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HomeMy WebLinkAboutBLD2000-00204 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 #: BLD00-00204 Received Date: 3/30/2000 SITE ADDRESS: 23 MEADER AVE Issue Date: 4/12/2000 PORT TOWNSEND, 98368 Expiration Date 4/12/2001 APPLICANT: GARY JENSEN COLLEEN JENSEN 10964 RHODY DR SUBDIVISION: IRONDALE Block: 101 Lot: 13-18 PARCEL#: 962110104 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ DEALER INSTALLER: JAIME KOZELISKI WAINS0626 Expires: 7/20/200 1112 JACOB MILLER RD PORT TOWNSED WA 98368 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION MAKE: FLEETWOOD YEAR: 1983 SIZE: 24X52 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 4/12/2001. REQUIRED INSPECTIONS: y r.. [ ] Footin etba of eonti /S nous footings are used):OK 1/ /4/O l [ ] Blocking/Setbacks/Plumbing: p] Final/Skirting/Vents/Porches/Steps: J) 7 Cr. ?-61-0,-) 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 MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00204 Received Date: 3/30/2000 SITE ADDRESS: 23 MEADER AVE PORT TOWNSEND, 98368 APPLICANT: SUNSET INVESTMENT INC PHONE: 4890 S DISCOVERY RD PORT TOWNSEND WA 983689676 SUBDIVISION: IRONDALE Block: 101 Lot: 13-18 PARCEL NUMBER: 962110104 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ DEALER: INSTALLER: JAIME KOZELISKI WAINS0626 7/20/2000 (360)385-3215 1112 JACOB MILLER RD PORT TOWNSED WA 98368 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: FLEETWOOD SETBACK: VALUATION 10,000.00 YEAR: 1983 LABOR & INDUSTRIES APPROVAL? SIZE: 24X52 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUBLIC BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Wetland Erosion Exist: Exist: Seismic Streams Prop: 3 Prop: 2 Flooding Landslide Total: 3 Total: 2 F&W Plat Conditions Shoreline Aquifer Routing Date: Forest: Commercial Rural Proximity Type Amount Paid By: Date: Receipt: ,/r Approved/Date Permit $141.00 MAM 03/30/00 25538 +41 PAO 0 Potable Water Application $30.00 MAM 03/30/00 25538 ,' ', Total: $171.00 i 4 R 12 \ ' \ ii 4" �✓e a }Qr� 4 '1% 1 , \ r 8U%/ ilfcrunty I:\F_BLD_App_Mob.rpt 10/29/99 11/11 JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368 ' MANUFACTURED HOME INSTALLATION PERMIT APPLICATION ❑ NEW BUILDING ❑ REPLACEMENT SIZE x c; YEAR i 9 (1 3 MAKE �--- ei.£ frt)on0 ; 2k.5I-, 12c-_ Q4., COST Q(�3(� BEDROOMS: BATHROOMS: EXISTING 3 EXISTING __ PROPOSED PROPOSED TOTAL 3 TOTAL TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: 0 SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL M INDIVIDUAL SYSTEM A Conventional PUBLIC PERMIT # SEPbO-OOolb❑ Alternative Name of water system: 3L) Di 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 regulr businessusi hours. SIGNATURE .►E./ a C DATE Jam'7L�c NAME (PLEASE PRINT) C% 6,r),y r � /1 s,.4g. ye_.. FOR OFFICE USE ONLY 2sx.aii. BASE FEE RECEIPT# , �% • ADDITIONAL SECTIONS . CASH/CK# , 1C..) SUBTOTAL / ;� DATE ' . /".ju u POTABLE WATER i ,+_C C 911/ROAD APPROACH TOTAL / /7 f. C H:\H O M E1 PLN C NT R1 FORMS\M O B I L EA P.10/9 9 . , MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00204 Received Date: 3/30/2000 SITE ADDRESS: 23 MEADER AVE PORT TOWNSEND, 98368 APPLICANT: SUNSET INVESTMENT INC PHONE: 4890 S DISCOVERY RD PORT TOWNSEND WA 983689676 SUBDIVISION: IRONDALE Block: 101 Lot: 13-18 PARCEL NUMBER: 962110104 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ DEALER: INSTALLER: JAIME KOZELISKI WAINS0626 7/20/2000 (360)385-3215 1112 JACOB MILLER RD PORT TOWNSED WA 98368 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: FLEETWOOD SETBACK: VALUATION 10,000.00 YEAR: 1983 LABOR & INDUSTRIES APPROVAL? SIZE: 24X52 BANK HEIGHT: SEWAGE DISPOSAL: CONC✓nU0`'0LQCC t c2AoL,c:±, WATER SYSTEM: PUBLIC ` BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Wetland Op Erosion 0 Exist: Exist: Seismic \ Streams Prop: 3 Prop: 2 Flooding Landslide Total: 3 Total: 2 F&W Plat Conditi ns Shoreline Aquifer J Routing Date: Forest: Commercial Rural /0p 4 • L( Proximity Type Amount Paid By: Date: Receipt: Approved/Date Permit $141.00 MAM 03/30/00 25538 Critical Area Potable Water Application $30.00 MAM 03/30/00 25538 Total: $171.00 Revita° w '� Requiret Alylio Mi(F• I:\F_BLD App Mob.rpt 10/29/99 STORMWATER CALCULATIONS Owner/Applicant: 7- 11 (/ ❑ PROPOSED LAND DISTURBING ACTIVITY Site Address: Drainfield area cleared /r C) sq.ft. Driveway Length IRO ft. / X Width 47 ft. 9 Digit Parcel Identification No.: 9 c�- -`x//c la)" = Total Driveway v&r` _ _sq.ft. Permit Number: Clearing and Grading for Site Development PLOT PLAN (Well/Structures/Utilities/etc.) sq.ft. sq.ft. INDICATE the following information. Total Land Disturbance /et). sq.ft. Draw entire parcel to scale. Indicate scale of plot plan: One inch equals ❑ IMPERVIOUS SURFACE Proposed Structures (all roof area) /, ;5 sq.ft. d 1. North arrow Existing Structures (all roof area) sq.ft. 2. All property boundaries and dimensions Sidewalks sq.ft. 3. Names of adjacent streets Concrete Patios _sq.ft. .2 4• Driveway/s & parking spaces Proposed: 5. Major features such as ravines, Driveway Length ft. seasonal creeks, bodies of water, etc. X Width ,:21-1 ft. )Q, �1 6. Septic tank, drainfield and reserve area location, = Total Driveway `f .6 sq.ft. existing or proposed, and distance to Total Impervious Surface ) $ ('‘) 5 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: Neighboring wells within 150 feet Construction vehicle access shall be, whenever feasible, limited to one route. Access points shall be stabilized with 14. Paved surfaces (patios) quarry spalls or crushed rock to minimize the tracking of 11. Structures, existing and/or proposed sediment onto public roads. If sediment is inadvertently �� transported onto public roads, roads shall be cleaned ;a 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, t 1 3. Easements for access or utilities seeding, mulching, plastic covering, application of gravel base /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 INDICATE: Management Practices (BMPs). • Maintenance: ❑ 15. Ordinary high water mark All erosion and sediment control BMPs shall be regularly inspected and maintained to ensure continued performance of 0 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:\HOME\PLNCNTR\FOR MS\PLOTPLN.FRM9/97 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: CA 1 TC n)S The purpose of this questionnaire is to obtain information ADDRESS: /09(n /l (�( ,1 _ regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will �0�L / q., 9� � help our office determine whether the mobile home is already 7 1-/R C/>�Ck �,J`� . 39 on the tax rolls in Jefferson County or if it has been moved to this county from another area. Please see reverse side for TELEPHONE NO: 3/0 n/ R5— -< , 'J 9 additional information. 1) MOBILE HOME DATA: (A) MAKE /S'_6-)-74.)nQ 0 (B) MODEL k R 1'c Sj I Inc (C) YEAR /93-3 (D) LENGTH (E) WIDTH c-9"cj (F) SERIAL NUMBER /4 (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) /3,00 o (H) PURCHASE DATE c3/J3 100 2) PREVIOUS OWNER/ LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE MOBILE 7 ' (1")O th G-© in 5 b_ty ADDRESS (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO,WHAT COUNTY? 01 5( ) IF YES, WHAT WAS PREVIOUS ADDRESS OF MOBILE? 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 at ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK: NAME OF LAND OWNER: C, F\R to, LOCATION (ADDRESS) £.(�3 I -�- t)F j C ;' e REAL PROPERTY PARCEL NUMBER/DESCRIPTION 96 Q i l c r"� ,p `7 THANK YOU FOR YOUR HELP! SIGNATUayc KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 CRITICAL AREAS QUESTIONNAIRE Applicant Name C)19 g " E )5 En) X Building Application s Land Use Application Shoreline Application On-site Sewage Application — Subdivision Application Other: 1 . Is there any standing or running water on the surface of the _ Yes A I No property or on any nearby property at any time during the year? If YES, please describe: 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 _ Yes X No on your property or adjacent properties? If YES, please describe: 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) 0 0 4 Q ❑ ❑ ❑ ' i i i i i i i� i� ,❑ �, r r i i i i i SC cue" eat . E, crYnerire i 11, r r i i i i i .- III , , , , rriiii/ ryif r ---- --------------❑ (Questionnaire Continues on Back) Page 1 of 2 6. Does the site have steep slopes with little to no vegetation? _ YES X- No If YES, please describe: 7. Does the site contain high percentages of silt and/or very fine YES X NO sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the _ YES X NO surface of the ground? If YES, please describe: 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 Date t 3 - FOR OFFICE USE ONLY ❑ Wetlands ❑ Seismic CRITICAL AREAS ON OR ❑ Aquifer Recharge Area (zone_) ❑ Fish & Wildlife Area 1 IMMEDIATELY ADJACENT TO SITE: ❑ Frequently Flooded Area ❑ Fish & Wildlife Area 2 ❑ Erosion ❑ Landslide :Seismic ❑ Commercial Forest Section `94.1 Township 30 l\J North Range O j /*) Parcel Number: C ( ,2 / /b / 41 Parcel Size: 7 Comprehensive Plan Land Use Designation: Reviewed by: Community Plan: Date: Page 2 of 2 h:\home\pincntr\forms\car.docl/00 .... K A\\ Oi rtY 1-- ....._. _ __ ..„___7_____. ' .,'"..-- .-"' -7Z ,, .. - • ---V ,-.''''.,7 7 7 , . ' f<7.r III ,--' / ,,' „," ..- 1 lil i - , -1„• y‘•;.N --f ' ,/ .., . W 4• Irl fri 1,-, ,Tv —, -- - --•— -- — -- IT:Lis , 1 , < ... ... 0 1 ! -< I -- - -- I i ; i ! i t t ...... t . 1°1 lc i i' ,-„.... i r i s IC.7, 7-- t —1 1 I U,, i ' I 0 K.,./ ' 1 Ill r- __f___ -..? Gn ,,-... --4 ... ."1 / 1- • L. S. 3 ET BA cK_ --...„ / / / '....„„. li ! .)........ 17 7 / / ..,. 7-1 , C) .‘,..., -ri liVii i / ,.... 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