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HomeMy WebLinkAboutBLD2008-00069 08 lit , N UILDING PERMIT APPLICA MRL Review Ty 070 ype: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00069 Received Date: 2/21/2008 SITE ADDRESS: 8335 FLAGLER RD NORDLAND, 98358 OWNER: GEORGE R NORDBY TRUSTEE PHONE:425-643-3241 NORDBY FAMILY TRUST 4/94 6023 166TH AVE SE BELLEVUE WA 980065565 NORDBY-CLARK SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 953700438 Section: 29 Township: 30 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NSFR W/A/G 120 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,604 VALUATION 345,000.00 ADD'L: 395 HEAT TYPE: HTP CODE EDITION: 2006 HEAT BASE: 1,019 HEAT TYPE: EEE OCCUPANCY: R-3 UNHEATED: 585 #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK: 590 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 4 Total: 3 Total: 4 Routing Date: a j aa I cg Type Amount Paid Bv: Date: Receipt: AOroved/Date Permit $2,385.75 LYK 02/21/08 96955 d� d Plan Check $1,550.74 LYK 02/21/08 96955 State Building Code $4.50 LYK 02/21/08 96955 MAY a3 2i I'; Potable Water Application $59.00 LYK 02/21/08 96955 Jefferson County Planning Total: $3,999.99 & Building Department Jefferson County Building Division Permit Number: BLD08-00069 Applicant: NORDBY TRUSTEE BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks Erosion Control ` .. Ca Ki✓,..hcns f Foundation Footing '� I Gi/6/06 Id)LG : ✓ FT4 @ FA QTR.Y WAS Footing Drains Foundation Stem Wall -1 7"S L of 5 66- L` ftwa/ 1A-'I >ri s a Underground Plumbing `/2S/cg Under Floor Framing /6/0e/ /' • Straps(hold downs) ., Ext. Shear Wall Nailing ��i'rfri r / Rough-in Plumbing Q/Z,VOS J Framing Blocking Airseal 9/4 Insulation: Walls Insulation: Floors Insulation: Ceiling tau $c saw rErz.)A4er I iJc-4 7e0 (A-08# Int. Shear Wall Nailing /Xkta E r Wallboard Nailing D-3—O9 Gas Line: Interior ,q/,i/e3 V Gas Line: Exterior )qi),0C4 pp Propane Tank '1✓�6tM f41)Heat/Chimney Clearance 10 4/t.)g LL ePAAJLsr Drywell/Alt Drainage l.cr td1C r ( F• z Address Posted FINAL INSPECTION �G� y11.2 I _ FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD08-00069 1.) DRYWELL DESIGN CRITERIA PER 2005 DOE MANUAL ALL INFILTRATION SYSTEMS SHALL BE AT LEAST 10 FEET FROM ANY STRUCTURE, PROPERTY LINE, OR SENSITIVE AREA. ALL INFILTRATION SYSTEMS MUST BE AT LEAST 50 FEET FROM THE TOP OF ANY SENSITIVE AREA STEEP SLOPE. FOR SITES WITH SEPTIC SYSTEMS, INFILTRATION SYSTEMS MUST BE DOWNGRADIENT OF THE DRAINFIELD. DRYWELL BOTTOMS MUST BE A MINIMUM OF 1 FOOT ABOVE SEASONAL HIGH GROUNDWATER LEVEL OR IMPERMEABLE SOIL LAYERS. EACH DRYWELL MAY SERVE UP TO 1000 SQUARE FEET OF IMPERVIOUS SURFACE FOR EITHER MEDIUM SANDS OR COARSE SANDS. TYPICALLY DRYWELLS ARE 48 INCHES IN DIAMETER (MINIMUM)AND HAVE A DEPTH OF 5 FEET (4 FEET OF GRAVEL AND 1 FOOT OF SUITABLE COVER MATERIAL). FILTER FABRIC (GEOTEXTILE) MUST BE PLACED ON TOP OF THE DRAIN ROCK AND ON TRENCH OR DRYWELL SIDES PRIOR TO BACKFILLING. SPACING BETWEEN DRYWELLS MUST BE A MINIMUM OF 4 FEET. 2.) A SILT FENCE SHALL BE INSTALLED AT A MINIMUM 30 FEET FROM THE TOP OF SHORELINE BANK TO PROTECT THE LANDSLIDE HAZARD AREA AND SHORELINE. THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE MAXIMUM HEIGHT SHALL BE 2 1/2 FEET ABOVE THE ORIGINAL GROUND SURFACE. THE SILT FENCE SHALL BE BURIED IN A TRENCH TO A MINIMUM DEPTH OF 5 INCHES BELOW THE GROUND SURFACE. THE TRENCH SHALL BE BACKFILLED AND THE SOIL TAMPED IN PLACE OVER THE BURIED PORTION OF THE SILT FENCE, SUCH THAT NO FLOW CAN PASS BENEATH THE FENCE AND SCOURING CAN NOT OCCUR. ANY DAMAGE TO THE SILT FENCE SHALL BE REPAIRED IMMEDIATELY. SEDIMENT DEPOSITS SHALL EITHER BE REMOVED WHEN THE DEPOSIT REACHES APPROXIMATELY ONE-THIRD THE HEIGHT OF THE SILT FENCE, OR A SECOND SILT FENCE SHALL BE INSTALLED. 3.) PRIOR TO OCCUPANCY & BUILDING FINAL - MEET PERMIT CONDITIONS OF AND FINAL APPROVAL OF SEPTIC SEP07-203 IS REQUIRED. 4.) A MINIMUM OF 5' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND EDGE OF SEPTIC TANK AND PUMP CHAMBER. A MINIMUM OF 2' MUST BE MAINTAINED BETWEEN DECK FOOTINGS AND EDGE CF SEPTIC TANK AND PUMP CHAMBER. ACCESS TO SEPTIC TANK AND PUMP CHAMBER MUST BE MAINTAINED. 5.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS. 6.) To help prevent seawater from ining landward into underground aquifers, aw 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. 7.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 8.) 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. 9.) 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. 10.) 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." 11.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 12.) 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. 13.) 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. 14.) 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. 15.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 16.) 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. 17.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 18.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. • 19.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 20.) Minimum setback from SR 116 (Flagler Road) shall be 30 feet. Minimum north and south setbacks shall be 5 feet. Minimum setback from shoreline top of bank shall be 30 feet. (Site plan identifies a shoreline setback of 43 feet from top of bank). 21.) 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. 22.) 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. 23.) The building height is not to exceed 35 feet. 24.) The standard setback for residential structures, including common appurtenant structures such as garages and workshops, shall be thirty (30)feet or one (1) foot for each foot of bank height, whichever is greater. This setback shall be measured from the bank's edge when the bank's height exceeds 10 feet. When the bank's height is less than 10 feet, the setback shall be measured from the ordinary high water mark. The setback shall not exceed 100 feet. STORMWATER SITE PLAN SUBMITTAL TEMPLATE .E.-L 2 1 2008 (for George Nordby home) February 1,2008 Responses to "Template"items per the "Template"headings and numbering are provided as follows. Project Overview 1. The total project area is 1.96-Acres of which 0.93-Acres is located west of Flagler Road. An existing1600+ Sq.Ft. manufactured home located on the westerly portion of the site will be removed and replaced with a 1604 Sq. Ft. footprint stick built home at essentially the same location.The existing driveway and garage will continue to be utilized. See the Master Land Use Application Site Plan (Site Plan) for details. The easterly portion of the site east of Flagler Road will remain in existing condition. Existing Conditions Summary (Only the westerly portion of the site) 2. The easterly 1/3 of the parcel exhibits a slight slope towards Flagler Road.The remaining 2/3 of the west portion of the parcel drops about 25 feet to the low (16 feet high) bank at Kilisut Harbor. See the Master Land Use Application Site Plan (Site Plan)for spot elevations and existing contours. 3. East of the existing garage the site is covered, with the exception of the existing driveway, primarily with scattered fir and cedar trees along with Oregon Grape and Salal. Vegetation of the remainder of the site consists of ground cover and primarily native grasses. See the Master Land Use Application Site Plan(Site Plan)for details. 4. Soils around the existing manufactured home are a well draining combination of a sand and gravel material. The existing manufactured home and associated garage have used downspout drywells for roof stormwater disposal since 1984 when the home was moved onto the property. There has never been any evidence of drywell plugging or overflow during rainstorms. 5. The west portion of the site does not have any surface water from adjacent properties draining onto it. Neither does any surface water from the site drain onto adjacent properties since the stormwater runoff from the site infiltrates into the soil. The Test Pits used for design of the new drainfield (See the Master Land Use Application Site Plan (Site Plan)for details) were dug the fall of 2006. Rainwater never accumulated in the holes at any time during last winter nr cpring Surface drainage has never been a problem or issue on this site. APPROVED 6. The existing use since 1984 has been a single-family home as w�he continua! PLAN use after construction of the new home. Therefore, noise generat on will not MAY 2 2 2008 NOP 1 of 6 StQrrllW •• r`I, 1EF S N O N Y uired �,1� DFPT.OF SIG\ATIiR IT D VF..OPM NT Req • change. During construction there will the normal construction noises aRiale1l 2008 with house construction. 7. The only significant geographic feature of the Parcel is the low (1:6 feet high) bank on Kilisut Harbor. 8. Flagler Road bisects the Parcel in a N/S manner with the West edge of the Parcel located on the shore of Kilisut Harbor. Residential lots border the Parcel on both the North and South sides. Permanent Stormwater Control Plan 9. Stormwater will be "infiltrated/dispersed"on the site as described below. Roofs: The existing garage roof rainwater discharge will continue to be infiltrated in existing drywells (see Item 4 above). The proposed home has approximately 2200 Sq Ft of roof area. The rainwater discharge from the new roof will be conveyed via tightline piping to two drywells for infiltration. Each drywell will be sized for half the roof area and will be constructed similar to Figure 3.4 of the DOE Stormwater Management Manual. See the Storm Drainage Site Plan (SD Site Plan)for drywell locations in the flat area just west of the daylight basement. Driveway: The existing driveway will continue to be used for dispersion of surface runoff. Runoff from the easterly portion of the driveway will continue to sheetflow to the sides of the driveway. Runoff from the westerly portion that slopes to the west will continue to"sheetflow"to the sides of the driveway and off the west end of the driveway into the native grassed area adjacent to the existing light pole and into an approximately 100 Ft long grassed area along the north side of the home sloping down to the west. Note: This Driveway Dispersion will be the same as has been utilized on the site since 1984. 10. Stormwater treatment facilities are not required. 11. The goals of this project are to construct the proposed new home with minimum changes to the site hydrology and vegetation from that associated with the existing manufactured home site. As can be seen on the Site Plan, the proposed home location and size are essentially the same as the existing manufactured home. The existing driveway, garage and garage apron will continue to be utilized. In the end the vegetated areas around the proposed home will be very similar to that of the existing manufactured home. 12. Flow control systems are not required. 13. Since the proposed home site is essentially the same as the existing manufactured home site and the existing driveway, driveway apron and garage will continue to Paoe7ofFi • • be utilized (see Item 9 above),the "water quality"will remain essentially F E B 2 1 2008 unchanged from existing conditions. 14. There are and will be no concentrated flows on the site.Therefore,there are no conveyance systems. 15. Fill material that will be used around the proposed home foundations and to provide for finished grading will be material excavated from foundation excavation. Any excess excavation will be removed from the site and disposed at approved locations. 16. All structural foundations will bear on undisturbed in-situ soils. Therefore compaction will not be required. There will be some deck and stair post foundation supports that may be located on backfill. If so, backfill lifts and compaction effort will be provided to result in at least 95% density. 17. The existing surfaces (vegetated and treed, grass, driveway and garage concrete apron) will remain and/or be replaced in kind to the maximum extent that is practical. 18. Home foundation excavation will result in existing vegetated/grassed areas around the home site to be disturbed. After finish grading, these areas will be re- vegetated and landscaped. 19. An O&M Manual is not required. 20. There are none. 21. Septic tank drainfield permit has been issued by County. Construction Stormwater Pollution Prevention Plan (SWPPP) Section I—Construction SWPPP Narrative 1. Construction Stormwater Pollution Plan Elements 12 Required Elements 1. Clearing of forested area is not required since the proposed home will be constructed at the same location as the existing manufactured home. 2. No new construction access is required since the existing driveway will be used for construction access as well as for the proposed new home. 3. Flow rate control is not required since there is no existing and there will be no new concentrated flows on the site. Pam. of6 • • 4. Sediment control will be provided by installation of Silt Fence (BMP C23lan 2008 the north, south and west limits of excavation/fill activities as shown on the SW Site Plan. 5. Stabilization of excavated and disturbed materials will be provided by application of Mulching (BMP C121)and/or Plastic Covering (BMP C123). 6. Slopes on the proposed home site vary from approximately 10 to 20 %. There are no steep slopes so specific slope protection is not required. 7. There are no drain inlets so protection is not required. 8. There are no channels and outlets so stabilization is not required. 9. The building Contractor will be required to maintain construction debris and conduct construction equipment maintenance so as to minimize pollutant sources. In addition, the Contractor will be required to utilize BMP C151 to control concrete spillage. 10. The site has always been a dry site with no surface or ground water issues. The on-site drainfield test holes were dug during the fall of 2006. Ground water was not encountered when the holes were dug nor did any water accumulate in the holes during the wet season last winter. Groundwater is not expected during foundation excavation. If it is, it can be pumped into the vegetated/treed area east of the existing garage. 11. The Contractor will be required to implement and maintain all required BMPs. In addition the Owner will check on compliance. 12. The required BMPs are simply to install and maintain. Very little management will be required. As noted in Item 11 above, the Contractor will be required to maintain all required BMPs and the Owner will be checking for compliance. 2. Adjacent Areas a. Single-family residential homes are located on the parcels to the north and south of the subject property. The slope of the western portion of all three parcels is the west; therefore, surface water does not drain from one property to the other. With the use of sediment control provided by Silt Fences (see Required Element 4 above) there will be no affect on either adjacent parcel. b. The existing manufactured home as well as the proposed home at essentially the same location and with essentially the same footprint is approximately 45 to 50 ft from the low bank of Kilisut Harbor to the west. The proposed home is located approximately 60 ft from the Ordinary High PauP4nfESi • Water level to the west. The downstream drainage path is from the 1 2008 �s� to the bank. 3. Environmentally Sensitive Areas a. The low (16 ft high) bank at the west side of the parcel is the only potential sensitive area.The bank has not been impacted from surface water since the existing manufactured home was installed in 1984. b. The Silt Fence (BMP 233) will be installed 20 to 30 ft from the top of the bank and therefore,will limit construction activity near the bank. 4. Erosion Problem Areas No site erosion problems are envisioned given that the soils are a well draining combination of sand and gravel; ground water during excavation is not anticipated and BMPs 121 and/or 123 will be implemented. 5. Construction Phasing After manufactured home is removed the following construction is anticipated: foundation excavation,foundation,foundation backfill,framing, roofing and siding, interior,finish grading and landscaping. 6. Construction Schedule I. Assuming receipt of the Building Permit in April 2008, it is anticipated that construction will start during May 2008. This schedule will result in all excavation and fill activities occurring outside of the normal wet season of the year. II. The only wet season activities during the latter part of 2008 will be interior work. 7. Financial/Ownership Responsibilities a. George R. Nordby b. Personal responsibility 8. Engineering Calculations None are required. PaaP5ofFi • 110 Section II—Erosion and Sediment Control Plan Please refer to the Master Land Use Application Site Plan (Site Plan)for related site data and to the SD Site Plan for identification and location of BMPs. / •7i/1. FEB 21 2008 I i Paoe6nf6 4 ¢,SON co ,, JEFFERS01. OUNTY • A DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 r -- 360/379-4450 • 360/379-4451 Fax o� www.co.jefferson.wa.us/commdevelopment FEB 2 Is, � 2008 Master Permit Application MLA: 0 - --Ad Project Description (include separate sheets as necessary): el. /•.1.., fYLr f'w7. . / j'', .s"j/e" i -nn ,I/ `ice ink Tax Parcel Property j ,/�j Number: ) J — >e C, ,-- "/ _j 1: Size: /. ,- (acres/squafefeet) Site Address and/or Directions to Property: ) / ,) J.) /''l6r `' / - /-" /( /l 1 u i/ e' t't/' ) /�-. ii e- [ .5 /!c 2 z e- Property Owner(s)of Record:" e-- {a,-- :i e` V /CJ.✓ ii A. l i— ,/ Telephone: 42_ — C 4"3 -- 3 Let/ fax: email:pin 4 r-c11 y� !c'., 'u sf Mailing Address: E C`'. 3 /E ( h /1 `.e .5 L E--//t`'c ,,, J _ / L�i7 y . elE i1r.y Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies building 0 Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]** `Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** jfi( Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis A,Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development*" 0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 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 0 Tree Vegetaion Request *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: ) Se fle r�zi-1L/ /Y'f<itsj tt rya( NI�Y`7?!J� e k,1 or r-<r l y i e:i e-.e(/ DES GNATIO OF AGENT $e i) / „ "o 4 C 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 inspe ions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appl'%- ion that he or siwant or notice. Signature: i' Date: 2 Z / L 4 The action or action/-2 pplicant will undertake as a resu f the issuance of this permit may negatively impact ct upon one or more threatened or endangered species and could lead to a potential"tak f 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 comp!' nce with t e Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transf le responsibi' for adh� ig to and mplying with the ESA. The Applicant has read this disclaimer and 29s and dates it below.2 e92".9 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.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 as u 'rig the r onsibil. the G al Contractor for the proposed project Signature: / Date: 0 /1zoe GENERAL CONT CTOR OR MANUFACTURED H E INSTALLER: PHONE: Fax: ,,/✓1 t tc Y . `li 1 tp r C t' 6 c-e's✓ s(c `()'C:,I <Sf, ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: I'( New X Wood Existing: ❑ Sewer ❑ Addition /❑ Steel Proposed: .4.'t Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: Zi- Height: , peIndividual System El Repair 0 Masonry G. SEP Permit# C I t tc 4-G`, ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑. Private well 0 Two Party Proposed: :- ij-J re:;j Public Type of Heat: .� ,,�e'� p w e o-1i. Total: 3 ,r. Name of System: PG4 i/ e iec...- a AiA r 4F FJc::rbl: cif Jelfrt-til.Yr Lam''%G .3/1 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 ove ground lark," Size of Propane Tank: 6 C G: z / i Heat Stove t1 ook Stove)i Woodstove Fireplace Insert~ i Hot Water Tank i Pellet Stov' i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes /Gr. 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 ,131-Alg l• ase i1'lyi, : y Main Floor Heated a '" ' H BId App Review: 2"°Floor Heated /'� �_/'1_) 3 ��- A r,` t Consistency Review: Other Heated - : 15 Base fee: •) 38 r Mezzanine (; , 'a:, Additional Section: -- Heated Basement I 0 / 9 lk• '`ri��1 ` Plan Check fee: I 55,0 `14 Unheated Basement K '.'-'''*:. State Surcharge fee: ,e 50 .�jG J #e, ,, 1. Other Unheated s it;' Pot Water Review fee: 5 Garage/Carport SUBTOTAL )6..7a C\t Decks • -i.' 6) 911/Rd Approach fee: Other`c✓ere," /nitric} / 0& ?- TOTAL: $ Receipt Number: Gl �0 f r �y`' Cash/Check Number: ESTIMATED COST(REQUIRED) Date: f (- -Fair market value of all labor and materials founda ion to finish F t`(nrgak: 2008 ('"C, i 13'4-5; ©,0�' 0Z G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc ""—" CI gg # II "'1 / Tr ' , c.,11- ,--,(-- -c-4- do' 1-lartr c-- qr.) f ri ci , 2\ ' ._._.__.=--._._.___________.--<-- -----. \ . r I I S Li_t' .�. _ �----- -- Ors i J', y g-' ii _ _, �-- 1�,,Ji r V't f r r § ...s> (-11 --C ,r‘ a r. 1 / i 6 , _ ..,_ __ ___-_-,__ __ „..i, ,____ __ • , . _ __ , - , • ....._ .._ , of, _ [34-t 0 it" (VD a f"n ...... _ 7_ _ ___ ... -- :-. �_ i DZ 1 0 (....,11,_._ / �� (/c. bGac �T / o N U) o -- '4k4.--$46- -- - --- ----- O., 4 ) ,, I 0 1 o‘,, ''. * N. i'''' — - & .--- —IV .4--, ( --- ls- -f•.--- ..vs ,.. 0.,\C; 1 N‘ _j� ' 4_. _% 0 --- b*-1-- C) ---AZY I X; v - 1 ^ ► ) to I r‘ ti i D 7 (1): '�Q _ m v + 1..._--- ---7-- Z..: ------'g e-, ,� -mow T v ry __ _-_._.-„, 8 ''‘i L- - -I IT --1F- --- ____ ___,- ----- N____ 3tiiii V4 ‘k " • '. ..?) ?t /0, 4,---*7 ' 41 it- fl\ .t,. -=161 N r 9=-5 - -- N. - I rZ' / ' — it ktT\ 3 ? 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