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Home My WebLink AboutBLD2000-00720 - CANCELLED THIS BUILDING IS NOT FINALED . THIS IS AN INCOMPLETE BUILDING APPLICATION . THE PERMIT WAS NEVER ISSUED . MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00720 Received Date: 11/7/2000 SITE ADDRESS: Hbr9 CENTER RD CHIMACUM, 98325 APPLICANT: DALLAS YETTER PHONE: 385-6650 TAMARA YETTER 4617 CENTER RD CHIMACUM WA 98325 SUBDIVISION: JOHNSTON SHORT PLAT Block: Lot: 4 PARCEL NUMBER: 801034018 Section: 3 Township: 28 N Range: 01 W CONTRACTOR/ DEALER: PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: FLEETWOOD SETBACK: VALUATION 26,000.00 YEAR: 1979 LABOR & INDUSTRIES APPROVAL? SIZE: 14 X 66 BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 2WELL BEDROOMS: BATHROOMS: PARCEL TAGS: YES • STORMWATER: YES 'O Exist: Exist: AREA Plat Conditio alj Prop: 3 Prop: 2 Wetland Erosion Total: 3 Total: 2 Seismic t'u Streams k • Flood Way i Food Plan Routing Date: F&W ► Landslide Shoreline Aquifer Forest: commercial t 4 Rural Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $141.00 MAM 11/07/00 35413 Potable Water Application $30.00 MAM 11/07/00 35413 Total: $171.00 i:1F_BLD_App_Mob.rpt 10/29/99 V . .. . STORMWATER CALCULATIONS Owner/Applicant: 6i in el-t, Sia IL P - CI PROPOSED LAND DISTURBING ACTIVITY Site Address: L C.1 9 P il.''F r'A c/ Drainfield area cleared t tOn sq.ft. Ch i keVt a_C. K t.ii 14A i4. 7Rc,7 c Driveway Length q o ft. X Width 'a o�ft. 9 Digit Parcel Identification No.: gr., I 03,y ® 18 = Total Driveway r cd,e, sq.ft. Permit Number: Clearing and Grading for Site Development PLOT PLAN (Well/Structures/Utilities/etc.) sq.ft. 106 sq.ft. INDICATE the following information. Total Land Disturbance ,1 n el 6 sq.ft. Draw entire parcel to scale.� y Indicate scale of plot plan: / One inch equals te)'-c" — ❑ IMPERVIOUS SURFACE Proposed Structures (all roof area) sq.ft. 1. North arrow Existing Structures (all roof area) /3 ggsq.ft. ❑ 2. All property boundaries and dimensions Sidewalks sq.ft. ,3. Names of adjacent streets Concrete Patios sq.ft. 7'4. Driveway/s & parking spaces • Proposed: ❑ 5. Major features such as ravines, Driveway Length 76 ft. /// seasonal creeks, bodies of water, etc. X Width 20 ft. jE 6. Septic tank, drainfield and reserve area location, = Total Driveway $00 sq.ft. existing or proposed, and distance to Total Impervious Surface ,R / JJ sq.ft. closest structure 7. Sewer lines The Stormwater Manual sets forth the following Small Parcel Minimum Requirements: "8. Wells and/or water lines • Construction Access Route Stabilization: ❑ 9. Neighboring wells within 150 feet Construction vehicle access shall be, whenever feasible, limited to one route. Access points shall be stabilized with ❑ 10. Paved surfaces (patios) quarry spoils or crushed rock to minimize the tracking of (I/ Structures, existing and/or proposed sediment onto public roads. If sediment is inadvertently 11. transported onto public roads, roads shall be cleaned ❑ 12. Setbacks (distances to property thoroughly at the end of the day by shoveling or sweeping. Street washing should only be done after the bulk of the boundaries, structures, banks, sediment has been removed by sweeping. and shorelines) • Stabilization of Exposed Soil: All exposed and unworried soil shall be stabilized by sodding, ❑ 13. Easements for access or utilities seeding, mulching, plastic covering, application of gravel base 2 14. Arrows showing direction of slope— on roads and driveways, or other appropriate means within seven days during the period from May 1 to September 30 assume an elevation of 100 feet at one and within two days during the period from October 1 to April lot corner and indicate the other lot 30. Mulch shall be applied to a minimum depth of two inches. • Protection of Adjacent Properties: corner elevations in relation to it Adjacent properties shall be protected from sediment deposition by appropriate use of vegetative buffer strips, sediment barriers or filters, dikes, mulching, or by a FOR APPLICATIONS ADJOINING SHORELINES, combination of these measures and other appropriate Best Management Practices(BMPs). INDICATE: • Maintenance: ❑ 15. Ordinary high water mark All erosion and sediment control BMPs shall be regularly inspected and maintained to ensure continued performance of ❑ 16. Top of bank, if over 10 feet high their intended function. ❑ 17. Slope of bank in degrees • Other Appropriate BMPs as required by Jefferson County to mitigate the effects of increased runoff shall be applied. H:\H OMEIPLN CN TR\FORMS\PLOTPLN.FRM9/97 • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 CRITICAL AREAS QUESTIONNAIRE Applicant Name K ►'l L°,7LJi Sirt,44 e- Budding Application _ Land Use Application _ Shoreline Application On-site Sewage Application _ Subdivision Application _ Other: T . Is there any standing or running water on the surface of the >c Yes _ No property or on any nearby property at any time during the year? If YES, please describe: I n 03 w e-- c, /Q e ck Pa 6 ji 2. Has any portion of the property or any nearby property ever been _ Yes x No identified as a wetland or swamp? If YES, please describe: 3. Are any willows, skunk cabbage, alders, or cottonwoods present X Yes _ No on your property or adjacent properties? If YES, please describe: 9_i , S 4. Are there any indications on any portion of the property or on any _ YES X No nearby property of rockslides, earthflows, mudflows, or landslides? If YES, please describe: 5. Please indicate which line best represents the steepest slope found on your property. (Check appropriate box) 7 7 T. 7 i7 r 'r I / / / / / / / / / / I / / / / / I / / / / / / r / / / / / I / / / / / / r ,-1 l ! / / / / • r r/- r / / / / / • // I / / / / / / / / / / / r � - / / / / / r/ 7 -- .� r / / / / r r / r/ -- /- I r / / / / / / / // / / / --� uu----� ----- -- (Questionnaire Continues on Back) Page 1 D 2 6. Does the site have steep slopes with little to no vegetation? YES Nc If YES, please describe: 7. Does the site contain high percentages of silt and/or very fine YES A.4. NC • sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the YES NO surface of the ground? tt // If YES, please describe: pm Y1 CI Fro VAT /9r r f_CA L} "i t,v ; /-4 Q et- .�; l1 urc et- By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the 'best of -he:r knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application oac'<e- 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 'aes 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 it's employees, representatives or agents for the purcose application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requestac arc shall occur during regular business hours. • I� Signature I ; �! Ar _,Ir.lA! • Date /7/2/6 C FOR OFFICE USE ONLY = Wetlands G Seismic CRITICAL AREAS ON OR - Aquifer Recharge Area (zone I = Fish & Wildlife Area 1 IMMEDIATELY ADJACENT TO SITE: = Frequently Flooded Area ❑ Fish & Wildlife Area 2 Erosion Z Landslide Seismic Commercial Forest Section Township North Range Parcel Number: Parcel Size: Comprehensive Plan Land Use Designation: Reviewed by: • Community Plan: Date: • Page 2 of 2 h:1home1pincntrlforms1car.dac 1,00 AeyLa 1 M 0 - lr 3E NA n)4 ALA 1 W h ai 5 0 now oaa sat. �I PLEASE TYPE OR PRIME REAL ESTATE EXCISE TAX AFFIDAVIT This fawn is your receipt CHAPTER 82.45 RCW—CHAPTER 458-61 WAC when soaped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS 1-7 ARE FULLY COMPLETED (See back page for huhucdons) ❑Check btu if partial sale of property If multiple owners,list percenlage of ownership next to nave Patricia A.Kahn,a single person,and Ben C.Kahn, 1111 a single person,as Joint Tenants with Rights of Name Kenneth H.Stone,as tiV separate estate Name Survivorship and not as Tenants in Common ra�K a Merlins Address P.O.Boa 65199 I Mailing Addrcae 155 Lindsey Lane en City/State/Zip Port Ludlow,WA 98365 or City/State/Zip Port Townsend,WA 98368 Phone No.(including area code) (360)732-7457 Phone No.(including area code) (360)385-9783 A Send all property tax correspondence to:❑Same as Buyer/Grantee List all real and personal tax parcel account listed assessed value(a) numbers—check box if personal property Name Patricia A.Kahn&Ben C.Kahn 801034018 ❑ 70,530.00 Mailing Address 155 Lindsey Lane ❑ City/State/Zip Port Townsend,WA 98368 ❑ Phone No.(with area code) (360)385-9783 ❑ Mall Street address of property: 4619 Center Valley Road,Chimacum,WA 98325 i i This Property is located in ®unincorporated Jefferson County OR within❑city of Chime= ❑Check box if any of the listed parcels are being segregated from a larger parcel. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) Portion of Lot 4 of the Johnston Short Plat,FULLY DESCRIBED IN EXHIBIT`A'ATTACHED HERETO AND MADE A PART HEREOF. . There is situate on said premises a certain 1979 Fleetwood/Broadmore 14'X 66'Mobile Home,Serial No.3659. There is also situate on said premises a certain 1971 Allen Four Seasons 12'X 64',Serial No.OW-1375,TPO#62407. ® Enter Abstract Use Categories II List all personal property(tangible and intangible)included in selling (Please see list on back page of this form) price. If exempt from property tax per chapter 84.36 RCW(nonprofit organization),include: 1 Seller's Exempt Reg.No.: r,. YES NO Is this property designated as forest land chapter 84.33 RCW? ❑ ® If claiming an exemption,list WAC number reason for exemption: Is this property classified as current use(open space,farm and ❑ Eil agricultural,or timber)land per chapter 84.34? WAC No.(Section/Subsection) Is this property receiving special valuation as historical ❑ El property per chapter 84.26 RCW? Reason for exemption If any answers are yes,complete as instructed below. Type of Document Statutory Warranty Deed (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) NEW OWNER(S):To continue the current designation as forest land or Date of Document July 11,2006 Classification as current use(open space,farm and agriculture,or timer)land, you must sign on(3)below. The county assessor must then determine if the land transferred continues to qualify and will indicate by signing below. If the Gross Selling Price S 120,000.00 land no longer qualifies or yes do not wish to continue the designation or •Personal Property(deduct) S classification,it will be removed and the compensating or additional taxes will be due and payable by the seller or bar oferor at the time of sale. (RCW Exemption Claimed(deduct) S No 84.33.140 or RCW 84.34.108).Prior to signing(3)below,you may contact your local county assessor for more information Taxable Selling Price $ 120,000.00 • This land❑does ❑does not qualify for continuance Excise Tax:State $ 1,536.00 Local $ 600.00 SUB TOTAL S 2,136.00 0.500 Local $ DEPUTY ASSESSOR DATE (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) Tech Fee S $5.00 NEW OWNER(S): To continue special valuation as historic pi us.. sign(3) Tota'.Due $ 2,141.00 below. If the new owner(a)do not wish to continue,all additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or A MINIMUM OF$10.00 IS DUE AS A PROCESSING FEE AND TAX. transferor at the time of sale. 'SEE INSTRUCTIONS" (3)OWNER(S)SIGNATURE 1 T. I CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT „,et.. • i Signature of �// Signature of Grantor or Grantor's Agent • / % Grantee or Grantee's Anent 9r�9: G/ Nam"(print) • Beth IL S Sc Name(print) PA. Kahn Date&city of cigthug LIKE ?l1TS'arrtfZR Dase&olty of signing I'G7h'i!s' l■_�=T=1Bn.ni Perjury: Perjury is•class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than firs yeah,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(IC). REV S4 0001a(03-31-05)(Po 03-31-05) THIS SPACE—TREAS ' ' ' SE ONLY 0 ersoo 1 0 71 1 4 V cr\ i ti iiis . , --t) , r !A A( Ti z7r- OR X � 2� -- p + a �► C. � dz � � 4 COX ` _ <( -k '? -o �� y 1. \ " • r s -/-- (/1.1-r1 `. „e,%t' -42 `Iv— �e y A Elf ckl 3 � A i)') •--4_,� -ri rb .7 — fi > 4. — — a C� C� " 5 < - - o ' S '-`- '`-' E f-- p -,,, -. A-. . . 5 P, r. r �i Ilk 43V,i1 - r e■ ' 0._ C'C ',,:t X ,.1_ `� ; (A •• -c i -k (XI CA jv / . 7 , _,..., .: n ,,, qi:. \,.,,!, -�-� 5 � U rh P –1-1; -r--\--) t r 7- 3 q cn a) r B m v 0 CD 01 r 2 .-) a 0 • co ■ r ` C, D Z ur 2 O 0 yq ` 1\ 1 1l o■ co G 2TY ,n 90 _-I �.- SST o , c) q tr C A o r TF o D Z m o _ n .< z m -Ai z y�, z .'. --C o m 9Y x m m ... z E c" . O A n /h -0 V I tl I- V n m m m -< . - Sj1- -I, < O o m i n A r + o <• r 0 S-.3-z o C m -n/ 0 O SETBACKS m B G7 b o C Z rA ` -_, v 'xi o m 4 4 N g 4 C > may° Ld ter. . •-o -0 hj '4. Q w r ft r. - - c3 ° era - 'oe �' vy �' N nn ry ro a- y a F,�, / Vi '1 y N r,. y" y n ,Qy N Q. N N /}U��] '.7 1�"1 y N. �yGJ 'I�\ \ .. ry� (� N N YT) fA O O N n z N. 1 ft •• rl $ O I V r f9 n� 'wV•! o Cry Q. ro N� rn CD o 'O ,� (p y H o, , �`� z Al –A R �`C I 5T o. 0 h o W r w cn co ~N n N,- � u q CD cn a• N. R 0 0 W CI) 0 L DJ N. N... o 9•-) > ►1 A P ap o Q .- n trl Ilk _ '� '"' CO N 0 CI\, r.r N �� 1-4 �' ro ro by ro ro ro `� o oO 0 0 0 �, 0 0 B .� n sip 5- a R co a N �.. In Cu o ° \q o ►i m o 00 , it a cam, \i U i� m 1 I. JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST. PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION ,tV NEW BUILDING r ( ❑ REPLACEMENT SIZE C y X YEAR j 9 7 9 MAKE Fl e�,c,f IA] o (� J COST C, Ono . 0 (� BEDROOMS: BATHROOMS: EXISTING 3 EXISTING PROPOSED PROPOSED TOTAL TOTAL TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: ❑ SEWER ❑ COMMUNITY SYSTEM ❑ PRIVATE WELL TWO PARY WELL ❑ INDIVIDUAL SYSTEM ❑ Conventional ❑ PUBLIC PERMIT # SEPJP P�'L Alternative Name of water system: IF WATERFRONT PROPERTY, DISTANCE TO BANK OR HIGH WATER LINE ft BANK HEIGHT ft By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner 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 it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. SIGNATURE A i yl f ,r AK %ATE //,/7/ NAME (PLEASE PRINT) Ik - . r A FOR OFFICE USE ONLY BASE FEE j9I RECEIPT# ADDITIONAL SECTIONS CASH/CK# t0\g'./5 SUBTOTAL r DATE 1. POTABLE WATER 30 Cro 911/ROAD APPROACH TOTAL a1 . cP HaHOMEIPLNCNTRIFORMSIMOBILEAP.10199 PLEASE MAIL TO: JEFFERSON COUNTY ASSESSOR JACK WESTERMAN III JEFFERSON COUNTY COURTHOUSE ASSESSOR PO BOX 1220, PORT TOWNSEND WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME / MAILING ADDRESS: THIS IS NOTA TAX STATEMENT NAME: K e dt }1 e_t I 14 . S +0 „ e, The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the ADDRESS: II b / 9 C P_ +-t' 1( previous ownership and location of a mobile home. This will r • G 2 1 a- help our office determine whether the mobile home is already n„ rt C Lt net t✓�.�/. /O �(� on the tax rolls in Jefferson County or if it has been moved to S i h 7 3 ty� 7 this county from another area. Please see reverse side for TELEPHONE NO: l?1% additional information. 1) MOBILE HOME DATA: '7 g (A) MAKE �� ! F' P f 4J O O C! (B) MODEL B rQ Ct d inn '� (C) YEAR / 9 / / 11c ' 3 �57 (D) LENGTH (0 CI (E) WIDTH (F)SERIAL NUMBER (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) a 6 00 P C (H) PURCHASE DATE b 2) PREVIOUS OWNER / LOCATION OF MOBILE HOME: ' (A) FROM WHOM DID YOU PURCHASE MOBILE /' r� I ' CL s p`_- f/ t- ADDRESS Li L^ 1 9 ( . p b"L P t- /l Cpl J wl L(CUi1i 6j , ,, , (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? CO NO (IF NO,WHAT COUNTY? IF YES, WHAT WAS PREVIOUS ADDRESS OF MOBILE? SA n/-- v 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES NO (B) IF LOCATED IN A MOBILE HOME PARK: NAME 8L ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK: ( /J J NAME OF LAND OWNER: Kp-�y7� (left. �,c-,"�A"O�ye pi•�rcLoCKi&F�'O1 YK DC�Q�(yIa-s f e 1-kr LOCATION (ADDRESS) L, J _{ C P,tA� @-I`/ 1 l , A ; tvt R((tny� W�/9, 1 p 3 `S� REAL PROPERTY PARCEL NUMBER/ DESCRIPTION L n't L.j (Mt L h S Q IA SA 0 h� "pLI T LPN— ?17 1 -03y -e1 8` Or THANK YOU FOR YOUR HELP! LL., , , , SIGNATURE KELLI LARSON, 'roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. A