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HomeMy WebLinkAboutBLD2007-00545 Jefferson County Building Dion Permit Null: BLD07-00545 Applicant: KENNEDY BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks V ,, l\1- Erosion Control Foundation Footing l2 2 -(_,7 Us) C _< Footing Drains Foundation Stem Wall 0L 2 -o 7 LU 1 -:-)--- Under Floor Framing i_1— Cif-- Straps(hold downs) ,J, /og !3/ Ext. Shear Wall Nailing imik ,2, Rough-in Plumbing W6A_, a.,,..) Framing 11 s(oc Blocking Airseal ahled- 9 , Insulation:Walls 2\ 2_ 1/ac I ) C- Insulation: Floors Insulation:Ceiling 5 Z r1 1 v Int. Shear Wall Nailing •2\i0\0% (el"' Wallboard Nailing °A"`0( Gas Line: Interior Gas Line: Exterior Propane Tank Heat/Chimney Clearance Drywell/Alt Drainage Address Posted FINAL INSPECTION 'j 2 TC'' L'V FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • . CONDITIONS for Building Permit# :BLD07-00545 1.) The application was reviewed by the Jefferson County Department of Community Development staff on November 13, 2007 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 and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: SARPA Auquifer Recharge Area. 2.) 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. 3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) 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. 5.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 6.) The applicant is proposing to create or add 1835 square feet of impervious surface and 4575 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require your proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of Ecology Stormwater Management Manual for Western Washington 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. 7.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP) Elements#1 through#12 of the Department of Ecology's Stormwater Management Manual for Western Washington 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. 8.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 9.) 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). 10.) The revised site plan dated October 29, 2007 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 November 13, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 11.) This approval is for a Single Family Residence with Attached Garage 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. 12.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 13.) Outdoor residential storage shalliknaintained in an orderly manner and shalOate no fire, safety, health or sanitary hazard. 14.) Not more than 2 unlicensed vehicles shall be stored on any lot unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor vehicles is prohibited except in those districts where specified as an autormobile wrecking yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter 18.18 JCC, and such storage shall meet the requriements of JCC 18.20.100, Automobile wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor vehicles be stored in a critical area. 15.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 16.) The building height is not to exceed 35 feet. 17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 18.) 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. 19.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 20.) Minimum setback from South Seventh Avenue and Market Street rights-of-ways shall be 20 feet. Minimum North and East setbacks shall be 5 feet. 21.) An address of 302 S Seventh Avenue, Port Hadlock has been asigned to the parcel. S Seventh Avenue is a County Local Access (C635809). 22.) Potable Water is supplied by Quimper PUD. 23.) Lot was created through the Seventh Avenue Acre Tracts subdivision on September 1, 1909 under AFN 28361. A BLA(SUB05-56) to consolidate lots 25 thru 30 of Block C was finaled by recorded survey under AFN 509072. 24.) A Road Approach permit(RAP05-165)was finaled on January 25, 2007. A building permit (BLD06-11) for a detached garage was finaled on March 5, 2007. A septic permit (SEP05-382)was approved on March 17, 2006. 25.) A MINIMUM OF 28' IS REQUIRED FROM THE SOUTH PROPERTY LINE TO THE RESIDENCE FOR THE RESERVE DRAINFIELD AREA. • • ON RECEIVED ire. , c°��, JEFFERSON COUNT'r OC T16 ti DEPARTMENT OF COMMUNITY DEVELOPMENT 2007 4. , 621 Sheridan Street • Port Townsend •Washington 98368 JEFFEOSON COONIY OCG 1,0 ,�0� 360/379-4450 .360/379-4451 Fax 2IINO http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 09-32 I PROJECT/APPLICANT NAME: i A vK /U /LL v\v\.e Cil I Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. t.R lrtlt ( ) 4-1.2..Q t 4-5 s Existing Conditions Summary T 2. Describe the existing topography. Indicate contours on the site rnap. � 'II 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. ta:-ZEa 9),•c.C5 , 1-3I ✓+LIL i7 ¢vey l/lQAti I S 4. Describe the existing soils. Indicate soil type on the site map. 5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable, and indicate acreage of each. L i -1r5 p,L��.2,,,,>LL��>, 2 vs.�) T 6. Describe any excess levels of noise generated by the proposed use or activity: , �Fer l/IGf -(,' 1 CDvtck VIA C1-tv✓ Dwt APPROVED STORMWATFR RI-AN stormwater site plan templete.doc-rev.1 0/1 22 00 3 V IOrN 1 tlll er \ N O V 1 3 2007 Require w s\ 1 FERSON COUNTY DEPT.OF C tit Vt :L MF.NT SIGNATURE: �� �/� • • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. /v a $ /op-es 0 k 5 • 1 t e t>�( /-too .f- 1-4 e,tCJ >4 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and5e�nAive ritka1 Areas Ls; (streams,wetlands,lakes,steep slopes,etc.). CctnAA. 117 12aAd? 01,1. (Svi.e. 2,1t1,1 Gt7 at,toe] pLof (oti ,1•.( 2oaco ev-t S: ,�►_ IfffrONtaws ° 11ct Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30 in the Manual)or, if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. S4011 vv` w i4 11- i . t74_ vS-Qc2 10. If the project requires the use of stormwater treatment facilities, ,describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for"large"projects or projects that involve the potential for dispersion of contaminants.] t O p vopo,-off -fk 1✓a-/- . " -Pa c ;11'4 11. Describe the performance goals and standards applicable to the project. i d --o t d- <t-t vt?p xtc t ap,�� . , ; f� /.t.,v Re_ )'t c, h .e d 0 4' tY 12. Describe the flow control system. ACArt— stormwater site plan template.doc—rev.10/12/2003 6 • • RECEIVED 13. Describe the water quality system. n'^1( 1 ,ti s14i4-1 ►�-y �;,�--4-.e.z OCT 1 $ 2E7 JEFFERSON COUN1'DCO 14. Describe the conveyance system analysis and design. t7Otvrl 5Co1:1,4-5 I✓'. LI DYGt.CAL o- Ov-o(e.ti& 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. L�r b vi 0_e W H-�J 1�14-i-S 3/ lam,t'k va 5 G7#0-4-v-e�l 17. Describe the proposed surfaciterial. 046_ `figc' S©i J ►=nR L a,u,w 18. Describe methods for restoration of the site. I-"y,p,-c 4-I tom.✓Svtto c Ca_p, wt.el cc. cQ LG-„.sh S�-.e.‘,( 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff] If included,list the Manuals here. N/4- 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.ho v Zpotf , 54-t4v4PS cc,-cd oi✓l..e la4Zvi I-? Ve 1-2,Per 1-7 �l at iio,>y1/y 4441 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. .P Iv i, L- Sys k—wr et-- D In&t_;r�, t=t.7 Ice OSA- stormwater site plan template.doc-rev.10/12/2003 7 • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particulart with ar t-af-/Iskciept0,1 development. � J 'i \, (r4 SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements ha b'ben et' will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manua 2-15). l9lt (� �fHng lgry ��,t,. n t tit IVTIJ 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. C b 00,tcL ( :S��� l>�hlZ 2. Establish Construction Access. 5 y h 5 l¢ C v'c1 S 6,2-,1 jrz,, t.A 3. Control Flow Rates. 4. Install Sediment Controls. T.i s /4I( S; 1 4- • 5. Stabilize Soils. Lt vQ._tZ Lu S 6. Protect Slopes. d4" Le_ "-a- ( 45 7. Protect Drain Inlets. 12) -fi!i 1,o.-I-s 41, Le_ stormwater site plan template.doc—rev.1 0/1 2 2 00 3 8 • • RFCEIVED CEIVED 12 Required Elements-Construction SWPPP(continued) o�++ © 2007 8. Stabilize Channels and Outlets.fteigek pp ��gg /1)0 CA( k (� ,v,) s c7,-'t 1-0 s v R foutri 9. Control Pollutants. f C Ix iMQ � �- Cv, - l: : vl vv. 6, ►,v; 1 I .to Lt ►a-k it s p;I I I< d- 'e6 o P- l<;ft y L;i4u& 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 0944- ( y /4 S $ !q- try C, -1-1 A✓Z C.-t t/l p t-e p r y 11. Maintain Best Management Practices(BMPs). r✓cI) ,v (-Lt R�1a5 / art �cizykr (4..2__Her / 61t,c&C 5vr 17 A 196(AA- u,.1-e s 12. Manage the Project. Sot Sn.ec 1 . Ati 2 LQH c 1a.,f. rt4 T3--e-i T, 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). 1 w Y7 -VJ 62," c? )44-2 �' J3L,,f 1a,-L y 1L0' *, _,(J-c y (Zaa a c .S t,�L , Co ,, tP w-re. Jc V , o i-kllc�? Sy. r;{ b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). ,s N t4 ' 110 f y 4 ( i 4- R L./ i h 410c )jj2.p f 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. Lv'4-S ia- l.,v u-t. I i4-R o r. ( -4,-y,f stormwater site plan template.doc-rev.10/12/2003 9 • • II VIP 113 b. Description of special requirements for working in or near environmentally sensitive areas. 21331 y 7 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g., erodibility,settleability, permeability,depth,texture,soil structure). S to l L-c^ w— s c>> 1 G�vc \J.r2 R 7 y 5. Construction Phasing. a. Construction sequence ryroi(gt Lcti5i✓toc.4-ca�' / F� UwGtri toh . t=vWw.i� , r F: KiS' b. Construction phasing(if proposed) vl- 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. 3 J- c v o R Aczo Lt. ik.)0V 1ST II. Wet Season Construction Activities. a. Proposed wet season construction activities. l4bl ' ; i S-easc,� b. Proposed wet season construction activities for environmentally sensitive areas. NI4 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. - pie,2 44-I cpov►Sily/�J. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. NI rt b. Diversions. .✓l p c. Waterways. ,v/,d d. Runoff/Stormwater Detention Calculations rv/t1- stormwater site plan template.doc—rev.10/122003 10 RECEJ[ ]1 I JI �/ Stormwater Site Plan Changes OCT 1 2iti If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all prdiFcf'•.—•i 1 cti i'- drawings showing any structural changes,and any other supporting information that explains and supports thea � ; u iy Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. 1-► 1�t� � � /e)//b/o7 (LAND ER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: • stormwater site plan template.doc—rev.10/12/2003 12 �,,iiiv..., ON c0G, JEFFERS. COUNTY4111 W `i� ,�j DEPARTMENT OF COMMUNITY DEVELOPMENT �' y '� ` 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450 • 360/379-4451 Fax '�qt-ifI G�p� ww.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: j' EI Project Description(include separate sheets as necessary): ►t.s<s'-' 5!)7 .'/x Fri-wt, ty 0 _ - )I,•lei' / ff'4ctu0 (, av* .2 Tax Parcel Property Number: `/(-/ cI 2vc 3v I S e: / Z '7S G (acres/square feet) Site Address and/or Directions to Property: 30 Z- 5 -7Ey 4d Pt✓izr 1 47 1.,�(I+- ice, j �Y351 Property Owner(s)of Record: .)4 Vb. -g it; e_e_,,+1t,al Telephone: 3 c(a'J •;1 11 Le( 34 t IC y•j Fax: J Mailing Address: 5 Z5 ]�:�t v r► -eit,y V(Zd--• © email: S Iq,.l 4iv�t, H,1 q;) Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies I:1i3Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit A —_.:� i 0 Conditional Use[C(a),C(d),or C]** 14 Single Family iN Garage Attached/.Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑Special Use(Essential Public Facilities)*" ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address ❑Road Approach 0 Binding Site Plan** ❑Home Business 0 Cottagelndustry 0 Long Plat** 0 Propane ❑Planned Rural Residential Development(PRRD)/Amendments** 0 Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 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: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 it's 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 attomey'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 applon that he or she wants prior notice. Signature: , i,c /C.-.--.5„---( Date: /-t//et /c3'7 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 and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and igns and dates it below. Signature: 9 e --L.:, /I% /G.--^—, ".1 Date: /e//lc" 07 C:\Documents and Settings\canal\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc 411 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 be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: pi. 1 4 20117 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: pi. /-I L;-v,;- (-(4 i -t- ( ) ( ) ���� MAILING ADDRESS: EMAIL: t, . [N u tiI L t, CONTRACTOR'S LICENSE 0- t/..,i pi /- `��) 9 r WAINS �+ NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: `91- New p.L. Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: 2 Bank ❑ Community System [H Alteration/Remodel 0 Concrete Total: Z Height: 1,9 Individual System I Repair 0 Masonry SEP Permit# 5�13+."..co7Y L ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: H Private well ❑ Two Party Type of Heat: Proposed: 'J ] Public I J2+,,it Total: 3 Name of System: P-vs n 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: ❑Underground Tank °Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 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 properly lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review )) .. . /707 z(,£t`1c' l(?��� 21°Floor Heated Consistency Review t - w Other Heated Base fee: 1 5 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: A , Other Unheated Pot Water Review fee: 3uT` Garage/Carport v r _3` 1 SUBTOTAL acali ] Decks t 4 -1� 911/Rd Approach fee: } 13,--- ( Other TOTAL: $fi Receipt Number: gri4 ,f--? .,-t ` Cash/Check Number: + , ; i ESTIMATED COST(REQUIRED). -. Date: `/� .Fair market velue Ef all labor and materials foundation to finish I D- OrlIcrl ( $/ I 0 0 4 0 Initials: — .__-.,--. \........ 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FLOOR JAMES .. .. gcNm Z KENNEDY HiL NE o $>> 525 KENNEDY RD o w '>°Z PLAN PORT HADLOCK, WA 98339 H 0 M E S ``' \ - R1 (360) 385-3112 �� o �wm� www.HiLineHomes.com \\\ ©copyright 2005 HiLine Homes il/ FILE COPY