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HomeMy WebLinkAboutBLD2009-00326 • • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 Al Scalf, Building Official PERMIT #: BLD09-00326 SITE ADDRESS: 51 E ALDER Issue Date: 12/30/2009 PORT LUDLOW, 98365 Final Date: 9/21/2010 APPLICANT: RAELENE M ROSSART PHONE: 360-437-0280 MARGERY L B LOVE 51 E ALDER ST PORT LUDLOW WA 983659739 SUBDIVISION: PARADISE BAY ESTATES Block: 10 Lot: 21 PARCEL NUMBER: 983401020 Section: 22 Township: 28 N Range: 01 E PROJECT DESCRIPTION: NEW M/H REPLACEMENT - MODEL 5V460T5 THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes 0.0 THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 9/21/2010 I:\F_BLD_Occupancy.rpt 10/29/19 • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD09-00326 Received Date: 9/29/2009 SITE ADDRESS: 51 E ALDER Issue Date: 12/30/2009 PORT LUDLOW, 98365 APPLICANT: RAELENE M ROSSART MARGERY L B LOVE 51 E ALDER ST PORT LUDLOW WA 983659739 SUBDIVISION: PARADISE BAY ESTATES Block: 10 Lot: 21 PARCEL#: 983401020 Section: 22 Township: 28 N Range: 01 E CONTRACTOR/ PARAMOUNT BUILDERS INC PHONE: 253-606-7313 DEALER P.O. BOX 112452 TACOMA WA 98411 Contractor's License PARAMBI001JE Expires 3/25/2010 PROJECT DESCRIPTION: NEW M/H REPLACEMENT- MODEL 5V460T5 MAKE: PALM HARBO YEAR: 2009 SIZE: 60X40 HIS T15 VAUD FOR CINE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAS CALL IN FOR THE REQUIRED INSPECTIONS THAT APPL IYOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTIN !A or PADS USED):I LC, Stormwater FINAL Approval: Blocking/Plumbing:? +4--- -rr—c..) Z1'4-IO ` -)4.)�huL,4.S 7y�t✓ �3y Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: FinaVSkirting/Vents/Porches/Steps: i k (ICA S 7 _a-i id ritIS APPROVAL RE UIRED PRIOR TO FINAL INSPECTION HEALTH DEPARTMENT AND PUBLIC WORKS � THIS PERMIT IS VALID FOR ONE YEAR -k Set /l (� BUILDING INSPECTION HOT-LINE 379-4455. Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY • SPECIAL CONDITIONS APPLY-SEE REVERSE 41.1 f.; IUILDING PERMIT APPLICASN MLLA09 00322 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00326 Received Date: 9/29/2009 SITE ADDRESS: 51 E ALDER PORT LUDLOW, 98365 OWNER: RAELENE M ROSSART PHONE: 360-437-0280 MARGERY L B LOVE 51 E ALDER ST PORT LUDLOW WA 983659739 PARADISE BAY ESTATES SUBDIVISION: Block: 10 Lot: 21 PARCEL NUMBER: 983401020 Section: 22 Township: 28 N Range: 01 E CONTRACTOR: PARAMOUNT BUILDERS INC PHONE: 253-606-7313 P.O. BOX 112452 TACOMA WA 98411 Contractor's License PARAMBI001JE Expires 3/25/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW M/H REPLACEMENT - MODEL 5V460T5 TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 2,460 CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop:— 3 - Total: 2 Total: Routing Dat^) Cif y Type Amount Paid By: Date: Receipt: ' • rt../ dam _ e Manufactured Homes $213.00 LYK 09/29/09 111018 Add. Manufactured Home $37.00 LYK 09/29/09 111018 Potable Water Application $62.00 LYK 09/29/09 111018 DEC 30 2089 Total: $312.00 Jefferson County f Iammns & Building Department • SPECIAL CONDITIONS CASE .LD09-00326 1.) The proponent shall follow the mitigation proposed in the Wetland Delineation Report and Mitigation and Habitat Management Plan (dated March 2009) EXCEPT that the following plant species will be installed in Planting Area B: 2 big-leaf maple (Acer macrophyllum), 2 red alder(Alnus rubra), 1 shore pine (Pinus contorta), 6 serviceberry (Amelanchier alnifolia), 6 Pacific ninebark (Physocarpus capitatus), 6 vine maple (Acer circinatum), and 3 Sitka willow (Salix sitchensis). All plants shall be obtained from a nursery in 1-or 2-gallon containers, except the Sitka willow which may be obtained as slips. Big-leaf maple and serviceberry shall be planted higher on the slope; red alder, shore pine, and vine maple shall be planted mid-slope; and willow and Pacific ninebark shall be planted closest to the stream. Any plant substitutions require prior approval from Jefferson County. Landscaping varieties and non-native plant species shall not be considered acceptable substitutions for buffer plantings. Other plant installation and maintenance methods described in the Wetland Delineation Report and Mitigation and Habitat Management Plan shall be followed for Planting Area B. 2.) Annual monitoring reports shall be prepared by a qualified wetland specialist and submitted to Jefferson County no later than October 31 for each monitoring year. 3.) Silt fencing shall be installed between the reduced buffers and the building areas prior to beginning any construction or other ground-disturbing activities. 4.) Orange barrier fencing shall be installed along the outer edge of the buildable area prior to beginning any construction or other ground-disturbing activities. 5.) The project proponent shall contact Jefferson County Department of Community Development, Development Review Division (360-379-4450) at least 72 hours prior to initiating any ground-disturbing activities. Development Review Division shall review and approve the installation of the silt fencing and the location of the silt fencing and orange barrier fencing prior to beginning any site development acitivities. 6.) PRIOR TO SCHEDULING A FINAL BUILDING INSPECTION, THE PROPONENT SHALL PAY ALL COSTS RELATED TO THE DEPARTMENT OF COMMUNITY DEVELOPMENT'S APPLICATION REVIEW AND INSPECTIONS. IN ACCORDANCE WITH THE JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT FEE SCHEDULE, ORD. NO. 12-1209-96, AS AMENDED PER ORD. NO. 02-0223-09, THE DEPARTMENT'S REVIEW FEE IS CURRENTLY$71 PER HOUR. 7.) The reduction of a front yard setback adjacent to a right-of-way may cause the land owner inconveniences in the future if certain items such as fences, landscaping, driveways, buildings, drainage facilities, etc. are placed in or near the right-of-way. Rights-of-way may include the installation and maintenance of utilities, ditch maintenance, road widening, etc. Owner may be financially liable for the cost of removing items near or within the rights-of-way for such installation and maintenance activities. 8.) WATER LINE MUST BE LOCATED 10' MIN. FROM ANY PORTION OF THE SEPTIC SYSTEM. 9.) The application was reviewed by the Jefferson County Department of Community Development staff on December 23, 2009 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review, the following ESAs were confirmed to be present on the subject property: Type N Stream, Seawater Intrusion Protection Zone (SIPZ): Coastal. 10.) 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. 11.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1) All Industrial Land Uses (2)All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit(5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 12.) A Type Np Stream (Fish anciidlife Habitat Conservation Area) has beerSntified on the subject property. The standard stream buffer is 75 ft. However, the administrator has approved a buffer reduction. Consequently, the stream will require a buffer of 56.25-feet. The buffer shall be measured horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat Areas shall also have Buffers and Building Setbacks established. 13.) Stream and Wetland Buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of vegetation may be permitted as long as the function and character of the buffer are not diminished. 14.) 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 (Sambucus racemosa), Snowberry (Symphoricarpos albus), Evergreen Huckleberry (Vaccinium ovatum), Red Huckleberry (Vaccinium parvifolium). 15.) 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. 16.) 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. 17.) 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. 18.) VOLUNTARY MEASURES •OASTAL &AT RISK SIPZ: • Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 19.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 20.) All construction activities shall not encroach upon the stream buffer. This includes the storage or preparation of materials. 21.) The identified Fish and Wildlife Habitat Area Type Np Stream, shall maintain a vegetative buffer setback of 56.25 feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to the proposed manufactured home. 22.) An additional setback of five (5) feet is required from the edge of the buffer area to the proposed manufactured home. 23.) A permanent physical separation along the boundary of the buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 24.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to and during construction activities. The signs shall contain the following statement: "Buffer- Do Not Remove or Alter Existing Vegetation." 25.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 26.) The applicant is proposing to create or add 2,460 square feet of impervious surface and 2,460 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. 27.) A Medium Stormwater Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 28.) 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). 29.) The site plan as submitted 40he building permit application on Septemt 6, 2009 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 December 30, 2009 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 30.) This approval is for a manufactured home 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. 31.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 32.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 33.) 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 automobile 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 requirements 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. 34.) This parcel is within a no shooting area per JCC 8.50. 35.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 36.) Pre-existing legal lots of record less than one acre in size in rural residential districts are subject to the stormwater requirements in Chapter 18.30 JCC and must meet the"Area of Impervious Surface Coverage" to the maximum extent practicable as determined by the administrator. Lot coverage is defined as amount of impervious surface, which includes rooftops, driveways, concrete, etc. 37.) The building height is not to exceed 35 feet. 38.) Standard setback from E. Alder Street(C506609) right-of-way is no less than 20 ft., however, the administrator granted a reduction on December 30, 2009 to 10 ft. Side and rear setbacks are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 39.) 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. 40.) A Declaration of Restrictive Covenant has been recorded on October 22, 2009 under AFN 547402 for the purpose of consolidating the lots to meet minimum land area requirements for on-site septic ad to allow zero lot line setbacks. The Covenant is strictly for building and septic purposes only. 41.) This parcel was created through Paradise Bay Estates under AFN 142981, recorded September 20, 1954, Volume 4, page 5 with the Jefferson County Auditor's office. 42.) A Wetland Delineation Report and Mitigation and Habitat Management Plan for Proposed Buffer Reduction preapared by Westech Company dated March 2009 was submitted to address the wetland adjacent to the proposal and the buffer reduction for the Type Np stream. 43.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 44.) A setback of 37.5-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 45.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 46.) NOTICE: This permit does excuse the proponent from complying wither local, state, and federal ordinances, regulations, or statutes applicable to the proposed development, but consistent with RCW 90.58. Development pursuant to this permit shall be undertaken subject to the applicable policies and performance standards of the Jefferson County Shoreline Management Master Program and the Jefferson County Unified Development Code. If during excavation or development of the site an area of potential archaeological significance is uncovered, all activity in the immediate area shall be halted, and the Administrator shall be notified at once. The Federal Endangered Species Act rules to protect threatened Chinook and Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the ESA, any person may bring lawsuit against any individual or agency that"takes" listed species (defined as causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine Fisheries Service can levy penalties. All areas in Jefferson County are included as "critical habitat"for a listed species. Development of property along any marine shoreline, freshwater shoreline, or floodplains could harm habitat if protective measures are not taken. To minimize the potential to damage habitat, all property owners developing adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the following: -All development activities should avoid unstable slopes, wetlands, and forested areas near surface waters - Remove minimal vegetation for site development, especially large trees -Allow trees that have fallen into surface waters to remain there - Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into surface waters or roadside ditches Any individual, group, or agency can bring suit for a listed species"taking", even if you are in compliance with Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a professional fisheries habitat biologist, and following the recommendations for site development provided by the biologist. For more information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and Wildlife Service. JACK WVESTERMAN III Jefferson County Srthouse ASSESSOR Po noa 1220, Port Townsend, WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: �k-�- ILogs Loae. ADDRESS: 5 ! �oL.- 1�-►-� l��.d l0,1 61Z3(,S PHONE NO.( (20) L13-1- O2Z 0 The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 1►MOBILE DOME DATA: (A) MAKE P/i-m /mem, (B) MODEL S`(4(60 Ts AC)YEAR LC-Z) 5 FFa 'crc1Os K cle (D) LENGTH (/e)� (E)WIDTH 4(Q 2 (F) SERIAL #)b/3E,0t7 "11 (G) YOUR PURCHASE PRICE (Do not include sales tax)/ )1414. PURCHASE DATEL/22/09 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILEfili-e4 49/11tS ADDRESS / tOo,' 3757- ,4 E/43/ f Cf%✓�' g89 J (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes 0110 If Yes, Previous address of mobile. /VW 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 o (B)IF LOCATED IN MOBILE HOME PARK: //!�/ f�/n NAME & ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBIIA HOME PAR // NAME OF LAND OWNER: Qe-� SS/�h�/� / L 5/,t= 10 we— LOCATION ADDRESS 1 ,'9 ,, REAL PROPERTY PARCEL #/DESCRIPTION 9 3 4%i/ l / 2T ign are of applicant THANK YOU FOR YOUR HELP! Lauralee Kiesel, Property Technician • • 1 MIR iili!liggil ' Wei. ci, N9S 4 0 Co H i ilitiliiiiiiiill o 0 11 1 ;:ii::!;t{!::,.,..„,...,..„:. a�6 9 I. 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NOSlI3333! , Q. -©-• 600Z 'b C 33 a 1, r',l __) V.,, ; �. ,-., 1 Mv'Id a1IS rl�__. • fig A O?TtIdV 0 • l�ON' a CO wow � JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT '' ....T4 4 621 Sheridan Street• Port Townsend •Washington 98368 �'� 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Cs Master Permit Application MLA: og ' 322 Project Description(indud parate sheets as necessary): !� L i V(- ICcpn. Ct --� f Tax Parcel Number: 98 01 d 19 1$ I t �- Property Size: I COUO x I SO (acres/square feet) Site Address and/or Directions to Property: Si E Axd.ef 1 Pork L,,d1o,-1 Vox 9T3LS SLi 2 9 2009 Property Owner(s)of Record: R6.t.1-''-2- P-os sue- -4.. d Le s I i-c Lo„e Telephone:(,3 bo)`[31- O2lo Fax: email: Mailing Address: Si t✓ •A-\dR� {?o'{ L.k.)&tom 9�365 Applicant/Agent(if different from owner): R//.,i .v,,.vl' ,S- ,�,0F , rY --- ,'t?1,• �,9,J� Telephoner £' '' 73/3 Fax: 3t'o ci$ 1/4/1B email: Mailing Address:�,d. /30 r< 2t Sly' q / kq- "7. s i What kind of Permit?(Check each box that applies 0 Lot or Road Segregation tgRirilding 0 Critical Areas Stewardship Plan )emolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** 1$.Manufactured Home ❑ Modular . 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane ❑Long Plat** ❑Sign - • ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate / to act as my agent in matters relating to this application for permit(s). OWNER SIGNATUR2a—/L- Date: 9/1/# 9 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 provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application tjaat he or she want�.prior notice. 3 / / �ignature. 'c 4,,,,-"( o Date: `/( D � r C 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 you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual 2 and non-trans ble responsibility for adhering to and complying with the ESA. The Applicant has read this disclaim,.r and spns and dates it below. Signature: . w 7 1 k---••-vc------__.-.__.__._..._ Date: .)(i/ . ‘-//0 7 - • • 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 beAsumi g the resppo�nsibiJi f the General Contractor for the proposed project. q Signature: t'' 1"` t` "-"��' Date: 1 b'2 TL I O l GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: Fax: PaYt moat.i- 6i, i Iei-QK-- fr.)^G r )�J ( 3)37,5---d Oa. (/ )`IS0s"•�`#67 MAILING ADDRESS: PO 13 o . a) 3 V h �I�OA C/b l EMAIL: in dCe gat 0b j° ., (oirl Lri e; AJ t CONTRACTORS LICENSE 4 WAINS NUMBER: PCke ow)QQ 1;€ NUMBER v'•, ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: N New Ync,6 i\ r'�"' 0 Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System 0 Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# DI Demolition 0 Other Bedrooms: Water Supply: Existing: /. Setback: ❑ Private well ❑ Two Party Type of Heat: c-OQ.04 1\2 Proposed: AM ❑ Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 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 ce U 4- 4 ``= r y. I �� Main Floor Heated •. t EH BId App Review: 3"- na " Consistency Review: 2 Floor Heated �� Other Heated Base fee: A 13 , . .. , Mezzanine - Additional Section: -Heated Basement Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: qaoGarage/Carport SUBTOTAL Decks 911/Rd Approach fee: --SC[ST? 'w��Y! :z _ t `' Other TOTAL: $ 3 _` Receipt Number: 1 I. 012 Cash/Check Number: �`' I ESTIMATED COST(REQUIRED) Date: �C 1V V>. .Fair market value of all labor and materials foundation to finish Initials: