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HomeMy WebLinkAboutBLD2007-00163 0 • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD07-00163 Received Date: 4/19/2007 SITE ADDRESS: 86 OLYMPIC GREENS DR Issue Date: 6/5/2007 APPLICANT: OLYMPIC GREENS LLC 650 EAST CLARK AVE ORCUTT CA 93457 SUBDIVISION: OLYMPIC GREENS Block: Lot: PARCEL#: 979900100 Section: 2 Township: 29 N Range: 01 W CONTRACTOR/ L & L CONSTRUCTION INC PHONE: (360) 479-8312 DEALER PO BOX 785 PORT ORCHARD WA 98366-0785 Contractor's License LLCONI*044NA Expires 8/31/2007 INSTALLER: L & L CONSTRUCTION INCLLCONI*044NA Expires: 8/31/200; PO BOX 785 PORT ORCHARD WA 98366-0785 PROJECT DESCRIPTION: NEW MFH-rritl'ratta tre (BLD07-01643\; LOT — ' MAKE: PALM HARBO YEAR: 2007 SIZE: 48 X 48 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 6/5/2008. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): Stormwater FINAL Approval: Blocking/Plumbing:, ci- ig3-0? //✓ Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: )11t wr(c;A"6 L'v18d HEALTH DEPARTMENT AND PUBLIC WORKS 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 BUILDING • MLA07-00191 PERMIT APPLICATION Review Type: l Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00163 Received Date: 4/19/2007 SITE ADDRESS: 86 OLYMPIC GREENS DR PORT HADLOCK, 98339 OWNER: OLYMPIC GREENS LLC PHONE: (805) 345-6700 650 EAST CLARK AVE ORCUTT CA 93457 OLYMPIC GREENS SUBDIVISION: Block: Lot: PARCEL NUMBER: 979900100 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: L & L CONSTRUCTION PHONE: PO BOX 785 PORT ORCHARD WA 98366-0785 Contractor's License LLCONI*044NA Expires 8/31/2003 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW MFH LOT 7 TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 94,945.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CMY WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: /O..) Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $163.00 KAS 04/19/07 89791 APPROVED Add. Manufactured Home $34.00 KAS 04/19/07 89791 Potable Water Application $58.00 KAS 04/19/07 89791 JUN 5 2007 Total: $255.00 Jefferson County Plannir & Building Departmr JACK WESTERMAN I> Jefferson C. Courthouse ASSESSOR PO llox 1220. Port Townsend, WA 98368 (360) 30 3-910.5 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: C )' taet-6.<2._), ADDRESS: 60 . C Q4rc, PHONE NO. EO5 3 '7- o s77 Iff[0:10 lin The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 1)MORILE HOME DATA: (A) MAKE � N (B) MODEL O G 'j 4/8 D Ce � (C)YEAR a 7 (D) LENGTH (E) WIDTH ,ES , ,.� (F) SERIAL # (G) YOUR PURCHASE PRICE (Do not include sales tax) 9.76� PURCHASE DATE 6 / d, 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PU HASE MOBILE / / j L /z. ADDRESS 3 f 37 Ale rit. c ?7 3 Z I (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAS YEAR?Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? No (B)IF LOCATED IN MOBILE HOME PARK: • NAME & ADDRESS OF P RK Lot/Space # 7 2v� /3 / , eclek. (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: LOCATION ADDRESS REAL PROPERTY PARCEL #/DESCRIPTION / /7-O7 THANK YOU FOR YOUR HELP! <` ,�ty'� o pplicaht eib -ei2 JOD/I COSSELL, Property Technician • • :\i `4/Ei '1f ;f )) LIMY 3916011 II WM/*101851 ,132654 iiib S7 JEflitISHigUefillYUP pa 1 • f.f c l''' l 'I'k 1 O Oil 1 toq 0ll _ . IA CO ggil ^•• �I���I f ftrR • f•f S k in- T1 MOW.�owrr fwu Si IA Agi MIN 0 m *LYEmis �p 70 .rr• .n. i / aE co Diigi: m g I D sal 4 R \ L J—n xm p 1■ OPTIONrwrnAcc OD rn 3 it ee■f ig E.,, \ G $ x Y A -I, r I xe sseze sseie� 3y < ; L_ • i € . 1 II 0 09011 I ; ;;g 1g a 2I I 2 E fK m n MR. _ i / .A.OAFMRTat0in in ia J rrYYnn K A 2 n 210 2 p (�N rcn Ad T • • SPECIAL CONDITIONS CASE # BLD07-00163 1.) 10' MINIMUM SEPARATION REQUIRED BETWEEN WATER LINE AND SEPTIC TANK AND EFFLUENT TRANSPORT LINE. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on June 5, 2007 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: pacific lamprey; SARPA aquifer recharge area. 3.) 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. 4.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 5.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1) All Industrial Land Uses (2)All Commercial Uses (3) All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 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 3094 square feet of impervious surface and 8164 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.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 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 applications on April 13, 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 June 5, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 12.) This approval is for a manufactured home and 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 site maintained in an orderly manner and sigcreate no fire, safety, health or sanitary hazard. 14.) 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. 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.) Minimum setback from Olympic Greens Drive right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 20.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 21.) The lot has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 22.) An address of 86 Olympic Greens Drive, Port Hadlock has been assigned to the lot. Olympic Greens Drive is a private road (P506). 23.) The lot was created through the Olympic Greens Retirement Community BSP on August 8, 1997 under AFN 402752 and is subject to plat conditions and CC & R's. 24.) The lot is served by PUD #1 public water. 25.) A septic permit (SEP07-0137) was approved on May 23, 2007. • • a JEFFERSON COUNTY ' cin 'la EE ,(4---,:esozsT "� DEPARTMENT TMENT OF COMMUNITY DEVELOPMENT 0,4 ,, 621 Sheridan Street • Port Townsend •Washington 98368 I. C I 0 22'ff 7 360/379-4450 • 360/379-4451 Fax N- http://www.co.jefferson.wa.us/commdevelopment/ Itfff (aI;liNfV1 STORMWATER SITE PLAN SUBMITTAL TEMPLAT IMLA# V ri ^ [ l 1 p� PROJECT/APPLICANT NAME: — j "„Q 7-hQ 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 i• 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map., -cam 9 Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site m .A-A.e_ce Kz_l_Q---- f- L-t -(-' , ,---6_,..-/'/ e.J-c-ti..,...-3-,...f.,_. c. 3. Describe the existing vegetation. Indicate nati e vegetationeas n the site map. 42. 4. Describe theexisting soils. ndicate soil eon they site� . ® ' • ry�t t� �L�tirQ� CJ C e 4 --,--(---,1 .,,y)..z..a..�C eC_ ,gyp� � �Qii �"� Q- 'O �I/2 c��v�- 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 p Iicable,and indi to acreage of each. old i �l1t1— !� r� 1 / :L : _: la ti r,:s'rr �i ..0 Ar:W�.rS, 6. Descr1je any excess levels of noise generated by the proposed use or ; tivi : p : -�z ✓fir- -c,a�P '. ":T I�'R w • '� ., ' -7 • MIN — 5 xrp Stormw R JEF, ',1 iOUT#stormwater site plan template-rev.10/12003 equire DEPT.OF ••yy!'`r SIGNAT. : //i l D 'P NT 5 • illaif-N4 fiEjf , may) . , it 1 1 273 7 7. Describe significant geographic features and critical areas (i `.environmentally sensitive areas such as wetlands, streams, steep�slopes,etc.)on the site. Indicate locationon the site }environmentally �, ^�� i�i-P _. ./V1-c �`l Jt )11.1r 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical areas (strea9isi wetlands,lakes, eeplopesr etc.) ✓� � d � �} .C.---'vm2 c ��t G✓ ;i l4`'t' -1 ^wit ztt !7'Yx 3 . ,' . 4. at—t `^-mil a-y..0 2.410-a- A— . �✓__.( . ..,-1--e-- 4--te_All - . .. re(---e271_ e,--)`-e--4--'f 4--CZ--- ...1.z:L.2_ „51) ,,s -, „ar 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 oTte these facilities on the site p n and differe tiate propo ed facilities from e 'stin facilitie . a---effa-c4-L-t-c:e,7 cc/Le `7� /..dun' ' 1-f it. -�. 6n'l .,�n .��� �e 2-cam� 7-r �iA 10. f the project requir the use o tormwater 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 p ojects that involve the potential for dispe ion of contaminants.) fit; • 11. Describe the performance goals and standards appl' able to the project. _ �/7A-t- -te cr2-1 ,<Z- &- k:/--------0—&71r �".� �-c. tom.. 12. Describ- the flow c trols�•tem_�'-�-•-1, / / �' �i ... _ .Gib /z i G /`re i. . (, r ' , , � * Ow. r 47; I '_ / / /!I /ML b"ce� a.--), // a/ F" � i l i` C%L-crz-.-n L 74- ryli 1..1:l,1 6 o teTiftdb(an i4 riv..1t f1/2003' " ,: HgeEIMED AN 11 ` ? CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) *UMW The Construction SWPPP addresses sediment and erosion control during construction. The BMA 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. M tic Cle Limits. .emu- ,1 ' -t.G 4 r /Ll-t c G�-t-fa 2. Establish onst ion Acce (J'`Q &_--c-e__.,2-4--z, 3. Cont ow Rates. / y��a ,,� ��e,7 �_ �2 ' J ''tea 01 4 Install Sediment Cont o s. 4,51' _i - 5. Stabilize Soils. . et j4___A , • , p ti r;:j.2 3U07 . .r 6 flotect pes. A 1 mil C .�vi is ��y.4� ' -Cn OG • 7. Pr ect Drainlnlets. , �--1-ate �-,-1 �-�. t /f ' c.-t r /J - m J---a � --r-t.4-7,-r j" 4-..e.. -,-,...g„,4_,Ute e • atormwater site plan template-rev.10/1/2003 8 • • . 13. Describe the wager quality�systee.. 7 . Zoq 7 " ,. L ts.---6--R ,e Q,, . v - ;::y..,..„.„... - 14. De ribe the cony yance s stem analysis and design. 6.4 CL-C-c-cf?--c4,. a.4.- -e.r 1--e-v-6 01---- . 6 .....4.-71 Ad—c--e---c—ci..7y,L5t,C. , ...3—7 3 8 ., ,e-u-c.-e-4 ' jr-c_ 76/el-tr>li 6-17, . f �ti1 / L A Gad�� f 6/ ( - ''� /7-n-1./1,�l�Yrs-c-,-Y-] �Yl 1-G4_-ci c/ - 15. D cribe p source of fill aterial,ph sical characteristics of fill mate ' I,and depos'ion of exce material. -e- ..( e,J-c-el-6--( chk ,c.. , .c-ee' -c r -1 " 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 41/ /-• Xtx.. i)-0-e_ 17. Describe the pr posed surfacing material. d e Q 18. Describe metho for restoration of the site. ' C4 f-cZ, Aga-hz- d frl a--Yx-Ci o k-rf C.-c/V-e-A-t," . -1-1-(x-)-) - wt4,,eritx.. .e.,,._ e4.)„,_ 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. ' e�f -� Pi 20. List here and include ny special reports pr tudi s conducted to prepare the St water Si Plan. ei.-1 t, zija_ cO!:,idt--4:-O-Yr 21. Lis 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 heJe. y A'Rk-lr; j1 RVA DA rat Ok6V\il\ifi 0\ stormwater site plan template—rev.10/1/2003 • • f BCE (F T i ti ri 1. t. t. 12 Required Elements-Construction SWPPP(continued) IEF FIBI iill 11 1_1(:08. S abilize Channels utlets�� > al c-i ', 9. Control Pollutants I a_ /� r-am • /a Control De-Watering(the act of pumping gro dwate2r or stormwater away fr man ac ive constriction sitep71 �(/ —' -ItU-c,„-1Q.e/4 ` 11. Maintain Best anagement Practices(BMPs). . .i 73 v 12., Manage the Proje t. i --..* (C...e../>-,4_, i 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). _ / / 0-r, b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). , r tit, ,t_d a4 1 Carl-k-i 1'-r`-c) �p- G 3. Environmentally Sensitive Areas. >21_,. Description of envir nmentally sensitive real that are on or adjacent)°the s, e.D u �C�-C�rxXe �[ 4yt %/ti: -2=-7 ., --er71-1 _e4e_ --a-cec. a_.- e-,t., 3 , . stormwater site plan template-rev.10/12003 9 • 0 . b Description f special requirements for Orkin in or near environm nta y sen hive eas. j -Tv o-r\or &i 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). - • &� � i c�tY(vrr� • • IMl1irMIIIIW_gw /, 4ILL( , V ii !. 1 Ft_`�:' `/w/_i. �� / �e 7 f • 5. Construction Phasing.a. Cho tnstructi sequ c� s J v Q�— 6 6 ,j1-e- r-4--(.i b. Construction phas ng(if roposedy e �-=�YL,- X, -( / 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). .1// I. Pro idea proposed construc'on schedule X .y .fin ai "1 7— <5—/ '7' -• II. Wet Se son Contruction Activities. a. Proposed wet season construction activities. �,/h.c�hAJ REflWRJ1) b. Proposed wet season construction activities for environmentally sensitive areas. n 7. Financial/Ownership Responsibilities. (EffttiSHIV AND OCP a. Identify the propertx ow er re nsible for the iiitiation of bonds and.___ /g� her financi I secun s. � ens / �{ t�0`e0 �c.�� ` P. / ! • ;� Cr7, 7Y1,f?he b. Describe bonds and/or other evidence of financial respo ibility 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. ----(`i.---'`'c—r `.--12 1 c. Waterways. P",7---C(' IA • d. Runoff/Stormwater Detention Calculations 10 stormwater site plan template-rev.10/12003 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 signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct tot t-e my knowledge. I also certify that this application is being made with the full knowledge and consent of all own r o the affected p perty. ( oh A IZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: GfJ�'3-�Ys--c.+-,. �'�i ct�C ✓'�PiC,�.nt't' "` �' __,-,,t.6..6,,, ,.,t.4 ,,...4 ,.....4„ ....,:o ,, ,,,..,-....14, ,..a.„ ,_r__-t„,„..„-( .6,;__,,i,-:, ..„4:_-&- •_,..-}„...,,za,„ r"-"('-(.-44-1-C ' R FCEWED tAT f\ x J ‘gtttiDW Ile CO 12 stormwater site plan template—rev.10/1/2003 ��gsoly cow JEFFERSONUNTY ai x F rjA g� DEPARTMENT OF COMMUNITY DEVELOPMENT v 621 Sheridan Street • Port Townsend • Washington 98368 e 360/379-4450 • 360/379-4451 Fax , . 1r, NO�o www.co.jefferson.wa.us/commdevelopment Master Permit Application M ! g ' llliplip Project Dpscr Lion (include separate ee s n essary): )11.4.4"-c4 44--)-1-,_st_,NI),A-.2---Ceatt-c-e-ce-IN. ,.....L.--),6:„..‘ _e-/,-(,_..t.L.,...:LA: ,,,,,e4,__,,..„_AuyLk Tax Parcel Number: 7 7 9 U 6/00 Property '/ Size: -,/'? ' (acres/square feet) Site Address an /or Directions to Property: 86 0 r,,,_„_,,_, -6'L--,k,,,, .6A . 4,-t.11_4(-1_,Ile--4 &}4 E.) 3 3 ? Property Owner s)o Record: ' 0 ; p, c3,ecFivz- 44L Telephone:6(.'a 937- j✓ 79 Fax: C 23 7 -r6 b 2 3 f Mailing Address: � £- J � . � l email:Cc�•+� h r t ct 4 p 3 �CLv[ ,� tr,,l �u:u�, Cat q 3 Vs'7 J 1 Applicant/Agent(if different from owner):V Telephone: e 5-g 5 700 Fax: 6d 13 -0 b2 email: SCs tAN c+ 5 649UN; Mailing Address: („ ) Q,,.re- 6 ca 5.3)4-9-7 What kind of Permit?(Check each box that applies �Jt Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification T51f Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan-- ❑ Home Business ❑ Cottagelndustry 0 Long Plat** ❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium o Tree Vegetaion Request *May require a Pre—Application Conference Pre-Appliction Conference Please identify any other local, state or federal permits required for this aproposala if known: I hereby designat DESIGNATION OF AGENT 1.4E/4eA( to act as my agent in matters relating to this application for permit(s). OWNER SIG TUR r �' Date: r!-/7_b�' By signing is application fo + ,the o. er/ t attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's ledge._Any - rta1 alsehood 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 reguirecl later i Spections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicati hat he o she wants prior notice. Signatur l La's Date: !c1_j 7-617 The on on ppli t will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endan n 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 yi . late the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding action(s)even if.yoore in complian a with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tr- .,;onsibility f r adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signal y-1 7`6 7 apor Date: G:\PermitCenter\##•FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 0 • _ BUILDER STATEMENT The signe his statement doe hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they ,•ri gtfie respons•ility of the General Contractor for the proposed project. /� gn, c 1i oj Date: ` —/7 7 GE CT• !' MANUFACTURED HOME INSTALLER: PHONE: FAX: {� ,,,c . (;3c,o) /7 - 3,2 ( ) �t1c.�rr-c� -�-t•�'1� / � C�.C�t.. MAILING ADDRESS: f 0� L x 766 7 ( ,.. EMAIL: CONTRACTOR'S LICENSE c't•34 leWAINS NUMBER: 44 (OA/ / 0 IV i NUMBER C -)—(e C ARCHITECT/ENGINEER: ! PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Type:T e: Bathrooms: Shoreline: Type of Sewage Disposal:New TN Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Z Height: , [I Individual System ❑ Masonryl4/f" SEP Permit# =SIP`i6-',,s3� ❑ Repair Bedrooms: Water Supply: ❑ Demolition ❑ Other: Existing: Setback: ❑ Private well 0 Two Party Proposed: Z- X Public Type,of Heat: Total: Z i\i//-: /Name of System: 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: i Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i 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: J 2-,3 oil (Dtei• W 2"0 Floor Heated Consistency Review: J Other Heated Base fee: ,, ;(p3 . 2 CO 4I,.A--' i'1t,-,,',4 Ai ,rYi-„'-';.r,\ , r11l,1 •,, Mezzanine .,' C 1 , `\'y j 11 Additional Section: 4 Heated Basement Plan Check fee: . . ;% ; Unheated Basement " State Surcharge fee: ---_— Other Unheated Pot Water Review fee: t� CO ^v-il%Ill\ 1 It ` I t a 4 _3tiii_ 't1 SUBTOTAL Garage/Carport 5 `� C Decks 911/Rd Approach fee: X.►L°-E-t a I Other TO AL: $ 5/ ! 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