HomeMy WebLinkAboutBLD2008-00133 Ii ILDING PERMIT APPLICATION ML Ty 167
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00133 Received Date: 4/7/2008
SITE ADDRESS �S-'f X' HWY 101
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: J A G CONSTRUCTION PHONE: 360-452-9892
PO BOX 1665
PORT ANGELES WA 98362
Contractor's License JGCONGC930NZ Expires 8/9/2009
REPRESENTATIVE: BUY-RITE HOMES PHONE: (360) 681-0777
BIRDIE (360) 681-0780
259403 HWY 101
PROJECT DESCRIPTIOP NEW GARAGE ATTACHED TO M/H
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 31,689.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: 576 SHORELINE:
CONST TYPE: DECK: 680 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $461.95 LYK 04/07/08 97134 APPROVED
Plan Check $300.27 LYK 04/07/08 97134
State Building Code $4.50 LYK 04/07/08 97134 JUL ) 1 2008
Total: $766.72 Jefferson County Planning
& Building Department
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Jefferson County Building DiJTsion Permit Num.: BLD08-00133
Applicant: PETERSON
BUILDING PERMIT INSPECTION APPROVALS \pplicable 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 r0a t✓
Foundation Footing 9120A #fr mono pour "f/�dt�E Koce 6.i..4 6
Footing Drains q//51° ,
Ext. Shear Wall Nailing z_9/eg R
Framing 9_s-_d,g-
Blocking u/J14„
Wallboard Nailing 'i5 rb�, 4,
.7
Drywell/Alt Drainage 6-- j3-W9 ii..._-- SEE CONDITIONS 1 7 2 FOR DRYWELLS AND SPLASHBLOCK
CRITERIA.
Address Posted q/jsf ile' /11/
FINAL INSPECTION tv YI o'r - , k r.c.� se.ie (On DI-}Xuv' 3 d 4
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•
CONDITIONS for Building Permit# :BLD08-00133
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 FEE:T 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 OBTAINED, THE
MANUFACTURED HOME WILL EITHER NEED TO BE REMOVED FROM THE PARCEL
OR MEET REQUIRED SETBACKS FROM RIGHTS-OF-WAYS.
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.) 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.
6.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
7.) 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.
8.) 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.
9.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
10.) 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.
11.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
12.) Minimum setback from private ingress/egress easement rights-of-ways shall be 20 feet.
Minimum side and rear yard setbacks shall be 5 feet.
13.) 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.
14.) 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.
15.) The building height is not to exceed 35 feet.
MAn. ► -+E 0
�, JEFFERSON COUNT( ; i _,F
i ,c DEPARTMENT OF COMMUNITY DEVELOPMENT
_., t 621 Sheridan Street • Port Townsend •Washington 98368 J`rr" ' '` c
Yys O� 360/379-4450 • 360/379-4451 Fax
http://www.co.tefferson.wa.us/commdevelopment/ r ,O
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# OS 1 1 PROJECT/APPLICANT NAME: ik
i ci 701/54rt-
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.
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map. /
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--)4. Describe the existing soils. Indicate soil type on the site map. , 3 w T {. PM
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.
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6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
- STORMWATER PLAN
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Stormwater BMP'• JUL 1 6 200$
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b. Description of special requirements for working in or near environmentally sensitive areas.
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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,so,l structure).
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5. Construction Phasing.
a. Construction sequence
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b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
a . .
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II. Wet Season Co stM ruction Activities. U /
a. Proposed wet season constructs n activities.
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b. Proposed wet season construction activities for environmentally sensitive are
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7. Financial/Ownership Responsibilities. I I^I (�
a. Identify the property owner responsible for the initiation of bonds and/or other financial safigilSO N COUNTY O CO
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b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts. //
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8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps.
b. Diversions. � ,/�
c. Waterways. �(
d. Runoff/Stormwater Detention Calculations
1111
stormwater site plan template.doc—rev.10/12/2003 p ' @ ;•• r r - i 0
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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,
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.).
Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the select;on 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.
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.
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12. cribe the flow control 6stern0
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stormwater site plan template.doc-rev.10/12/2003
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13. Describe the water quality system.
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14. Describe he conveyance system analysis and de ign.
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15. Describe the source of fill material, physical characteristics of fill material,and deposition of excess material.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code. / n
17. Describe the proposed surfacing material.
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18. Describe methods for restoration of the site.
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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.
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20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
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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.
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stormwater site plan template.doc—rev.10/12/2003 7
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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. �, %he_ �
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3. Control Flow Rates. ll
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4. Install Sedirmt Controls.
5. Stabilize Soils. •NA
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6. Protect Slope .
7. Protect Drain Inlets.
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12 Required Elements—Construction SWPPP(continued;
8. Stabilize Channels and Outlets.
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9. Control Pollutants. r
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Pr cti s(B s).
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12. Manag t e P oject.
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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).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are cn or adjacent to the site.
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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' OR AUTHO•Ir''''RESENTATIVE TORE)
(DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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` PetCrson, Gary 0 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
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-- ,N c% JEFFERSON LINTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
.' N��p7 www.co.jefferson.wa.us/commdevelopment .
Master Permit Application ifFfFfSO J NMI)! [j#.,t.MLA: (Dg - 1637
Prof ject Des ption includearatesheets as necessary): /�
�/ jam / r.,_ ,,,, i �u� ,
Tax Parcel ,/ Property
Number: 46 /A_ �D Z_ ,Q 7 Size: (acres/square feet)
Site Address and/or Directions to Property:
28011.0 t-` /o / ,c.r) �g 978 33
Property Owner(s)of Record:
Telephone: ,.O -6R -// 76 Fax: email:
Mailing Address: —c_ ,7-7/_p_o- xJ �,,.,�,
Applicant/Agent(if different from owner): c� ` - ; �,LI 2e-ci-;
Telephone: 56 O - 68/- 6 7 7 7 Fax: /nD -D 78C) email:
Mailing Address: �,s- 5 id / C\ ( 2/„ iJQ yry3�Z
What kind of Permit?(Check each box th pplies s
Building 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]**
❑ Single Family %Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address 0 Road Approach ❑Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
0 Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
0 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 Vegetation Request
*May require a Pre-Application Conference **Requires a Pre-Application Conference
Please identify any other local,sta or federal permits required for this proposal, if known:
SIGNATION OF AGENT
I hereby des nat --u to act as my agent in matters relating tot this application for permit(s).
OWNER SIGNATURE Date: !T/r'/de
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 its 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 pro e access and rig t of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review-and ny re red.later inspe on . Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time'\f thhe ppli 'on that h of sew s for notice.
Signattr ,✓ i �/7id 8
Date:
The action or actions Applicant will ndertake as dresult 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
perm as been issu will not viola the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s) en if yo iv in comp' n with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tra sfe respo ' dity ad ering to awn omplying with the ESA. The Applicant has read this disclaims and igns and dates it below.
Signature: ' -. Date:'DL_ — ��. d,5
/
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
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BUILDER STATEMENT
The si ner of thistatement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
;they- a ming th r ponsi ; ty of the Genera ontractor for the proposed project.
SianattVr: � �, Date: .h' 6
9ENFp°AL CONTRACTOR OR MIi1FACTURED HOME INSTALLER: PHONE: FAX:
a 4 ,� utja ��: c� .6o - 6o -ggg i
MAILINGL9,`DDRES: , ,& .6 65 / A4� 0�i��, EMAIL:
CONTRACTOR'S LICENSE / / WAINS
NUMBER: I�Q G'0 4l 6 9 36Al z NUMBER
ARCHITECT/ENGINEER: `I� /_ �j 1 /.� ��zA r, �, J PHONE (�i) Z/6,d_86c// FAX:( )
MAILING ADDRESS: V / �-�,z ( ,J , 5 �cc�./c/i Je Jo EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New Wood Existing: 0 Sewer
❑ Addition ❑ Steel Proposed: Bank I i Community System
❑ Alteration/Remodel 0 Concrete Total: C.) Height: XIndividual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: Eli Private well 0 Two Party
Type pf Heat: Proposed: KPublic
U/tiLLQ.�i e d Total: U Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants, employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove I Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:
271-d Floor Heated Consistency Review: 1 �� YIV•
Lc/ ()/-
Other Heated Base fee: 41 ( (i13
Mezzanine Additional Section: (per-----'
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: ,/�j3°
Other Unheated Pot Water Review fee:
�-)() I—L1—if))
Garage/Carport r/ 'I L4 2 SUBTOTAL ---, / I Z
Decks c. 51i1lRd Approach fee:
680 f�1 I - +k - -P f`U)
Other TOTAL: $ ! O 72
Receipt Number: C—7 12,c-i
C T, Cash/Check Number:
`11 s
ESTIMATED COST(REQUIRED) _.---// Date: � ---,
•Fair market value of all labor and materials foundation to finish
- � 606 , UG Initials: 4 --7_
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Aim JEFFERSON COUNTY DO
• fER iIT # BIB
Peterson, Gary
0 0 8 - 0 3 280930 Hwy 101
OPort Townsend WA 98368
trAll JEFFERSON COUNTY DCD Parcel # 964-502-604 (27,900 sq ft)
WContact:
Birdi c/o Buy-Rite Homes 1
259403 Hwy 101 Sequim WA 98382
E ���� , 360-681-0777 fax 360-681-0780
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