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HomeMy WebLinkAboutBLD2008-00132 MANUFACJRED/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 #: 132 Received Date: 4/7/2008 SITE ADDRESS: Y 101 Issue Date: 7/17/2008 PORT TOWNSEND, 98368 APPLICANT: GARY L PETERSON MARILYN A PETERSON 140 GREEN MEADOW DR SEQUIM WA 98382 SUBDIVISION: JUNCTION CITY Block: 26 Lot: 4-6 PARCEL#: 964502604 Section: 13 Township: 29 N Range: 02 W CONTRACTOR/ BUY RITE HOMES PHONE: (360) 681-0777 DEALER 259403 HWY 101 SEQUIM WA 98382 (360) 381-0780 Contractor's License BUYRIH*0840B Expires 5/20/2010 PROJECT DESCRIPTION: NEW M/H SERIAL#29157 MAKE: KARSTEN YEAR: 2008 SIZE: 66X28 Directions SEE DIRECTIONS& MAP IN FILE To Site: THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 7/17/2009. CALL I N s:— QUI RED INSPECTIONS THAT APPLY OUR PROJECT. ooting (CONTINUOUS FOOTIN SLAB o PADS USED). 7 V eV' Stormwater FINAL Approval: Q e_ nr t)%•k-1 n r 1 tt Z. 1r D/y t&A,115 e s pl kW,1i Blocking/Plumbing: E L ►Jp O < 8 0 Propane Tank/Lines 1Jr uL` Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: (� Final/Skirting/Vents/Porches/Steps: SQQ- (On LA-10 r S 3 +4 -p l(w 'E'b �I n& t, riliAL c'1I4.. 11:11-6 HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL/INSPECTION 4 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 *ILDING PERMIT APPLICAT Review T Ty 167 N ML ype: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00132 Received Date: 4/7/2008 SITE ADDRESS:' xI_ HWY 101 /2 OWNER: GARY L PETERSON PHONE: 360-477-7678 MARILYN A PETERSON 140 GREEN MEADOW DR SEQUIM WA 98382 JUNCTION CITY SUBDIVISION: Block: 26 Lot: 4-6 PARCEL NUMBER: 964502604 Section: 13 Township: 29 N Range: 02 W CONTRACTOR: BUY RITE HOMES PHONE: (360) 681-0777 259403 HWY 101 SEQUIM WA 98382 Contractor's License BUYRIH*0840B Expires 5/20/2008 REPRESENTATIVE: BUY-RITE HOMES PHONE: (360)681-0777 BIRDIE (360) 681-0780 259403 HWY 101 PROJECT DESCRIPTIOP NEW M/H 2y.151 TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,778 VALUATION ADD'L: HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $168.00 LYK 04/07/08 97134 APPROVED Potable Water Application $59.00 LYK 04/07/08 97134 H Total: $227.00 JUL 11 2008 Jefferson County Planning & Building Department • • SPECIAL CONDITIONS CASE # BLD08-00132 1.) 2005 DOE STORMWATER MANUAL DRYWELL DESIGN CRITERIA ALL INFILTRATION SYSTEMS SHOULD BE AT LEAST 10 FEET FROM ANY STRUCTURE, PROPERTY LINE, OR SENSITIVE AREA. FOR SITE WITH SEPTIC SYSTEMS, INFILTRATION SYSTEMS MUST BE DOWNGRADIENT OF THE DRAINFIELD UNLESS THE: SITE TOPOGRAPHY CLEARLY PROHIBITS SUBSURFACE FLOWS FROM INTERSECTING 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 COURSE 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.) DESIGN CRITERIA FOR SPLASHBLOCKS: A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED BETWEEN THE DISCHARGE POINT AND ANY PROPERTY LINE, STRUCTURE, STEEP SLOPE, STREAM, WETLAND, LAKE, OR OTHER IMPERVIOUS SURFACE. SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS. A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH SPLASH BLOCK. A SPLASHBLOCK OR A PAD OF CRUSHED ROCK (2 FEET WIDE BY 3 FEET LONG BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE POINT. NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT. FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFILED AREAS. 3.) COUNTY APPROVAL OF THE MANUFACTURED HOME PERMIT IS ONLY GRANTED UPON THE CONTINGENCY THAT QUIET TITLE BE OBTAINED THROUGH THE JEFFERSON COUNTY SUPERIOR COURT FOR THOSE PORTIONS OF COMMERCIAL AVENUE, 6TH AVENUE AND ALLEY ADJACENT TO LOTS 4-6 OF BLOCK 26 JUNCTION CITY SUBDIVISION. SETBACKS ARE BASED OFF OF THE FINAL QUIET TITLE. APPLICANT UNDERSTANDS THAT PLACING THE HOME ON THE PARCEL IS AT HIS/HER OWN RISK UNTIL FINAL. QUIET TITLE ACTION IS OBTAINED OR IN THE EVENT QUIET TITLE IS NOT CBTAINED, THE MANUFACTURED HOME WILL EITHER NEED TO BE REMOVED FROM THE PARCEL OR MEET REQUIRED SETBACKS FROM RIGHTS-OF-VVAYS. 4.) UPON RECEIPT OF SUPERIOR COURT QUIET TITLE ACTION, APPLICANT SHALL SUBMIT A COPY OF SAID DOCUMENTS TO THE DEPARTMENT OF COMMUNITY DEVELOPMENT SO THAT FINAL OCCUPANCY OF PERMIT MAY BE GRANTED. 5.) The application was reviewedthe Jefferson County Department of Comity Development staff on (date) 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: Geologically Hazardous Area (Moderate Landslide Hazard Area and Unstable per Shoreline Slope Stability maps), and Critical aquifer Recharge Area (Susceptible Aquifer Recharge Area and Coastal Seawater Intrusion Protection Zone-SIPZ). 6.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 7.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 8.) 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. 9.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea sitchensis), Shore Pine (Pinus contorta), Douglas Fir (Pseudotsuga menziesii), Western Red Cedar (Thuja plicata), and Western Hemlock (Tsuga heterophylla). Among native tree species which may be used includes: Vine Maple (Acer circinatum), Big-Leaf Maple (Acer macrophyllum), Red Alder(Alnus rubra), Pacific Madrone (Arbutus menziesii), Quaking Aspen (Populus tremula), Black Cottonwood (Populus trichocarpa), Bitter Cherry (Prunus emarginata), Oregon White Oak (Quercus garryana), Cascara (Rhamnus purshiana), Pacific Willow (Salix lasiandra), and Scouler's Willow (Salix scouleriana). Among the native shrub species which may be used are: Sevice-Berry(Amalanchier alnifolia), Red Osier Dogwood (Cornus stolonifera) Salal (Gaultheria shallon), Ocean Spray (Holodiscus discolor), Indian Plum (Oemlaria cerasiformis), Pacific Ninebark (Physocarpus capitus), Red Flowering Currant (Ribes sanguineum), Wild Rose (Rosa nutkana), Swamp Rose (Rosa pisocarpa), Willows (Salix ssp.), Red Elderberry (Sam bucus racemosa), Snowberry (Symphoricarpos albus), Evergreen Huckleberry (Vaccinium ovatum), Red Huckleberry (Vaccinium parvifolium). 10.) 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. 11.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and 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 Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 12.) 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. 13.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 14.) Critical Aquifer Recharge Areaay require special protection measures t•tigate 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. 15.) The applicant is proposing to create or add 4421 square feet of impervious surface and 3662 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. 16.) 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. 17.) 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). 18.) The revised site plan dated July 14, 2008 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 July 16, 2008 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 19.) This approval is for a manufactured home and an attached garage only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 20.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 21.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 22.) 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. 23.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 24.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 25.) Minimum setback from private ingress/egress easement rights-of-ways shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 26.) 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. 27.) 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. 28.) The building height is not to exceed 35 feet. 29.) An address of 280890 Highway 101, Port Townsend has been assigned to the parcel. Acess is actually off of platted rights-of-ways from SR 101. 30.) The parcel was created through the Jnction City Subdivision on March 5, 1891 under AFN 7057. 31.) The parcel is served by the Discovery Bay Village public water system. 32.) A septic pemrit (SEP08-0061Ss approved on June 25. 2008. • 33.) On June 30, 2008, the Planning Manager determined that a geotechnical report is not required for this project. JACK WVESTERMAN Il410 Jefferson C r Courthouse ASSESSOR ro Box I22, Port Townsend, WA 9113611 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S AME/MAILING ADDRESS: NAME: �� ADDRESS: /1 4�4 / � )G� . (J ,fr,-, /2. z (&3$2- PHONE NO. ,_3l�D-CB3 -//76 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. ' MOBILE HOME DATA: (A) MAKE ,//� _ (B) MODEL holy/D3 (C) YEAR 2Od8 (D) LENGTH CL 66 (E) WIDTH -,iB (F) SERIAL # e2t9/n7 (G) YOUR PURCHASE PRICE (Do not include sales tax)9di,D/3 . PURCHASE DATE *2-08 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WIIOM DID YOU PURCHASE MOBILE 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 di. ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBI 011 OME PARK: a •A NAME OF LAND OWNER: ' 'izQy[, 2 j/ /O LOCATION ADDRESS /O/ �,e- ix_40b,L,01 9 REAL PROPERTY PARCEL #/DESCRIPTION 96iL 5'62.-6D - ..�.eL�a 44 -5-6 i,,t n Z(P k-- natur applica a 4 IR-Ty I THANK YOU FOR YOUR HELP! _�14� 6 _?D ss-F Qx -- , JO COSSELL. Property Technician JEFFERSON CAIfNTYOC • 0 4 3 /1 I '`,isr .A l' i _zeor I� - _ r m t),2,§ .. 1 14 g-.-g _ -,......, t 1 ,a irm • N;Zat:o sl ' L4.2i_ 0 ..noo..tr M a -14 • I .0 (le: r - i L m11111111% O rA ,lik ---, N'S -all" tal RI ILI 0 I A I1Ii _ ='��l' ; I--- -d JI iiiii M I* Q - +�GL�7_1S I Z r11 111_ , z, In N 1gill=III ,III!Ji!m i `7■_ �\ I aG/ . , a ,A■rl. l44• I iwrt liadkiklai pip ci = i 1 w 1 I . . �• -'`, , >I i t iEft *wow i I ,� oly co !UNTY & JEFFERSON „,_..'., . . • ,.AA DEPARTMENT OF COMMUNITY,p)^V4OPMENT "cl 621 Sheridan Street • Port Towniend •Washfigtop"9$3,6$ ;, 360/379-4450 • 360/379-4451 Fax q �O� www.co.jefferson.wa.us/commdevelopment S�NG�L Master Permit Application MLA: C 1(0-7 Projec Description(include separate sheets as necessary): I " ; ,-,. Tax Parcel �j C (J � Prop‘rty Number: 96 yji--_4Z -2/0t f Size: 2 Z gee) , k �j,,. (acres/square feet) Site Address and/or Directions to Pr erty: ,480 q, p /Q, i,/jf L�itl.'�- d`i 98, 8 Property Owner(s)of Record: / y L� �, d' L/4. Telephone: ,.36O-683 //'D Fax: email: Mailing Address: /5l-Q �c_ /e) /0 ZG!!j- y� �,2 / Applicant/Agent(if different from owner): jj ,- Y 1, C_'./u , ,, zGi,/L- Telephone: , 60 -68/-0777 Fax:,1Cz O-6(6/-O 7/,6 email: Mailing Address: 259 5-03 Z. U /p/ (j Sze -- p4-k 94-5)..?, Z What kind of Permit?(Check each box that applies) (Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]** ❑ Single Fami" ❑ Discretionary"D"or Unnamed Use Classification Garage-'Rttacl' 'i Detached ❑ Special Use(Essential Public Facilities)** XManufactureo Home ❑ Boundary Line Adjustment 0 Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use 0 Long Plat** ❑ Address_ H Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** n Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment 0 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: /- Z-. DESIGNATION OF AGENT I hereby desi at .-cv to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ' .1...,.-7 Date: VA 8 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 attomey'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 vide access d right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review aV any r uired later i ctions.Access and right of entry to this property shall be requested and shall occur only during regular business hours.( , Signatu //7 l� ca Date: 42 ! 6 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 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 y re in co li nce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tra fer e resp n bill fo adhering to and complying with the ESA. The Applicant has read this disclaim777O and si ns and dates it below. Date:Signatur -� G:\PermitCenter\FORMS\DRD F RMS\Master Permit Application 7-8-04.doc eOWNER BUILDER STATEMENT 0 , 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: Date: GEN L CON TOR �R MANUFACTURED HOME INSTALLER: PHONE: FAX: 1 l G 1 -J ( )lvgl-6 777 (3(c0 ) 681-u7Ro AILIN DDRESS: ,1,q 5/6.✓ )dar /O/ di2 , hki 9M LEMAIL: CONTRACTOR'S LICENSE r2 // v'/^ WAINS NUMBER: /31L vg_r Af 6 ry 6 NUMBER io4/AJc'0 Z JL} ARCHITECT/ENGINEER: A�J )04`22 w PHONE (f860)926,-0/56 FAX:( ) MAILING ADDRESS: /• X 63.7 o z n, a, Q73 q,EMAIL r Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: X New X Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: 2 Bank ❑ Community System O Alteration/Remodel 0 Concrete Total: 2- Height: 1K Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well LI Two Party Type of Heat: Proposed: 3 LI Public _date 4-__ Total: ,3 Name of System:fe.e.j te--u-et. 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 CI Above ground Tank Size of Propane Tank: I Heat Stove I I Cook Stove ❑ Woodstove LI 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. Square Footage For Office Use Only I r- Current Proposed -1 Main Floor Consistency Review: /778 ( 7 2Nu Floor Base fee: ' 3rd Floor Additional Section: Mezzanine: •Plan Check fee: Heated Basement -utate'Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated J"d Approach fee: / - tVt( :. <Garagearport TOTAL: $ ct • Decks eCjpt,Numer: � I J`` Other `I Cash/Check Number: ; _ luly 7 ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and materials foundation to finish A, S _ Initials: G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc `_ Mk>1E (49 ox co 6 TrJEFFERSON COUNTY t -- 1 =°y 7 j \q "� N DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street •Port Townsend •Washington 98368 Qq O� 360/379-4450 . 360/379-4451 Fax ` 7N http://www.co.jefferson.wa.us/commdevelopment/ �c�Fi �'?,�� room Jl1 i tilt? .:!.,.9 STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# OS- I r7 PROJECT/APPLICANT NAME: ika,c)t._- a/ 702/54rt--) 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. yo4-6- --r--0-772L- .41-4EA-4(---yr.... diulii-e_z..c.),zy n '.,d.,(1, Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. (dot, - '. a 3. Describe the existing vegetation. Indicate native ve etation areas on the site map. `y/ - 4. Describe the existing soils. Indicate soil type on the site map. i -)az..., 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. eA 22 J L 2c yci_L L& U , 4.wizz_e- _. /,e .en a_y . Fiat- --i D c-�ae- r24L-ac__, 6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED STORMWATFR PT AN JUL 1 6 2008 Stormwater BMP'•1 guired �11 `.-•� •.•stom,watersite plan template.doc-rev.F 1 003 Ill JEFFERSON CAUNTY 5 DEPT.OF aryl =VELOt.NT ). SIGNATURE: ` ' '` e • • b. Description of special requirements for working in or near environmentally sensitive areas. ,_______2y 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). _ 0 5. Construction Phasing. a. Construction sequence `/ �` V u�--,,p, ' a- la-1-1_ 5„2,,, -...,,_,6 /tea/ ,,r>, b. Construction (if proposed yl--)-/Z 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. .i� , 1, 1-U-,-_-� .,,o_tt - 4f2 . i. 1-x.i II. Wet Season Co stYr ruction Activities. / a. Proposed wet season construu!cti n activities. N/f) RI CEIV.�D b. Proposed wet season construction activities for environmentally sensitive are "/� i. 1. \J 1 x.:,.:3 7. Financial/Ownership Responsibilities. I i N a. Identify the property owner responsible for the//initiation of bonds and/or other financial s I�l SON CO U NTY f BCD CD zi b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. / j� /1/ 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. /0 d. Runoff/Stormwater Detention Calculations stormwater site plan template.doc—rev.10/12/2003 10 • • • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. L. 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical areas (streams,wetlands, lakes,steep slopes,etc.). /f 1 /' O ..,' Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed(i.e., per BMP T5.30 in the Manual)or, if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. l9 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. 1�G/ / - ZA/Ate el /J b � � G. 12. cribe the flow control ystem S possi bl d chars2.7/1? teir.Attocits ,; , ,k , stormwater site plan template.doc—rev.10/122003 6 • • 13. Describe the water quality system. -,977 1 /,L)T Q� O i�✓J 14. Describe he conveyance system analysis and de ign. )1 At.imeku yio,s,c1Ni 5 dshjbl od 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 7//fq 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. // /Ln 17. Describe the proposed surfacing material. J 18. Describe methods for restoration of the site. zzefi,a1 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. i /l � 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 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. ' 77M stormwater site plan template.doc—rev.10/12/2003 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. 2. stablish Construction Access. • A 3. Control Flow Rates. l ll 4. InItall Sediwit Controls. .. Sr 1 P ih.a.i4L4Q• 5. Stabilize Soils. on s 7' & M tad 6. Protecttect Sl` rb (me...„46j. 4/A 7. Protect Drain Inlets. , / - RECEIVED stormwater site plan template.doc—rev.10/12/2003 J E F F E R S O N C O U N TY D C O 8 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 7/ A 9. Control Pollutants. r 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). /7/7-71 11. Maintain Best Management Pr cti s(B s). 12. Manag t e P oject. r • 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). 4/4 b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). C-77 A 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. -77//g stormwater site plan template.doc—rev.10/12/2003 9 • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities, flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all o ers of th ffected prope • r' �f /— OR AUTHO PRESENTATIVE'TURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 1° 11 ,ll� �til�a+ ' stormwater site plan template.doc—rev.10/12/2003 Yg it i{�` j cPS COIti TY Cal 12 ' Pe{erso,n, Gary • Contact: • 280930 Hwy 101 Birdi c/o Buy-Rite Homes Port Townsend WA 98368 259403 Hwy 101 Sequim WA 98382 Parcel # 964-502-604 (27,900 sq ft) 360-681-0777 fax 360 681 0780 m z /lEthseGX .QS cc 7/ /0 a s?a, noo =ZC V moo ��11D 32Du X ,6. �� � Z� a 12t-1iOc- 'o° > \g w Df- co PI rorie ,,,-, ` z o x o\ o gy0� °' 010• xs 14 a 61 H X. N" CO eAo I Zcn / t ?i ,c,9, —sk. PI it / ' q \ RE, `►` ,�i, o moo. (4o 60 \-, Ai \ (T) crk..„,7 Ilk\ \\‘, 7 k ° .r.,- . ‘2, c°- \ •• 1` /..N \ o c:\ 11/41\\ -.1,\ ' \, l'P :6\Y / 0 O \' (4— %. ' ( \ 7. g O \ r/ 0301 c �, 0 _ r 0 • ' 1:\ ,'''- -''cr-Q N cill 1/41) ••••' ry��� / i i .�,_d-. 01- � F >• to rt ,. ..4(f) o -�,s�. a8 ECEr D �ZFN T co cLx)3 ----� ►v ,• cia ,._. —, C td..ri „s (1) \ ..y � � " JUL142008 II ii. w'I*, a; , 3Z % cr\c_ . I� •,, ...i 4.. m. • .. „ RETURN ADDRESS Olympic Peninsula Title PO BOX 1479 SEQUIM, WA 98382 02090557DF L47STATF.OFWASHINGTON PLEASE CHECK ONE D�a.rm.�rof MANUFACTURED HOME APPLICATION nTITLE ELIMINATION lICEnSInG ❑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 KARSTEN 66 X 320" STA0291370R © LAND LEGAL DESCRIPTION ON PAGE _ REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE ®AFFIXED ❑ REMOVED 964 502 604 LOT BLOCK PLAT NAME SECTION/TOWNSHIP/RANGE 4 TO 6 26 JUNCTION CITY c� GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 1 NAME OF REGISTERED OWNER GARY L. PETERSON NAME OF ADDITIONAL REGISTERED OWNER MARILYN A. PETERSON ADDRESS CITY STATE ZIP CODE 140 GREEN MEADOW DRIVE SEQUIM WA 98382 NAME OF LEGAL OWNER FIRST FEDERAL SAVINGS & LOAN ASSOCIATION OF PORT ANGELES NAME OF ADDITIONAL LEGAL OWNER ADDRESS CITY STATE ZIP CODE PO BOX 351 PORT ANGELES WA 98382 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: Signature of Registered Owner and Title,IF APPLICABLE _4a-I // ,� SignaturgpfAdditionalRegistered Owner and Title,IFAPPLICABLE= �� 1. 67/9,,�(�'.ru1�v� WdrA9'(SEALIO0 NOTARIZATION/CERTIFICATION FOR REGISTERED RED OWNER(S)SIGNATURE er4 ga�i'Sry r1 �J /j� State of Washington Signed° ttested C�•I �uyr / County of CLALLAP/1 for me on `f- „ trnny by GARY L. PE T ERSON Signature: L (��� A _ PRINT NAME OF REGISTERED OWNER AFIY OR AGEN -y�. St_‘G by MARILYN A. PETERSON DAWN L, FLEMINO s >x // V NI) � :�^�O� PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR 'ill:: WqSH\ ,;` Title NOTARY AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY _ Notary Expiration Date D 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 PERMITOFFICE CERTIFICATION I certify that: the 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. NAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONEY BLDG PERMIT Y e -4>' G-/AtO BLD 08-132 31Gt7ATURE/POSrTI DATEcT a -(Ler 1- 13-cR �"`.-_--TQ.l2D.•, -P.HOME APPL(W8/8 OR Page 1 of FINALED 12/11/2008 6 SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMI rT,I�ON OF TI /REMOVAL F M REAL�PPROPPE�RTY. Signature of Legal Owner and Title,IF APPLICABLE 'S A /l lt— �.< �.i1:g;2 1•!_ Signature of Additional Legal Owner and Title,IF APPLICABLE NO-c,WIEAUt�3�i P I NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE �\\\\\\\\p• KELLF,9y���i�� I State of Washington CLALLAM Signed or attested Lj l 3010F `� �'�• .•• I County of before on 1 J ? Q :'•pIARY \ ff ? pA 0 i Z by I / r5 T to //Pt a 1 Signature • ' pA10`jj2 G Q PRINT NAME OF LEGAL OWNER OTARYO A T (f '•, PUBV\ :' -by /�/'_/l- / ,00P / ('M' Amy eller i •. ,- I PRINT NAME OF LEG/V.OWNER PRINTED NAME OF NOTARY /% "OF.. +F 1 P,`,\\\\\ i Title DEALERSSHI P OSITION/AGENT/NOTARY AND: Noota Expiration DaRe C�,�O)/1 riLAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office LOT 4 TO 6, INCLUSIVE, BLOCK 26, JUNCTION CITY, AS PER PLAT RECORDED IN VOLUME 2 OF PLATS, PAGE 103, RECORDS OF JEFFERSON COUNTY, WASHINGTON. SITUATE IN THE COUNTY OF JEFFERSON, STATE OF WASHINGTON. 0 DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT.THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN. ANY REQUIRED SALES TAX HAS BEEN COLLECTED. DEALER NAME(TYPED OR PRINTED) WA DEALER NUMBER DATE OF SALE BUY RITE HOMES 4624 05 PURCHASE PRICE ) TAX JURISOICTIO AX RATE DEALSE';AUTH,9RIZ SIGNATURE ./ USE TAX EXEMPT Sale to a Certified Tnbal member on the reservation(attach no rized statement of delivery). D 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 pi TITLE FEES FLING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES a TAX IMPORTANT: 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 PP , P Y 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. It you need special accommodation,please cal(360)902-3600 or TDO(360)664-8885. TD•420.729 MANUF HOME APPL(FU13/98)OR Pogo 2 01 2