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HomeMy WebLinkAboutBLD2007-00229 • 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 #: BLD07-00229 Received Date: 5/15/2007 SITE ADDRESS: 72 BENTLEY PL Issue Date: 6/27/2007 PORT TOWNSEND, 98368 APPLICANT: PETER CENTENO LINDA MC CORMACK CENTENO 5920 VALLEY HI DR SACRAMENTO CA 95823 SUBDIVISION: Block: Lot: PARCEL#: 902252002 Section: 25 Township: 29 N Range: 02 W CONTRACTOR/ GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 DEALER 19647 VIKING AVE NW POULSBO WA 98370 360-697-4606 Contractor's License GOLDEHP950KB Expires 5/18/2009 PROJECT DESCRIPTION: NEW MAN HOME MAKE: SKYLINE YEAR: 2007 SIZE: 66X28 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 6/27/2008. CALL IN FOR THE REQUI S-THA--C.,9E�Y TO YOUR PROJECT. Setbacks/Footing ONTINUOUS FOOTAQ SLAB or PADS USED) „,___.( G ' 1—0 7 Stormwater FINAL Approval: Blocking/Plumbing: .Pi.m's 6j(� ////9/ 7 / Propane Tank/Lines A F'A Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: rr Final/Skirting/Vents/Porches/Steps: t1 cam tines.( 4j.i/p HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY- SEE REVERSE MLA07-00243 A. iLDING PERMIT APPLICATICO Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00229 Received Date: 5/15/2007 SITE ADDRESS: 72 BENTLEY PL PORT TOWNSEND, 98368 OWNER: PETER CENTENO PHONE: 916-391-1640 LINDA MC CORMACK CENTENO 5920 VALLEY HI DR SACRAMENTO CA 95823 SUBDIVISION: Block: Lot: T-1 PARCEL NUMBER: 902252002 Section: 25 Township: 29 N Range: 02 W CONTRACTOR: GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 19647 VIKING AVE NW POULSBO WA 98370 Contractor's License GOLDEHP950KB Expires 5/18/2007 REPRESENTATIVE: GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 19647 VIKING AVE NW 360-697-4606 POULSBO WA 98370 PROJECT DESCRIPTIOt NEW MAN HOME TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 67,000.00 ADD'L: HEAT TYPE: 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: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: 5// 1�;j c Type Amount Paid By: Date: Receipt: Approved/Date Permit $163.00 CJZ 05/14/07 89973 APPROVED Potable Water Application $58.00 CJZ 05/14/07 89973 V V L. Total: $221.00 JUN 6r/ 2007 Jefferson County Planning & Building Department ¢,g i L,p44 � JEFFERS( OUNTY to a eni% ``� DEPARTMENT OFCOMMUNITY DEVELOPMENT--- 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ;`,' Z 2007 ny• p"J www.co.jefferson.wa.us/commdevelopment ' I Master Permit Application MLA" "...41 -D2A Project Description(include separate sheets as necessary): // 7/i 1C" tee,c) "i ?6- Cc�I�-zGr_"/dad r>-'t--c=_ J l Property Tax Parcel Number: g0co15 00A Size:5 i-TA,Gi'.LS jt(6iiiim)1,.5f(acres/square feet) Site Address and/or Directions to Property: „ PJe v1{I Plo "e, Por4"TOtN'fsPn 11, WA .�i30-$1- j Property Owner(s)of Record: i ft4r j LIMA C ,gin 0 Telephone: (g(1.77 '�A I•— Y 4O Fax: G email: Mailing Address: �jga2a �i►ei� (-f1 �rll/G,S�C( i1Z t'I')-� C"t, , i _ Applicant/Agent(if different from owner): C Ofr �f1 �YY}"( (9 POvi Isle Telephone: (?.(,70) VII'—3 t 33(9 Fax: (-7-ifo)lob— t'O(9 email:VINO-VIACVIV O1NG5 �'~ N b lsc exMailing Address: I q(p<F1 v i Ki 1 . Ave, 1J.v • 'PNA 15 k o1 / N -4-0 What kind of Permit?(Check each box that applies) 0 Building 0 Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or Cl** ❑ Single Family 0 Discretionary"D'or Unnamed Use Classification ❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)** 1:4I Manufactured Home 0 Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑ Commercial* 0 Binding Site Plan** ❑ Change of Use 0 Long Plat** ❑Address 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane 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 ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 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: r. DESIGNATION OF AGENT I hereby designate Li-,\C\((C`V ( \k \\"*S to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 1 l�`CkiA ( .1\\l�\l;. Date: 11 h 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 ma, 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: `-i` �\M't 0.\ 1 A.(i ��. Date: 1 i The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permi has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s) even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- transferable responsibility for adhering to and complying wi the ESA. The Applicant has read this disclaimer an signs and dates it below. Signature: i ,; ck1\" L t\L Date: y t \ I I 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: t-1 Date: }1 (i'J f 1 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: C'ioici i-tomes of Pooi�ioo (vivo)04-3144,, (3(e0) 0 - '1-(7a(p /� MAILING ADDRESS: I-14 41 V i K IM lv& IV.V', P i/115 l0 EMAIL: voNi ,q pieti©encs_poVt(s o. com CONTRACTOR'S LICENSE ` j� / '�-O WAINS (� NUMBER: G't il, k, C� > v �` NUMBER 2 Lica 1 ARCHITECT/ENGINEER: S` �i" 1 *,__ PHONE (?U!) ) J 3? 2LI FAX:( 3 ) Li Z j 6 MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New Wood Existing: 2 ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: ❑ Individual System E Repair ❑ Masonry SEP Permit# O h- Bedrooms: Water Supply: ❑ Demolition ❑ Other: Existing: 3 Setback: q Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: 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: ❑ Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ 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. ' --di-< ,__ ,x�xc+, a rt,T, c,� s Str a "Y}y-- v}K ,�.A,,.. r ',..:.i- ','i.�."c'�pg...° ^_x .c ; c��4- `*.� --tir P is��{ r`44��` ;4� .'sr'',yt+�s �,�r FFR.. +. Square Footage Current Proposed d. .. : `. (I, ,.,,,._~�,. , _ . ' , '. Main Floor Heated 0 '` ,. `'.: EH BId App Review: 2n°Floor Heated U rxw ; Consistency Review: .,z 3' CD 3 YTL i k� 3 Other Heated = Base fee: Mezzanine 1.'�'' ,y ' ?; Additional Section: Heated Basement x 1 Plan Check fee: r Unheated Basement f �vatimo V-}'z. State Surcharge fee: faitikX'J w C Other Unheated 1" t Pot Water Review fee: q 3 S ,_ .. .3E� '3, ,Garage/Carport .4, -At, SUBTOTALza.4 71 ' �--\--1 }' 2at4 t,::. Decks 911/Rd Approach fee: ; -� / i<t5MiCS, Other $ ; s TOTAL: {/per( G f^T ors,'+-" i X i _ /` 1 /'] ^ 3 Receipt Number:- `/ of I`3 ;- :.,,ivz` x� 'i Cashi,Chec Number: , : tf:71-;'-• M - i I 4 Ll'U. - -t(42 ESTIMATED COST(REQUIRED) Date: T •Fair market value of all labor and materials foundation to finishq ( 4k Initials: oK G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • • SPECIAL CONDITIONS CASE # BLD07-00229 1.) The application was reviewed by the Jefferson County Department of Community Development staff on June 14, 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: landslide hazard area 1; commercial forest lands adjacent. 2.) 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. 3.) 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. 4.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 5.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 6.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 7.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 8.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 9.) The applicant is proposing to create or add 7648 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. 10.) 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. 11.) 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). 12.) The site plan as submitted withe manufactured home installation permit pplication on May 14, 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 14, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 13.) This approval is for a manufactured home installation 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. 14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 15.) 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. 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.) Minimum setback rom Bentley Place right-of-way shall be 20 feet. Minimum south and west property setbacks shall be 5 feet. Minimum east (commercial forest lands adjacent) shall be 250 feet. 21.) A minimum of two (2) on-site parking spaces shall be provided for the manufactured home. 22.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 23.) An address of 72 Bentley Place, Port Townsend has been assigned to the parcel. Bentley place is private (P613). 24.) The site is served by an individual on-site well. 25.) A complaint case (COM05-0080) is pending for alledged excavation without a permit. A septic permit (SEP05-0246) was approved on September 27, 2005. A well review (USR)7-0031) was finaled on May 24, 2007. A forest practices permit (FPA2604527) was finaled on January 23, 2007 for construction of a new road and even age harvest. 26.) ANY PORTION OF TRANSPORT LINE UNDER A DRIVEN WAY IS TO BE SLEEVED/CASED OR EQUIVALENT. 27.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS. 28.) PRIOR TO OCCUPANCY OR FINAL BUILDING INSPECTION: FINAL APPROVAL OF SEPTIC SEP05-246 IS REQUIRED. 29.) A MINIMUM OF 5' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND SEPTIC TANK OR PUMP CHAMBERS. JACK WESTERMAN I Jefferson is Courthouse ASSESSOR PO llos 12Z(1, Port Townsend, WA 98368 (360)385-9105 MOBILE HOME INFORMATION FORM t._ OWNER'S NAME/MAILING ADDRESS: MAY 1 4 29, w NAME: Peru 4 Z yi a OtAl ff ri o ADDRESS: 5 2.0 Vail1�I DYI Iles,Mcr(A onii IN- et 58 PHONE NO. �9 ILO ?I I l'40 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)MOBILE HOME DATA: (A) MAKE 31g1 (B) MODEL (1303 (C)YEAR (;1091- (D) LENGTH tett) (E)WIDTH vt3 (F)SERIAL # 0 (G)YOUR PURCHASE PRICE (Do not include sales tax) fn1,o'47 PURCHASE DATE✓//v7 2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE AO 1-1 UVY1t O POW s hO ADDRESS igte Vikin lit/' N.W) Pd1I1�190> wit ,gV31-o (B) WAS MOBILE HOME ASSESSEn IN JEFFERSON COUNTY LAST 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? Yes (II)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOB E HO E PQRK: NAME OF LAND OWNER: -c-1 �OIQI �} (') LOCATION ADDRESS 'Ic7�• }HCt ' acc,POr1'1owyis( WA-GA 83/A y S7a5" REAL PROPERTY PARCEL #/DESCRIPTION ID26oO jock ('t:' 11 t-L 11(-N) THANK YOU FOR YOUR HELP! Signature of applicant ",.64,3 01) SS X JO COSSELL, Property Technician e RETURN ADDRESS e',oc R 8 #200idComnons-mElkooGwo.vCAkto9575 Manufactured Home y,( L. AS CH CKON Jf WASIUWIOM STALE.,,AAIMEtn Or ATITLE ELIMINATION Gi� LICENSING, Application :TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty ❑REMOVAL FROM REAL PROPERTY of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR f MAKE I LENGTHM/IDTH(FEET) VEHICLE IDENTIFICATION NYHIBER(VIN) goo f' / L, . x....s R,/�`/; -C/:4 -r.. :;) 13 © LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE lia AFFIXED ❑REMOVED IRI PyOlITY rAt(;ARCELNCB j,� LOT BLOCK PLATAME OR SECTIONROWN_SHIP/RANGE �,-,r�, 1�JtLQUUARTT7E}WQUAR`TER SECTION . .. :"/ . j /CiL'" .X(; t' ( L t. S•f., © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNT(NUMBER L. J NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS q ) NAME EGISTERED OWNER • o _ DOL CUSTOMER ACCOUNT NUMBER c7t1\ ( t /)`7 ( t NAME Afp�T. �h .T/p) pgR/it 1)r��`/ k- C/1( /1) /C/) DOL CUSTOMER ACCOUNT NUMBER ADDRESS '/) C -,'�! CITµ"� f -7' STATE ZIP COD.•.. 7� �%) / ( f T /7o...v- t/1c'�/ i ` 7,j NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER { DOL CUSTOMER ACCOUNT NUMBER ADDRESS LL,CITY. r`: STATE ZIP CODE j . �--/`(/(. �` "i/- C(/, >1 C >' / 4�L• L i/ // i, y �` </-6%f GRANTEE / / )^ NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY T Th.WE AM/ARE THE REGIST RED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: \�)� �� \�����MEli yyf/9f Registered Owner and Title,IF APPLICABLE �,`.,d/fV '/ ., \�Si. NQ o f Addy I i/red Owner NOTARIZATIO P C(CAB(CATION F��REGISTERED OWNER(S)S)SIGNATURE le �QjAfMStiA.S1R�•/` �jJf. :•• • p T q/4••• 5' .State of Washington Signed or attested ' - �^•• County o .-f• -me on �is • N :EXP• 02/13/2010 7 - A� a S 2iy Ignature Pa.\i _ .;,►. 51.• 7��• A(ISO .S 1 0 O ` RINT NAM F REGISTERED NER 0. .•• •• r 7 to••'•., L V••• \�by • - \!' t I � of PRINTNAME OF STEREO OWNER i .M 0 'DIARY Op..;;I; I lA Count/Office No.•R �J/�y/y //!t/////�I,111�7''++` \`\' I III DEALERSHIP POSIT( NTWOTA ot �C _AND: Notary ExpirationDate % � 4 TlYdI ffiAPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRIyyED) ' TITLE COMPANY/PHO �nyi�ysER / ,/ �� �1 {/ G i i)( k r - //9, i,.'Y/i f L.i ""( ��(j`llr �'� --C SIGNATURE/POSITIQ /' /..' - DATE 1 T J /, 1 1 L/ r ; l `,-..'. Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. © BUILDING PERMIT OFFICE CERTIFICATION I certify that: )B.lho manufactured home has been affixed to the real property as described. tJ a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME(TYPED OR PRINT ) BLDG PERMIT OFFICFJPHONE M BLDG PERMIT M L t� A 37q 44 o`7-2Zq SIGNATURE/POSITION —.. th DATE CA A 1 MANUFACTURED HOME-FROM SECTION 1 TPO!PLATE NUMBER YEAR I MADE I LENG7WWIDTH(FE ) VEHICLE IDENTIFICATION UMBER(VIN) nt i f f'/X•�, - C /-J)/ J ') a SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR EL TIO TITLE/ EMOV L ROP Signature of Legal Owner and Title,IF APPLICABLE �/1/ /irt Signature of Additional Legal Owner and Title,IF APPLICABLE 8 / NOTARY SEAL OR STAMP NOTARIZATIOWCSsERTIFICATION FOR LEGAL OWNERS)SIGNATURE State of Waatnnylan �C�,1 f b/l116 Signed or attested (/_til..� ti ! NTHIA C. MEIER ` County of `` ' CM 31124 before me on =t , I COMM.# 1647705 by signature S. '�f'r•I1� c�t1 (,® 1 / :iGVRY PUBLIC-CALIFORNIA LP: PRINT NAME OF LEGAL OWNER NOT OH AGENT a \(.`; . i/ 3ACRAMENTO COUNTY . (('' r r,t% MY tOt",M.EXP,MAR.9,2010 E by V n� � C (;� '4<- '�'�'^"�� PRINT NAME OF LEGAL OWNER PRINT NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITIOWAGEN/NOTARY Notary Expiration Date FA LAND DESCRIPTION (A legal descrIption of the land can be obtained from the local County Assessor's Office) [Lie (ciLL -,._, , 4, , ,,..2( , .......„ . la DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT.THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN- (/��AANY/!R�E�Q+U�REQUIRED]S`ArLLEESLn�T�AX HAS BEEN1[�I COLLE`CITED. DEALER}µ7- L. ,L1X 1 E�/�V 1 PRINTED) I �--5 I Cl-. l Ll�� \�j�' WA i 1 NUMBER DA1E�0�SAL ` 1 PURCHASE PRICE TAX JURISDICTION/TAXRATE DE SAUTHORIZEDSIGNATU -�}L V 61LF la :•cr' / °� lC�,.1 ti �tie____; USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized stateme if of delivery). El COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents) I certify that the above application appears to have been completed correctly,and the applicant has sufficient documentation to proceed with the recording of this form. NAME(TYPED OR PRINTED) COUNTY OFFICENFS OPERATOR NUMBER SIGNATURE DATE 10 TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE El IMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES&TAX MPORTANT: Once the application has been approved by the County Auditor/Vehicle Licensing Office,take your application form to the County Recording Office. Retain proof of the recording fees paid.If the Recording Office retains your original application form,obtain a certified copy of the recorded form. APPLICANTS: Once recorded,you must return to a Vehicle Licensing office to file the Manufactured Home Application,paying all required fees.Vehicle licensing subagents charge a service fee. For full instructions on completing this form for Title Elimination,Removal from Real Property or Transfer in Location,see form TD-420-730,Manufactured Home Application Instructions. The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation,please cal(360)902-3600 or TTY(360)664-8885. TD-420-729(R/6/06)W Page 2 of Exhibit "A" Legal Description All that certain real property situate in the County of Jefferson,State of Washington,described as follows: That portion of Government Lot 1,Section 25,Township 29 North,Range 2 West,W.M.,described as follows: Commencing at the Southwest corner of land conveyed by Chas A.Smith to Herman Frapaer by deed recorded January 13,1890 in Volume 25 of Deeds,pages 277 and 278(also being the Southwest corner of Lundstrom's Addition recorded in Volume 2 of Plats,page 42); thence South 330 feet; thence East 660 feet; thence North 330 feet; thence West 660 feet to the point of beginning,in Section 25 in Township 29 North,Range 2 West, W.M.; Situate in the County of Jefferson,State of Washington. • 0 � I JEFFERSON COUNTY 'l , I ►"" DEPARTMENT OF COMMUNIIY DEVELOPMENT : Y1 4 2007 IL--) 4, 621 Sheridan Street • Port Townsend •Washington 98368 I 360/379-4450 • 360/379-4451 Fax w TY� http://www.co.jefferson.wa.us/commdevelopment/ - Urvr_LOPh.MENT STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# NO' ( i 6 PROJECT/APPLICANT NAME: PaCr A LAM el &rifelil V 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. 3 . i Ltn� li ( otn aD10 i 1cs: - btu ' -trtli is ectiu LA icilk C�e(• 1, irIV,4) .t.i, in .177Ackriac � JorAla .-tyla VA 0. P Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the s e map. Ai IT t SDI Ct fii ve ' -hall, e le t't�.l o-vv ail-�- erene cs r zco --A- Is lcJ. 'fly' Zy . 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. elr , 14 4. Describe the existing soils. Indicate soil type on the site map. D ,90Mj i l.t-yvt J i I o f G0--z(4 irir111) . 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. Vi 7 �* r Vic situ) (g �1cwc� z'/ (t fA,LC k t_ tot rf _sl, A_La 0.e. dl 400 .0 l7)4, () Nil APPROVER 6. Describe any excess levels of noise generated by the proposed use or activity: ►kikdDzt-tn pCl$e, i�l.0 k1,i.C�G� l�,ve( 1 > ` f STORMWA ER PLAN StOM1W e 's U Requir d JEFFER O NT DEPT.OF T D s EL PM NT stormwater site plan template—rev.10(1/2003 SIGNATUR 5 i • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate I ation on the site ap. ' , VIII& ovielrh, 4 it-pe oir(tata' k, 0 Q61/1datti U-1 r.Srit. liVayte, i,iL ci 1/ii/rL4-. 1 ItAidfs-vu , am _.q.c...-V2it u 8. Describe the general vicinity of the site,including adjacent land uses and structures, utilities, roads,and sensitive/critical areas (st ear; we ands,la es,steep sl e ,etc.) 0 -cQio 6 7 /� . tit LS r -- e 5- ; c( avlo;-- r z 4 til .z 0 yu ivie6LitLtilt. JI, 91,;1.- 191 --izr --..tikiltatit,4.- v t 1- -� toe ell ' L -I .�v,�{� L 3 J- 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 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 es facilities on the sit plan and differentiate proposed facilities from existing facilities. M tt(i5VAwte vt - [met ormAilC 19e I) ' � 71, i v f1a✓>�_ cc` . . a e�.- Vowmaul r�i rCt (,1.4 (i47it.rv�it.1c+� a� �( c,0 t t L� ( Z>> i I-�c1 o- I for rl i , TGIF h L .o-1 S k�S it have 1. 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of-contaminants.] 11. Describe the performance goals and standards applicable to the project. ,11�t.�i i "D Ofcv 11 i vV twl,( OM ) 1 - hct-i-- i I cilA 1 15 IMCLL 41 hi `7T c til v�. 1 gall i 1( F hOmo. AMP yv(1( 1x uSe� ne -�(t is e e -. d ,ri l7 � s I i } £L _ SL. L i c-1I Ci,�rJ . -fiAnn1 wi 1 12e r l a.5 n e , -� 12. Describe the flow control system. , r11(2 (VI I 1 tea ,. U,rrns 4�h i;+,v� w�;1�1 f IA le . �..: :A,�sl 1 4 f jU; L..J stormwater site plan template—rev.10/1/2003 , .`v c LJ h.4E • • 13. Describe the water quality system. •.G1J(t` l n �SI�Ct,L1 ie ' :;r;�- " a- Vvl,�,�tit,4aitu wt:This 1,5 14. Describe the conveyance system analysis and design. 4All ) c rr fr,w,e de.S t. 5 a,pirtv . k-bS Ic , 21)1 ,c 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. a avicJ can-(,-tP. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. nrtn pfk rr c COV/6 Wit( �� 1.1 M1}sr], . 17. Describe the proposed surfacing material. jheh et Ind quaf'd-er �s Wi lI lAcLrder t.nd, wtivius en,tSk Rx.k. 18. Describe methods for restoration of the site. t N17410 � , Q v� t (,i.( i,l,I he It ,r.vt]: mo -k0- ( Q�s nec 0-beerI IA.Vtd 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 naquired to control flow or treat runoff.] If Included,list the Manuals here. /A 20. List here and include any special reports or studies conducted to prepare the Stomiwater Site Plan. gig 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. 14/A 1 I : MP,' 1 n ,..),, "!ENT storrnwater 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.t.J 1 2. � t`s ab`ish Construction Access. Dck 3. Control Flow Rates,, • Nbvle 12ert j,t i tki 4.i II�nsQtalL5ed�imnt Controls. 5. QStnabilliize Soils. e)I MP 6. Protect Slopes. 7. Protect Drain Inlets. t.�. 1 ,, t,i ce: stormwater site plan tenplate—rev.10/1/2003 -e`�' ) • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. NVA 9. Control Pollutants. KVA 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). C1( 12. Manage the Project. a, ibAynd 01.EW 2. Adjacent . a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). WA b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. I r NIA ._' 1('' r (I v. L. ` MAY 1 4 2, _..1 Y . ,.\! tOG' 1ENT stormwater site plan template—rev.10/12003 9 ! 0 b. Description of special requirements for working in or near environmentally sensitive areas. NIA 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). KVA 5. Construction Phasing. a. Construction sequence (� (thE Gi/` ,4 f -C-b-utvicozli,CM 1 I Vts zL L( VI rSytu I -"1 YI sk e ac f/1,49 b. Construetion phasing(if prdposed) NV pc 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a prqposed con truction schedule. Mai. - c�A �. II. Wet Season Construction Activities. a. Proposed wet season construction activities. KIM b. Proposed wet season construction activities for environmentally sensitive areas. KS/R 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for a initiation of bonds and/orother financial securities. OK Li nQa Y v ('_ev 410 b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. r)4. 60(d `e/ii 1--l01q,c? pool.,130 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. Fqt\ ___ C. Waterways. i[O i u d. Runoff/Stormwater Detention Calculations ! i 1 �" k. MAY 1 t.`J storrnwater site plan template—rev.1 N1/2003 T 1,3 I4hi N 7_ - - .. ... s Stormwater Site Plan Changes 41111 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 appliicant/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. A PIM Ce:' (LhDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: Fr.- 1,,--:: f'r r I I ' r i.I MAY ? n h.__! 1 4,1_siteplant �' stormwater 'U T I template 12 . ill,. • s — t r `" NIQOaO38 Kt NOLLdO . A ;1 - • J �� �J __, Noov4 B I 1 ON]NV3a NOLL4O 1 1 / 1- uGii1�i -- i■er■mmmilliSINIIII i fell ...r■1 l I L'WI-;L.Nanammouths 1 N3O NOLLun -r r u.u.i HM RN.tANNOO NOLLdO J r.-'..1 r ra►o I MOM'1e0 _-. .1l..i1 -7 1 �. I rig 1 3A7 Ioo irr■mp �ooa a3A0d NOLLdO Emhoso 3 biro'' ..■.■■pM alenoaF_ �. al■ 01�.■►.■ I..r.1 ■...^U T ��i 1..11....Li I•u ill: . .P.Zi �r c.1■,�� I,,,. 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