bav�
What kind of Permit?(Check each box that applies)
❑Building ❑Variance(Minor,Major or Reasonable Economic Use)
[j Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
d Single Famil Discretionary"D"or Unnamed Use Classification
NI Gara•- •ttached '.-tached OSpecial Use(Essential Public Facilities)**
Q Manufa ure• "ome OBoundary Line Adjustment
d Modular °Short Plat**
Q Commercial* °Binding Site Plan**
Q Change of Use °Long Plat**
Q Address i Road Approach (°Planned Rural Residential Development(PRRD)/Amendments**
El Propane OPlat Vacation/Alteration**
DAllowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
OStormwater Management OShoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* OShoreline Management Variance
OTemporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment
OWireless Telecommunication* OJefferson 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 •� 1A-4",ink -, to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE (i!.✓ ' .L-1/e,�,�— Date: /C �/ 4;'U16'
By signing this application form,the own /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 required later inspections. Staffs access and right of entry will be assumed unless the applicant informs e County in writing at the
time of theappf +t that he he wants prior notice.
Signature: JDsGSN Date:
The action or actions Applicant will undertake as a r It 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-transfer fes sibili dhert g to and complying with the ESA. The Applicant has read this disclai er nd ns and dates it below.
9
Signature: -44 --ptel c.-- .. Date: 7e/4 ...
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc
• •
1 1 2.'.( II ,i, !' -1 if
i '-t 7 I 'e' 4 '(
BUILDER STATEMENT f
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project. , _.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: }S� 'FfOO T!' : 0n
S}}bt. Li i 1(Ii3U9 ,J ij; I J u
P �XcAV Pr Tit•Ar xl.)G ( ) td 7
MAILING ADDRESS: Qo "a 1 9 ,1 1X+_,�` Ot,L EMAIL:
CONTRACTOR'S LICENSE I:J iQQQ►,jjj WAINS
NUMBER: S AbLoI-4 2a4 LT NUMBER
ARCHITEC 'A DA14rt+C \ .T.1 AA`Z` PHONE ( ) FAX:( )
MAILING ADDRESS: Z 11 �, M "�7 ErsT K.iGG c J��� 6o 0W IA
%Il k
Project Type: d 'F`rlame Type: Bathrooms:)// �1SJhorel�inne:J O Type of Sewage Disposal:
64 New Wood •Existing: �� ❑Sewer
Addition nu Steel Proposed: • Ban ID Community Syste
D Alteration/Remodel El Total: ;'� H�igj� 0 Individual Sy e
0 Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Set.: : �'rivate well 0 Two Party
Type of Heat: Proposed: �1Ili
❑Public
k t..) f0 Total: '" Name of System:
0
If this is a Commercial Project you must answer the following:
14 )pi
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 Serv. ? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: N In Underground Tank 0 Above ground Tank Size of Propane Tank: �+
❑Heat Stove ❑Cook Stove 0 Woodstove ❑Fireplace Insert ❑Hot Water Tank ❑ Pellet Stove in Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bid App Review: la S F�—
�7
2nd Floor Heated Consistency Review. C t--,�
Other Heated Base fee: SF
G3
Mezzanine Additional Section:
Heated Basement Plan Check fee: a54.31
Unheated Basement State Surcharge fee: 0
Other Unheated Pot Water Review fee: C)S re_re___.-
Garage/Carport / SUBTOTAL `wJ
Decks (P (4a
911/Rd Approach fee: ,
Other TOTAL: $
(p50°1
Receipt Number: 85 /o3
,,..?loop.._
o -- Cash/Check Number: 51 D a
ESTIMATED COST(R Date: n r 1 l D
.Fair market valu o abor and materials foundation finish 4
a Spa Initials:
D:\PermitCenter RD FORMS\Master Permit Application 12-30-05-2.doc
N= T
T
m T_
O� (
Cl� 4 )
wok
0; O
;1 = 0'
=
i
O f =K
z
O
Z =..
111
8
4 4 Igli
I:* .7,5 'i. 8 r
GI ,, ,, 1 ,,,
.,
, $
1:). \ / iE P
, A 0›, $
Ei
o ' vj \ /
W 1 ii.
/\ Icp
of 2
4
tee► \-
I I
13 I / \ 1
101
It
r- 4 40,. ,4.
00,.. ,.o 1
Z
4
a
\ \
W/T GRIDS Ri
no0o -! 20'-6' / 15'-6' /
snMzz f1.-4'/ 56'-0• /1'-4'f
my %I• _ OH.
v %N� •
J N
O:O
0-o R
�� m
R
rr•
E •`: A
(IDN
• DS
2 _
O m N
of m
vi 111
XIZ l o�a .S 092
—I A7 cm o cars t...
a , s ....,
XI
v 70 ' P N Z
�
► r ° rri drn a TIMBER AND
m e HOMES
r
O
1 N2 22'13" E 330.54'
H "'off 10 m
42
4 �N
N y �y
•O'
I
, H
/ 0
tn
m �qb7
H Y H
, y O H H
r m
^ ~ w 0
/ y 0 m
, 6) d H
8 ; 8 H
1-3
NN
; o
u / g Q.
128'
,6- �^
11
/ o i
HF
pQ a ,roI m 1ox2 H 0,- o rn Al I p E
w modo$ 4� H
'xx�m o
a S' ` Oge 6r
,
Ni/ v P' 0 , / ,,
1rfo// 1\ /
,// ' -0
z ma � a) oIf
�' yro
Ky
./118114
—• Allokill' ' .45,
ji
tw a CD
R'� N r r M
OPP tr i wilk,firr �� 1 t H 147 w
- i° - 30 0
/
, ...1NORTH ' ✓ r? - l �b
• xxgg / ,
'.1r trot-. N
a,mZ�o H
0�V)tn N0 /
ry3 N.) AN.cn Ci) - / / / /
O I mqq0 R1 _ I/ii /'
/lir / /
O I mtC• .O o i
O 0 N\O N J,p �p r� H
WM1O (n Z - r _t Qo mrP Y+
'y'. to'fy Z* 4.- .� E g2r ,/ //"
G)ji
3 // �/'N ro /1 11 , f r�i� L%'
en
tt
E N2 19'22" E 330.13' ,•
rn
'/''^�n' EAST MARROWSTONE CO. ROAD
1 U-r -r �9
T` T4
Z
^ '•�'•t ,, r r 43'-6"
2N Fin]
0
orri to C�
bi. ad
O Gin s 71
� CCU C.
v
Era m `�r -I
z-4 "� =
C12
> ,' Ili CIJ W N 'a W snr Pedant I...
Z r H . ''. CYNTH IA S CHNE I DER Imo% 14Mil
o Parcel Norr ato921 0e 3 003 VOK,fff lWwrrrY
Z � :�o � East Marrowstone County Road ^�c_f'�ir,la►lR
• 5 N o Nordland, Washington AY/y) ' J T11
o O
0`a September 15, 2006 LI*•CMITICtUTAI b*$ISN •, IN•