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HomeMy WebLinkAboutBLD2013-00128 BUILDING PERMIT APPLIcION BLD13-00128 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00128 Received Date: 4/18/2013 SITE ADDRESS: 213 GREEN MOUNTAIN LN BRINNON, 98320 OWNER: DESMOND MC CANN PHONE: 360-301-3880 PO BOX 191 BRINNON WA 98320-0191 LEMBERG SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 602341050 Section: 34 Township: 26 N Range: 02 W CONTRACTOR: BUY RITE HOMES PHONE: (360) 681-0777 259403 HWY 101 SEQUIM WA 98382 Contractor's License BUYRIH*08406 Expires 5/20/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW MANUFACTURED HOME - REPLACING AN EXISTING HOME TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,456 VALUATION ADD'L: HEAT TYPE: EEE CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: 24 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 1PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $0.00 JLA 04/18/13 State Building Code $4.50 JLA 04/18/13 142007 APPROVED Potable Water Application $66.00 JLA 04/18/13 142007 Total: $70.50 JUN 1 1 2013 Jefferson County DCD \\lirlomorLAAn+n\fnrmc\F RI Il Ann PIA rnf A/1R/9l12 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 Carl Smith, Director/Building Official PERMIT#: BLD13-00128 APPLICANT: DESMOND MC CANN PHONE: 360-301-3880 PO BOX 191 BRINNON WA 98320-0191 SITE ADDRESS: 213 GREEN MOUNTAIN LN Issue Date: 06/11/2013 BRINNON, 98320 Final Date: 5/21/2014 SUBDIVISION: LEMBERG SHORT PLAT Block: Lot: 1 PARCEL NUMBER: 602341050 Section: 34 Township: 26 N Range: 02 W PROJECT DESCRIPTION: NEW M/H - REPLACING AN EXISTING HOME -SERIAL#34159 THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 5/21/2014 \\tidemark\data\forms\F_BLD_Occupa ncy.rpt 5/21/2014 • 0 . 1 ., ..... . .. 0_ C2.1F L7-1 .— '1 '. 1..'1)1111.1,4 i.t".'.111 'I .... a it.i'o :f'-,,..`134V M ral; • C:lif7C)1", puP S ..411 PC., - CO C...) _ j: ,-- — -'1.■-- ' 1111 1 1 . li 11H . i ' 1 . , CV _ # 0 . t I_ u_ ----2- 1 1 I I 1 ' i :- I 0 0 . I... ItllA c_ j 1 ' j i' ll ' l j • j 4 1 1 0 0 CO ol , 1 . i , , 1 , , ;I , 1 , 1 , , 1 >-. ! , , . , 1 , . 7-z--- , 1 1 . CI\ 1 ' 1 ■ i i--- . I < m • ; 1 . , . . . . , 1 . 1 1 111116•111MINIM10111011=111a : ' 1 , ; • 1 ;' I r , o.... ::. -1,.. t i I 1 ; II ill , ' ' 1 ' ; Z ■ ; ; ' ' 4: _>.. —" ° 0 1 , , 1 1 1 , ,„ ,,, , ' r■ '' 4-1-1 c , . ....., , ; 1 , , , 11 , ., ....i.... v) . I ' 1 , oi 0 . . ' - o i cc ' 0 ' 1 • :k1 f _!,,...■ 1 , . . . , H , ' .. 1 ' - ! : ' 1 ' .,7. , , , , i= i , 1 H 1- . 0 0 (1) x inx . cc 1 •.: Z , 8 co , , Lk, co I.1 1 cr) c:1 . 1 w . • (/) ■ 1 a . ' , < . : Li., , . • . x • 1, ; , , 1 „.., 1.-- , I • • . . ' • 1 I 1 1 , , ..:t --- ,• :: •--....--.:._._-:-:-/ ; , 1 1 . ; 1 . • • 0 ter,3 %cc JEFFERSON COUNTY D VEP EPARTMENT OF COMMUNITY DEVELOPMENT '! , L , ,7 621 Sheridan Street • Port Townsend •Washington 98368 u� �' 360/379-4450 . 360/379-4451 Fax g JEFFERSON COU y JEFFERSON COiJMY hftp://www.co.jefferson.wa.us/commdevelopment/ COMMUNiTYDFVELO MFNT Stormwater. Calculation Worksheet MLA# PROJECT/APPLICANT NAME: e&/ `b6c61210,6 pG DETERMINING STORMWATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required. PARCEL SIZE(I.E.,SITE) Size of parcel ¶ acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet o./7r go D sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species, other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar, alder,big-leaf maple,and vine maple;shrubs such as willow, elderberry, salmonberry, and salal;herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY.CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared,graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert%acres or more of Construction site for structures / sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank, etc. sq/ft Circle: Yes No Well,utilities,etc. sq/ft Does the project convert 2%acres or more of native vegetation to pasture? Driveway,parking,roads,etc. sq/ft Circle: Yes No Lawn, landscaping, etc. sq/ft Other compacted surface,etc. sq/ft _ Indicate Total Volumes of Proposed: Total Land Disturbance ,-}t/to sq/ft Cut Fill (cu/yd) -72/24.4) % . /4 •/? [over) 6e44 t+.o , ham?6wd -9 4'0 Lpaito ae,Ynanre®C-280 4/6 • • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area)- 14454 sq/ft Structures(all roof area) 2/66 sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios 028/) sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway,parking, roads,etc sq/ft Driveway,parking,roads,etc v Ob(") sq/ft Other sq/ft Other sq/ft Total New 111452, sq/ft Total Existing D sq/ft TOTAL NEW+TOTAL EXISTING* .5/3/, sq/ft This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v.REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: St Does the site have 35%or more of existing impervious surface? Circle: Yes No� FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture,the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small° projects who must comply only with Minimum Requirement #2--Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is two and correct to the best of my knowledge. also certify that this application is being made with the full knowledge and consent of all owners •f the affe =• •roperty. • - ';OWNER 0- ORIZED REPRE ATIVE SIGNATURE) (DATE) y i.....�.;iti101,1 '. .,.... 1'�}i i�n� .. ..,.:�._ �Y�dn`E. �-_ "v..w..�.`_.�$ i_LL�� �� }�� �h Pd_14eP� � �°'YIt 7 j�"ak 4 d-, ....� „�....Q>..—.. .._.= I3 LO I '5-14 k c;" JEFFER4 COUNTY DEPARTMERT OF COMMUNITY DEVELOPMENT .1 `-c 621 Sheridan Street• Port Townsend • Washington 98368 360/379-4450 . 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment `-- _TAT— Master Permit Application MLA: Project Description(include separate sheets as n eces ary):�t��/b q 171,9A)oc- ici�.Le d / ac Tax Parcel , Number: OZ, 3y/ 050 Size: - , (acres/square feet) Site Address and/or Directions to Property: ,3 4 , ri�4' '----''7 6-fir0- 7"__ 6 1 / -.Z //&I.j � m-n o�eww ,o�d ,L. tc . 1�..taf�ch-,,cam(, 6---A hte ,e-t- .PropergOwner(s)of Record: A• 6 A)d if e Ay ! 1... L.r,lc, 1 , / Telephoneo( -6OI - 880 Fax: email: Mailing Address: {?©. I©X /9I 4eiivA)onJ Ge? 9 2 Applicant/Agent(if different from owner): 6-,..y- e. /,fi s Telephone: ,Stp6-/0f31-O7'77 X 3LO 4 70..501 Tax: '�0-6,81--0777 email:h6-dip rbaucjkr Cjf}hcv.co m Mailing Address: 2.594/0,S SUu t /o / S eept i LOA 9838 a What kind of Permit?(Check each box that applies OBuilding ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Garage Attached/Detached ❑ Discretionary"0"or Unnamed Use Classification X Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address ❑ Road Approach ❑ Binding Site Plan** ❑ Home Business ❑Cottagelndustry ❑ Long Plat** ❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions*" ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: / n / DESIGNATION OF AGENT I hereby design !� !' i1 �'. ., to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE `'""/%42-ti-.n'� 'u" �,2 -ti, Date: 1144-7-1 a.7e 7 6 13 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 a • right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any re•J =• later in •-«ions. Staffs a •-ss and right of entry will be assumed unless the applicant informs the County in writing at the time of- appli„iron th=the w= is prior noti•-=. Signatar UK/ . 19.._ -��4L _ Date: 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 lake"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 iss ed will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)e en if y are in comp with the Je - -on County development code.The Applicant acknowledges that he,she or it holds individual and non- sfe -i•le tesponsib• or=•hering to a d complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature:'v , i ' _ , i_ A--u- Date: II BUILDER STATEMENT • r The signer of this - ement does h by certify thayt they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they i 'kassu ng the sponsi '` •f the Ge ral Contractor for the proposed project. Sign ture �� '.L' - / Date: GEN RAL CO TOJR MANUFACTURE;HOME INSTALLER: • PHONE: FAX: ily- - f) 06b) 6S1 `6777 (5w b61 - 67 O MAILING ADDRESS: 2_55Gj /a zj/.0 j_)6/ , a-C )yl EMAIL. t,;y,41 r Qr(JQ.Gt.h i.(l f kb P• Ctlf 6ri CONTRACTOR'S LICENSE GJ WAINS l NUMBER: )5114,e_7:// * 684LO b NUMBER ARCHITECT/ENGINEER: a_436-16 -4‘6 AP s PHONE (g46 g,2_6 -a,c Ax:( ) MAILING ADDRESS: 2 l/i/c 54), a , 254.6,Q/A,41 , /MAIL Project Type: Frame Type: ' Bathrooms: 3 Shoreline: Type of Sewage Disposal: y New )2< Wood Existing: o Sewer ❑ Addition ❑ Steel Proposed: 2 Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: Z Height: 1 Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: A Private well ❑ Two Party Typ f eat: Proposed: . ❑ Public _PLIEla Total: o Name of System: If this is a Commercial Project you must answer the followina: 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:. ❑Underground Tank. 0 Above ground Tank Size of Propane Tank: ❑Heat Stove ❑Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑Hot Water Tank ❑Pellet Stove ❑Other Is this appliance beina 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 Bid App Review: .�y b r 2"O Floor Heated Consistency Review: Other Heated Base fee: 2-g-. c Mezzanine Additional Section: Heated Basement Plan Check fee: _.- Unheated Basement State Surcharge fee: if' S a Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $9 j(O. 50 Receipt Number: /i` -7 Cash/Check Number: 3/�q� ESTIMATED COST(REQUIRED) Date: g:-/ per/J 2 .Fair market value of all labor and materials foundation to finish 0 Initials: <J4- ' 1 • \ f i -7--- 7\ / \ \ 1 ' i1 om I ° �o i m rD� /z / N, 8._____\_\ , -0 ao % i______- ) to �, �Zjj I 2 g \ Dy oOA11 � �h..Q OCR / IAO NA1� 2= • . 2 �� \ \ D°8 conC7 b�i M pb o b pii / \ \ . A 7 �/' \ ~ 4 \( \ ti I D o —___._�� y . , ,\y/ ,.., (.1...., . 6., ,,, /I '� C°i 0 2. 'y` ' 50 0 .. cs _'ms's xi m o ,, / �y Op - �� rt )c-ct. U \ -i a i M� / \\ \ yO Q°� k- I I P O 4,../rn r1 07 i i \ \\ \ \ Rl O N ~ \ N O y CA rl CO i _ -\\ ____.----- ..__.-----Z1 P / _____\ _____ ' i . \, _ GREEN — OUNTAIN LAN — ------ _ v+ n cf ei f 0O `0 y 0 n\ v $r k J ( .J l Ns VP: � i 0n C Co 0 CD co 4 It =) iffil o 0 r,, Op Front Parcel Review 0 Parcel 602341050 Printed: April 22, 2013 DESMOND MC CANN Site Address: PO BOX 191 213 GREEN MOUNTAIN Lt BRINNON WA 983200191 BRINNON, WA 983200191 BRINNON WA, 98320 Parcel Number: 602341050 S-T-R: 34-26N-02W Total Acreage 5 Legal Description LEMBERG SHORT PLAT LOT l(S/C XMPT Land Use: 1100 PTN)SUBJ/EASE Flood District: Fire District: 4 Planning Area: 11 Flood Map(FIRM)Panel No: School District 46 Zoning: e-C- COMP PLAN DESIGNATION: CppIMUNITY PLAN: UGA: UGA Trans [ ] Plot plan states "property line" [ 14 Assessor's Map(Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ VI Legal Access to Property YES NO [✓f Parcel Tags or Scanned Documents YES NO [ ✓J ESA's: Special Reports Nearby YES NO [V] Designated Ag YES 0 [ 1/f Shoreline Designation: YES NO [C.( Shoreline Slope Stability: YES cD Stream Type:YES NO Fish & Wildlife:YES NO Wetlands: YES NO Rare Plants:YES NO Seismic: YO Landslide. NO 5 u Lk-` Flood: YES NO Erosion: YES NO Aquifer Recharge Are. `► NO S-C SIPZ: none At Risk High Risk Coastal CMZ: none High Risk Moderate RiskDisconnected CMZ Stormwater site plan sus is itted: YesNo [ Forest Lands: YES M Adjoining Forest Lands: Commercial/ Rural/ Inholding [j- Mineral Lands: YES gra [ n-- Agricultural Lands: YES lb_ [ (j- Archaeology: YES _ �^ [ f/( Stormwater: New Im,-r 'I Surface `/L Land Disturbing Activity 2 (f p ESA's Stormwater R : :Min Req#2 Min("LE #1 thru#5 Min Req#1 thru#10 Engineering [ i'r Notice Provisions I • ure:Ai ort YES NO MRL YES NO Forest Lands YES NO [ Landscaping Required: Yes ,' o [ Parking Spaces Required NO Other [ Building Height: allP UBC Standard [ r Impervious Surface covers ercentage: Resource Lands&Public: 10W Rural Residential.) Rural Indus.Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industrial Lands only [ Total Building (s) Size: [�VC:20,000 SF CC: 5,000 SF NC:7,500 SF GC: 10,000 SF All others:subject to septic&water constraints/None specified etbacks: Front: Left Side: Right Side: Rear: Shoreline Setback: LSHA Setback: [ frf Road Classification: Road Approach: 44118P NOT REQ'D RAP [ V SEPA Required: YES 4 EMPT [ t Flood Certificate: (4 [ LA Existing Case(s) &Condition(s): Violations: Yes No ^^-- [ t C'Recorded Date of Subdivision: (7� AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [ Lots/Require Declaration of Restrictive Covenant YES O, bmitted: YES NO [L UGA No Protest Agreement YES .!S submitted: Y NO [�r�J Site Visit conducted YES '� [ vJ Require Final Zoning Approval YES [ ] ADMIN: Setbacks entered in Permit Plan case 4184 YES New Parcel Tags entered in Permit Plan 4 /: YES Special Reports Scanned&YEs No parcel tags found for parcel Cases Associated with APN 602341050 Cases Name Review Type Status Planner BLD13-00128 MC CANN P Application Received: 4/18/2013 Permit Issued/Case closed: Case Finaled: NEW MANUFACTURED HOME - REPLACING AN EXISTING HOME BLD85-00028 LEMBERG F Application Received: 4/23/1985 Permit Issued/Case closed: 7/13/1995 Case Finaled: 7/17/1995 Reactivated for inspection &T.b. SEP13-00045 MC CANN P Application Received: 4/19/2013 Permit Issued/Case closed: Case Finaled: SEP78-00229 MC CANN N Application Received: 8/24/1978 Permit Issued/Case closed: 8/31/1978 Case Finaled: SOM78-00229 MC CANN N Application Received: Permit Issued/Case closed: Case Finaled: \\tidemark\data\forms\R_Parcel_CRMIA.rpt 4/22/2013 Page 2 of 2 JACK WESTERMAWI Jciie re ty i;oartho� ASSESSOR p0 w x 20, Pori Tsnnred,WA 90308 (384038341M MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: .tJ�+ o,Ji ADDRESS: .D . C.�X /9/ s(ge/,{JAJO•c) PHONE NO. 3 4QQ 1-388() The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 1)MOBILE HOME DATA: (A) MAKE eS7 • (B)MODEL /046/C (C)YEAR 2D/2 (D)LENGTH ,62- (E)WIDTH at`f3 (F)SERIAL# 1/15-q (G)YOUR PURCHASE PRICE(Do not include sales taa),I,OC)G . ° " PURCHASE DATE 091/3 2)PREVIOUS OWNER/LOCATION OF MOBILE ROME: (IF NEW MOVE TO QUESTION 3) (A)FROM WHOM DID YOU PURCHASE MOBILE ADDRESS (B)WAS MOBILE ROME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No If Yes, Previous address of mobile. It 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 ROME PARK Yes 0) (B)IF LOCATED IN MOBILE kOMB PARK: NAME do ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: LOCATION ADDRESS .43 g ■L/ 1'//o1L/7 T / ) L.L sde/.U.c..b.J QB d REAL PROPERTY PARCEL#/DESCRIPTION 6 D Z 3 AIl ()SO. A ature of pplleant/ THANK YOU FOR YOUR HELP! t 4JO CASSELL.Property Technician MANUFAJRED/MOBILE HOME INSTA!ATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00128 Received Date: 4/18/2013 SITE ADDRESS: 213 GREEN MOUNTAIN LN Issue Date: 6/11/2013 BRINNON, 98320 APPLICANT: DESMOND MC CANN PO BOX 191 BRINNON WA 98320-0191 SUBDIVISION: LEMBERG SHORT PLAT Block: Lot: 1 PARCEL*: 602341050 Section: 34 Township: 26 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*08408 Expires 5/20/2014 PROJECT DESCRIPTION: NEW MANUFACTURED HOME-REPLACING AN EXISTING HOME MAKE: KARSTEN YEAR: 2012 SIZE: 52X28 Directions To Site: To schedule inspections, call (360)379-4455 no later than 3:00 PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. Office Hours 9:00-4:30 MONDAY-THURSDAY 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 L1N6/ qjc ,-7. I qi n ' 3w ...., , 7/23f 13 FINAL INSPECTION /✓ (3-�'(�j � ��, �' el< FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR SPECIAL CONDITIONS APPLY-SEE REVERSE • • SPECIAL CONDITIONS CASE # BLD13-00128 1.) 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. 2.) The site plan as submitted with the Building Permit application on April 18, 2013 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 April 22, 2013 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 3.) This approval is for a Replacement 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. \\tidemark\data\forms\F_BLD_Permit_Mobile.rpt 6/11/2013