Loading...
HomeMy WebLinkAboutBLD2007-00121 • • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 PERMIT #: BLD07-00121 SITE ADDRESS: 100 JOHNSON AVE Issue Date: 04/20/2007 PORT TOWNSEND, 98368 Final Date: 4/1/2008 APPLICANT: CLIFF SELF PHONE: 360-379-8134 JANET GOLDENBOGEN-SELF 4303 HOLCOMB ST PORT TOWNSEND WA 98368 SUBDIVISION: INGERSOLL'S ADDITION Block: 6 Lot: 1+ PARCEL NUMBER: 961500601 Section: 18 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NSFR W/ATT GARAGE THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yesJ no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 4/1/2008 I:\F_BLD_Occupancy.rpt 10/29/19 A07- BUILDING PERMIT APPLICAT!N MR Review Ty 150 vpe Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00121 Received Date: 3/22/2007 SITE ADDRESS: 100 JOHNSON AVE PORT TOWNSEND, 98368 OWNER: CLIFF SELF PHONE: 360-379-8134 JANET GOLDENBOGEN-SELF 4303 HOLCOMB ST PORT TOWNSEND WA 98368 INGERSOLL'S ADDITION SUBDIVISION: Block: Lot: PARCEL NUMBER: 961500601 Section: 18 Township: 30 N Range: 01 W CONTRACTOR: HI-LINE HOMES PHONE: 253-840-1849 11306 62ND AVE E PUYALLUP WA 98373 Contractor's License HILINH*981BT Expires 2/10/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NSFR W/ ATT GARAGE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,152 VALUATION 214,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: WOD OCCUPANCY: R-3 OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: 576 SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: CAPE GEO BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: 7CVT-C---b 317371 Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,632.15 LYK 03/22/07 89600 APPRO\JEIJPlan Check $1,060.90 LYK 03/22/07 89600 State Building Code $4.50 LYK 03/22/07 89600 APR i 2007 Potable Water Application $58.00 LYK 03/22/07 89600 Total: $2,755.55 Jefferson County Planning & Building Department • Jefferson County Building Division Permit Nun0: BLD07-00121 Applicant: SELF BUILDING PERMIT INSPECTION APPROVALS applicable 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 1 Erosion Control Foundation Footing Footing Drains Foundation Stem Wall Fj (� 1�` CX-9, �A.,'r'ft.„4,\4 Underground Plumbing Under Floor Framing IV Straps(hold downs) 11/_ 167 Ext. Shear Wall Nailing Rough-in Plumbing t5 y Framing g 11 Blocking Airseal ., f 1 S'lp CyL� Insulation:Walls I/111 t1_ Insulation: Floors Insulation: Ceiling Int. Shear Wall Nailing Wallboard Nailing 20,& -)ft- Gas Line: Interior Gas Line: Exterior Propane Tank Heat/Chimney Clearance -- Drywell/Alt Drainage Address Posted —.— FINAL INSPECTION 90:r G� ,o( 4,r FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD07-00121 1.) PRIOR TO OCCUPANCY: FINAL APPROVAL OF SEPTIC SEP04-111 ARE REQUIRED. 2.) A MINIMUM OF 5' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND SEPTIC TANKS. 3.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS. 4.) The application was reviewed by the Jefferson County Department of Community Development for the presence of Environmentally Sensitive Areas (ESAs). The Department conducted a review and has concluded that the property DOES NOT contain Environmentally Sensitive Areas. However, future proposals will be subject to a new ESA review and conditions may be added if new ESAs are found on the property. However, a Category III wetland was identified on the parcel to the east. A portion of this wetland buffer does encroach upon the subject parcel. 5.) A setback of 50-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 6.) Wetland buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 7.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 8.) The applicant is proposing to create or add 4380 square feet of impervious surface and 5200 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. 9.) 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. 10.) 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). 11.) The site plan as submitted with the building permit application on March 22, 2007 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 April 20, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 12.) This approval is for a single family residence with attached garage 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. 13.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 14.) Not more than 2 unlicensed vehi shall be stored on any lot unless totally s•ned 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. 15.) Minimum setback from Johnson Avenue right-of-way shall be 20 feet. Minimum rear and west property line setbacks shall be 5 feet. Minimum setback from east property line shall incorporate the wetland buffer setback of 50 feet from edge of wetland and 20 feet from the portion of"O"Avenue that was platted and not vacated. (Site plan as approved on April 20, 2007 meets these required setbacks). 16.) 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. 17.) 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. 18.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 19.) The building height is not to exceed 35 feet. 20.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 21.) A Declaration of Restrictive Covenant was recorded on July 14, 2004 under AFN 486919 to consolidate Lots 1 (Is N30'), 2-5 Block 6 of Ingersoll's Addition for the purpose of meeting land area requirements for on-site sewage with a public water supply and to allow development over and across common lot lines as the county does not have a zero lot line setback. 22.) The lots have been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 23.) The lots were created through the Ingersoll's Addition Subdivision on April 22, 1889. (No AFN available). 24.) An address of 100 Johnson Avenue, Port Townsend has been assigned to the parcel. Johnson Avenue is private (P79). 25.) The parcel is served by the Cape George Colony Club public water supply. 26.) A septic permit(SEP04-00111) was approved on August 2, 2004. A SPAAD (ZON05-00022) was approved on May 4, 2005. 27.) A Wetland Delineation Report dated January 2004 prepared by Olympic Wetland Resources Inc. was submitted in conjunction with the SPAAD application to address the wetland to the east of this parcel. The report identified a Category III wetland that requires a 50-foot buffer. • EC, saN c MAR 2 2 2007 i"ifffrikt .° JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT If fff H I� + i ffl j$ �� '� 5,, 621 Sheridan Street • Port Townsend • Washington 98368 �!�� 360/379-4450 • 360/379-4451 Fax "ENO http://www.co.Jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE ' (+ L ifF SELF MLA# ( -I)V\ PROJECT/APPLICANT NAME: SA-AJET 6oLbeN63 06-EA/-SE.L..F 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/NGLE FAmi�y 4rt✓E4_1-IL) G ltJ /37-7-AcHE d G- A-44GE G -i ,V o ,I f3 / 0 G/ LTEe- SEP Tl C fyITEM JJ el urtufiy, .f/o wfie_lrS, P A- T/a Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. G #rL y .t c•o P//0 G, Th p sr T L y /= G. R-T T,E4,e/4-/4V 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. ^ S E W g"TLAI/d err F"f - - / 0O 'Vo (A) BT L4,v - TDLEieA-A)7- V ES-ETAT/OA) /N GtJETLA-NQ F/a. S ) Sto t E A F E e/t// D R-€6.ON t.�e 4 PE d u T S 7 AE. w E1 7" L-A,O 0 S 4. Describe the existing soils. Indicate soil type on the site map. - S E 1.- by _-T r;f►A/d /ZE flD�'T erne TIC "fvC t5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—above, below, and on the ground). indicate, existing toxmwater dr galn$nd ftom the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. PEFEP Ta s,7- e p4-,-/v g` GvLTGA-/ve /aEPo4> c9 A/,C E . v L,4 r E. Gv E r L"44v d 44,V r-E/L I o,2 7-0 Al- a U S' C A/ Esc- AtA/ 4 EAs-roF PeaPE1Ty — n iI 6. Describe any excess levels of noise generated by the proposed use or activity: AP PRO v 1D /71 --,¢v y i 9 v i n in CAI r ,0 v 2//Y,ISTO W ATFARtiP,LN ,,y/ APR 2 0 2007 Stormwat 's Required v IEFFE UN Y stormwater site plan template—rev.10/1/2003 pF.PT.OF C I DF FL E T( \ s SIGNATUR ,IIJ • • 3 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicat Ian on the site map. /PE-GUL Gu t f AL/1/13 9 ,v a44srEe/Y ,S /D E o f P gdPef-ry 0v eiG-u&A 7- e- /vE7 GA/U,6 0 4/ A/7E4/e Nd /29hi �✓✓o a F P PF7 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.). C APE GEOR-GE At/ Gf4 -411) ,05 Pag7 r w N.rL , P eOPEe7 / 5- sve40o,f/DE,Q g c/ U6v0EU£ - PED L4' Ll ON 3 Y/DES 7" , 4 70/AI 5 e p//9.4 4,27 71/' --�� GU£> L i4,fi 6 , /t/ g s-r 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. 9. Describe the developed site hydrology, as proposed. Indicate whether stomiwater 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 siteplan and differentiate proposed facilities from existing facilities. 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.] N/A 11. Describe the performance goals and standards applicable to the project. //7h ii/I77-/-/ S roe.,>rJ "A'rrre. D/v s/ r6 12..,..Describe the flow control system. s d • stormwater site plan template—rev.10/112003 6 • • RECEVf [). 13. Describe the water quality system. A/ /4 14. Describe the conveyance system analysis and design. /✓/A. 15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material. l2"4j/ ee44 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 41/4 17. Describe the proposed surfacing material. Pi r,e vN m v G eN1 ,4'L A-/0/ 18. Describe methods for restoration of the site. NArvE 409NrS inv Cl/ G,eOOW IS-CavE.� 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/ 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. A r ' 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. NbA 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. mmot 2 2. Establish Construction Access. dL A ULiui- 7 f ovA,eel/ sPALS 3. Control Flow Rates. / 4. Install Sediment Controls. S/ L T F -A/CE / 4. c 6-ti ig r E4 4 /e:,41 s 5. Stabilize Soils. VrsQv£E,V 6. Protect Slopes. 7. Protect Drain Inlets. 4V/4 storrnwater site plan template—rev.10/1/2003 8 td - 12 Required Elements-Construction SWPPP(continued) t `D s3 8. Stabilize Channels and Outlets. 9. Control Pollutants. S/ < 7 1 E4/cC 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). /Y/n 11. Maintain Best Management Practices (BMPs). 61) uP -t G�c V ( 5 ¢ v E E.c/ 1 1/1"-4 e 2 £A-4/ N 6- L/ m ITS', vSE SILT F c6 , cT, 6A/ - cu SJ ry c_ C- PI- /4- c I 11- w 6 ,4 ` E s o 2 q u f!- /L 2 y O S TO ET 6 2. ,D 112T F. IC 20 A Q - 12. Manage the Project. ff/ G.itit /716 m E S GvtvE4_ e ) (L L GfUEc Gc'e£eLV A-r l £ sL S 1 O -Th F_v E--A-) s ;'O .s C L. l / '1 J -771.- L //,Y' PLAcj 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). l70 .neeearn 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. stormwater site plan template—rev.10/1/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. /h GU -�fi-r-- G(._ A L/ /ie .-. -) 9,,e_o_f.,,,e6c, _____o_r-s64.-- 4--e- etAAI-1-f..L.--- . .00‘--/1,-.4:d 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). /10 Ott '- -irt 5. Construction Phasing. a. Construction sequenc i/9-I3/o7 b. Construction phasing(if proposed) N/, 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. II. Wet Season Construction Activities. a. Proposed wet season construction activities. /V/11 b. Proposed wet season construction activities f9r environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. 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. �///� b. Diversions. j'( c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template—rev.10/12003 10 Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities,or structural source control BMPs (not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. -� �- -v '7 WNER OR AUTHORIZED REPRESE TIVE SIGNATU E (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/1/2003 12 C- C • ,4 •� , JEFFERSC•COUNTY DEPARTMENT OF COMMUNITY Djr OPM�HT lib `� 621 Sheridan Street • Port Townntl sl' "'�VVas Ihgton 8368 ° 360/379-4450 • 360/379-4451 Fax �gS, NO�O' www.co.jefferson.wa.us/commdevelo ment, �1AR 2 2 200r Master Permit Application MLA: Ori — 150 Project Description(include separate sheets as necessary): -14.J. F111N1 up /V S F P t it?T c-H GA-e-At&$: 1 Tax Parcel Number: ' / .S�c,Q G D/ Pros Zey 1 c'.3 o S g• Z',["t- (acres/square feet) Site Address and/or Directions to Property: /p O J—O ,1 N S 4N A v . , Property Owner(s)of Record: C L/F F S E c_ F f .0—y -ELT 6:o i-A g'u 0 0c-EA/- S F_ L F Telephone: 3(,O- .3 2 (1- ,/3e/ Fax: email:(21../fFek4B<ESPgEO.C©rn Mailing Address: L/3 C+3 H 6 i- e 6 ,i ST, Po ,_T 7C5 La.)..)S L-,v 8 w,44 9 ,g'3 6<E Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: Wpat kind of Permit?(Check each box that applies) re'Building ❑Variance (Minor,Major or Reasonable Economic Use) ❑pemolition Permit ❑ Conditional Use[C(a),C(d),or C]** Single Famil ❑ Discretionary"D"or Unnamed Use Classification /Garage Attached Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* E1 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 required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: ,tom..--Cl— Wll,p- Date: p�,l(pT Pam, - �� ty 3 —I /— 6 7 The action or ctions 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 re onsibility for adhe innd complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: AL,t �r--/-1-p--1 - Date: 3 — / 5 O G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • • 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 assuming the responsibility of the General Contractor for the proposed project. Signature:____ L/,r�--CY h'iL- - "'-41-ez4z� - -'��-ey Date: 3-/ 9 - 0 7 GENERAL CONTRACTOR OR MANUFACTURED HOMEO INSTALLER: ('' PHONE: FAX: ill LINE (��-0) 37i- 56ozs ( 3 ) 37 >- Y/7/ MAILING ADDRESS: 1/3 o' b� NA , UE , , EMAIL: I-AE1 y_ Pao, 6-,1/LINE/4-o/r1 c_5-,cop) CONTRACTOR'S LICENSE P t/y,4 d L ei f', (Ai 4 9 Si 13 WAINS NUMBER: C c 0/ N I L I N// ?B 1 13 T NUMBER ARCHITECT/ENGINEER: l R V i,t/ REP PHONE (:50 y)5-y y- (jog? FAX: ( ) MAILING ADDRESS: . a os' S I' ,'J s 7 l� A/.� EMAIL /2/9 5 c d / c.f.//9 Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: M' New '1 Wood Existing: b ❑ Sewer ❑ Addition ❑ Steel Proposed: A Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: individual System ❑ Repair CI Masonry Masonry SEP Permit# 67/d R&C'k ❑ Demolition ❑ Other: Bedrooms: Water Supply: o in C ss t Existing: O Setback: Lt �nvate well [I Two Party C- Type of Heat: t' ' `'Z� Proposed: j / re-Publicfu, , t L /J fir -,e 5 Total: 3Name of System: 6-t)D0 A sry .v CRPE &l:oe-6.4. 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: ❑ Underground Tank [l Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove [1 Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove I 1 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 a lea (013rj�p EH Bld App Review: � w U 2' Floor Heated N./ Consistency Review: 153 Other Heated Base fee: /Y/4 1IVa).i5 Mezzanine Additional Section: N//./ Heated Basement Plan Check fee: Y/4 - (b Cob-°I° - Unheated Basement / State Surcharge fee: 4-50 Other Unheated Pot Water Review fee: �� Ay,/ 00 Garage/Carport S7 135-14.' SUBTOTAL ` pll - Decks 911/Rd Approach fee: /1// 1nK1-1 Other /v /4 TOTAL: $ il_I , Receipt Number: OCko w Cash/Check Number: 102- ESTIMATED COST(RE Date: (3Z-�(,� .Fair market val labor and matena oundation to finish �"�' I q Initials: G:\PermitCent DIFaster Permit Application 12-30-05.doc c .--\ W 1-i �I T > 0 -O & 00 tnp V 0p � IS 7177v � -fan W rN Q!-- m � p r T7r � � r- A m mrn ' Qp ' Q' p Z7 pZm xi c. o � cm(� � a > o � mZ n � chin pH n0 > tn m O pua t m p7z,2W 11 b -fu ivm SO Sp OC W cnr�i H � w � O, tZTt cz1� � QU' mvl 0 )'rnZM mtn �rn rn2 Zoe � mc, mrp-1 (A > � Zip � rn �H yma � a7_ p -iip m > � r m - o Z > t� ZO v, O m HZ Ovl ,,, Hzc, m � lib-im 0, - > O ZomZ 0 (n � oZ cnZ r r tri) v pRi zrnmmZ -{r H� Hp Z � mZ uc�n � 5 a o < 0 00N ym 0 -1 70 )->-I --I' cZr"-o p7o m1.' alp .HZX, rip no Z HN 3)0 W 0 0mp Z7J to > C� Z --� to t7Up =ZH Op � 7t7 (n Zx WC 'or) -1p�7c' -1 oF47C p0 > m Otn H m to t7H m -i —I c) of CA " �. m 0 m 0 p --I to -I m m to -, 0 Z7 o p > cN2 70 0tom 07w H.0 77 > p mS p > < C Qc0 �� -iz' r�i ,i �plml ?rno3 oy cZnm p � � ot`�i, Z mO � HH -_�i 0 -1 >� ►:f A7° 7rnvmp � pZZ• Zm v poz ,Zu.1 = m co u, � O 0 p q) p m OF > Q mF mG 'SO � N (nr�rl > v, rn� ap Ai a � � mo -,, � , Z -1m z,rr3 x, H toZ F > > rjW m W m O -I mr 0H DX 0 � W ' 230v -i Zg a = F 0 -1m,� u, cna Zim wZ mx7 -I am � m� v w o -1 p -1 -< 0 > aCocm3 U) O r-m m > � YH (h � DO17 > M D �c� �� c >-.3 "Dp p , > p mZ Cl) � 0 � o �Z > p� a --iaN ma I.1i ). mp > NH C7 " -I ,--, ,-- --1 -I Z •• m� 0 �Z W D � � _.1 H � Z > --Ii " C) �� o1mC m "Z ) v � c Otn z- > cvcv' A 47002 m 0tmi, ( -D-1CI11-'-1 Zv c) > X -i � * � 1c--?II porn 0 m � -I > -I '-IZ i > 0 I� � rti S�Sm �IC rOrlSr�r C � ZF rnp 'c> > .Hz zc, p p H C (mjI (.,, PI III ODH Zt77t7 -'I t7p -CD H7� m 0 -IcO > 0 � O FI Wo, v oyH Smm as tmi, m rn 0 � r p m m p � ZU) �) 0 > 0M m > . Z D g ZOr� 1�- Hm Z rti FC7 GI ...I Z � Zz Z c c XI iv rn ›.. Z CI (nth m i- Z -I 1 m m '' � rn -I �' m Co F p Zp rn / 42'-0" 16'-3 " I1'-31" S 2 , 14'-5" _ II y 5 9 / 2'-611 , , 60501 H5 3036 H5 \ \ \ -. I Pk- I c.) N.,) \ \ >Mot _ _0 0 _ 0 I Z - 0mCs) I Cr'-A. - uum Z I I >� 0y 0 _- rn Zm F- �mmOOZ oT 1'-9"G� > o ,® > O t9 m Z�= -I 1 �O ' AO O � sy0my ,II b � r � I CE <ZI Ow \-I I l0 X I - / O - -I m \ \ a iiT/ZJ ' m 11 0 T, < < z1 \ ti ' P. - 1 Itn0 t�-I r-1 '-0A 3'-1" 5'-0" 0 1 -1 4A �� N I� I�;�, p �'_ III'7�21--111 ' 0N� aaN m \N H ‘,.,:.„..7 's.....— „„m-I C et .._____ ,,,, Om IM° -8 e __ �) I l9 - as I-p x 0 4' .211 61_1" m-3m -1 =tnmo .I )., - U' la �� I - - Zrn n�H� cn = cir _ 0 m o b -i = O Zm� X (Tr p --t o, 3 Q> x to m 10'-0" ' C CnX 0 Wmr , . 0 w m 2 _911 E060'" 30' - — — \ �F® \N \ \ ' to C Aw , Z � I 2p 0 w H ! IcnZ` DaE II t� j fa.)Y 1 _ 2" t1 O rr, � 6) 'W „Ara - O -- (--_-?) r-i 6 _., n LoL pH m `"_ o Sv n I _ 1 `=pi ' O �I_< I 3'_1 1 8'_-1 11 oo K., �TNAmO 1 Io i l 7 - 21 m t> Ur as Z - z O pkep� � H GI ot^O n a m q3 0Z > " Zm H 2 II 0 Z F v _ \ - oZ . o C rn C m - . �_ � 1 1 ,- )J� _I = 1 , Kb-. "— L 50501H5 5'-11 " / 24 -0 11'-5 " /2I_-1' IS'-il 0 / 54'-0" / / , or ° b w>,oI- CLIFF & JANET -� ... • FLOOR > pro.Z o o�Zm SELF �,� 5>U=O 4303 HOLCOMB ST N x so z PLAN PORT TOWNSEND, WA 98368 H 0 M E s N '•'cm (360) 379-8134 www.HiLineHomes.com �\ A O U3 ^�wm(n \\" 4 V N ©copyright 2005 HIUne Homes l S/rE ,°,,q,V / -0,4 ; Cl_/FF ANO j"A4/ErS6LG y3o3 Not ca/78 ,c-- .dv,)r' 7-424.11114",S.14, 4/11 98.'6 8 Cc4V779 -7 74`- ,... 6d-37 / - ?/2y Plot Map Drawn To Meet u E. E • HIUne Homes Specifications. /i 3 0 6 l� a o A s /7-E 4{/Fa.toii q?"'/o Ai / Any Revisions To Be Made p vy A /.. v P, t A 9:3 7 3 _..._...,_._____.._.,..,_�._._._..„_..,....�._...�.._ fop TaN,vS a mot/ v/_ By The Homeowner 3 6 b- 3 "1 `l — 8 6 e CD •-7a47-•' Toc,..M.I.c-✓J 7, 4'4 9 Q'.? 8 .o 9oc24. G. 96 l S" 6'a / ®— /bD- toNt/SoAJ A v - - /0 / �' Job 'AYE? ° iis� 0 oe*��, " bah '011 J F 4/4 , a ff 61SoO6o / y � � 9 5� %ar���d�/1' (Pt)Age fav rl4GE d �/ ao r,�, � 5 � s 1 rX Qr �3'� )111 \ /toad t? rill' --i13?i,No9 \ - ' f� r£/ —� $l � f � ; P / e / a <z- -% a0/ \ - GARAGE 4,N ''` / ti ,j cN *ii. <-- \_.._Th Pl a r°.rc, e. 24 X 241 • _fit 1 e it'd / ► z� way .Rf�1i • . ; -) a _ n 1114N- Jf....... I, E---a.g zs + -- 56+ 2 / 6'2 SQ F-r 1 A / ��}A1 I' V PRopoSa4 I, so Art C.1AN 11 lt ; 4 APPROVED )cIA , ,► SITE PLAN a O/Vcove,2- ON APR 2 0 2007 a PA/7,, -ID Gei ► 0 ,EFFERS CG i"PT.of •• ii i.g DLOPM • j SIGNA • ,' 40 P p i✓,. . - J� 0 Stormwa r Require lif /ih 'A37' (RECEIVE11 ) //d MAR 2 2 2007 ifffFRSIHt, i:IIIINTk fJCIl