HomeMy WebLinkAboutBLD2006-00669 � MLA06-00640
UILDING PERMIT APPLICAi!JN Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00669 Received Date: 11/20/2006
SITE ADDRESS: 100 GRAN RD
BRINNON, 98320
OWNER: MICHAEL J HYDE PHONE: (360) 796-4163
JUDI M HYDE
PO BOX 190
BRINNON WA 98320-0190
SUBDIVISION: Block: Lot: TX 5
PARCEL NUMBER: 502162005 Section: 16 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIO1` NEW SFR W/ATTACHED CARPORT
ALSO A/G 500 GAL PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,938
VALUATION 194,509.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: 5N GARAGE: 334 SHORELINE:
CONST TYPE: DECK: 549 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: 2WELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 2
Total: 3 Total: 2
Routing Date:
11\ aalo ,
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,525.75 KAS 11/20/06 86787 -
Plan Check $991.74 KAS 11/20/06 86787 \ _J _ 1iL L
State Building Code $4.50 KAS 11/20/06 86787 'A
Potable Water Application $55.00 KAS 11/20/06 86787 JAN
2007
Total: $2,576.99 e C..CaUc� U
n�q =�Na�nent
• •
CONDITIONS for Building Permit# :BLD06-00669
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on November 29, 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
3 Stream; osprey/elk/blue heron; seismic; landslide 1; SUSC aquifer recharge area;
commercial forest lands.
2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological
formations that allow percolation of the surface water into the soils and the underlying
zone of saturation. Aquifers are geologic formations that contain sufficient saturated
permeable material to yield significant quantities of water to wells and springs. Aquifers
serve as the source of drinking water within most of the rural portions of Jefferson County.
3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
4.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type,
geologic material, and groundwater that may combine to create problems with slope
stability, erosion, and water quality during and after construction or during natural events
such as earthquakes or severe rainstorms.
5.) 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.
6.) 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.
7.) The applicant is proposing to create or add 2979.33 square feet of impervious surface and
2989.33 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.
8.) 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.
9.) 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).
10.) The site plan as submitted with the building permit application on November 20, 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 November 29, 2006 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
11.) This approval is for a single familsidence with attached carport and 500 gab
above-ground propane tank 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.
12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
13.) 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.
14.) Minimum setback from Gran Road right-of-way or private ingress/egress easement
rights-of-ways shall be 20 feet. Minimum side yard setbacks shall be 5 feet. If an ESA is
present, then the more stricter setback(s) shall apply.
15.) 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.
16.) 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.
17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
18.) The building height is not to exceed 35 feet.
19.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
20.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
21.) An address of 100 Gran Road, Brinnon has been assigned to the parcel. Gran Road is a
county local access (C229309).
22.) The site is served by a two-party well.
23.) The proposed single family residence is not located within the landslide hazard area or its
buffer. GIS mapping appears to be incorrect when comparing it to the contour maps. The
single family residence will be located within the southwest corner of the parcel where it is
flat. About mid parcel is where it begins to steepen.
24.) County GIS maps identify a Type 3 stream from the northwest corner of the parcel to the
southeast corner of the parcel. The proposed single family residence is located in the
southwest corner of the parcel and is greater than 238 feet from the mapped stream.
25.) The proposal is greater than 3000 feet north from nests, however, in 2003 nests were
gone.
26.) A building permit (BLD06-00548) for a pole building was approved on October 26, 2006.
A septic permit (SEP06-0033) was approved on April 6, 2006.
• •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (:360)379-4451
PERMIT #: BLD06-00669 Received Date: 11/20/2006
SITE ADDRESS: 100 GRAN RD Issue Date 1/23/2007
BRINNON, 98320 Expiration Date 1/23/2008
OWNER: MICHAEL J HYDE PHONE: (360) 796-4163
JUDI M HYDE
PO BOX 190
BRINNON WA 98320-0190
SUBDIVISION: Block: Lot: TX 5
PARCEL NUMBER: 502162005 Section: 16 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: NEW SFR W/ATTACHED CARPORT
ALSO A/G 500 GAL PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,938
VALUATION 194,509.00 ADD'L: HEAT TYPE EEE
CODE EDITION. 2003 HEAT BASE: HEAT TYPE: PRO
OCCUPANCY: R-3
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: 334 SETBACK:
DECK: 549 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: 2WELL Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: Permit $1,525.75 KAS 11/20/06 86787
Exist: Exist: Plan Check $991.74 KAS 11/20/06 86787
Prop: 3 Prop: 2 State Building Code $4.50 KAS 11/20/06 86787
Total: 3 Total: 2 Potable Water Application $55.00 KAS 11/20/06 86787
Total: $2,576.99
Directions to Site:
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 ATTATCHED
Jefferson County Building Division Permit Number: BLD06-00669
Applicant: HYDE
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2003 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks .15-.-/c lo.7
Foundation Footing y/o/07 ` L2I_ zz
Footing Drains J �491 p,,.;'zF n'nr
Foundation Stem Wall SJ`4'f 07
Underground Plumbing 4A-
Straps(hold downs)
Ext. Shear Wall Nailing
_(g_(2t--r
Rough-in Plumbing e/' /OS ,/ f
Framing e/22/94c /Il
Airseal co/'
Insulation:Walls
j0.-0c1
Insulation: Floors 0.--)1 0°V C- , rg
Insulation: Ceiling
Int. Shear Wall Nailing 2C, 0 t
Wallboard Nailing _.C
Gas Line: Interior Ot4
Gas Line: Exterior tZ '-OCk r/'
Propane Tank (- k-b �s
Heat/Chimney Clearance 112-
31�b<<
Drywe I/Alt r 'nage 71
tct�(G, a-IAA`( Pb
�
Addr@ss Posted -� _�
I q , j,
1
FINAL INSPECTION (-5cY( 4:70
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
., ON CO
r
*, JEFFERSON COUNTY
4. 44o .1 DEPARTMENT OF COMMUNITY DEVELOPMENT
,1 621 Sheridan Street • Port Townsend • Washington 98368
16
O 360/379-4450 • 360/379-4451 Fax
NO http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# V ((I ' PROJECT/APPLICANT NAME: PI t k(, 1 r )c .G�
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.
_j 9 I -PCs, I t I Jet )CC_ t I t-k I F- c Y
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
F t(t ( c'e, , L I.f IN c je/1-t e rli\c-,
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
i i C Cki/161 -161-1 i vr% �-C.��,���. t7 t--; (\vA PERMIT # BIB
4. Describe the existing soils. Indicate soil type on the site map.
06 0669
)C r k �r =%L - f1 r rl(t( C urr Ellen pr f,n111‘1`t-s r,;y1-
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.
LL to It - A11;Lt(7) f) i ('d ;'( � C1c"e_1 C c(t_-tLlli2
R 'IF ift
6. Describe any excess levels of noise A, a d o use or activity:
/ STORMWATER PLAN
t4'• MHO 0111111
JEFFE 0 C UNTY
stormwater site plan template—rev.10/1/2003 DE PT OF IT PM.N 5
SIGNATUR :
• •
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.
•
II� tE��.r, ter� v, IC
i, ti����� ia
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.).
(tic I(1, a�) LI tt• -�� ��c . 1L_� i1j rl `�1 trt--
at, of i,l a ceLs Kr;3,7j; )n.S 7c,1 x,c : fi{ 'c. cc_ C i 1 I y
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.
I I S C%K tl\ � Ctfc:l Lc, l t�E, 4t � ( c�I SQci -1'(1i • -1c'[l (CC' +
lq%p- co I U L v'oc‘Q A al C
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. iR
q P( �1_C I I C ; I, 11 j , \ v� `
12. Describe the flow control system.
stormwater site plan template—rev.10/1/2003 6
• •
13. Describe the water quality system.
14. Describe the conveyance system analysis and design.
PICur\ ( LL LLA i f-h ' Ia,,sk O ad ciif Pci i
i vvi t dAAAr' Ci 1 k c J e,t "e ck c (LCi-
1
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
1 Pc
17. Describe the proposed surfacing material.
18. Describe methods for restoration of the site.
I CiJ)6,,S. p& a.nct p ep 100 t ct-n au)CLS c1 +_star b b.(,
of-) tin
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.
1\- /1-r t'U1 tVH # B O
0 6 .. 6
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
'-I , �rr�ti f INTY BCC
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 requirem is _ n th e o dit�ons or
restrictions here. iiA
� it A '�1f �� )j
1 1 I i > r,_ � )Lc - is i,-3 1' i�'
t r , r)
11[14+6Tj , P I,II
stormwater site plan template—rev.10/1/2003 7
• •
CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential
development.
SECTION I—CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
It / -,i;
2. Establish Construction Access.
3. Control Flow Rates.
4. Install Sediment Controls.
5. Stabilize Soils.
6. Protect Slopes.
IR El °al
7. Protect Drain Inlets.
A d_
JIFFEM1Ni +lI,Bh
stormwater site plan template—rev.10/1/2003 8
•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
9. Control Pollutants.
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
1--1 e�ti � �r: (,t ( t ;1L) i ( i i'V (co, t i3IL1 s . -k p(P.i!P.%l
F'i' riA
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).
/ti .f,
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
'` J4ffERSB-N COUNTY OCU
3. Environmentally Sensitive Areas. C IE W "T 1
a. /Description of environmentally sensitive areas that are on or adjacent to th �� \� 1,
.IEEEEISR 1,IIUNIY BCD
stormwater site plan template—rev.10/1/2003 9
• •
b. Description of special requirements for working in or near environmentally sensitive areas.
1- it Ct4 /1 it t fig,itiIV% LA,41 Soo t- c'A_L_- 1i2;4 �t:'c i1
4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(?.g.,erodibility,settleability,permeability,depth,texture,soil structure).
(4,r) tI G.tn.xe.d'
5. Construction Phasing.
a. Construction sequence
c e ;fC P>;: \ (w`CLA' ti1c . s LA rc c �;.
b. Construction phasing-(uf proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction schedule.
'v11 C,' � C C C
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
7. FinanciaVOwnership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
11 .151a; I c c ,
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 th lc rk,IfI i �il d� 11
a. Sediment Ponds/Traps. { i��\\
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations nk , ``N
ifffi
iti
stormwater site plan template—rev.10/1/2003 t0
• •
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
l ,
cLi A.(
/ / /o (
DOWNER OR AUTHORIZIFD REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
RE( FAIRT,1,4-
JEFFFH 111\1111) 1
stormwater site plan template—rev.10/1/2003 12
• •
ON CO
�� JEFFERSON COUNTY
' S� DEPARTMENT OF COMMUNITY DEVELOPMENT
('' ,.it 04 621 Sheridan Street• Port Townsend •Washington 98368
. 360/379-4450 • 360/379-4451 Fax
'L•O www.co.jefferson.wa.us/commdevelopment
S�NG
Master Permit Application MLA: C(,
Project Description(i clude separate sheets as necessary):
rS c/W/6 fa/ 1 y KG.. id e.�C& air dh 00 r
`Tax Parcel ]
Number: 6-0 2/�' 2 00.5 Property f /7 �
e� (acres/square feet)
Site Address and/or Directions to Property: /(a2 4c 4c � ,7n 6,0 /061eki_1 a. .h Dc / a( t)Rd
Property Owner(s)of Record: Ai i t1 Lf cy," I
Telephone:,.36 O 794. h//6 3 Fax: .4(vU. ``1 fh. 1//341 email:/j j•-ea./e/c/e 61/yid n-Cdn
MailingAddress:A O. hey /9Z) 6/in fie n 98.32C
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
W at kind of Permit?(Check each box that applies)
Muilding V (( ` �, ❑ (M ,Major Rab
d Demolition Permit f J�11\\' 1P�1I )i ❑ConditionalVariance Use
inor[C(a),C(d)or ,easonor C]**le Economic Use)
(, Single Family °Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)**
❑Manufactured Home NOV 2 0 2006 I1Boundary Line Adjustment
d Modular OShort Plat**
❑Commercial* OBinding Site Plan**
Q Change of Use ❑Long Plat**
,,Address i Rodifit � {� till1�,4 j'I'Ii UPlanned Rural Residential Development(PRRD)/Amendments**
M Propane ��uu wtTl<* + ❑Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis OShoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management ❑Shoreline Management Substantial Development**
OSite Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance
❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre—Application Conference **Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any re uired later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the apyIida ion th//at''he or she a s prior notice.
Signature: < LLB /� ., i '. % Date: ////(e10 6"
The action or tions Applicant will unde ake 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 or dhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: ////
b J.
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc
1
• •
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be as ing//the resp9 sibility of the General Contractor for the proposed project.
Signature: t& ! e(./ Date: ////O) (F'
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: ....aht-> C. 1_1 D I Dei 4 PHONE (3(00) 7 tit',,3i72. FAX:( )
MAILING ADDRESS: 235 6t.(rr,C,AS(. {)(fY1,1oCl, tAiA EMAIL
Prpject Type: Fame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Q'New E _Wood Existing: 0 Sewer
❑ Addition 0 Steel Proposed: 2 Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: 2- Height: 4Individual System
❑ Repair ❑ Masonry A SEP Permit#. joOb -00e33
O Demolition ID Other: Bedrooms: _ Water Supply: _/
Existing: Setback: ❑ Private well WI Two Party
Type of Heat: Proposed: 3 0 Public
E/e cJric, Total: 3 — Name of System:
ID
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
0 Underground T nk C Above ground Tank Size of Propane Tank: '59O q .
d Heat Stove gd Cook Stove NrWoodstove ❑Fireplace Insert Hot Water Tank 0 Pellet Stove p 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 4Bld App Review:
2n0 Floor Heated Consistency Review: 1- ,
� JJ- '
Otheri+EciElqp} r) Base fee:
Ar 15. —ICI
Mezzanine {� Additional Section:
Heated BaseNOYntV 2 0 � Plan Check fee: q 1
Unheated Basement State Surcharge fee:
1I 5Uf i;UllM$ �I�:i► 5�
Other U Pot Water Review fee: G}0 co
Garage/Carport SUBTOTAL
t .k aS A, cii?
Decks 395 11/Rd Approach fee:
Glo/Oth N/�y PO
cii 45,/ TOTAL: $
7 3c�a�,� g a sag.gel
Receipt Number: c6 V I g-7
Cash/Check Number: 3 ?K/;g
ESTIMATED COST(REQUIRED) —Date: �
.Fair market value of all labor and materials ation to,f1inish
$/S6;000� tciAtcq. nitials: I
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc
1 61 I W 1 r
4T-I O•
/ /
/ /37'-I O' 1 O'-0' /
I.
/ / /11'-6' 2'-10' 8'-10' 2'-10' 11'-IO' / S
0 op.
D
T-. G-0' 13'-2' 12'-8' 6'-0' 3'-I I 1/2' 6'-O I/2' a '" .3 A Z
09. Z
= L g ° o N in 0
C c or11 o rn
m
z 23 $ -
y
`� '
o € a
8 G
0.
A ty
nn
IIIII
Eli'
Goa0xO 40 X0 G030x0
digit_ W�i i-
F. ___,
. ,n, 1 i NI ......111... '. i \\ a)
rn = rn
Y N rn N
O 0 Q Q ! p
Z ud Sm'
O O
1 B'11J5 ry (1 w
71 h MIMI. I 0 11 1
•
I z
II
iiip
Q a --D
Z I• Z 37'-1
i Q
N rn
O -4 n
J c9
Q � gjr
. O0 1Da Z
A
_ K gi V
N \ !I 20-10 0/10 ii._11 NM
II
D a
a e'e I
ro I ii O
n5(
s1111111j1110 a AIM'
`� WP LK-IN ` .1 0
RE
•II I �I . CL JSET '---
m:� -� umr _ d r . -
oft IEN
01 IA li
\
, •
Z s 73 CDs - bm.41",�•���-i "'' , o a
• 00 t N r ��Jl�\i 1l1�■���J� BE
' £ Pray 1 1 ..I■� Q w 5111.7
o W
EWAhMIe.
4077x0
•
40 1X0 40300 `\ •,,
n
D
0 rn O a to /�
i -13
O D Z - 0 D
O { D o
o N .
Cl
a
- 4) 4) 4) 4) 4 -
A - \
1 22'4'
/
CARYOKT
Co N CD 7-4• / 7 8• , 6 O' , 7 7" 9 6' S I' / 4 8• / .
W 4, In W
J (J1 N C''
0 -n -n 0
'IIn 54 / 40' 58" 6 l0" /
w
11'-0' 15'-0" 21 10"
/ /
47,10'
) S' -HOME DESIGNS- 1
PLooR Mr. $ Mrs. Mike Hyde I 9L
PLAN 00 GRAN ROAD\ ; Brmnon, WA. 98324 ; 1
a,
L __ N f°3O'E
r it
O i ;• �I �� 4. a +'Mq
A
Mk
411# 4b9, M'C 5 are 1 i
4 %‘ I-
Lr c I t 8 `uIppp{i
11,
-- A
E rl'n4N �iU�'�
UM
�� 'Ap
rn
O —I ,,,, ,,,, -) \\ N O A ( '
,K
--'" ,„. .Z-W,,
Y �..r4
,7\T
]0 'ft. n ,I / N N ____
. ,02.,.....1, =.S./,4,/?f_ -'
3 f!il?. w
, , , - ..-,,,,,,, ,.9, , ,,, r 0,,,, -------- - 0
-fo- 03 -,S.1,/ ! 0 :•'• .G' %1111p4 U
N 0 ���. f + 6 �y 0 z
n .f�T D _ - 03
N Q o
rn
rA
d
Wm
%J
W N
�w V
A
AP,P!MHP
m m
8 Rrn°A�'-AA�m tNn NcgZ-Z5�O 5 u
°
RQ
;O SnO ' ''N➢o QAD VN 9 159z .nO cn(); Pp.EJEJ €aI1b { Or r
°, a,Qg =�-rnoioa �nO opp rn rnzo op rn rnzgOnc(n5OOjrnP^ g , NNz 0
0 O90-.4k,$QzN ppz O0p n O in 1 X ? o-2 - 0 Oz0 0Oz p 11Y z A i ,g OD'a aOcgolGi gA in o
5 ZA C C = S prn
D zz p60 0 vrn P,a'-- rn J°
P. LI 83� y4z p - zz0 n
89LL 26 z zrnp QO-~=, �
r,4 N
a•60vo•tl A m D
qL"
+1- NbKTh
350.00'
z
O
O
co
03 — K K -o -13 0 co W K O
a m r -,. z7
rnZ — _
zZr- 7JON o
OOiv 0Ozrn
zCz � � � cop7 Z
z �� D = Zfie-+-, x v) b CD
O /� (n z (1)
eL Da
co rm r'r C"...1. - 7i Cza4J .-4- AM ' ' >I._7, 1.4.4
-1 , 0 r— r er2)1.1
O I
II o
01 z031 co
O c, 1—
zil
0