HomeMy WebLinkAboutBLD2000-00754 •
•
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 #: BLD00-00754
SITE ADDRESS: 572 LAST CAMP RD Issue Date Received Date 01/26/2001
QUILCENE, 98376 1/2 /200
Expiration Date 01/26/2002
APPLICANT: ANN M UHEREK
DANIEL J CUMMINS PHONE (425)454-4644
18930 NE 168TH ST
WOODINVILLE WA 980729168
SUBDIVISION: LAST CAMP LARGE LOT
PARCEL NUMBER: 701205013 Block: Lot: 5
Section: 20 Township: 27 N Range: 01 W
CONTRACTOR: WOODMASTERS, INC
-re-" r6 ®Ccc: PHONE: (206)842-6558
PO BOX11814
BAINBRIDGE ISLAND WA 98110 �"�/ 5�"?
Contractor's License: WOODMI*101 KU Expires: 05/25/2001
LOAN LENDER/ WASHINGTON MUTUAL BANK
BOND HOLDER:
PROJECT DESCRIPTION SINGLE FAMILY RESIDENCE (LOG HOME)
REQUIRED INSPECTIONS:
[ ] Setbacks (Shoreline Setbacks): y',e,- ' ,3exi
[ ] Footings: I_.A "-o-
[ ] Foundation:
[ ] Underground Plumbing/Underground Insulation:
[ ] Shear Wall:
[ ] Framing/Plumbing: ( ./Cnr� "o-;,3
[ ] Propane Tank/Lines:/",✓rc-` =e>c,is '
G/v �
.(U
[ ] Insulation: i ' C /
[ ] Sheetrock: J
[ ] Final/Occupancy Approval: OK 4 - CAC. J/'Z/ LI
HEALTH DEPARTMENT APPROVAL REQIIIRED 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.
HOT LINE AVAILABLE 24 HOURS A DAY
i:1F_BLD_Perm it_Bu ildng.rpt
10/29/19
! ,
BUILDING PERMIT APPLICATION Y 4 a
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00754 Received Date: 11/21/2000
SITE ADDRESS: 572 LAST CAMP RD
QUILCENE, 98376
APPLICANT: ANN M UHEREK PHONE: (425)454-4644
DANIEL J CUMMINS
18930 NE 168TH ST
WOODINVILLE WA 980729168
SUBDIVISION: LAST CAMP LARGE LOT Block: Lot: 5
PARCEL NUMBER: 701205013 Section: 20 Township: 27 N Range: 01 W
CONTRACTOR: WOODMASTERS, INC PHONE: (206)842-6558
PO BOX 11814
BAINBRIDGE ISLAND WA 98110
Contractor's License WOODMI*101KU Expires 05/25/2000
ARCH ITECT/
ENGINEER :
PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE (LOG HOME)
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,005
VALUATION 97,226.00 ADD'L: 641 HEAT TYPE: WOD
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES: 2
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: 612 SETBACK: 125
BANK HEIGHT:
SEWAGE DISPOSAL: OSS
WATER SYSTEM: PWELL PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: 0 Exist: Wetland Erosion
Prop: 3 Prop: 2 Seismic Streams
Total: 3 Total: 2 Flood Way Flood Plane
F&W Landslide
Routing Date: Shoreline Aquifer
Forest: Commercial Rural
—Proximity - Flat G d dons
Type Amount Paid By: Date: Receipt: Approve�R ate
Permit $979.75 MAM 11/21/00 35502 APPROVED
Plan Check $293.93 MAM 11/21/00 35502
State Building Code $4.50 MAM 11/21/00 35502
Potable Water Application $30.00 MAM 11/21/00 35502 14 N 2 4 7 0 01
Total: $1,308.18 FF RSO 0
DEPT. OF COMWNITY DEVELOPw1�FNT
SIGNATURE: ,C b.-y�.�c•rL
is\F_BLD_App_Bld.rpt 10/29/99
Jefferson County Department of Community Development
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6 621 Sheridan Street,Port Townsend WA 8�8[360]378-4450
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Project Description:
Building Type: Project Type: Frame Type:
Single Family X New (Wood
I. Garage Attached/Detached i Addition i Steel
Modular Alteration/Remodel Concrete
▪ Commercial = Repair I Masonry
Multi-family/#of Units = Demolition i Other:
I Industrial
▪ Other:
Bedrooms: Bathrooms: Type of Sewage Disposal: . Type of Heat:
Choose one:
Existing: _ Existing: Sewer =Community System Electricity Oil
Proposed: 3 Proposed: a Individual System XWoodstove IT Propane
Total: 3 Total: o� If not sewer,fill out the following: 1 Heat Pump
Conventional i Alternative Other
Permit # SEP q5-- no ?q
Water Supply: I
XPrivate well - Two Party Well I Public:Name of water system:
Square Footage: _ ' For Office Use Only
Main Floor j_`_ . _ UBC OCCUPANCY GROUP
21\'�Floor Base fee9. 1
3rd Floor Plan Check fee v ' O 3
Htd Basement NA State Surcharge fee LA ' ° ..J
Unhtd Basement N P I Subtotal \ a l - t
Ts-
Garage/Carport t\I t" I Pot Water Review fee 3C (30
Decks _ JC) 911/Rd Approach fee
Commercial TOTAL 1 . C . \
Industrial Receipt # c 3`5 ` -i___‘)
Other .,.. Cash/Check#
7.-----)..0:1C, ' -'- 3
Total Valuation: �^� Initials
Or ,,,�;° Date l l —�"/ — C` O
Estimated Cost:
\
If within 200' of the Shoreline,
Distance to Bank or Ordinary High Water Mark i&6- 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 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 struc
ture shall be requested and shall occur during regular business hours. /
Signature: &?44'L ��7!• Date: /( /I/ 0 0
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00754 Received Date: 11/21/2000
SITE ADDRESS: 572 LAST CAMP RD /4
QUILCENE, 98376
APPLICANT: ANN M UHEREK PHONE: (425)454-4644
DANIEL J CUMMINS
18930 NE 168TH ST
WOODINVILLE WA 980729168
SUBDIVISION: LAST CAMP LARGE LOT Block: Lot: 5
PARCEL NUMBER: 701205013 Section: 20 Township: 27 N Range: 11 W
r
CONTRACTOR: WOODMASTERS, INC PHONE: (206)842-6558
PO BOX 11814
• BAINBRIDGE ISLAND WA 98110 \ �'l�
Contractor's License WOODMI*101 KU Expires 05/25/2000 e '.
, ''' _j1. r
ARCHITECT/ q(i)1-
' '
ENGINEER : /� 1�ti �% , (
04.-
,,,r. iy,,I,
ti to
or
PROJECT DESCRIPTION: SINGLE FAMILY RESIDENCE (LOG HOME)
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,005
VALUATION 97,226.00 ADD'L: 641 HEAT TYPE: WOD
CODE EDITION: 1997 .
OCCUPANCY: R-3 HEAT BASE: HEAT TYPE:
n ,
OCCUPANCY: UNHEATED: # OF STORIES: 2 An
CONST TYPE: 5N GARAGE: SHORELINE:OTHER: ��1
CONST TYPE: DECK: 612 SETBACK: 120-1
BANK HEIGHT: , �
SEWAGE DISPOSAL: OSS LA-6
WATER SYSTEM: PWELL PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: 0 Exist: Wetland t. yJ/<W/4 Erosion
Prop: 3 Prop: 2 Seismic fir Streams
Total: 3 Total: 2 Flood Way AO .Flood Plane c
F&W _ andslid
Routing Date: `( IZZ ' G��,'','�g Shoreline YA- quifer 54/5,e—
J Forest: Commercial / ORural pia
Type Amount Paid By: Date: ~rReceilp '`.11 aov`ed ate ns
Permit $979.75 MAM 11/21/00 35502
Plan Check $293.93 MAM 11/21/00 35502 , '1/'\1tA.
State Building Code $4.50 MAM 11/21/00 35502
Potable Water Application $30.00 MAM 11/21/00 35502
Total: $1,308.189031r 114° 0
t
i:1F_BLD App_Bld.rpt 10/29/99
i Jeffers county Department of Community Development January 16, 2001
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: ANN M UHEREK i5) [ C [S II U E
DANIEL J CUMMINS
18930 NE 168TH ST
WOODINVILLE WA 980729168 111 JAN 2 2 2001 11-9
) Crilcal Area Review Case Number: CAR00-00334
JEFFERSON COUNTY
I Project Description: Single family residence. DEPT.OF COMMUNITY DEVELOPMENT
Parcel Number 701205013 S-T-R: 20-27N-01W
Site Address: 572 LAST CAMP 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:
1.) The application was reviewed by Jefferson County Permit Center staff on 7/25/00 for the potential presence
i of critical areas regulated under the provisions of the Ordinance, and the following critical areas were
confirmed as potentially present on the subject property: Wetlands, Susceptible Aquifer Recharge Area,
1 Erosion Hazard, Landslide Hazard Area II (Moderate), Eagle Habitat, Type 4 Stream, Shoreline
Conservancy. In addition, several plat conditions have been recorded for this parcel.
2.) Acting upon the above information, Jefferson County staff conducted a site inspection of the subject
property on 9/20/00 and confirmed the existence of the following critical areas and/or their associated
buffers on the property: Shoreline (Conservancy), Type 4 Stream, Eagle Habitat, Landslide Hazard Area II
(moderate), Erosion Hazard Area, Susceptible Aquifer Recharge Area, and Plat conditions.
3.) Last Camp Large Lot Subdivision was recorded on January 27, 1995 (Jefferson County Auditor's Number
378752). The subdivision contains several conditions pertaining to the development of the property. The
conditions include the following:
A. A Small Parcel Sediment and Erosion Control Plan is required (see attachments).
B. Building applications located less than 200-feet from the ordinary high water mark(of the
shoreline)must be accompanied by a Geotechnical Report.
C. A 50-foot buffer must be maintained from both sides of the two streams within the
subdivision.
D. That portion of Lots 5 and 6 which is within 125-feet of the shoreline has been designated as
a culturally sensitive zone known to contain Native American Archeological Resources. Ground
disturbing activities within this area may only be conducted after completion of a detailed
archeological study conducted by a professional archeologist.
E. Clearing is limited to 30% per each lot.
4.) All proposed Land Disturbing Activity is located further than 125-feet from the ordinary high water mark
(OHWM), therefore, an Archeological Study is not required.
5.) The applicant has formally requested a reduction from the Moderate Landslide Hazard Area from the
standard 30-feet down to 10-feet from the toe of the slope located on the southern portion of the property.
6.) 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.
-usceptible 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).
g,) 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.
g,) 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.
10.) This waiver also includes findings and conditions for evaluation of shoreline areas as regulated under the
provision of The Jefferson County Shoreline Management Master Program, adopted March 7, 1988, as
amended.
11.) The standard setback for residential structures, including common appurtenant structures such as garages
and workshops, shall be 30 feet, or 1 foot for each foot of bank height, whichever is greater. This setback
shall be measured from the bank's edge when the bank height exceeds 10 feet.
This w4verfrom 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.) A vegetive buffer of 10-feet shall be permanently maintained from the top or edge of the landslide hazard
area.All buffers shall be measured perpendicularly from the top of the landslide hazard area.
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.) 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).
4.) Among the native tree species which may be used are: vine maple (Acer circinatum) big-leaf maple (Acer
macrophyllum), red alder(Alnus rubra), Pacific madrone (Arbutus menziesii), quaking aspen (populus
tremula), black cottonwood (Populus trichocarpa), bitter cherry (Prunus emarginata), Oregon white oak
(Quercus garryana), cascara (Rhamnus purshiana), Pacific willow (Salix lasiandra), Scouler's willow(Salix
scouleriana).
5.) Among the native shrub species which may be used are: service-berry (Amalanchier alnifolia), red osier
dogwood (Cornus stolonifera)salal (Gaultheria shallon), ocean spray (Holodiscus discolor), indian plum
(Oemlaria cerasiformis), Pacific ninebark (Physocarpus capitus), red flowering currant (Ribes sanguineum),
wild rose (Rosa gymnocarpa), Nootka rose (Rosa nutkana), swamp rose (Rosa pisocarpa), willows (Salix
ssp.), red elderberry (Sambucus racemosa), snowberry (Symphoricarpos albus), evergreen huckleberry
(Vaccinium ovatum), red huckleberry (Vaccinium parvifolium).
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.
7.) 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."
8.) All construction activities, including the storage and preparation of materials, shall not encroach upon the
designated geologically hazardous area, or its associated buffer.
9.) Damage to vegetation to be retained on site shall be minimized by directional felling of trees away from
these areas.
10.) The applicant shall permanently separate the boundary of the landslide hazard area buffer from the
remainder of the subject property through installing and maintaining one of the following; logs, trees, a
hedge row, or other prominent physical marking. The separation method identified by the applicant shall be
approved by the Critical Area Administrator prior to planting or installation.
11.) 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).
ees and understory lying outside of approved construction limits shall be retained during clearing for
oadways and utilities. Understory damaged during approved clearing operations may, however, be pruned.
I• Clearing limits for roads, septic, water and stormwater utilities, and temporary erosion control facilities shall
be clearly identified on site and inspected by the Critical Area Administrator, or their designee, prior to the
it,*"‘ commencement of any clearing activities.
14.) Clearing for roads and utilities shall remain within marked limits.
15.) The applicant shall develop and submit to the Permit Center for approval, a "Small Parcel Erosion Control
Plan"(see enclosures). 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.
16.) A setback(buffer)of 50-feet, measured perpendicularly from the ordinary high water mark along the bank
of the Type 4 Stream shall be permanently maintained as a fish and wildlife habitat area.
17.) 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.
18.) Residential structures shall not exceed thirty-five (35)feet in height.
19.) Applicant shall fully and completely adhere to all the conditions and requirements of the eagle habitat
management plan which have been agreed upon between the applicant and the Washington State
Department of Fish and Wildlife.
kiCASF
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.
VO/
Applicant's Signature Date
c:2.4e•,---AgC(11/VvvIrtli,
is\F_CAR_Waiver W_Conds.rpt 12/13/99
1
Erosion Control Plan:
And erosion control will be provided by using Best Management Practices. The
`: 1Is are susceptible to erosion when exposed. During construction precautions
be taken to minimize the chances for erosion from the site. The Department of
.ogy
Stormwater Manual has requirements for small parcel erosion and sediment
.1. Drainage and erosion control elements for this site will include the following:
Clearing and grading should be done between April 1 and November 1. Clearing
• Unfits should be marked in the field prior to construction. Erosion control features
such as the silt fence should be installed prior to construction. Refer to the Small
Parcel Erosion Control Site Plan for location of the silt fence,
2. Previously disturbed areas outside of the building area should be revegetated with
native plants. Refer to the Binding Advance Determination for approved species.
3. Existing vegetation should be retained where possible. This means limiting the new
construction to the existing pad site. The existing single access site should be used.
As needed the roadway should be graveled to minimize erosion.
4. Denuded areas should be reseeded and stabilized as soon as possible. During the wet
season cases straw mulch or plastic sheeting should be use to cover exposed soils.
5. Adjacent properties should be protected. This means diversion of stormwater away
from the creek. Stormwater runoff should be routed around the structure to the
existing 8 inch culvert pipe located near the path to the beach. This pipe discharges to
the level ground between the shoreline and the building site. The native vegetation
should be maintained in this dispersion area. Rock spreader bars can be used to help
disperse the runoff. No direct runoff should be allowed to the creek of the beach.
6. Stormwater should be diverted around the construction site. These will include
diversion of water away from the working areas.
7. Maintain all features of the erosion control plan and upgrade as necessary.
Maintenance items include timely gravelling of the front parking area and Flash Road,
use of straw mulch to control erosion, maintenance of ditches, and reseeding the
disturbed areas after construction.
8. Revegetation should include timely seeding of the slope and disturbed areas with a
mixture of grass and clover. I recommend that the area behind the retaining wall be
planted with salal (Gaultheria shallon).
5
•
„wary of Recommendations:
-or construction at this site we have the following recommendations:
1. Maintain existing native vegetation on the site as much as is possible. When trimming
is necessary,window or top trees rather than cutting them down entirely. Immediately
`` south of the proposed house there are several trees which could pose a hazard to the
new. These should be removed with the stumps left in place. Do not use poison on
• b 'the bank vegetation.
..; 2. Establish and maintain at least native vegetation on disturbed areas. Promote native
salal and other low growing and drought tolerant plants along the cut slope. Allow the
root systems to provide strength to the soil.
3. Direct the stormwater runoff from new construction to the titeline drainage system.
Control the stormwater runoff such that there are no direct discharges to the creek or
the beach.
4. House construction should be placed on the existing prepared building.pad.
5. Construct a retaining wall along the toe of the existing slope. The retaining wall
minimum 5 feet high with drainage behind. Back fill the wall to within 2 feet of the
top. The wall should be an Ultra-Block segmental concrete wall as shown on the ��� ,.�
attached plan. The engineer should be onsite to inspect the foundation preparation ;
prior to placement of the blocks.
6. The house should be placed a minimum of 8 fee .way from the retaining wall. -�
Grading between the house and wall sho • i dude ditch to channel stormwater
toward the existing culvert.
7. The engineer should be onsite to view the excavation prior to placement of foundation
forms or installation of the retaining wall.
8. The south foundation wall should be reinforced to a minimum height of 4 feet.
Construction should be such that if debris overtops the retaining wall,the area
between the house and wall can be easily cleaned.
9. All backfill of the retaining wall shall be imported free draining sand b.nd gravel.
10. Place a continuous 4 inch diameter footing drain behind all footings. The footing
drains chall be non corrugated pipe and should slope to discharge to the east.
11. In accordance with the Uniform Building Code, the following values should be used
for design of the foundation:
• Allowable bearing capacity for this soil is 2000 lb. per square foot.
• Lateral Bearing 200 lb./sq./ft/ft. of depth below natural grade.
• Lateral sliding friction coefficient is 35 %.
• • All footings shall be placed onto firm native ground,unless approved structural
backfill is placed and compacted. Contact the engineer prior to placing
structural backfill.
6
YI`5
0 �
"..a 1
?i
project site is the proposed location of a new residence for Ann Uherek and Daniel
K'`,cuunmins. The recommendations within this report and indicated on the Small Parcel
Erosion Control Plan have been provided to satisfy the requirements of the Jefferson
County Interim Critical Areas Ordinance. The site is in a location with many
environmental restrictions. These restrictions are detailed in the Binding Advance
Determination. Construction on this site while conforming to the environmental
conditions and the above recommendations will not cause added instability to the
surrounding slopes. The recommendations within are intended to stabilize the area within
practical and economical means.
This report is based on a visual inspection of the existing site conditions and limited
subsurface exploration. The sole objective of this investigation has been to diagnose the
geotechnical conditions at the site of the proposed residence and provide
recommendations for construction. The report has been prepared for the exclusive use of
the Ann Uherek and Daniel Cummins and may be used by others only with the expressed
written permission of the Engineer. The observations,interpretations and conclusions
herein are based on generally accepted professional engineering and geologic principals
and practice. This warranty is in lieu of all others, either expressed or implied. In the
event of changed or unforeseen conditions,the Engineer should be contacted to review
the site and prepare an updated report.
z .
Signed, s, I'
J •
13789
11
EMIRATES_ /d-O6-Z_,00Z J
Jay S. Petersen, PE
4 Seasons Engineering, Inc.
•
Jefferson County Department of Community Development
c)1\ c"p� 621 Sheridan Street,Port Townsend WA 98368 (360) 379-4450
az :\
moo$ Universal Plot Plan
Fill in the following blanks as completely as possible:
Project Description: rare el 5 of Last Caryl p De Ve(op ow4,--,t Sha re floe am
VQhd b
9 Digit Parcel Identification Number (from your tax statement): �Q` 9-0 O (3
Site Address
911#: 5 7a. Road Name: Last Ca o p I cad Zip Code: 9 8-3 76
Legal Description
Subdivision Name: 1 Q 5 Celvn p Block: Lot(s): 5
Section: oZ O, ,R l Township: a 7 N Range: O I W
Parcel Size (acres or square footage): 3. 13 A Gre__
Phone: hia
Property Owner: s— L3A./ . (9 yh1 (wJ
inn (AhereK aina bate, Cumrnll� S tias- 7Fs � 30,E 3
Mailing Address:
) fs93o NE I(D -, st. 1/Iood►nvrl�� , VtJcc1 9IS'Dt70?
Applicant/Occupant: Phone:
(if different from owner)
Mailing Address:
Authorized Rep: Phone:
Mailing Address:
General Contractor: Woo o dl.ma a f e '.S , ' t 9CO-'f a a- $-(7 /
Or Manufactured Home Installer: Roger Fer re (I Phone: a 06—g7-la— ,y elq
Mailing Address: R . Box '10 i'4 Bahl) b ri'd3e Ts(end, W�4 9 811 CD
Contractor's State License Number: �1 e\fO o d 1AVlV # to
y Expiration Date:
Septic Designer: " 1� Phone:
Mailing Address:
Architect:/Engineer: Phone:
Mailing Address:
Loan Lender/General Wet 5h,h # - Mutt-tat( t3 Mel., k Phone:
Contractor's Bond Holder: (-18'Q0-7%- BoO
Mailing Address:
FOR OFFICE USE ONLY
Fire District: Planning Area: School District: Zone:
1/00 H:\home\pincntr\forms\universal plot plan