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HomeMy WebLinkAbout BLD2000-00077 + r BUILDING 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#: BLD00-00077 SITE ADDRESS: 7450 COYLE RD Received Date 02/1/2000 QUILCENE, 98376 Issue Date 03/22/2000 APPLICANT: THRASHER/BOYKER Expiration Date 03/22/2001 3049 E LAURELHURST NE PHONE: (206)527-8860 SEATTLE WA 98105 SUBDIVISION: PARCEL NUMBER: 701344011 Block: Section: 34 Township: 27 N Range: 01 Wt. CONTRACTOR: OWNER PHONE: LOAN LENDER/ BOND HOLDER: PROJECT DESCRIPTION SINGLE FAMILY RESIDENCE w/ATTACHED GARAGE REQUIRED INSPECTIONS: [ ] Footings/Setbacks (Shoreline Setba ks): ,et,-.L.' I tri[ ] Foundation: & 1®(C 7 , / .n G�'r,i�� L cS1 � c [ l nde un lum in �� © c; 'o fv.► nderground Insulation: _ .� I ] Shear Wall C7 ' f/�97® S"i�rgF p : O // I 2 5 t i CNirxd/ 11 - C .,/ O�i/1 4�- 7-�i g/Plumbin.• ,�i e/c• i , + r Pc v�a8- ©�� E,��m I ] t Fr3r A.,„+ j 1 [ ] Propane Tank/Lines: - ((// [� sulation: c _ [ T Sheetrock: / =Z—'d [0- Final/Occupancy Approval: w HEALTH DEPARTMENT APPROVAL RE UIRED PRIOR TO FINAL INSPECTION. THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTI NjqIn7 �-�mm Office Hours 9:00 a.m. -4:30 p.m. ONS. je/��/iql, 7 Inspector's Phone Hours 8:00 a.m. - 9:00 a.m. 7c.) itni G SPECIAL CONDITIONS MAY APPLY - SEE REVERSE,) a l '. 6 _ 149 , HOT LINE AVAILABLE 24 HOURS A DAY cr9JC 4103la /1'1 F . _ t_. r I (1) 05'5-00,505 BUILDING PERMIT APPLICATION (406 04.cii), Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00077 Received Date: 2/1/2000 SITE ADDRESS: 7450 COYLE RD QUILCENE, 98376 APPLICANT: THRASHER/BOYKER PHONE: (206)527-8860 3049 E LAURELHURST NE SEATTLE WA 98105 SUBDIVISION: DABOB COVE Block: Lot: PARCEL NUMBER: 701344011 Section: 34 Township: 27 N Range: 01 W CONTRACTOR: OWNER PHONE: ARCHITECT/ BOB HOBBLE ENGINEER : 304 WYATT WAY BAINBRIDGE ISLAND WA 98110 PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,388 VALUATION 256,076.00 ADD'L: 714 HEAT TYPE: PRO CODE EDITION: 1997 HEAT BASE: 120 HEAT TYPE: OCCUPANCY: R-3 UNHEATED: # OF STORIES: 3 OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 528 SHORELINE: CONST TYPE: DECK: 1,200 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: PWELL STORMWATER: YES NO AREA BEDROOMS: BATHROOMS: Wetland Erosion Exist: Exist: Seismic Streams Prop: 4 Prop: 4 Flooding Landslide Total: 4 Total: 4 F&W Plat Conditions Routing Date: 2 _2- Z0-0—� Shoreline Aquifer Forest: Commercial, Rural Proximity _ Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,872.95 MAM 02/01/00 24111 Plan Check $561.89 MAM 02/01/00 24111 Crtca1 State Building Code $4.50 MAM 02/01/00 24111 i Area Potable Water Application $30.00 MAM 02/01/00 24111 Review'. IA \ Total: $2,469.34 -rPap Relttimd _:'. ii \-7/ W is\F BKD Aoo Bid rnt 10/29/99 Jefferson County Department of Community Development December 22, 1999 621 Sheridan Street, Port Townsend, WA 98368(360) 379-4450 lS C ! , FINDINGS AND CONDITIONS OF APPROVAL AS REQUIRED ' ER 41'1i 1 1 2CCC JEFFERSON COUNTY INTERIM CRITICAL AREAS ORD, ANCE JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Applicant: THRASHER/BOYKER 3049 E LAURELHURST NE SEATTLE WA 98105 Critical Area Review Case Number: CAR99-00505 Project Description: new alternative Parcel Number: 011 ,S-T-R: 34-27N-01 W j Site Address: 7450 COYLE RD QUILCENE WA, 98376 - • - FIN DINGS: In accordance with the authority provided under subsection 4.101 and the requirement 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 12-20-99 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: landslide haze d 2), adjacent commercial forest land, susceptible aquifer recharge area, stfcamo (type 5). 2.) Acting upon the above information, Jefferson County staff conducted al site i spection of the subject property on 10-13-99 and confirmed the existence of the following critical areas and/or their associated Av buffers on the property: landslide hazard area, steep slopes, adjacent commercial forest land, streams 0 3.) 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. 4.) Susceptible aquifer recharge areas are those with geologic and hydrologic conditions that promote rapid infiitration 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). 5.) These bluffs are considered unstable and are subject to catatrophic slides. The potential for an earthquake of a high magnitude occuring in western Washington in the near future is considered a high probability by regional experts. 6.) 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 natural events such as earthquakes or severe rainstorms. 7.) Designated commercial forest lands are located on the north and east adjacent properties. According to the Jefferson County Interim Forest Lands Ordinance (Ordinance No. 01-0121-97), buffer and development restrictions are required on property located adjacent to designated forest lands. Please refer to the attached letter regarding buffers and development restrictions for this property. is waiver from the provisions of the Jefferson County Interim Critical Areas Ordinance is granted subject to the , !lowing conditions. Any deviation from these conditions shall result in this waiver being revoked and the application becoming subject to further review. . v t1/ CONDITIONS OF APPROVAL: el' dreln, 60 1.) A vegetive buffer of 30 feet shall be permanently maintained from the top or edge of the I area. All buffers shall be measured perpendicularly from the top of the landslide hazard area. 2.) 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." 3.) Vegetation retained on-site following completion of clearing for roadways, utilities and the like, may be cleared only if such clearing is absolutely necessary to complete the proposal (Note: This condition shall not be construed as allowing removal of native vegetation within a designated critical area or its associated buffer). 4.) All construction activities, including the storage and preparation of materials, shall not encroach upon the designated geologically hazardous area, or its associated buffer. 5.) 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. 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.) A setback (buffer) of 15 feet, measured perpendicularly from the ordinary high water mark along the banks of streams on the property shall be permanently maintained as a fish and wildlife habitat area. 8.) Fish and wildlife habitat area 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 fish and wildlife habitat area buffer without prior authorization by the Critical Area Administrator. 9.) All construction activities, including the storage and preparation of materials, shall not encroach upon the designated fish and wildlife habitat area, its associated buffer, or any critically important plants and trees identified on the subject property. 10.) Damage to vegetation to be retained on site shall be minimized by directional felling of trees away from buffer areas. W Ofi ,✓1 /-kut / • 12 , 0 0 Warren Hart, Planning Manager Date Department of Community Development 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 re m to the Department of Community Development. 14, .��y�-- an _ _o_ Ap it's ignat re_ i Dto c: 11e I:\F_CAR_Waiver_W_Conds.rpt 12/13/99 VDNGPEIiPIIONN1d cc - Cicl/�'7 PROPERTY OWN'ER(S) (Please Print) CNk L 1.. v- y ' • W. ��16-� LEGAL DESCRIPTION Ptret. vi -644-0 t t S3k• Tzfi • Rt W SITE ADDRES ri S 1 Ce' t air CONSISTENT WITH THE REQUIREMENTS OF JEFFERSON COUNTY INTER IN FOREST LANDS ORDINANCE (ORDINANCE NO. 01-0I21-97), I AGREE TO PROVIDE ADEQUATE ACCESS FOR FIRE VEHICLES TO TI-I AFOREMENTIONED PROPERTY. SIGNATURE OF EACH PROPERTY OWNER TECIEOVIE 11 as R 2 0 IOC JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT This form does not need to be notarized Please return to: Jefferson County Permit Center, 621 Sheridan Street, Port Townsend, Washington 98363 , -=- U , Jefferson County Permit Center September 11, 1998 621 Sheridan Port Townsend WA 98368 (360) 379-4450 BINDING ADVANCE DETERMINATION FINDINGS AND CONDITIONS OF APPROVAL JEFFERSON COUNTY INTERIM CRITICAL AREAS ORDINANCE Applicant CHARLES THRASHER Mailing Addr: KATHRYN W BOYKER 3049 E LAURELHURST DR SEATTLE WA 98105 Critical Area Review Case NO: CAR98-0070 SEP94-0209 Project Description: Binding Advance Determination Parcel : 701344011 S-T-R 34-27-01 W Site Address : 7450 COYLE 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: (car bad. txt) 1) The application was reviewed by Jefferson County Permit Center staff on 4-30-98 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: landslide hazard (2) , critical aquifer recharge susceptible area, adjacent commercial forest land. 2) Acting upon the above information, Jefferson County staff conducted a site inspection of the subject property on 4-30-98 and confirmed the existence of the following critical areas and/or their associated buffers on the property: steep slopes, adjacent forest land. 3) These bluffs are considered unstable and are subject to catatrophic slides . The potential for an earthquake of a high magnitude occuring in western Washington in the near future is considered a high probability by regional experts . 4) 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 natural events such as earthquakes or severe rainstorms . 5) A geotechnical study was performed by Zipper Zeman Associates, Inc . (dated July 14 , 1998) which addressed proposed development of this property. The report concludes that the proposed building will not decrease slope stability on this or adjacent properties . 6) Designated commercial forest lands are located on the northern and astern adjacent properties . According to the Jefferson County Interim •Forest Lands Ordinance (Ordinance No. 01-0121-97) , buffer and / development restrictions are required on property located adjacent to designated commercial forest lands . Please refer to the attached letter (copy) regarding buffers and development restrictions for this property. 7) Designated long term forest lands are located on the northern and Iiir,, eastern adjacent properties, on which a variety of forest related activities may occur that are not compatible with residential development . These activities include spraying, pruning, harvesting, blasting, drilling, rock crushing, and vehicle movements, which can generate dust, smoke, noise, and odor. Forest or mining activities performed in accordance with county, state and federal laws are not subject to legal action as public nuisances . This binding advance determination is issued subject to the attached conditions . Please sign and return to the Permit Center. • Page : 3 CAR98-0070 CHARLES THRASHER CONDITIONS OF APPROVAL 1) The applicant shall develop and submit to the Permit Center for approval, a "Small Parcel Erosion Control Plan" (see enclosures) when applying for a building permit . Once the subject permit has been issued, the applicant shall fully implement the provisions of the submitted "Small Parcel Erosion Control Plan. " A Certificate of Occupancy will not be issued until the Permit Center verifies plan compliance . 2) 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. 3) 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 . 4) Due to this parcel being located in a landslide hazard area, plans submitted for building permits must be stamped/approved by an engineer. 5) Development permits will not be issued until required forest land submittals are received and approved as per Ordinance No. 01-0121-97 . Due to the topography and potential landslide hazards present at the site, proposed development will not have to meet the 250-foot setback requirement of Ordinance No. 01-0121-97, and has agreed to maintain the maximum setback possible . 6) The proposed development shall be located on the subject property exactly as identified on the Universal Plot Plan, or other Site Plan, approved by the County as part of the triggering permit application. Applicant shall be responsible for contacting and notifying contractor (s) of the above conditions in order to ensure compliance at various stages of construction/development . 7) All recommendations as stated in the Zipper Zeman Associates, Inc . geotechnical study shall be followed. !lit, Al ST Date Dire or 4ACommunity Development I the undersigned hereby agree as to the presence of critical areas on the subject property as outlined above . I understand that no alteration of the critical areas or their associated O uffers is allowed unless specified in the conditions above. .According to the provisions of the Jefferson County Interim Critical Areas Ordinance, this Binding Advance Determination is valid for three years . I also understand that during this three year period, the presence of threatened or endangered species may alter the critical areas present on the subject property. (k)Page : 4 . •'. CAR98-0070 CHARLES TH SHER ‘, • illijK --. A li4cant q- 11-11 Date (c rbad_c .txt) I 0fin 1.._ ,Ir„____,_—_, II iii i SEP I 1 .;! .. . .____.:...„.._ • % r JEFFERSON COUNTY STORMWATER MANAGEMENT ORDINANCE SMALL PARCEL EROSION AND SEDIMENT CONTROL PLAN EROSION AND SEDIMENT CONTROL WORKSHEET Property Owner:rnTR 0/f#674/C/W. /71/00/RZ.Telephone:(tap) ✓9z7 SSr%DD Address: %'°'4/ CC ,4 szefir?-4'T £ ' NE:' rnE, al, 99i05. Assessor's Parcel Number: 'la/344aii 70/39 0/2 Building Permit or Septic Permit Applicatio, Number(if applicable): SEf9q-DoZ70 Brief Project Description: CprsrjWer/ON 4 /N61-E i M'L(r' /C3',454CE at 54.cc si ' Ch.4.r rtovo,¢,goti (Nor" )D,4a3D/3 SAW Site Location: COFLE jlp NC,fna /fl1EP EC770/N 01 1zN7Pekk / 442' Person Responsible for BM?Installation and Maintenance: Address: Telephone: 1. Describe/check the Best Management Practices (BMPs) that you will implement during land disturbing activities or construction to control erosion and prevent sediment from entering water bodies (marine waters, streams, rivers, lakes, or wetlands) or impacting adjacent property or roads. Please check the measures you plan to implement and show their approximate location on the site plan. You may also propose measures other than those listed. Attach additional sheets, if more space is required. yiStabilize construction access route. Limit construction vehicles to one route, if feasible. Provide a stabilized construction access by applying quarry spalls, ballast, or crushed rock to minimize tracking sediment onto roads. (See attached illustration from Stormwater Management Manual.) If sediment is transported onto roads, they will be cleaned thoroughly. pol, Minimize the extent of land disturbing activity and preserve existing vegetation. Preserve buffers of well-established vegetation between disturbed areas and property boundaries, roads, water bodies, and designated critical areas (wetlands, fish and wildlife habitat areas, landslide or erosion hazard area,etc.). SPESC Instructions—Long Form Revised June 3, 1999 9 EROSION AND SEDIMENT CONTROL WORKSHEET { Phase clearing so that only areas that are actively being worked are uncovered. Start and complete land disturbing activities and stabilize the site between April 1 and September 30. Stabilization means that disturbed areas will have well-established plant cover or be landscaped to minimize erosion. Stabilize exposed soil Exposed and unworked soil will be covered within 2 days between October 1 and March 31 and within 7 days between April 1 and September 30. [ ] Cover exposed soil with a minimum of 2 inches of straw or hay or other material approved for this purpose. Cover soil stockpiles with plastic sheeting and locate away from water bodies, roads, and property lines. • {I Place gravel base on roads,driveways, and parking areas after clearing and subgrade preparation. Protect adjacent properties and water bodies from sediment deposition: Place straw or hay bales in ditches and drainage ways down slope from areas of land disturbing activity to filter runoff before it leaves the project site or enters water bodies. (See attached illustrations from Stormwater Management Manual.) [ ] Install a filter fence down slope from areas of land disturbing activity to filter runoff before it leaves the project site or enters water bodies. (See attached illustration from Stormwater Management Manual.) Regularly inspect and maintain all BMPs especially after storms events. [] Describe other erosion and sediment control Best Management Practices. Be specific as to design and specifications. POPE*, rrC/PArEr' SPESC Instructions—Long Form Revised June 3, 1999 10 EROSION AND SEDIMENT CONTROL WORKSHEET 2. Describe how disturbed areas will be permanently stabilized(seeded, landscaped, apply gravel base to roadways, etc.) Yard areas around residence to'be seeded and permanently planted with ground covers and indigenous plantings allowing undisturbed vegitation to spread. Existing gravel road (drive) into site to be overlaid with new basalt crushed rock base for use during construction;finished upon completion with new gravel topping. The portion of existing drive to be abandoned to be overlaid with top soil and permanently seeded, planted with indigenous ground covers. 3. Describe how runoff from impervious surfaces will be controlled (disperse to vegetated areas to infiltrate,dry well,infiltration trench,route runoff to existing drainage facilities,etc.). Continuous straw bale barrier around downhill side of residence to be installed at limits of disturbed clearing/excavation. Runoff from drive above proposed residence to be directed by existing or new drainage ditching around proposed residence, back into existing ditches, with straw bale barriers installed per 13M17 requirements. SPESC Instructions—Long Form Revised June 3, 1999 11 • EROSION AND SEDIMENT CONTROL WORKSHEET 4. Specify your construction sequence. Describe the timing of all land disturbing activities (clearing and grading, construction, installation of drainage facilities, landscaping, etc.) and Best Management Practices.Describe proposed maintenance of BMPs. Installation of new gravel base on existing drive to be installed, graded and stablized prior to moving in construction equipment. Proposed residence location is relatively clear of trees and major planting. Following excavation for residence and grading for drive revisions and auto court, surplus material to be stock piled in designated location and covered with plastic per BMP requirements. Upon construction completion, final grading and drainage installation, permanent landscaping and finished impervious surfaces to be installed. The Best Management Practices proposed above will be implemented to control erosion, sediment, and stormwater runoff.I will notify the Permit Center for inspections as required. -r . aff_p f P.if AZ iMet" Si .ture of Owner/Agent D to SPESC Instructions—Long Form Revised June 3, 1999 12 4. BUILDING PERMIT APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00077 Received Date: 2/1/2000 SITE ADDRESS: 7450 COYLE RD QUILCENE, 98376 APPLICANT: THRASHER/BOYKER PHONE: (206)527-8860 3049 E LAURELHURST NE SEATTLE WA 98105 SUBDIVISION: DABOB COVE Block: Lot: PARCEL NUMBER: 701344011 Section: 34 Township: 27 N Range: 01 W CONTRACTOR: OWNER PHONE: ARCHITECT/ BOB HOBBLE ENGINEER : 304 WYATT WAY BAINBRIDGE ISLAND WA 98110 PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE / AlTeu Er.Q TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 466-e7'6:00�t°�"�� MAIN: 2,388 CODE EDITION: 1997 ADD'L: $�Sy -% HEAT TYPE: PRO OCCUPANCY: R-3 HEAT BASE: /13y HEAT TYPE: OCCUPANCY: UNHEATED: J #OF STORIES: 3 OTHER: CONST TYPE: 5N GARAGE: 528 0� SHORELINE: CONST TYPE: DECK: 1,200 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: PWELL STORMWATER: YES NO AREA BEDROOMS: BATHROOMS: Wetland Erosion Exist: Exist: Seismic Streams Prop: 4 Prop: 4 Flooding Landslide Total: 4 Total: 4 F&W Plat Conditions Routing Date: Shoreline Aquifer Forest: Commercial Rural Proximity _ Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,872.95 MAM 02/01/00 24111 APPROVED Plan Check $561.89 MAM 02/01/00 24111 State Building Code $4.50 MAM 02/01/00 24111 �, Potable Water Application $30.00 MAM 02/01/00 24111 `/`�('" Total: $2,469.34 Jefferson County Planning Zi Bt;il:0, s! . nci, u � •.u:GI tGIs.u: I:\F_BLD_App_Bld.rpt 10/29/99 r 3(,000 - 0003.Tr , ` Jefferson County Department of Community Development ,; � � °° �{ 621 Sheridan Street,Port Town :nd WA 08368[360]370-4450= $ perm A 0 C G cc`F0 _ C ... i Project Description: Building Type: Project Type: Frame Type: Single Family "<New 'Xs Wood 7 Garage Attached/Detached ❑ Addition ❑ Steel it Modular n Alteration/Remodel ❑ Concrete Commercial 11 Repair El Masonry In Multi-family/#of Units n Demolition ❑ Other: Industrial Other: Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: U Existing: D 7Sewer E Community System n Electricity El Oil Proposed: ' Proposed: 7rxdividual System Woodstove Propane Total: Total: 4- If not sewer,fill out the following: Heat Pump / ii Conventional Alternative Other Permit# SEP 9'qd 27 o Water Supply: XPrivate well ❑ Two Party Well ii Public:Name of water system: Square Footage: •`i For Office Use Only Main Floor 23 S s )r?j ® Q iq\ H� UBC OCCUPANCY GROUP 2�Floor 7/4- Base fee i'q 3�} - ! 1 2 .q5 l o 3rd Floor /� L ,5 - 'LiPlan Check fee S%0.11 51 I • �9 I ,A 1 Htd Basement fi 54 LZ- / 10 ` 1° State Surcharge fee 4.9 Li • 5 0 ---�:yi; - 2 „� b� lbtotal ___- 3 e J Unhtd Basement �` _ Garage/Carport (0-1,� g ` - � Pot Water Review fee Decks /Z100 I ti l bbp 911/Rd Approach fee q Commercial TOTAL 2b(1 . 3 ` tJ Industrial Receipt # 2 I f I i 9 Other /) l ,0 Cash/Check# '�,,. Total Valuation: f'// �_ ``" ( Initials i( Or ^ , .�-- � � � ` Date '"2 . 1 _ �}j"} Estimated Cost: 67�9 151 OP" If within 200' of the Shoreline, Distance to Bank or Ordinary High Water Mark l i 4• ft. Bank Height /.A• 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 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 pro .•-access d righ f en to fferson County and it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right o -• to the pli t prop o e shall be requested and shall occur during regular business hours. Signature: . ik•"' I'Cg--'—" Date: 2 P tit1 ql ^Sr�J/�son1• co),,{ Jefferson Canty Permit Center * Department of Com mnity Development ~ V� 621 Sheridan Street Port Townsend WA 88368[360]370-4450 ..... ....-•".:!t, '''1,...:-.::- ey 11sUrliVergall Pro)i) pari 'du a t!c katio649 11.41(04 44 COmgeeeet 44 friaddle= Project Description: rnai off, ‘ 19 Digit Parcel Identification Number(from your tax statement): ® I j 74f Site Address 7 � -�, oLe ram® ,4 eoi. 7�e 7 911#: Road Name: I ZipCode: 96374 ILegal Description Subdivision Name: I Block: I /5 /G fSection: Lot(s): 3q I Township: -2-7 I Range: /w !Parcel Size (acres or square footage): 5 Ac e- 440ES Property Owner: fmtjyN60f K.efe/eYAs. 774/ PNe/e. 2d4 I Phone:® � �C-�%< ���o Mailing Address:�oir9 C eAt /gc1"', .me.: E �� f���,� I Applicantpant: (if different f/Occurom owner) -� /TeGj® Phone: z � 2-- ���® Ph Mailing Address: �„A a , .0�� 1t/Nr,�®6� /5. Authorized Rep: one: -Mailing Address: General Contractor: Or Manufactured Home Installer: Oiiii6 Phone: Mailing Address: Contractor's State License Number: IExpiration Date: Septic Designer: F.e Aivv‘ew I Phone:( ,�® Mailing Address: , 437_ 4,1� !7.7/ 0a✓ �ewvatE • po/Z7 L c-t�cu, GU,4 le .3GAS' Architect:/Engineer: ��,��,,�,,, �✓19,r /ogo1 ' I Phonr'74'/4 04,7' Z�p� tie" Mailing Address: 34 aiottrr"ad,A Loan Lender/General Phone: _Contractor's Bond Holder: ®(,/t Mailing Address: ram.. ............... FOR OFF USE Q; ILY.: Thre District 'tannin Area: g f SCIYQoI DIStt7cC. I ) Zone: ` 4/98 H: home\pincntr\forms\universal plot plan 0 elf -rHOr'kNC)Yl<-E hoar ��loo 000H =50 WA�HINGTON ETATF PROFFPTY COYLF� GATE 00 N lq� 00 cz, Date Sheet of