The URL can be used to link to this page

Home My WebLink AboutBLD2000-00335 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 (800) 831-2678 PERMIT #: BLD00-00335 Received Date: 5/31/2000 SITE ADDRESS: 4264 E QUILCENE RD Issue Date: 9/20/2000 QUILCENE, 98376 Expiration Date 9/20/2001 APPLICANT: DOUGLAS HARBORD 13150 S MACKSBURG CANBY OR 97013 SUBDIVISION: Block: Lot: T 23 PARCEL#: 701311018 Section: 31 Township: 27 N Range: 01 W CONTRACTOR/ TOLLSHARK CONSTRUCTION INC PHONE: (360)732-4080 DEALER PO BOX 100 CHIMACUM WA 98325 Contractor's License TOLLSCI107D6 Expires 03/15/2001 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION MAKE: HOMEBUILDER YEAR: 2000 /,j4, c� '�i SIZE: 27x44 � THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 9/20/2001. REQUIRED INSPECTIONS: [ ] Footing/Setback (If continous footings are used):c9/� C /—/1.1'0) ['-] Blocking/Setbacks/Plumbing: Of` / G( [ ] Final/Skirting/Vents/Porches/Steps: �e for 4 03/0 it HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. Inspector's Phone Hours 8:00 a.m. - 9:00 a.m. SPECIAL CONDITIONS MAY APPLY - SEE REVERSE HOT-LINE AVAILABLE 24 HOURS A DAY ' r a • MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00335 Received Date: 5/31/2000 SITE ADDRESS: 4264 E QUILCENE RD QUILCENE, 98376 APPLICANT: DOUGLAS HARBORD PHONE: (503)266-8649 13150 S MACKSBURG CANBY OR 97013 SUBDIVISION: Block: Lot: T 23 PARCEL NUMBER: 701311018 Section: 31 Township: 27 N Range: 01 W CONTRACTOR/ TOLLSHARK CONSTRUCTION INC PHONE: (360)732-4080 DEALER: PO BOX 100 CHIMACUM WA 98325 Contractor's License TOLLSCI107D6 Expires 03/15/2000 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: HOMEBUILDER SETBACK: 296 VALUATION 48,000.00 YEAR: 2000 LABOR & INDUSTRIES APPROVAL? SIZE: 27x44 BANK HEIGHT: 6 SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO Exist: Exist: AREA Plat Conditions Prop: 3 Prop: 2 Wetland Erosion Total: 3 Total: 2 Seismic Streams Flood Way Food Plane Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Approved/Date roved/Date yp Amount Paid By: Date: Receipt: Manufactured Homes $141.00 MAM 05/31/00 31602 APPROVED Potable Water Application $30.00 MAM 05/31/00 31602 (.f Total: $171.00 S P 20 211 Jefferson County Henning ut Build*Department is\F_BLD_App_Mob.rpt 10/29/99 07/20/00 THU 14:43 FAX 503 682 3845 VISION MACHINERY I j002 2001j ITZ99 ON DI/IL] 9Z:9T QRM 00/6T/40 ir0'd '1d101 IEFF RSON GOUNTY QC Ail DEV .NU 42 SHERIDAN ST. PORT TDVMNSENND 1NA 83Bg MANUFACTURED HOME INSTALLATION PERMIT APPLICATION my NEW BUILDING d[�i 0 REPLACEMENT SIZE $ )( 4i/ 1173 17- YEAH 9000 MAKE (4 t'j e)[ t.I1 ICIT'I' WO itht.,VeAt TM, COST ¢�t00 D • BEDROOMS: BATHROOMS: EXISTING EXISTING PROPOSED PROPOSED TOTAL 3 TOTAL TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: Ii'SEWER ❑ COMMUNITY SYSTEM RIVATE WELL ❑ TWO PARY WELL NDIVIDUAL SYSTEM 0 Conventional ❑ PUBLIC PERMIT #SEP O Alternative Name of water system: IF'WATERFRONT PROPERTY. f�Q DISTANCE TO BANK OR FNGH WATER LINE f,1 i6 ft BANK HEIGHT tt 3y signing the spplitatien form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood of any Omission of a material faCt made by the applicant/ownef witrt respect to this application packet may result in this permit being null and void, further agree to save, indemnify end 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 of in consequence of the granting of this permit. I further agree to provide access end right of entry to Jefferson County and it's employees, representatives or agents For the purpose of application review and any ragulred liter inspections. Access and right of entry to the applicant's property or structure shall be requested and shell occur during regular business hours. SIGNATURE D I. DATE_ 772070 0 NAME (PLEASE PRINT) ti.C (( t4gr 1 , ) • tl • FOR OFFICE USE ONLY ?•'� BASE FEE RECE IPT I ADDITIONAL SECTIONS CASH/CK I • SUBTOTAL DATE Lt... 4 POTABLE WATER 911/ROAD APPROACH TOTAL •. � '`•. is ' `: • •Is„ w•tea. .s. 0'd I St'tr 6L2 092 d31N3a 1 I W2i3d 00 333f 12:91 000Z-6 I—'1f It • MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00335 Received Date: 5/31/2000 SITE ADDRESS: 4264 E QUILCENE RD QUILCENE, 98376 APPLICANT: DOUGLAS HARBORD PHONE: (503)266-8649 13150 S MACKSBURG CANBY OR 97013 SUBDIVISION: Block: Lot: T 23 PARCEL NUMBER: 701311018 Section: 31 Township: 27 N Range: 01 W CONTRACTOR/ DEALER: PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SETBACK: VALUATION 42,000.00YEA LABOR & INDUSTRIES APPROVAL? SIZE: : BANK HEIGHT: Z('f1 SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO Exist: Exist: AREA Plat Conditions Prop: 3 Prop: 2 Wetland Erosion Total: 3 Total: 2 Seismic Streams Flood Way Food Plane Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $141.00 MAM 05/31/00 31602 Potable Water Application $30.00 MAM 05/31/00 31602 Total: $171.00 I:\F_BLD_App_Mob.rpt 10/29/99 11/1F-77 " JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION [Li' NEW BUILDING po ''❑ REPLACEMENT SIZE (O loO Sc k Z( X YEAR MAKE LA Iler 1-9 >1 IIJCt h COST germ( 11'$ro0' BEDROOMS: BATHROOMS: EXISTING EXISTING PROPOSED PROPOSED TOTAL TOTAL 2-- TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: ❑ SEWER 0 COMMUNITY SYSTEM L9'PRIVATE WELL 0 TWO PARY WELL INDIVIDUAL SYSTEM 0 Conventional 0 PUBLIC PERMIT # SEP 90 'Z3g/ 0 Alternative Name of water system: IF WATERFRONT PROPERTY, DISTANCE TO BANK OR HIGH WATER LINE G ft BANK HEIGHT 7( ft ) SIGNATURE �_/�'� -� (� �c-.,:'�i DATE "7 7 �' NAME (PLEASE PRINT) Mnac_I let S R. / e4t )CJ FOR OFFICE USE ONLY BASE FEE 191 .ate RECEIPT # ii(00-) ADDITIONAL SECTIONS CASH/CK # g 1 Iy ) G� SUBTOTAL DATE 57_311 00 POTABLE WATER 91 1/ROAD APPROACH TOTAL -1 H:\HOME\PLNCNTR\FORMS\MOBILEAP.5/97 t 1�7`7 V L., LjL/ yi ‘ MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development J 621 Sheridan Street Port Townsend, WA 98368 T PERMIT #: BLD00-00335 Received Date: 5/31/2000 (--- SITE ADDRESS: 4264 E QUILCENE RD QUILCENE, 98376 APPLICANT: DOUGLAS HARBORD f;r1-vrMC�" � 6 PHONE: (503)266-8649 c\j 13150 S MACKSBURG 1 �? CANBY OR 97013 j'i / b 6g� �32 a �� Y� J SUBDIVISION: � Block: C a,>J i Lot: T 23 PARCEL NUMBER: 701311018 Section: 31 Township: 27 N Range: 01 W Q CONTRACTOR/ DEALER: r rC (-7 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SETBACK: 20 VALUATION 42,000.00 YEAR: BANK HEIGHT: 71 LABOR & INDUSTRIES APPROVAL? SIZE: SEWAGE DISPOSAL: CON lZg.A•C WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO / Exist: Exist: STORMWATER: YES ,• AREA Plat Con. tions rv.4 Prop: 3 Prop: 2 Wetland AID E sion K Total: 3 Total: 2 Seismic reams ^4 Flood Way Food Plane Routing Date: / F&W NO Landslide= (.1 Shoreline-1bt& 5 Aquifer Forest: Cornme ial K/ Rural Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $141.00 MAM 05/31/00 31602 4 "' b' ONC Potable Water Application $30.00 MAM 05/31/00 31602 Total: $171.00 t A\ '''' ' I I,lif ke 0414+' ' ' ' ' -. _App_Mob.rpt 10/29/99 �eei'i` IIIIth Jefferson County Department of Community Development September 6, 2000 (� (� 2 621 Sheridan Street, Port Townsend, WA 98'368 LS l� L 0 V (360) 379-4450 SEP 1g FINDINGS AND CONDITIONS OF APPROVAL AS REQUIRED UND R T E JEFFERSON COUNTY INTERIM CRITICAL AREAS ORDINAN EE JEFFERSON IIEP7 OF COh1�tUNITyCR , Applicant: DOUGLAS HARBORD 13150 S MACKSBURG CANBY OR 97013 Critical Area Review Case Number: CAR00.-00249 Project Description: manufactured home Parcel Number: 701311018 S-T-R: 31-27N-01 W Site Address: 4264 E QUILCENE RD QUILCENE WA, 98376 FINDINGS: In accordance with the authority provided under subsection 4.101 and the requirements contained in Subsection 5.402 of the Jefferson County Interim Critical Areas Ordinance, the following are findings of fact relating to the referenced application: 1.) The application was reviewed by Jefferson County Permit Center staff on 5/31/00 for the potential presence of critical areas regulated under the provisions of the Ordinance, and the following critical areas were confirmed as potentially present on the subject property: Seismic Hazard Area, Shoreline (Conservancy), Erosion Hazard Area, Susceptible Aquifer Recharge Area, and Landslide Hazard Area I & II (low to moderate). 2.) Acting upon the above information, Jefferson County staff conducted a site inspection of the subject property on 7/18/00 and confirmed the existence of the following critical areas and/or their associated buffers on the property: Seismic Hazard, Shoreline (Conservancy), Erosion Hazard, Susceptible Aquifer Recharge Area, and Landslide Hazard Area (low to moderate). 3.) A Geotechnical Report was submitted in conjunction with this application. Said report stipulates a minimum setback of 35-feet from the top of the bluff to the proposed building envelope. 4.) The Geotechnical Report also includes several conditions the applicant has agreed to implement. The conditions inciude: A. Construct a culvert to collect water from the south side of the driveway and divert it to a ditch on the south side of the property. This will be done with a 6-inch drainpipe. B. Construct a retaining wall with trench drain at the back of the building site. C. All roof runoff will be diverted to the south side of the property. This will be done with two 6" drainpipes. 5.) Aquifer recharge areas in Jefferson County are characterized by porous geologic 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. 6.) Susceptible aquifer recharge areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. This includes any portion of Jefferson County with a DRASTIC index of greater than or equal to 180 points as determined using the U.S. Environmental Protection Agency DRASTIC methodology: Drastic: A Standardized System for Evaluating Ground Water Pollution Using Hydrogeologic Settings (EPA 600/23-87-035). 7.) The potential for an earthquake of a high magnitude occurring in western Washington in the near future is considered a high probability by regional experts. 8.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during naturarevents such as earthquakes or severe rainstorms. 9.) This waiver also includes findings and conditions for evaluation of shoreline areas as regulated under the provision of The Jefferson County Shoreline Management Master Program, adopted March 7, 1988, as amended. This waiver from the provisions of the Jefferson County Interim Critical Areas Ordinance is granted subject to the following conditions. Any deviation from these conditions shall result in this waiver being revoked and the application becoming subject to further review. CONDITIONS OF APPROVAL: 1.) Landslide hazard areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, replanting with native vegetation shall be required by the Critical Area Administrator. No alteration shall be made to the landslide hazard area or its associated buffer without prior authorization by the Critical Area Administrator. 2.) A vegetive buffer of 30 feet shall be permanently maintained from the top or edge of the landslide hazard area. All buffers shall be measured perpendicularly from the top of the landslide hazard area. 3.) Among the native conifer species which may be used are: grand fir (Aibes grandis), sitka spruce (Picea sitchensis), shore pine (Pinus contorta), Douglas-fir (Pseudotsuga menziesii), western redcedar(Thuja plicate), western hemlock (Tsuga heterophylla). 4.) Among the native tree species which may be used are: 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), Scouler's willow(Salix scouleriana). 5.) Among the native shrub species which may be used are: service-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 gymnocarpa), Nootka 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). 6.) Surface drainage shall not be directed across the face of a marine bluff, landslide hazard or ravine. If drainage must be discharged from a bluff to adjacent waters, it shall be collected above the face of the bluff and discharged to the water by tight line drain and provided with an energy dissipating device at the shoreline. A shoreline permit is required to discharge water at the shoreline. 7.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Native Vegetation." 8.) All construction activities, including the storage and preparation of materials, shall not encroach upon the designated geologically hazardous area, or its associated buffer. 9.) Damage to vegetation to be retained on site shall be minimized by directional felling of trees away from these areas. 10.) The applicant shall permanently separate the boundary of the landslide hazard area buffer from the remainder of the subject property through installing and maintaining one of the following; logs, trees, a hedge row, or other prominent physical marking. The separation method identified by the applicant shall be approved by the Critical Area Administrator prior to planting or installation. 11.) Residential structures shall not exceed thirty-five (35) feet in height. 12.) The building envelope shall maintain a 35-foot setback from the top of the bluff. In addition, the applicant will implement the conditions as attached. R 17Z040 Warren Hart, AICP Date Critical Areas Administrator I understand that the granting of the above waiver from the provisions of the Jefferson County Interim Critical Areas Ordinance is made subject to my complying with the above listed conditions, and that any violation of said conditions shall result in revocation of the permit or approval and further review of the project under the Critical Areas Ordinance. Please sign and return to the Department of Community Development. • 1. .• • .• — 711-/o0 • •:Applicant's Signature Date c: File I:\F_CAR_Waiver_W_Conds.rpt 12/13/99 06/06/00 TUE 13:02 FAX 503 682 3845 VISION MACHINERY Z 005 ., .,,',i we,z -we%.7.$ e 41. . il g, •t., 1.i' •-••'r...4.. 1r 7,k4 . vg:-.,:-:.":''''.1,0-?. .: til4 i.0't v •FI.1,410. ''''4.7.:„Eir, ., .W:.;,1, il.: : I,itil ti 1 ;, F s �7". '�i, _'�'f' ,l:ate , ,..pi* ?'a:'c .1 n !-is•; �' 1 • 1 1,4:'it 1yy'r,', I Ifi f t 1 , 1J� r II mow 1)1,LLL ''1k q L_LL.L . p ., B-V.. 101Y1 LL f. t, I fit*w!-r `I 1 I s - MIY"i1�! iy 1. I..• ! 1►1L L. • myav�r I,' t_L 4,. 11 phi, 4re la1; MIMI 1►M� m '(0 L11,:Lt . ull,'' !� i t �T nsc:ts.o ! L LLL.LL.:li 1111 �' LLI 1 1 MI LLAT/DN t I�t L,L LIwrtta�rI I (!` 1�fiDOM 1 1 1 1 1. 1 . i..L L � � �0�'¢� �LLLL_LL f�'I� �... -LLLLLLI I t; I : 4;i1 1 % 1067 SO. FT. MR. 20A. rRNATE MASTER BATH KSZS4424 i il I. , .� ..._.._.. 111110 L C ALL aLL-1 II t \ t.i 1 • R 10i I.= 1. l 1 LL �' i / 11LLlc ii ' II;: cc, i 11! /I .i i 1 1 eWSW) vocals a .00110 M ^ . ,..Fs .WINS KUM* -V V.4 I a i ur w■awv Iiik'. :do i+'�a ' v. , 1,. 1060 SO. FT. 30R, 2HA. PRIVATE MASTER BATH IC82$4430 $ i!!U {T 4 ; 4 7,77aac1 —ate_` tiN•,•.rc...*M t ram.. r.rc.a.S:�I.n fir. •Iglu-V,7�_. - __ 'thcR-'r.'•�^` 07/20/00 THU 09:58 FAX 503 682 3845 VISION MACHINERY 1012 '� i • • Opt I4x39V 0 11 J Iu Ui U' = < § if I '2 [m.-i milpi IN , ... ir.. .B - 4 fl i .1 14a = (2, EiIII. r. N Fe a R Ki CSc 0 IQ 1 30x58V 14x39V 30x58V F13'4" Opt --- 1 13'4" 1 1- 26'8" i a &1 1 sw 1a o wis. Fl xW• '� ox -IS. P I) A ; o@H UlP • a C PO iy w� a � �E Li) MI 'fix' to tri '1 tb 0 0c4 0 c '—' p coo' 3 d mi I� tt c a 3.c n U? 1 A .— r a 4w c°� JEFFERSON COUNTY w � ti - DEPARTMENT OF COMMUNITY DEVELOPMENT q �. ' 621 Sheridan Street • Port Townsend • Washington 98368 `SFIINO 360/379-4450 • 800/831-2678 • 360/379-4451 Fax BUILDING PERMIT SUPPLEMENTAL CONTACT INFORMATION 'tie ek 0,104iiit9 61.444 44 edo lzte4 ad Ao44c&e: Project Description: !A c i I 1 l] 'o ( IJ„ `i�t i 0 ' i tvtre - 9 Digit Parcel Identification Number(from your tax statement): _70 '30 o t Site Address • 911#: 61- Ill;+ tfceri 12c Road Name: l�ts4- ijtef...en( fJ Zip Code: Legal Description Subdivision Name:L)r(d VC I Ci -ssAr s fy,474-is (yo4t Lok.2,_ 'Z Block: Lot(s): Parcel Size (acres or square footage): Property Owner: �4 11,[J4trt30 rei Phone: %-C>G-dab Mailing Address: i3Is° rnct 5.1c:400 Cc,iArva OR—. (AV) Applicant/Occupant: I Phone: (if different from owner) Mailing Address: Authorized Rep: Phone: Mailing Address: f General Contractor: Or Manufactured Home Installer: Phone: Mailing Address: Contractor's State License Number: Expiration Date: Architect:/Engineer: Phone: Mailing Address: 1 . G,\PI:RMIT CENT AVOR '\BLDG SUPP INFO Jefferson Comity Department of Conmuudty Development ��,¢Soly ° ?, U 621 Sheridan Street Port Townsend WA 183,1 [3601371-4450 -, r $ l ? rmA --,-3,__, ?.. cott}oorn- 0 4.�S Oro/ FIIN9 Project Description: Building Type: Project Type: Frame Type: Single Family ❑ New 1 Wood - Garage Attached/Detached E Addition 11 Steel • Modular ❑ Alteration/Remodel 7 Concrete Commercial ❑ Repair Masonry Multi-family/#of Units a Demolition i Other: Industrial ^.� 1/Other: I ✓ e - Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: Existing: ❑ Sewer E Community System 0 Electricity ❑ Oil Proposed: Proposed: ❑ Individual System 1 Woodstove ❑ Propane Total: Total: If not sewer,fill out the following: Heat Pump ❑ Conventional Alternative 1 Other Permit# SEP L Water Supply: Private well 1 Two Party Well 0 Public:Name of water system: Square Footage: For Office Use Only Hain Floor Consistency Review 39.00 ?ND Floor Base fee / 53. /S 3rd Floor Plan Check fee "'St61 D f� Htd Basement State Surcharge fee i". S 0 Unhtd Basement Subtotal ��- '73 Garage/Carport Pot Water Review fee Decks 911/Rd Approach fee Commercial TOTAL . 3 Industrial Receipt# Other Cash/Check# Total Valuation: Initials Or Date Estimated Cost: If within 200' of the Shoreline, Distance to Bank or Ordinary High Water Mark 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. .1ccess and right of r),..—.11,,,.., ntry to the applicant's property or structure shall be requested and shall occur during regular business hours. Signature: ( Ili c j( Date: /// '� D/r OVElimmitifirlito I I:I IO ME\PLNCNTR\INFOBLDG\FORMS\BLDpermitApplication 11-8-01 )1\ g-eff,(-Ait" ?(Or 5( \rt, t iu ' L\ 12,e'?fsi elk- --- . Yi f.e- -e, ' \C•ev' ,. i _ ,,,/,/ . , -, 64- . ..cY '.. ---- ..,.., ...„.... k.e.1 ' • . ,e.,-,,,'r...-(----- - • 1 .„-- „.---- , ,,,-- .. ,-- ,,.-/ VC ,. ' I. „ 1 5 ,..- „-- ,..., . .„ -. - . ). ,- c ,-,. . ., . ., . . 1 / i -- - \ 1 . , i il 0 / I (1 ii ,1 , "." V v3 1 C 1.1 3 , --- . , . 4 15e.__Hccv"-i .1„1.00::\c„ E.............1*......... : ,'''--- _____ r . 11 t C'• i . i 14 0 r'n f. i \kik ' c ii.,4"f' 1 leipr)A° • i - \-----k _ e : , ' N.i.._._±._........_..1/... ••_,IZ! . • hop04'.2 , . \ 1 .,„ , ......, , o i 5 k ,...,- ---------_____-------7 .,, '''l V of. boto k ,. .. __._ ..._ , . . . ....... ? , _ . 1..._..z. --.-..- • \--.-‘, ,, k).- . ,, 4 - , / VA0... tki O1tb'V‘c'4,r.Ift PA° (PO. . . 4E1 C=i 4 I. i4 t.' Co2 ND -....0 CO 11. 1 = Eig i ......D. = 13 .,..J I 02 e'r-- e\f) ,...1 VZ ---. . -77 -...0 n _..) 0 0 a 0 ke-. .i) ii) 0 ..0 N ci •'-e•. a) ''"----_.) ct ... "ri o L., ......S o ,--4.- .G.3 4 hi 4 0_, 4 4,0 4 c, ....).5 , .. b I) 0 4 ,.., . 0 .4 x 3 0 .. ..„... P-4 el C'01 = (--c-----• — NL:14 N,IN..i E .i.2 0 u .3t-7 b :-. oa ' _Q )0 , .s _ .. ....4. „_•...4_, 1. „.i, ..) .5 P N t z 55 ')1., ty)(13 •• L L--- M ,GI ..1.3 = 4 v 0 zz"-- „E g ......- al 60 (t r: H 4 ..5 ,...0 2 t ..,„.„.., 4, .., ..0 m 6 40.. i ' to csv_ E G ii-) *t i2i, ...Y, A) cu a b• _ czs 1/44) t 1 8 --,.) C0 10 3 j '-' tu E X a.) P ;4 a.) ...,, . ...- 0 cu at . u ,..,,,64'rY„. it-' • 01 c ' ° 0 ‘,(4 (--) —U) q L: .- a) cu ,..,./ 1...,' / .0 1:1 C'k 0 43 ° •• pi) c:'' 0 tu 0 t-.) ---- ' ,Iii p',% ca, , 14.4I st ..741 aj ti •-... a E i:14 U 4) i-L-i i-; .a (.../ 0 0 q Z c-) 0 .. 4., Pli .. C:1 .. .. PI .. ..5 { u 8 w ' X •— cYd if", 0 (1,4 '; '''; (1) b 40 w ,. ,-;,, w u a i 4) -- cl u w ° cNru 0 -0 E 0 ,,c1. i'), 4,r., *0 ii '' 4-7, 1-, g t -- -0 - „ eu -0 u , -0 .;..: -0 01 0 -0 -1,' •B ii P C .._. C3-4 "d' clj 2 N. -0 g (I) •-0 1`7 71 0 ./5 0 ‘:•4 71 0 73 al rj -1:7 •4 o ,21 4.. .0 A :,,.: •• (i) tj t-,, *z 71 g t, 4$,) ,. cl 4ar .3 It a.) .5.0 .. •• 74 •-' oc -,-; 02 to ;4 _4,4-4 to 2 to ti •,, to 1,-3 ..Y. to •" h° r4 °''' 1'4 0 r.: ---- "6 ;:t -0 • 4' -0 Ict 1 Q.''E' 1 -+9 1 il 4 1 54 1 "PI 1 v3 44 I r4 v co 0\ 4 •- .-, ... <,..) a L.. = CU 1.4 0 a) Q 0 0\ V) 0\ V) V) p... 4 ..,c :71- .., ',7,--, (..) c, U -4-- ) A to v kr) 1.0 LTi Z3 z " Z s>i3VELL3S -- . 5 a P Pq Z n w _ o o v) -0 frl cp Z a. C-6 N >" 0 il‘ LTIJ 1- cc a_ a w o a_ _i o cr , A a_ >- LT1 a -.. w to :1 S. cr a. P LP •,./ a. a \ 0 u_ .-9 in: 'LL W / -0 L. a / '5' u. 0 . -.. )--• w z 7 .j.c) v) a -'-,c co l• u_ z cc , Y 0 42 1=1 V) o u) _J - s(4, c.) 0o ,(62..... Oc!,, to Ise, 0 y , v>1 I I, 4, it _o , Z co se ---" c"---s'- >:_"------ z c's ii < e.) eo . ...I .0 0.. a., •-• 4 I- 0 , 4 o - a> ...11 C ty Z O W V) c a) •— I- _1 0 1, < 0. c td _Ye c.) 2 V) (t4 O 4 b E ....1 co