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HomeMy WebLinkAboutBLD2000-00627 • 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 #: BLD00-00627 Received Date: 9/25/2000 SITE ADDRESS: 2333 CAPE GEORGE RD Issue Date: 11/9/2000 PORT TOWNSEND, 98368 Expiration Date 11/9/2001 APPLICANT: DAVID JOHNSON 2333 CAPE GEORGE RD PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: T 16 PARCEL#: 002124011 Section: 12 Township: 30 N Range: 02 W CONTRACTOR/ DEALER INSTALLER: GUY JONES WAINS0254 Expires: 7/1/2001 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION MAKE: SKYLINE YEAR: 2000 SIZE: 27 X 56 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 11/9/2001. REQUIRED INSPECTIONS: ] Footing/Setback (If continous footings are used): [ta--"Estaking/Setba s 1 ! ' /e"l �� [ J Final/Skirting/Vents/Porches/Steps: "Y1 bK k%?O--z I tnrM— I��iyne n1,r. I 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 ,, s BUILDING PERMIT APPLICATION ' Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00627 Received Date: 9/25/2000 SITE ADDRESS: 2333 CAPE GEORGE RD PORT TOWNSEND, 98368 APPLICANT: DAVID JOHNSON PHONE: (360)385-3407 2333 CAPE GEORGE RD PORT TOWNSEND WA 98368 • SUBDIVISION: Block: Lot: T 16 PARCEL NUMBER: 002124011 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: ON GARRISON CQ,14S-Ti C ION PHONE: (360)379-0548 714PS ,5�e. w �ati -..1 T POR 98368 L,G,Y ,". Contractor's License VERNOG Q8 Expires 05/30/2001 ARCHITECT/ DBERG H ENGINEER : 250 T DR T TOWNSE 98368 PROJECT DESCRIPTION: MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB SQUARE FOOTAGE: 5 K M t I Na. ( Le Y `T"orf TYPE OF IMP NEW `.vr` c).e0-4) VALUATION 60,000.00 MAIN: 0 CODE EDITION: 1997 ADD'L: HEAT TYPE: PRO OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE. SETBACK: DECK: 0 BANK HEIGHT: SEWAGE DISPOSAL: ALT : ( -: 'el , ^'c- " L rswskt-„-•1, WATER SYSTEM: PWELL PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: 2 Prop: 2 Seismic Streams Total: 2 Total: 2 Flood Way Flood Plane Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural —Proximity Type Amount-Pam-By: Date: Receipt: Permit ($755.75.{MAM 09/25/00 34338 A : PROVED Plan Check $226.73 MAM 09/25/00 34338 State Building Code $4.50 MAM 09/25/00 34338 NOV 1 9 2 000 Potable Water Application $30.00 MAM 09/25/00 34338 Total: $1,016.98 Jefferson County Planning &Building Department e_c/.2-< :( 0 clo tkj.",,,k_ rvt4A4.— 1 tyi d d pocesi- cs � f 0 is\F_BLD App_Bld.rpt 10/29/99 a j \--\ V� FF R N N TY V T 1 .H RIDAN T T WN N WAMAN D HOME INSTALLATION PERMIT APPLICATION ❑ NEW BUIILybLDING// ❑ REPLACEMENT � _SIZE 71 )(S ' � 15 YEAR �OOfjMAKEiCOSTil..../144'.C.--e----1b _ __PORT DROOMS: BATHROOMS: EXISTING YJ EXISTING PROPOSED v PROPOSED TOTAL f, TOTAL TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: 0 SEWER 0 COMMUNITY SYSTEM RIVATE WELL 0 TWO PARY WELL INDIVIDUAL SYSTEM 0 Conventional ❑ PUBLIC PERMIT # SEP 0 Alternative Name of water system: 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 regul r business hours. SIGNATURE RiL} DATE /(/Z...//1---C3 NAME (P E P NT) 7)f A OVA L, �1, y F.i - ` . 6 h 0 n ,49 71 FOR OFFICE USE ONLY S EE / f° �,�0, RECEIPT.# •DDITIONAL SECTIONS CASH/CK# // SUBTOTAL ~7 t" G/ DATE I I POTABLE WATER 911/ROAD APPROACH TOTAL / / cc1 H:\HO ME4PLN CNTR\FO RMS\MOBILEAP.10/99 1 Jefferson Canty Department of Come y develenn t •�gsoN �°�. 621 Sheridan Street,Port Townsend WA 88368 MOW 378-4450 l U �JUUAp © ©o 4 r_Y='�$ 0 FIIN. Project Description: /2 1/c)/- l A`/t-` T b ii-A o<C._,.c�', , ,, - C Aile��' ,ale-X Building Type: Project Type: Frame Type: • Single Family ®► New ! Wood ❑ Garage Attached/Detached ❑ Addition ❑ Steel ❑ Modular ❑ Alteration/Remodel ❑ Concrete ❑ Commercial ❑ Repair ❑ Masonry ❑ Multi-family/#of Units ❑ Demolition ❑ Other: ❑ Industrial ❑ Other: _ Bedrooms: Bathrooms:• Type of&wage Disposal: Type of Heat: Choose one: Existing: Existing: ❑ Sewer ❑Community System igjtUottleyL ❑ Oil Proposed: Proposed: rAIE IF Individual System ❑ Woodstove /•)Propane� Total: Total: If not sewer,fill out the following: ❑ Heat Pump t— ❑ Conventional ❑ Alternative ❑ Other Permit# SEP per Supply: Private well ❑ Two Party Well❑ Public:Name of water system: Square Footage: { ' For Office Use Only 1 Main Floor 1 • 2© ±c., f T UBC OCCUPANCY GROUP _ _ 2�Floor / Base fee '� - ' - 3ed Floor /1 PfaEtrfee ' Htd Basement iU /'- ` State Surcharge fee t 1 �-' Unhrd Basement Al / j� Subtotal ci f 7 Garage/Carport ✓�I (D Pot Water Review fee ? - Decks to L� �`L✓ 911/Rd Approach fee q Commercial /`' TOTAL 1 0 1 1(9 - 9 C� Industrial / ( /-)- ___ e Receipt # _ Other A Cash/Check# Total Valuation: (0T-1- Initials Or — Date ) Estimated Cost: ( O If within 200' of the Shoreline, /l Distance to Bank or Ordinary High Water Mark /`- ft.Bank Height // ft. By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any A 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 provide acces d right of envy-TO' f efferson Counwarad it leinia dyees,representatives or agents for the purpose of application review and anyrequired later inspections. Access and right of entry t applicant's-ptitperty o�stnicane"shalli e-recifested and shall occur during regular business hours.7/7Z7/ Signature• ' Date: /� ,� BUILDING PERMITAPPLICATION ` Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00627 Received Date: 9/25/2000 SITE ADDRESS: 2333 CAPE GEORGE RD PORT TOWNSEND, 98368 APPLICANT: DAVID JOHNSON PHONE: (360)385-3407 2333 CAPE GEORGE RD PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: T 16 PARCEL NUMBER: 002124011 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: VEThg -GARRISON CONST ION G PHONE: (360)379-0548 714PSTREE "`� —�'0aes PORT TO WA (,JA rn.!S O.2, 7 1-1 Co ARCHITECT/ LIN H ENGINEER : LAP PORT TOWNSEND W98368_____a PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE A9/41vv�R.crUD.,D ,'dyd-e TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,120 VALUATION 65,672.00 ADD'L: HEAT TYPE: PRO CODE EDITION: 1997 HEAT BASE: HEAT TYPE: k OCCUPANCY: UNHEATED: #OF STORIES: '--1 { J OCCUPANCY: L' CONST TYPE: OTHER: SHORELINE: (` -; r{7 GARA CONST TYPE: DECKLE 368 SETBACK: BANK HEIGHT: f. SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL PARCEL TAGS: NO BEDROOMS: BATHROOMS: STORMWATE' iI NO AREA Exist: Exist: Wetland Erosion N(C) Prop: 1 Prop: 1 Seismic Streams Ty r1-` ;'� Total: 1 Total: 1 Flood Way 0 Flood Plane r1 0 F&W Landslide I 1— Routing Date: /�.;. Shoreline Aquifer �[]� Z �I Forest: Commercial Rural N —Prm xllt tove��date��ttlo ns ' Type Amount Paid By: Date: Receipt: ANlappr Permit $755.75 MAM 09/25/00 34338 Ncr Plan Check $226.73 MAM 09/25/00 34338 s. �, State Building Code $4.50 MAM 09/25/00 34338 8 c�' 4 .. Potable Water Application $30.00 MAM 09/25/00 34338 40 ,' ( I c...Total: $1,016.98 \ i I $%°°".. ''''" iii) ' ,. © 11 ofr K AVM. ' V `, SA4 ir 1 ,V9 cc7Q* ,_ ,,, ,,.. , (- --.- y0 V'-' i:\F_BLD_App_Bld.rpt 10/29/99 arson County Department of Community Development October 5, 2000 21 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: DAVID JOHNSON 1 ' I y M 2333 CAPE GEORGE RD •.�� — PORT TOWNSEND WA 98368 • Critical Area Review Case Number: CAR00-00425 t-- -- --- —J Project Description: Single Family Residence ( � ;' r Parcel Number. 002124011 S-T-R: 12-30N-02W Site Address: 2333 CAPE GEORGE RD PORT TOWNSEND WA, 98368 FINDINGS: In accordance with the authority provided under subsection 4.101 and the requirements contained in Subsection 5.402 of the Jefferson County Interim Critical Areas Ordinance, the following are findings of fact relating to the referenced application: 1.) The application was reviewed by Jefferson County Permit Center staff on 5/25/00 for the potential presence of critical areas regulated under the provisions of the Ordinance, and the following critical areas were confirmed as potentially present on the subject property: Susceptible Aquifer Recharge Area, Landslide Hazard I & II (low to moderate), and a Type 5 Stream. 2.) Acting upon the above information, Jefferson County staff conducted a site inspection of the subject property on 6/16/00 and confirmed the existence of the following critical areas and/or their associated buffers on the property: Landslide Hazard Area (low), Susceptible Aquifer Recharge Area, a Type 5 Stream. 3.) The proposed building envelope is located over 1000-feet from the Landslide Hazard Area. 4.) 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. 5.) Susceptible aquifer recharge areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. This includes any portion of Jefferson County with a DRASTIC index of greater than or equal to 180 points as determined using the U.S. Environmental Protection Agency DRASTIC methodology: Drastic: A Standardized System for Evaluating Ground Water Pollution Using Hydrogeologic Settings (EPA 600/23-87-035). 6.) A Type 5 Stream is located along the southern portion of the property. The Stream requires a setback buffer of 15-feet. The buffer shall be measured perpendicularly from both sides of the stream. In addition, the entire 15-foot buffer shall be vegetated. 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.) Among the native conifer species which may be used are: grand fir(Aibes grandis), sitka spruce (Picea sitchensis), shore pine (Pinus contorta), Douglas-fir(Pseudotsuga menziesii), western redcedar(Thuja plicata), western hemlock (Tsuga heterophylla). • .. which may be used are: vine maple (Acer circinatum) big-leaf maple(Acer (Anus rubra), Pacific madrone (Arbutus menziesii), quaking aspen (populus (Populus trichocarpa), bitter cherry (Prunus emarginata), Oregon white oak z '`-' ),cascara (Rhamnus pursh"iana), Pacific willow(Salix lasiandra), Scouler's willow(Salix .;� native shrub species which'may be used are: service-berry (Amalanchier alnifolia), red osier " (Comus stolonifera)salal (Gaultheria shallon), ocean spray(Holodiscus discolor), indian plum aria cerasiformis), Pacific ninebark (Physocarpus capitus), red flowering currant (Ribes sanguineum), 'wild rose(Rosa gymnocarpa), Nootka rose (Rosa nutkana), swamp rose (Rosa pisocarpa), willows (Salix v,� ssp.), red elderberry (Sambucus racemosa), snowberry (Symphoricarpos albus), evergreen huckleberry (Vaccinium ovatum), red huckleberry (Vaccinium parvifolium). ,,; '" 4.)" A 15-foot setback buffer shall be maintained from both side of the identified Type 5 Stream. This buffer shall be measured perpendicularly from the stream. In addition, the setback buffer shall be vegetated. ti/a.M.MtieV(91- 16 //, or) Warren Hart, Al Da /to 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 . and return to the Department of Community Development. °-u-wP E:i_C:=40.41_,L /®-6 - 00 Applicant's Signature Date c: File I:\F_CAR_Waiver_W Conds.rpt 12/13/99 • • STORMWATER CALCULATIONS Owner/Applicant: 11 Q� F �� \,6-zt7� ❑ PROPOSED LAND DISTURBING ACTIVITY Site Address: Drainfield area cleared sq.ft. S C '71 E9L� Driveway Length ft. (/ X Width ft. 9 Digit Parcel Identificafjon No.:0 - 1 "0 / ( = Total Driveway 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 sq.ft. Draw entire parcel to scale. Indicate scale of plot plan: One inch equals E IMPERVIOUS SURFACE Proposed Structures (all roof area) sq.ft. 1. North arrow Existing Structures (all roof area) _ sq.ft. 5�2. All property boundaries and dimensions Sidewalks sq.ft. 3. Names of adjacent streets Concrete Patios sq.ft. 4. Driveway/s & parking spaces Proposed: 5. Major features such as ravines, Driveway Length ft. seasonal creeks, bodies of water, etc. X Width ft. '\6. Septic tank, drainfield and reserve area location, = Total Driveway sq.ft. existing or proposed, and distance to Total Impervious Surface sq.ft. closest structure 4�QILc ce2 L 7. sewer sines- The Stormwate Manual sets forth the following Small Parcel Minimum Requirements: 8. Wells and/or water lines • Construction Access Route Stabilization: 9. Neig • s within Construction vehicle access shall be, whenever feasible, limited to one route. Access points shall be stabilized with ^ o Pri surfaces (patios) quarry spalls or crushed rock to minimize the tracking of Structures, existing and/or proposed sediment onto public roads. If sediment is inadvertently transported onto public roads, roads shall be cleaned E 12. Setbacks (distances to property thoroughly at the end of the day by shoveling or sweeping. boundaries, structures, banks, Street washing should only be done after the bulk of the sediment has been removed by sweeping. and shorelines) • Stabilization of Exposed Soil: All exposed and unworried soil shall be stabilized by sodding, 13. 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 Management Practices (BMPs). INDICATE: • Maintenance: ❑ 15. Ordinary high water mark All erosion and sediment control BMPs shall be regularly inspected and maintained to ensure continued performance of E 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\FORMS\PLOTPLN.FRM9/97 !IF . . . , ),,. , bi W (� r. 4 ,,,,, , , 7 I (I, ji Ce ., L.....±..H '\ r ; ' .f.../. P)4 ii 0 .3 \ �7 5— ' 27117-"ji:1 �6:1 9 I w . U c,... 1 i ! i .'y I._ 1 I I I UIS0. a io=�d f - 8 l''.,8 gig elt V. W..r. ' AJG ,T 1m�1 a n � I Q . �D M\. ' �'h- 7 mINR S y •Of I $0.. /]�\ cl 0 LF, j :7 i t t, _ Alial/ c<X1/4/ :. \ � " \..] . i r - 7 %Ia 1 �" tilir E u b Q 4 I 1 IraP Z. 4_ a q iill ; F i i 1111 F. `� r _0 3E 1d 3113NC3C b508TLtEa;T Lb : 0 6EET/6T OT Jefferson County Department of Community Development ' 621 Sheridan Street, Port Townsend, WA 98368 CRITICAL AREAS QUESTIONNAIRE Applicant Name ,V 1 a- cGVI't9� Y\'n S 0----3,c=_ _Building Application _ 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 K Yes _ No property or on any nearby property at any time during the year? If YES, please describe: LP 2:1:5- -41- -- '2' l 61 ( emu,y 1.‹.. Z.) ,;� 2. Has any portion of the property or any nearby property ever been _ Yes No identified as a wetland or swamp? If YES, please describe: 3. Are an ,willows, kunk cabbage,,alders, or cottonwoods present ' Yes _ No on your prop rty or adjacent properties? If YES, please d scribe: 4 -- i2.e- 4. Are there any indications on any portion of the property or on any YES — No nearby property of rockslides, earthflows, mudflows, orcndslides If YES, pl se.descri e: _ /,, 5. Please i dica e which line best represents the ste- est slv1-4, _ found on your property. (Check appropriate box) r' 7, 0 Ej / / / / / / // / / / / / / / / / / / / / / / / / / 1 / / / / / / / /J / / / / / / ♦ / / / / / / / / / I / / / / / / / / / / / / / / / /L / I / / / / / // // / / / / / / / / / I / / / / / / / // /+ I / / / / / / / / // I I / / / / / V / / I/ / / / / ♦ / // / TO III,,, , / / // ........--tJ I//////,/ /// (Questionnaire Continues on Back) Page 1 of 6. Does the site have steep slopes with little to no vegetation? _ YES No , If YES, please describe: 7. Does the site contain high percentages of silt and/or very fine — YES NC sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the _ YES 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. lip, I further agree to save, indemnify and hold harmless Jefferson County against all liabilities, judgments, court costs, reasonable attorney's ees 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 o application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested arc shall occur during regular business hours. Signature z �" ' (--d Date / / - FOR OFFICE USE ONLY Wetlands E Seismic CRITICAL AREAS ON OR ❑ Aquifer Recharge Area (zone ) Fish & Wildlife Area 1 IMMEDIATELY ADJACENT TO SITE: = Frequently Flooded Area ❑ Fish & Wildlife Area 2 LE Erosion C Landslide Seismic E Commercial Forest Section Township North Range Parcel Number: Parcel Size: Comprehensive Plan Land Use Designation: Reviewed by: Community Plan: Date: Page 2 of 2 h:AhomeApincntrAforms\car.doc 1/00 Z,4%.2J-- ,)/.&,/A j r /f c.fCvL._/ i Z 3 3 , OVA? 6-7,eort'i ig..d '1\\ C , ir aI 0 - 4, a - U 1 f 1 1 i 0 ° OV 1-- U Q d , t"-f , K fity J \ • 1`J I kip + . „lit 4, ic ,r, ,\\ ,---qo ----, ,puc7 , _ 1[40 - , ,, i, ---) ,..,, ---,)...„__ ._ , ,,,,---,<, -------------------_________ , _ ,0 ---. ; \,I . __..__________ . ---., ____________, ___ ___ _ ` ,..' _______ . t., i) ...____---- _______ _ -______ __------------ ______ ---- , ,.....__________---„ ----_____________ ----------...: 4 '," • ' k) 8 04 41 O Mcrl 0 M F�1 -) O ` ho �,�.� •U° +.4 D il ) Qt o -„, nt .,,,,, ... 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Z ti (l' Z W o � w • \I-5\1'91' zaN 7wy o � Z � o %) Y J o a F] V Q. �b(S Q OL lo- a Pyob N q 2 /2o Y 1 ti x . ,Q QY --��,f---- z �v a a. d 4 H y E . 0 c m O ili N C a . a H Q Jefferson County Department of Community Development /�� oN cpo 621 Sheridan Street,Port Townsend WA 98368 (360) 379-4450 , /w ' ,•, . 7r,tzyr, Universal Plot Plan Fill in the following blanks as completely as possible: Project Description: 9 Digit Parcel Identification Ngmber (from your tax statement): Site Address - `75 i' 911#: a. RoaNam � ' �` " Zip Code: Legal Description �, 2j2 P Subdivision Name: , � � `�" Block: <S 3 Lot(s): Section: 1 .. Township:3 j o r.t Range: o,2 z,e2/:-,(2_ Parcel Size (acres or square footage): / --a_ t, ,,; Prop Phone• Mailing Address: , _,t /5 f-e)22,(--,a--i-c-e-er 4.)0=--, Applicant/Occu�aannt: i Phone: (if different from owner) Mailing Address: Authorized R +""' Phone: _7i ,.,-)5,__.3 Li,6 7 Mailing Address: General Contractor: r 4 Or Manufactured Home " �,A.: " c_ .-�a. P Mailing Address: Contractor's State License Nurnber: , _, Expiration Date: f3'YZ �='f o ; ie,�.� � ( tg®sat-s C 2 .5` � S� m , Septic Desfiner• � Phone: / Mailing Address: C-` e Architect:/En eer: 7%, Phone: Mailing Address: Loan Lender/General / ;_ Phone: Contractor's Bond Holder: '"W L e;t_6 -- Mailing Address: FOR OFFICE USE ONLY Fire District: Planning Area: School District: Zone: 1/00 H:\home\pincntr\forms\universal plot plan