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HomeMy WebLinkAboutBLD2007-00363 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 #: BLD07-00363 SITE ADDRESS: 543 SEATTLE DR Issue Date: 08/16/2007 PORT LUDLOW, 98365 Final Date: 6/6/2008 APPLICANT: JANET L STIMACH PHONE: 360-765-4892 RENNY P BROWN 2253 E QUILCENE RD QUILCENE WA 98376 SUBDIVISION: TRAILS END HOMESITES Block: 4 Lot: 20+ PARCEL NUMBER: 950100416 Section: 16 Township: 27 N Range: 01 E PROJECT DESCRIPTION: NEW MAN HOME - GREENBRIAR 6325 SERIAL NO. 213W THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 6/6/2008 I:\F_t3LD_Occupancy.rpt 10/29/19 • • 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 #: BLD07-00363 Received Date: 7/3/2007 SITE ADDRESS: 543 SEATTLE DR Issue Date: 8/16/2007 PORT LUDLOW, 98365 APPLICANT: JANET L STIMACH RENNY P BROWN 2253 E QUILCENE RD QUILCENE WA 98376 SUBDIVISION: TRAILS END HOMESITES Block: 4 Lot: 20 PARCEL#: 950100416 Section: 16 Township: 27 N Range: 01 E 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 - GREENBRIAR 6325 MAKE: SKYLINE YEAR: 2007 SIZE: 49x28 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 8/16/2008. CALL IN FOR THE REQUIRED INSPECTIONS THAT LY TO YOUR PROJECT. Setbacks/Footing(CONTINUO FOOTING, LAB or PADS USED): A f Af7 Stormwater FINAL Approval: Blocking/Plumbing: ((.,oCk FL E (JL�/ / V - `1 - -2 4 Propane Tank/Lines // Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: -cor t 1,hi ./! to !j 0g HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUI ED PRIOR 0 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 !UILDING PERMIT APPLICA N ML 380 Rev iew iew T Tyype:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00363 Received Date: 7/3/2007 SITE ADDRESS: 543 SEATTLE DR PORT LUDLOW, 98365 OWNER: JANET L STIMACH PHONE: 360-765-4892 RENNY P BROWN 2253 E QUILCENE RD QUILCENE WA 98376 TRAILS END HOMESITES SUBDIVISION: Block: 4 Lot: 20 PARCEL NUMBER: 950100416 Section: 16 Township: 27 N Range: 01 E CONTRACTOR: GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 19647 VIKING AVE NW POULSBO WA 98370 Contractor's License GOLDEHP950KB Expires 5/18/2009 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NEW MAN HOME - GREENBRIAR 6325 TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 42,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BRIDGEHVN BEDROOMS: BATHROOMS: Exist: Exist: Prop: X.3 Prop: ;g. 2 Total: '( -) Total: ,$ ;- Routing Date: 7 l 310 l 7 W Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $163.00 CJZ 07/03/07 91414 APPROVED Potable Water Application $58.00 CJZ 07/03/07 91414 Total: $221.00 AUG !(c, 2007 Jefferson County Planning & Building Department 411 • SPECIAL CONDITIONS CASE # BLD07-00363 1.) PRIOR TO OCCUPANCY& BUILDING FINAL INSPECTION, ALL CONDITIONS OF SEP06-215 ARE TO BE MET AND FINAL APPROVAL OF SEPTIC SEP06-215 IS REQUIRED. 2.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC TANK, RESERVE & DRAINFIELD. MUST COMPLY WITH ALL PERMIT CONDITIONS, STATE AND LOCAL CODE. 3.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS EXCEPT WHERE APPROVED ON SEPTIC DESIGN. ANY PORTION OF WATER LINE <10' FROM OSS COMPONENTS IS TO BE SLEEVED. 4.) A MINIMUM OF 10' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND EDGE OF DISPOSAL COMPONENT AND RESERVE ARE. 5.) A MINIMUM OF 5' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND SEPTIC TANK AND PUMP CHAMBER. 6.) ALL COMPONENTS OF THE SEPTIC SYSTEM, INCLUDING RESERVE AREA ARE TO BE COMPLETELY PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE. 7.) The application was reviewed by the Jefferson County Department of Community Development staff on August 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, the following ESAs were confirmed to be present on the subject property: Seawater Intrusion Protection Zone- High Risk (SIPZ). 8.) 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. 9.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 10.) The parcel is located within a High Risk SIPZ (seawater intrusion protection zone) according to the County GIS map. There are mandatory measures identified in the Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A High Risk SIPZ is defined as: areas within 1,000 feet of a groundwater source with a history of chloride analyses above 200 milligrams per liter(mg/L). 11.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 12.) MANDATORY MEASURES OOIGH RISK SIPZ: • Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 13.) MANDATORY MEASURES FOR HIGH RISK SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirements: a. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-106 for a new groundwater well within 100 feet of a sea-salt water intrusion area per WAC 173-160-171 (i.e., within 100 feet of a groundwater source showing chloride concentrations above 200mg/L or within 100 feet of the marine shoreline); or for an existing or proposed groundwater well not subject to an Ecology variance, applicant must provide evidence through a hydrogeologic assessment(relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) of a reasonable probability that the subject aquifer will not be degraded by the proposed use of well. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 14.) The applicant is proposing to create or add 2,085 square feet of impervious surface and 7,256 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. 15.) A Medium Stormwater 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. 16.) 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). 17.) This approval is for a single-family residence and detached 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. 18.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 19.) A Declaration of Restrictive Co benant has been recorded on October 10, 29 under AFN 516351 for the purpose of consolidating the lots to meet minimum land area requirements for on-site septic ad to allow zero lot line setbacks. The Covenant is strictly for building and septic purposes only. 20.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 21.) 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. 22.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 23.) The road approach permit(RAP07-00100) must be inspected and finaled by the Jefferson County Department of Public Works prior to the final inspection/certificate of occupancy of this residence. Contact Terry Duff, Department of Public Works at 360-385-9159 for the final road approach inspection. 24.) The building height is not to exceed 35 feet. 25.) 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. 26.) Setback from Seattle Dr. right-of-way is no less than 20 ft., setback from Thorndyke Rd. right-of way is no less than 20 ft., side setbacks are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply 27.) Seattle Dr. (C436309) is a county local access road. A road approach (RAP07-00100) was approved on June 18, 2007 and an address of 543 Seattle Dr. has been assigned to the parcel. 28.) This parcel was created through Trail's End Homesites under AFN 123462, recorded August 7, 1950, Volume 3, page 30 with the Jefferson County Auditor's office. 29.) Pre-existing legal lots of record less than one acre in size in rural residential districts are subject to the stormwater requirements in Chapter 18.30 JCC and must meet the "Area of Impervious Surface Coverage" to the maximum extent practicable as determined by the administrator. Lot coverage is defined as amount of impervious surface, which includes rooftops, driveways, concrete, etc. 30.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 31.) The development will be serviced by public water and a well will not be utilized. If a well is required for potable water the applicant shall meet all of the Aquifer Recharge and SIPZ conditions. 32.) The site plan as submitted with the building permit application on July 3, 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 August 16, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. JACK IVESTERMAN Jefferson (•ty Courthouse ASSESSOR PO fox 1220, Port Townsend, WA 98:368 (360)385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILINGt, ADDRESS: NAME: ' S'T_�-\ ►r1Ctc k / • Pe n n LA, r.0 (,C'r1 ADDRESS: 41311.ct tc (4-1:1IC-C'e1<_ IC cyE )‘.: PHONE NO. (3 c0 "1II - 4 .c( - 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 , V1. LL.V (II) MODEL -gr i.'')flCir 63)5(C) YEAR :9C -1 (D) LENGTH HI I `-t el (E) WIDTH DE, (F)SERIAL # b (G) YOUR PURCHASE PRICE (Do not include sales tax) L L1 CLX__ PURCHASE DATE )/t /O� 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEWMOVE TO QUESTION 3) I (A) FROM WHOM DID YOU PURCHASE MOBILE 14..1 t ADDRESS (B) WAS MOBILE HOME ASSESSED 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 (NO (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK 1 Pr Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: .1(.t Y1 ft i v ki1ClL 2 • AZC n�l l i zto1. LOCATION ADDRESS `J�-I •L�"�� l r PG 1 + L L.CY I c1e1 L . REAL PROPERTY PARCEL #/DESCRIPTION CI 5L7 I LOt I 1 Zvi* 1J JUL - 3 2007 itillikature of applicant THANK YOU FOR YOUR HELP! NSI-e TY EV T ;�\'i���1: N JO I 1 COSSELL, Property Technician - —� 0 0 LIM ® mis t® 1 E.E 7sr:'Im-----m--ga---"----g--7 —7 II:,I, i ■i ■I E PANTRY---- --1,3 o I DINING BEDROOM II fig. g�./ G I ----1 - of �nB &' �� N RPE•I■Q►■� WASIt4 1 I I I' : _ CATHEDRAL THRU-OUT NAM! ■■■■■1 I .-■■■■■i..l■�� BDR OM UWIG� BEDROOM •an A 9P•T , riai! ■ ,Z° ,Q' Vil \ 4' a` 1 !I\ 6325CTI4128(I3W SQ.FT.)3BEDROOM-2SATHS-CATHEDRAL THRU OUT V . , v ,. 0 ■ AL II CORNER 11 TUB LINEN LI TUB 0 ER • OXEN OPTION MASTER BATH • '710N CORNER TUB BATH ■ I'i R IAIEp I I CORNER I I TUB v :957: JEFFERSON COUNTY — i 0:pi DEPARTMENTOFCOMMUNI DEVELOPMENT 621 Sheridan Street• Port Townsend Washington 98368 j 360/379-4450• 360/379-4451 Fax www.co.jefferson.wa.us/commdeveloprr�ent JUL - 3 2307 —' -- Master Permit Application MLA: Q)✓�� Project Description(include separate sheets as necessary): Tax Parcel Property Number: ci.c0-100 ( 16)( 2.?)L4-9f If) Size: 2?`"b) $9,- ef- (acres/square feet) Site Address and/or Directions to Property: 5iI3 $Pq/J7t' IA_ /'f 4 uc1 /et, Property Owner(s)of Record: 72r1 e 2` f jfrlhAeA 0- 7Q e it A y Br 0 cc,pi Telephone: 36( -7r; ` 491z Fax: / email: Mailing Address: 2.2 6"3 ea 410.a/cep e kit ev,ICen e Gvc, 47 3)6 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ®Building ❑Variance(Minor,Major or Reasonable Economic Use) cf Demolition Permit ❑Conditional Use[C(a),C(d),or Cj** d Single Family ODiscretionary"D"or Unnamed Use Classification q Garage Attached/Detached OSpecial Use(Essential Public Facilities)** l Manufactured Home °Boundary Line Adjustment d Modular °Short Plat** Q Commercial* 0 Binding Site Plan** Q Change of Use °Long Plat** Q Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** El Propane ❑Plat Vacation/Alteration** DAllowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** °Stormwater Management ['Shoreline Management Substantial Development'"* OSite Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment Wireless Telecommunication* °Jefferson County Shoreline Master Program Amendment OForest 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior notice. Signature: ) Date: 7(370? The action or actions Applicant will undertake as a result of the iss ance 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 recnnncihiIih,s,..-ati 4.,.,s.+,onrl,.,,molyi 'th the ES The Applicant has read this disclaimer and signs and dates it below. Signature: _ '7�dt L Date: 7/3/G? D:\PetmitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc I • 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: / % J ��I-" 7 Date: 7-2`a, GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 6�fdeh Yam es (360) 6g7- 3556' (360)6 r -46o6 MAILING ADDRESS: 19640 0( oy /iv', ��/ EMAIL•:9o�d 2h h0/1tPS de�UlS bD F ha¢M«. �•.CO rs� CONTRACTOR'S LICENSE / WAINS NUMBER: NUMBER �� `-' ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 13-New l-Wood Existing: 0 Sewer ❑ Addition 0 Steel Proposed: 1- Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: Z Hei ht: [ Individual System ❑ Repair ❑ Masonry i SEP Permit# 0 6 "21 7 ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: ,1, f Public 1 , t f t-tr,L Total: !n i Name of System:�J3,4F�andvt°II 0 U/ct7`Qr� co. 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: C]Underground Tank 0 Above ground Tank Size of Propane Tank: 0 Heat Stove ❑Cook Stove 0 Woodstove ❑Fireplace Insert 0 Hot Water Tank 0 Pellet Stove p Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only .ArinoUnt- • Revision Main Floor Heated EH Bld App Review: 13Fo &g .D6 2"°Floor Heated Consistency Review Other Heated Base fee: I+ �147 2 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: 9 CO Garage/Carport SUBTOTAL i �,-1 CD • Decks 911/Rd Approach fee: Other TOTt : $ Li ) O .. '°;__. ` Receipt Number .l1(4 t, ` i r Cash/Check Number j • ESTIMATED COST(REQUIRED) ,,';tr-�i Dat�t r�-7 1 3/ft7 .Fair market value of all labor and materials foundation to finish ! �+U — ��ur ` V + L Initials: D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc RETURN ADDRESS OLYMPIC NORTHWEST ESCROW, INC. 1480 NW SID UHINCK RD. #101 SILVERDALE, WA 98383 ATTN: PATRICIA L. DUNLAP 360-337-0118 Manufactured Home �y 'L AS CH CK ON r WASHINGroN STATE DEPARTMENT OF UpTITLE • ELIMINATION Ll' 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 MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 2008 SKYLINE 49 X 28 2191-0213-W AB © LAND LEGAL DESCRIPTION ON PAGE 2 REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE [AFFIXED ❑ REMOVED 950 100 416 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 20,35 &36 4 TRAIL'S END HOMESITES,INC. © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS JEFFERSON 2 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER PHILIP C. GUENTHER GUENTPC1 72PA NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER CHELSEA D. GUENTHER GUENTCD1 7813E ADDRESS CITY STATE ZIP CODE 543 SEATTLE DRIVE PORT LUDLOW WA 98365 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER FREEDOM MORTGAGE CORPORATION NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE P. O. BOX 202049 FLORENCE SC 29502 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: - -- 6%,ivii- Signature of Registered Owner and Title, IF APPLICABLE U cSignatu` y SEA °ry r`r0411Wyyri /l Registered Owner and Title,IF APPLICABLE d�Ac L, SEAL / I NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE Z. UNE:• < .J State of Washington Signed or attested . 0 L'O9•,9,°" County of K II )l\r' before me on E. --->S"Ce5 ,j, . ; �� �y FH PC k Signatur tlt { 44-h ? PRINT NAME OF REGISTERED OWNER NOTARY OR AGE f / *v'�,te by Cf-4ELj)FA I) . GUE/.4Tt-kEk PATKICIA. L. Tjl'I'ILAP �I„-f2,:. 04/01/2p1�:�.4• PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY l//��F WAOsi?I I Title N� 1 A(& Pr.6L-t C. County/Office No.OR AND: Dealer No.OR C`' ( C`l' a r II /MMMilttitt I DEALERSHIP POSITION/AGENT/NOTARY 6otaryl'Xpifa1).Qn_ ate, 4 TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. © BUILDING PERMIT ITT OFFICE CERTIFICATION I Certify that: ' she manufactured home has been affixed to the real property as described. a building permit has been issued for this purpose and the attachment will be inspected upon completion. !NAAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE 4 BLDG PERMIT# \G:.iy1 ' 0.Y.o. 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