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HomeMy WebLinkAboutBLD2000-00331 • . . . . • 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 #: BLD00-00331 Received Date 05/30/2000 SITE ADDRESS: 1254 SHINE RD Issue Date 07/28/2000 PORT LUDLOW, 98365 Expiration Date 07/28/2001 APPLICANT: J N R N L,J, ,Ock`- L. Dcn i3 PHONE 821 9TH ST CE ND WA 980404908 SUBDIVISION: SQUAMISH VIEW SHORT PLAT Block: ? Lot: 2 PARCEL NUMBER: 721031024 Section: 03 Township: 27 N Range: 01 E CONTRACTOR: OWNER PHONE: LOAN LENDER/ BOND HOLDER: PROJECT DESCRIPTION SINGLE FAMILY RESIDENCE REQUIRED INSPECTIONS: [ ootings/Setbacks�Shoreline 6aclts7+ — Li Epc!2 O/C ?////©1 f{) [ 'j Foundation: t� Copo 9-cy,o,- /// uti s a hand.rs,e VOW [ ] Underground PlumbingKJnderground Insulation: //6-6.;aimaio,:-/,514 i/ic4 f% fj va z,,e I;Pnuc Ok //Alaf 134 [ ] Shear Wall: d jer D.L/w r.r11(#6,/ - 2/ D [ ] Framing/Plumbing: / 14r14 �K Ole *LW, f/2ItN/06 al! liZaid(v 45AAitt ilAvi' [ ] Propane Tank/Lines: ZV L,,, S 4 4/4/dar Exr/..#41 4 TAtu CoC Via [ ] Insulation: 1/R4- t/It 0040 ' 41( V o- [ ] Sheetrock: UK 5/f346 (.iyy�-Y el4a.MLA [ ] Final/Occupancy Approval: 2 . -rot' ® q/,%6 v HEALTH DEPARTMENT APPROVAL REQUIRED 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 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 . 2_ puer,, :‘Allk _01 0° 0 0 ''��' " BUILDING PERMIT APPLIC ATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD00-00331 SITE ADDRESS: I25t1 SHINE RD Received Date: 5/30/2000 PORT LUDLOW, 98365 APPLICANT: JOHN R E 8215 59TH ST 1,41/1 S)7 i7� cr pew' LZJ/PHON /,� CER ISLAND la=' p t 5# WA 980404908 /„tA,1(�/A"- 3O �- SUBDIVISION: SQUAMISH VIEW SHORT PLAT PARCEL NUMBER: 721031024 Block: ? Section: 03 Township: 27 N Lot: 2 S Range: 01 E CONTRACTOR: OWNER PHONE: ARCHITECT/ DONALD GARDNER ENGINEER : PO BOX 16045 STATION B GREENVILLE SC 29606 PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: CODE EDITION: 1,514 VALUATION 134,363.00 642 HEAT TYPE: PRO ADD'L: OCCUPANCY: 1R93 HEAT BASE: OCCUPANCY: UNHEATED: HEAT TYPE: CONST TYPE: 5N OTHER: #OF STORIES: CONST TYPE: GARAGE: 420 SHORELINE: E_LINE DECK: 1,083 SET: •CK: 95 SEWAGE DISPOSAL: CMY s B EIGHT: , t WATER SYSTEM: 6 PUD BEDROOMS: PARCEL TAGS: ,�BATHROOMS: NO Exist: Exist: STORMWATE R: NO AREA Prop: 3 Prop: Wetland ! gDe. T0ta1: 3 Seismic Streams�! maj Ladlr�xi y � � Rural Permit Y Date: ecetp : a •a• ions:- $1,189.75 MAM 05/30/00 31547 'PProve. a. ------ ' lan Check $356.93 MAM I �.(� State Building Code 05/30/00 31547 /4,*y , $4.50 MAM 05/30/00 31547 �� �� 1P i 'otable Water Application $30.00 MAM 05/30/00 31547 Total: $1,581.18 ' .;,f� �l. - 7/1 0 _BLD_App_Bld.rpt 10/29/99 BUILDING PERMIT APPLICAT ION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00331 Received Date: 5/30/2000 SITE ADDRESS: SHINE RD PORT LUDLOW, 98365 APPLICANT: JOHN R NAYE PHONE: 8215 SE 59TH ST MERCER ISLAND WA 980404908 SUBDIVISION: SQUAMISH VIEW SHORT PLAT Block: ? Lot: 2 PARCEL NUMBER: 721031024 Section: 03 Township: 27 N Range: 01 E CONTRACTOR: OWNER PHONE: ARCHITECT/ DONALD GARDNER ENGINEER : PO BOX 16045 STATION B GREENVILLE SC 29606 PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW,. MAIN: 1,514 VALUATION 3.00 ADD'L: 642 HEAT TYPE: PRO CODE EDITION: o9 1997 OCCUPANCY: I,4's ' R-3 HEAT BASE:, Jed HEAT TYPE: OCCUPANCY: UNHEATEDIfv` is Pi #OF STORIES: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: 420 SETBACK: 95 DECK: 1,083 BANK HEIGHT: 6 SEWAGE DISPOSAL: CMY WATER SYSTEM: PUD PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: 3 Prop: 3 Seismic Streams Total: 3 Total: 3 Flood Way Flood Plane Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural --'r xim.itvr Hat Conditions Type Amount Paid By: Date: R d/D eceip : Approvea e Permit $1,189.75 MAM 05/30/00 31547 AitP R 0 V E D Plan Check $356.93 MAM 05/30/00 31547 dib -A State Building Code $4.50 MAM 05/30/00 31547 a Potable Water Application $30.00 MAM 05/30/00 31547 �J U ' �0 Total: $1,581.18 Jefferson County Planning &Building Department is\F_BLD_App_Bld.rpt 10/29/99 'Ef .\- -..... perm _91 1`9- GAO II plil : cc-AK)n 87N Project Description: Building Type: Project Type: Frame Type: i X Single Family_ X New X Wood • Garageetached ❑ Addition ❑ Steel Modular 0 Alteration/Remodel 0 Concrete I O. Commercial ❑ Repair 0 Masonry 1 O Multi-family/#of Units 0 Demolition 0 Other: ❑ Industrial ❑ Other: Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat: ?N. v Choose one: Existing: 0 Existing 0 Sewer )(Community System 0 Electricity ❑ Oil Proposed Proposed: yZ 0 Individual System 0 Woodstove Pro an Total: Total f7 If not sewer,fill out the following: 0 Heat Pump P 0 Conventional 0 Alternative 0 Other Permit# SEP y1/p.+ I Water Supply: �+ ❑ Private well ❑ Two Party Well', Public:Name of water system: II- P -Fr ( 0 Square Footage: For Office Use Only Main Floor 1 £i 1 'fr UBC OCCUP CY GROUP : ...-::.:4:,i.---.,..:::.:F.,..,- "� b�� ' 21`'D Floor 6 l l CS 5 '" Base fde' t ' ,. ' .'1 -! . = 0l0 ', t 3rFloor 35 y� 3 • ': 3o`: c 2 Planck fee LI D Htd Basement —' l State Surcharge fee • is :: t �. , LT Ba i /5^/'y-- ...v Subtotalj. .i St ., 1 1 �J Garage/Carport �' �0 9�° Pot Water Review fee °�� Decks j 19 911/Rd Approach fee ,: t Commercial TOTAL .` • 't $ Industrial G Receipt! � Q Other Cash/Check# : 7 j ( 1 Total valuation: 1 Gj 3 0,1 Initials - 1tt// IAD Or Date 7�a EsrimaredCost: �--� ce,)6 e ,� If within 200' of the Shoreline, Distance to Bank or Ordinary High Water 4:. f i .5 ft.Bank Height C ft. 4 By u g the application form,the applicant owner that informatm provided herein is true and correct to the best of their knowledge. Any material falsehood or any omissron of a material fact mark by the applicant/owner with.,i; to this application packet may result in this perms being null and void. I further agree to save,indemnity 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 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 rroperty or structure shall be requested and shall occur during regular business hours. r. i Signature: k� �� Date: j —'Z'�'( —c-4 0 • I , 0.sON Jefferson . , , 'O�.2, perni ? A 621 Slull�street.Port Townsend WA 88368[3so]378- W ., >� 4450 0 �q '°$ ° 00CCIcll' Onskr'vG� Project Description: Building Type: Project Type: Frame Type: X. $inOr Feyyp �g New Wood ❑ G ttach ?Detached U Addition g Steel ❑ Modular ❑ Alteration/Remodel ❑ Concrete 0 Commercial 0 Repair ❑ Masonry Multi-family/#of Units 0 Demolition 0 Other: ❑ Industrial ❑ Other. Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: Existing: �. 3 0 Sewer XCommunity System 0 Electricity 0 Oil Total:Propose& 3 Total �Proposed: ❑ Individual System 0 Woodstove "Propane If not sewer,fill out the following: 0 Heat Pump Conventional 0 Alternative 0 Other Permit# SEP Ft p.1:1-/ IWater Supply:7.3 I Private well E. Two Party Well Public:Name of water system: j2 L"' P - r Square Footage: For Office Use Only Main Floor % ; i !-/- 0 -3.-7g6/ UBC OCCUPANCY GROUP r 2ND Floor 6 4 2 55 i•fe Base fee 16 9 i5"1 i S9 TI S - 1 04(11 4 d 3rd Floor ~ Plan Check fee . - ? _�l#J . 9: o(. Htd Basement — state Surcharge fee 4 i St '-�' Unhtd Basement /5/'y 110/(40 Subtotal I SS( i g 1 S g 1 S Garage/Carport l} )v b c .D O Pot Water Review fee 'Decks f ' ©g 911/Rd Approach fee S ( , D Commercial TOTAL i(i) , l Industrial Receipt # Other _ . Cash/Check# ( S 3 e ( 0 Total Valuation / G 3 Not Initials \SA Or ( -- V v �� ) ' Date - 74 /D/ Estimated Cost: 6( cr'C / If within 200' of the Shoreline, Distance to Bank or Ordinary High Water Mark Ci 6 ft.Bank Height C 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,indrmni fr 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 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: .U . ( ---, z: Date: 7 -3--Cr. —CC C cos ritirnnRl- 'MAN SHEET NO.,. . OF N�i N E E RI N G , CALCULATED BY ///cf� /DATE � v Z� -C7 N C• CHECKED BY DATE ESCALE 7d 5'7- _s'T 7 7- V c \ i 4.7 i�rrf�l -,irrp, , ' - . tl ...i = t J ,/ i , 0— 7'7 4 RZ:r/&ee 0 6 "OC E>.,/ $ `/Z P��Y/ g 5-/OE .5.dg dle. • _. 1 . PG 7 ¢;'• 0 • e v- 17'"'-‘1‘ 0 1 I {)... / Sri , b --__._:... {— c-1-_ ..-.. . — . Al 0i • y arair44 111 , • • JOB SHEET NO. ¢ OF CALCULATEAN' ENGINEERING, INC. CHECKEDBYD BY � DATE 6/�zz�� DATE SCALE ( d }_. //2//PLY r Gr 0 TYPrca • u v>:_:kc,_ • : 7-7-"iti • eit==== r • i... ».__........_.._.. - - - ice/ .....- Cv 1 0 ___ _._ sit iV1(?_ KO,..et I ?/� Il Fo T IA) wl, 7 ' .1t >1 . L 33 C 43 "2,0 <11- _.4,. _ _ _ _ _ v _ , _ _ _ _. 1 . , Y I , 4-we Gee _ r J � G�,,a,e/S-ho`7 A 1 1 - s . 6--)- tfq 1 ; 1 . i I . ---(7/477-1 I/ i I �- - - • A.. c / - 1 4_ _ � szp4.�• -,, Tk . 1‘1,0 T� < EGA. 5 fbk+n E-5e.41€4 S"( I �7 ,L 1. I A !..__ De, ti1/L S t�. , SI-� kieK/, Tbe. a c.i,k,tz...\ — tt/`u-4Qv- L. %►1 - — _ �, d L�i S�f l< ® 5'e-f L/C-if )3,e4c}r w;ik -5 `c Cw _ I • 4. I f i I ; --li • ,)1-/ . (... , . i • r)1_1\,.,,, f--v'et....1 i . REVISED S LAM . r I : I dated (P , , • i Has been APPROVED ;St' 1 . -6,1 -1 i by JEFFER C \ \ v i a(t t 'l id ; DEPT,OF 1 MINATO • L fj - itty, k aki,i 2- 5ft ! ht; - I .- Sr 0 f Dt-.4,.t4f-e_ 2 elS WIWI.,1- sf - 1 6 la s•i)vv-,,PIA.i I - Io _ . _-- . 0 1/0 69 - bc(44_cirk tri\- ,iiac( wi ilcvnav .6-yy\ 1 . i c'' t loiv\. Wieuk IA) oN (-NA i_ ‘Wwit,a 7n. s' i ' ••-11\z G l• vvrit ,{- (;:v‘sk. I . W 10A —t'L9--- ,ei.Ws-g— • . . __. -_ 47) ....._ • _ vir ... , A r"--- ,. , • ''' -----i ----,_ AUG28 2036 ,..:...; 0' 1, , Ji:V1--L3PMENT 1 • • Jefferson County Department of Community Development July 5, 2000 621 Sheridan Street, Port Townsend, WA 98368 (360) 379-4450 FINDINGS AND CONDITIONS OF APPROVAL AS REQUIRED UNDER THE JEFFERSON COUNTY INTERIM CRITICAL AREAS ORDINANCE Applicant: f MI-0 P4 S Io Yeti 441)0Y 01. coittutA. vIA Critical Area Review Case Number: CAR00-00251 Project Description: single family residence Parcel Number. 721031024 S-T-R: 03-27N-01E Site Address: 1254 SHINE RD PORT LUDLOW WA, 98365 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.) Jefferson County requires the preservation of a buffer of undisturbed vegetation along the shoreline of Squamish Harbor. This buffer shall begin at the top of the bank and extend upland 25 feet with the exception of construction of a single beach access in the form of stairs and ramps. No clearing or construcition shall be permitted within this buffer. Residences, decks and other structures shall not be constructed within this buffer. 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.) All areas disturbed during construction of driveways, utilities, residences and accessory structures shall be revegetated upon completion of construction. The proponent or subsequent owners shall document completion of revegetation to the Jefferson County Planning and Building Department prior to issuance of a certificate of occupancy. 2.) The area within 25 feet of the top of the bank shall remain in natural vegetative cover and shall be supplemented with the planting of native plants which will further stabilize the top of bank. Supplemental plantings shall be as recommended by the U.S. Soil Conservation Service�e and the Jefferson County Conservation District. This 25 foot buffer is an environmentally sen -Letarea and shall not be developed or disturbed, with the exception of the construction of a single beach access in the form of stairs and ramps. 3.) The proponent and subsequent lot owners shall revegetate the exisitng and any future bare bank surfaces as soon as practical. Deep-rooted deciduous trees such as big leaf maple or madrona or other plant/tree varieties recommended by the U.S. Soil Conservation Serivce and the Jefferson Conservation District to best promote bank stabilization shall be utilized. 4.) The removal of any trees within the 25 foot bank buffer or on the bank slope for view enhancement is prohibited. Limb thinning up to a maximum of 40 percent shall be allowed per tree for the duration of each trees life. 5.) Any drainage over the bank that may cause accelerated bank erosion resulting from property owner's action shall be prohibitied. Any runoff from the uplands to the beach shall be piped and is subject to prior design approval from the Jefferson County Public Works Department. The diversion of upland runoff from an apparent slide area shall be tight line piped. SPECIAL CONDITIONS FOR CASE BLD00-00331 1.) Jefferson County requires the preservation of a buffer of undisturbed vegetation along the shoreline of Squamish Harbor. This buffer shall begin at the top of the bank and extend upland 25 feet with the exception of construction of a single beach access in the form of stairs and ramps. No clearing or construcition shall be permitted within this buffer. Residences, decks and other structures shall not be constructed within this buffer. 2.) All areas disturbed during construction of driveways, utilities, residences and accessory structures shall be revegetated upon completion of construction. The proponent or subsequent owners shall document completion of revegetation to the Jefferson County Planning and Building Department prior to issuance of a certificate of occupancy. 3.) The area within 25 feet of the top of the bank shall remain in natural vegetative cover and shall be supplemented with the planting of native plants which will further stabilize the top of bank. Supplemental plantings shall be as recommended by the U.S. Soil Conservation Service and the Jefferson County Conservation District. This 25 foot buffer is an environmentally sensive area and shall not be developed or disturbed, with the exception of the construction of a single beach access in the form of stairs and ramps. 4.) The proponent and subsequent lot owners shall revegetate the exisitng and any future bare bank surfaces as soon as practical. Deep-rooted deciduous trees such as big leaf maple or madrona or other paInt/tree varieties recommended by the U.S. Soil Conservation Serivce and the Jefferson Conservation District to best promote bank stabilization shall be utilized. 5.) The removal of any trees within the 25 foot bank buffer or on the bank slope for view enhancement is prohibited. Limb thinning up to a maximum of 40 percent shall be allowed per tree for the duration of each trees life. 6.) Any drainage over the bank that may cause accelerated bank erosion resulting from property owner's action shall be prohibitied. Any runoff from the uplands to the beach shall be piped and is subject to prior design approval from the Jefferson County Public Works Department. The diversion of upland runoff from an apparent slide area shall be tight line piped. i 0/29/99 • l'IWtXM 7)/o/0o 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. Applicant's Signature Date c: File i:\F_CAR Waiver W_Conds.rpt 12/13/99 ♦ JEFFERSON COUNTY STORMWATER MANAGEMENT ORDINANCE SMALL PARCEL EROSION AND SEDIMENT CONTROL PLAN EROSION AND SEDIMENT CONTROL WORKSHEET Property Owner: 70 h tit GL y F��`- `` ��41'elephone: no 376j —st`7 3 7 Address: Ite e-f�i ��-- �A fcr W L F3 Assessor's Parcel Number: 2. / — d 3 (- 0 2--4 Building Permit or Septic Permit Application Number (if applicable): Brief Project Description: „t ! 7e4 L Site Location: 5 c G 3 To U/h A'? )-_7 5 Person Responsible for BMP Installation and Maintenance: c Address: t C9ee c (7 (P--, C F3 Telephone: .3 c 3 Y T— 7 3 T j 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. 174 Stabilize 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. 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.). March 10, 1997 3 s EROSION AND SEDIMENT CONTROL WORKSHEET pf Phase clearing so that only areas that are actively being worked are uncovered. S 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. Iitj Cover exposed soil with a minimum of 2 inches of straw or hay or other material approved for this purpose. J, Cover soil stockpiles with plastic sheeting and locate away from water bodies, roads, and property lines. Place gravel base on roads, driveways, and parking areas after clearing and subgrade preparation. lProtect 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 Mana ement 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. l � March 10, 1997 4 EROSION AND SEDIMENT CONTROL WORKSHEET 2. Describe how disturbed areas will be permanently stabilized(seeded, landscaped, apply gravel base to roadways, etc.) , 21- // vek— /,k/ Gru5e�( 1"oe4 ci"--/ ��1. v /�z✓ct �J L/3-t� e�-c 5 L, UGC s c c- e L✓ Gl 2 cnep4 1 4/ v N CGK 5ry v G `'��� 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.). 7 (� i / • • EROSION AND SEDIMENT CONTROL WORKSHEET 4. Specify your construction sequence. Describe the timing of aII land disturbingactivities and grading, construction, installation of drainage facilities, landscapin , etc.) and Best Management Practices. Describe proposed maintenance of BMPs. e Ke G p [ C i e e Gt Q ct (- G-•Z�� 5 cam- t The Best Management Practices proposed above will be implemented to control erosion, sedi stormwater runoff. I will notify the Permit Center for inspections as required. ment, and a — Signature of 0wner/Agent —3 e, Date hmomep(ncntrutonnwaheet doc March 10, 1997 6 • Jeffers County Department of Community Development ��.-s°N co�1 621 Sheridan Street,Port Townsend WA 98368 (360) 379-4450 ,- I ti G!�^ 1 ' '-�* Universal Plot Plan `SF17NG`S Fill in the following blanks as completely as possible : Project Description: 5 .',-Lyle 1,-kv.1 ;* ik.7 pL,-eII,* L 9 Digit Parcel Identification Number_cfro our tax statemen't): 72 C� 2r 0,.- Site Address 911#: Road Name: 54 ;h e N Zip Code: j ,8' 3 C`j Legal Description C Subdivision Name: J el t s 5 A V,`erA/ 40 1L P/ar U yl Block: Lot(s): ;)-. Section: 3 Township: 7...,-7 IQ Range: I E Parcel Size (acres or square ea foot :- g � _ • q-3 _Gt G✓ eS Property Owner: \To bu ki N. Phone: Mailing Address: 1 f Applicant/Occupant: Phone: (if different from owner) &e j 0� v t 3 -3 4 0 3 F 5 -4 'l 3 q Mailing Addr7s� 3 4. 4 n i ( 17, 3( 7 Authorized Rep: / Phone: Mailing Address: r General Contractor: £:t' 'awl Or Manufactured Home Installer: Phone: Mailing Address: Contractor's State License Number: Expiration Date: Septic Designer: Pv h /i.� uti j' IL 12;,3 ,1 * / Phone: Mailing Address: 17 `et [ -l`7 Cj 4,_ d/ ` t-l' V i 1 �Vc�-(�5 Architect:/Engineer: Phone: RP-Yl Ct 6( A- Ga..- hc(l>l .e{r- 6 ti 2--fl--7 W Mailing Address: 176 1/6 /4 14- r Q 5/a6-74 B �k e.e 1°l t /l e 5 � 7I4 Loan Lender/General L Phone: Contractor's Bond Holder: c-l,, .E7 Mailing Address: FOR OFFICE USE ONLY Fire District: Planning Area: School District: Zone: 1/00 H:\home\pincntr\forms\universal plot plan 5A ;kte mac/ a - _ Wvc'(1r Pr� PY - _ 48 - r� I /G c N (1249 , 1 , 1 . . _ _ -----. . , r _ . r by ern e _ I • AC t 1000 ,�! 0/11(4-17 lc A;T ,.) e , r7!jL. 6-aea.,E/ hoi7 f!Tar�:'-j k ;- e i 1 - c IaKk I 1 I I le g0 ).- / t. ..:,.. - -- lou- `z'1 � D- l I T 141212 il,"X Toy c)15. kit c- A 17P"°X .6 e a i �^� 4 7 „1-7 Fe ulA clay-t‘c, N A iO 30 60 es u� 1 p1 cm = 1 1� �