HomeMy WebLinkAboutBLD2001-00624 •
. • `
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 #: BLD01-00624 Received Date 11/2/2001
SITE ADDRESS: 1054 RIPLEY CREEK RD Issue Date 01/4/2002
QUILCENE, 98376 Expiration Date 01/4/2003
APPLICANT: TOM MEYER PHONE: (206)842-0218
PO BOX 11727
BAINBRIDGE ISLAND WA 98110
SUBDIVISION: Block: Lot: T 20
PARCEL NUMBER: 802351003 Section: 35 Township: 28 N Range: 02 W
CONTRACTOR: OWNER PHONE:
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION SINGLE FAMILY RESIDENCE W/ATTACHED GARAGE
REQUIRED INSPECTIONS:
[4TSetbacks (Shoreline Setback ):(Or "/7/C) Yid /-
[ Footings:04- 7)/7):1— ,� !ji P[ Fo dation: - ° —4 ' to 5 13/02, /At 4 -C.Ca o/c___,4
[ nderground Plumbing/Under round Insulate /l. l"a
''?Cfil-
[ ] ,, Shear Wall: 6; h IN; Axor e i 7.b5- )--t S 4-ate
[kr Framing/Plumbing: Zo/S
[ ] Propane Tank/Lines: -) ��� _ 'Ic "0'
[ { Insulation: 5' i�
[4', Sheetrock: ,�'�l3 d 1
[‘e( Final/Occupancy Approval: ° e- --p5
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.
SPECIAL CONDITIONS APPLY -SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS FOR CASE BLD01-00624
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on November 9, 2001 for the potential presence of Environmentally
Sensitive Areas (ESAs) under the provisions of the Unified Development Code(UDC).
After an initial Geographic Information Systems mapping review and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
Wetland Area at the Northwest Corner of the Property; Erosion at the Southwest Corner
(est. to be abt. 2 acres); Slight(level 1) Landslide Hazard at extreme Northeast Corner,
Spotted Owl on Entire Property; and Type 5 Stream Acros Northwest Corner which is a
Triburary to a Type 3 Stream located Off-Site.
2.) 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.
3.) Jefferson County has determined that the use of real property for agriculture and forestry
operations is a high priority and favored use in the county. The county will not consider to
be a nuisance those inconveniences or discomforts arising from such operations, if such
operations are consistent with commonly accepted best management practices in
compliance with local, state, and federal laws. If your real property includes or is within
five hundred (500)feet of real property designated as Rural Residential 1:10 or 1:20,
Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to
inconveniences or discomforts arising from such farming and forestry operations,
including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the
operation of farm and forestry machinery during any 24-hour period, the storage and
disposal or manure, and the application of permitted fertilizers and permitted pesticides.
One or more of these inconveniences may occur as a result of agricultural and forestry
operations which are in conformance with existing laws and regulations.
4.) A Type 5 Stream (Fish and Wildlife Habitat Area) has been identified on the subject
property.The Type 5 Stream is a tributary to an Off-Site Type 3 Stream. The stream will
require a minimum setback of 50-feet. The setback shall be measured horizontally from
the Ordinary High Water Mark(OHWM). Fish and Wildlife Habitat Areas shall also have
Buffers and Building Setbacks established.
5.) Buffers are areas that shall be maintained in their natural condition, however, minor
pruning or alteration of vegetation may be permitted as long as the function and character
of the buffer are not diminished.
6.) Among the native conifer species which may be used in buffers or for re-vegetation
include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis),
Shore Pine (Pinus Contorta), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar
(Thuja Plicate), and Western Hemlock (Tsuga Heterophylla).
Among native tree species which may be used includes: 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(Saliz Lasiandra), and Scouler's Willow(Saliz
Scouleriana).
Among the native shrub species which may be used are: Sevice-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
Nutkana), Swamp Rose (Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry
(Sambucus Racemosa), Snowberry (Symphoricarpos Albus), Evergreen Huckleberry
(Vaccinium Ovatum), Red Huckleberry(Vaccinium Parvifolium).
7.) The project components are more than 250'from the mapped/identified wetland. The
requirement for a wetland delineation and report is waived based on maintenance of a
225' buffer from the wetland per UDC Table 3-3.
8.) The project is located in close proximity to an identified wetland and is subject to the
delineation provisions of Section 3.6.9 of the Jefferson County Unified Development Code.
Based upon the proposed location of the project in relation to the identified wetland, the
applicant has agreed to maintain a buffer of 225 feet that exceeds the standard buffer
requirements by fifty (50) percent. The applicant acknowledges the additional setback
and agrees to maintain the extra 50 percent buffer, therefore, waiving the wetland
delineation requirements of the Unified Development Code.
9.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), shall maintain a vegetative
buffer setback of 50-feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the Proposed Single Family Residence.
10.) An additional setback of five (5) feet is required from the edge of the buffer area to the
proposed Single Family Residence.
11.) A permanent physical separation along the boundary of the buffer area shall be installed
and permanently maintained. Such separation can include installing logs, trees, a
hedgerow, or any other prominent physical marking approved by the UDC Administrator.
12.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or
every one hundred (100) feet, whichever is less. Signs shall be in place prior to and
during construction activities. The sings shall contain the following statement: "Buffer- Do
Not Remove or Alter Existing Vegetation."
13.) The applicant is proposing to create or add 2,552.5 square feet of impervious surface and
3,700 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson
County Unified Development Code requires that your proposal submit a Stormwater
Calculation Sheet. The applicant submitted a Stormwater Calculation Sheet.
14.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
15.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
16.) The parcel is a legal conforming lot that is designated Rural Residential 1:20 under the
Jefferson County Comprehensive Plan Land Use map, effective 8/28/98.
17.) This approval is for a single family residence with attached garage only. Any future
permits on this site are subject to review for consistency with applicable codes and
ordinances and does not preclude review and conditions which may be placed on future
permits.
18.) The site plan as submitted with the building permit application on November 2, 2001 has
been reviewed for consistency under the UDC. The site plan has been approved by
Jefferson County Department of Community Development. Any modifications, changes,
and/or additions to the stamped, approved site plan dated December 14, 2001 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
19.) A septic system permit(SEP01-00112) for a conventional system was issued August 15,
2001 and is valid until August 15, 2004.
20.) A building permit application (BLD97-00761) for construction of a workshop was issued
January 9, 1998 on the property. It was renewed January 18, 2001.
21.) A building permit application (BLD00-00711)was a wood stove installation on the property
was issued October 30, 2000 and finaled October 4, 2001.
22.) A standard critical area waiver(CAR97-00328) was finaled by the Jefferson County
Department of Community Development on January 8, 1998 for a detached workshop.
23.) The Washington State Department of Fish and Wildlife visited the site to review the
potential spotted owl use of the property. According to WDFW, the nest is located
approximately 2 1/2 miles from the proposed project site. This coupled with the presence
of young vegetation conifer and deciduous tree species (approximately 12-15 years of
age)with no established overhead canopy, it is unlikely that spotted owls would utilize the
habitat that exists onsite. The proposed single family residence will not likely have an
impact on the documented spotted owl habitat. WDFW made recommendations to retain
conifer trees to the greatest extent practicable, to provide future dispersal habitat for
spotted owls.
24.) As recommended by the Washington State Department of Fish and Wildife, the applicant
should be encouraged to retain conifer trees to the greatest extent practicable, to provide
future dispersal habitat for spotted owls. Dispersal habitat has been greatly impacted by
land use conversations and/or associated logging in the past. Any enhancement of these
areas may aid in the recovery of the spotted owl and therefore should be encouraged
where feasible.
25.) The property(parcel#802351003) is adjacent to designated Rural Forest located north of
the subject property and adjacent to designated Commercial Forest located east of the
subject property. Special setback requirments for adjacent development apply under
Section 3.5.3.(c)(1)of the Unified Development Code.
26.) The applicant shall establish and maintain a minimum setback of 100 feet for the subject
structure from the north property boundary[Rural Forest(RF-40)j as a resource protection
area..
27.) The applicant shall establish and maintain a minimum 250-foot setback for the proposed
single family structure from the East property boundary(designated Commercial Forest
Land) as a resoruce protection area.
28.) Minimum setback from the west property boundary line shall be 20 feet. Minimum setback
from the south property boundary line shall be 5 feet.
29.) Maximum lot coverage shall not exceed 25 percent.
30.) The building height shall not exceed 35 feet.
i:T_BLD_Permit_Buildng•rpt 10/29/19
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
UNIFIED DEVELOPMENT CODE
TYPE I LAND USE PERMIT
APPLICANT: TOM MEYER
PO BOX 11727
BAINBRIDGE ISLAND WA 98110
DATE ISSUED: January 04, 2002
DATE EXPIRES: January 04, 2003
MLA NUMBER: MLA01-00556
PROJECT PLANNER: J SMITH
PROJECT DESCRIPTION:
SINGLE FAMILY RESIDENCE W/ATTACHED GARAGE
PROJECT LOCATION:
Parcel number 802 351 003, Lord's Lake Loop Tracts, Tract 35-17 in Section 35, Township 28, Range 02 West, WM
located at 1054 Ripley Creek Rd, Quilcene, WA 98376
FINDINGS:
1.) The Administrator finds that this application complies with applicable provisions of the Unified Developmen
Code, all other applicable ordinances and regulations, and is consistent with the Jefferson County
Comprehensive Plan and Land Use map.
2.) The application was reviewed by the Jefferson County Department of Community Development staff on
November 9, 2001 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions o
the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an
investigative site inspection, the following ESAs were confirmed to be present on the subject property: Wetland
Area at the Northwest Corner of the Property; Erosion at the Southwest Corner(est. to be abt. 2 acres); Slight
(level 1) Landslide Hazard at extreme Northeast Corner; Spotted Owl on Entire Property; and Type 5 Stream
Acros Northwest Corner which is a Triburary to a Type 3 Stream located Off-Site.
3.) 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.
4.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high
priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or
discomforts arising from such operations, if such operations are consistent with commonly accepted best
management practices in compliance with local, state, and federal laws. If your real property includes or is
within five hundred (500)feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial,
Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from
such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust,
smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or
manure, and the application of permitted fertilizers and permitted pesticides. One or more of these
inconveniences may occur as a result of agricultural and forestry operations which are in conformance with
existing laws and regulations.
5.) A Type 5 Stream (Fish and Wildlife Habitat Area) has been identified on the subject property.The Type 5
Stream is a tributary to an Off-Site Type 3 Stream. The stream will require a minimum setback of 50-feet. The
setback shall be measured horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat
Areas shall also have Buffers and Building Setbacks established.
6.) Buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of
vegetation may be permitted as long as the function and character of the buffer are not diminished.
7.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited
to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis), Shore Pine (Pinus Contorta), Douglas Fir
(Pseudotsuga Menziesii), Western Red Cedar(Thuja Plicata), and Western Hemlock (Tsuga Heterophylla).
Among native tree species which may be used includes: 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 (Saliz Lasiandra), and Scouler's Willow
(Saliz Scouleriana).
Among the native shrub species which may be used are: Sevice-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 Nutkana), Swamp Rose (Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus
Racemosa), Snowberry (Symphoricarpos Albus), Evergreen Huckleberry (Vaccinium Ovatum), Red
Huckleberry (Vaccinium Parvifolium).
8.) The project components are more than 250' from the mapped/identified wetland. The requirement for a
wetland delineation and report is waived based on maintenance of a 225' buffer from the wetland per UDC
Table 3-3.
9.) The applicant is proposing to create or add 2,552.5 square feet of impervious surface and 3,700 square feet of
land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires tha
your proposal submit a Stormwater Calculation Sheet. The applicant submitted a Stormwater Calculation Sheet
10.) Jefferson County determined that this proposal is categorically exempt from review under the State
Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
11.) The parcel is a legal conforming lot that is designated Rural Residential 1:20 under the Jefferson County
Comprehensive Plan Land Use map, effective 8/28/98.
12.) This approval is for a single family residence with attached garage only. Any future permits on this site are
subject to review for consistency with applicable codes and ordinances and does not preclude review and
conditions which may be placed on future permits.
13.) The site plan as submitted with the building permit application on November 2, 2001 has been reviewed for
consistency under the UDC. The site plan has been approved by Jefferson County Department of Community
Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated
December 14, 2001 shall be resubmitted for review and approval by Jefferson County Department of
Community Development.
14.) A septic system permit(SEP01-00112) for a conventional system was issued August 15, 2001 and is valid until
August 15, 2004.
15.) A building permit application (BLD97-00761) for construction of a workshop was issued January 9, 1998 on th
property. It was renewed January 18, 2001.
16.) A building permit application (BLD00-00711) was a wood stove installation on the property was issued October
30, 2000 and finaled October 4, 2001.
17.) A standard critical area waiver(CAR97-00328)was finaled by the Jefferson County Department of Community
Development on January 8, 1998 for a detached workshop.
18.) The Washington State Department of Fish and Wildlife visited the site to review the potential spotted owl use of
the property.According to WDFW, the nest is located approximately 2 1/2 miles from the proposed project site.
This coupled with the presence of young vegetation conifer and deciduous tree species (approximately 12-15
years of age) with no established overhead canopy, it is unlikely that spotted owls would utilize the habitat that
exists onsite. The proposed single family residence will not likely have an impact on the documented spotted
owl habitat. WDFW made recommendations to retain conifer trees to the greatest extent practicable, to provide
future dispersal habitat for spotted owls.
19.) The property (parcel#802351003) is adjacent to designated Rural Forest located north of the subject property
and adjacent to designated Commercial Forest located east of the subject property. Special setback
requirments for adjacent development apply under Section 3.5.3.(c)(1) of the Unified Development Code.
CONDITIONS:
1.) The project is located in close proximity to an identified wetland and is subject to the delineation provisions of
Section 3.6.9 of the Jefferson County Unified Development Code. Based upon the proposed location of the
project in relation to the identified wetland, the applicant has agreed to maintain a buffer of 225 feet that
exceeds the standard buffer requirements by fifty (50) percent. The applicant acknowledges the additional
setback and agrees to maintain the extra 50 percent buffer, therefore, waiving the wetland delineation
requirements of the Unified Development Code.
2.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), shall maintain a vegetative buffer setback of
50-feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to the
Proposed Single Family Residence.
3.) An additional setback of five (5) feet is required from the edge of the buffer area to the proposed Single Family
Residence.
4.) A permanent physical separation along the boundary of the buffer area shall be installed and permanently
maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical
marking approved by the UDC Administrator.
5.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred
(100) feet, whichever is less. Signs shall be in place prior to and during construction activities. The sings shall
contain the following statement: "Buffer- Do Not Remove or Alter Existing Vegetation."
6.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and
sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during
construction, and in the design and operation of stormwater and drainage control systems.
7.) As recommended by the Washington State Department of Fish and Wildife, the applicant should be encouraged
to retain conifer trees to the greatest extent practicable, to provide future dispersal habitat for spotted owls.
Dispersal habitat has been greatly impacted by land use conversations and/or associated logging in the past.
Any enhancement of these areas may aid in the recovery of the spotted owl and therefore should be
encouraged where feasible.
8.) The applicant shall establish and maintain a minimum setback of 100 feet for the subject structure from the
north property boundary [Rural Forest(RF-40)] as a resource protection area..
9.) The applicant shall establish and maintain a minimum 250-foot setback for the proposed single family structure
from the East property boundary (designated Commercial Forest Land) as a resoruce protection area.
10.) Minimum setback from the west property boundary line shall be 20 feet. Minimum setback from the south
property boundary line shall be 5 feet.
11.) Maximum lot coverage shall not exceed 25 percent.
12.) The building height shall not exceed 35 feet.
NOTICE: This permit does not excuse the proponent from complying with other local, state, and federal
ordinances, regulations, or statutes applicable to the proposed development.
Development pursuant to this permit shall be undertaken subject to the applicable development and performance
standards of the Jefferson County Unified Development Code.
If during excavation or development of the site an area of potential archaeological significance is uncovered, all
activity in the immediate area shall be halted, and the Administrator shall be notified at once.
The Federal Endangered Species Act rules to protect threatened Chinook and Summer-run Chum salmon
became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the ESA,
any person may bring lawsuit against any individual or agency that"takes"listed speces (defined as causing
harm, harassing, or damaging habitat for the listed species). In addition, the National Marine Fisheries Service
can levy penalties. All areas in Jefferson County are included as"critical habitat"for a listed species.
Development of property along any marine shoreline, freshwater shoreline, or floodplains could harm habitat if
protective measures are not taken. To minimize the potential to damage habitat, all property owners developing
adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the following:
- Set back buildings, utilities and roads as far as possible from surface waters(streams, rivers, lakes, marine
waters), or at least 150 feet from the edge of the water
-All development activities should avoid unstable slopes, wetlands, and forested areas near surface waters
- Remove minimal vegetation for site development, especially large trees
-Allow trees that have fallen into surface waters to remain there
- Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into
surface waters or roadside ditches
Any individual, group, or agency can bring suit for a listed species "taking," even if you are in compliance with
Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a
professional fisheries habitat biologist,and following the recommendations for site development provided by the
biologist. For more information, contact the National Marine Fisheries Service in Seattle at (206)526-6613, or the
U.S. Fish and Wildlife Service at(503) 231-6121.
APP EALS:
Pursuant to RCW 36.70C, the applicant or any aggrieved party may appeal this final decision to Jefferson County
Superior Court within twenty-one(21) calendar days of the date of issuance of this land use decision. For more
information,elaterrl to judical appeals see UDC Section 8.5.2.
`i/O�
UDC dministrator
;
1 r
56
BUILDING PERMIT APPLICATION ReAOw Ope: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00624 Received Date: 11/2/2001
SITE ADDRESS: 1054 RIPLEY CREEK RD
QUILCENE, 98376
OWNER: TOM MEYER PHONE: (206)842-0218
PO BOX 11727
BAINBRIDGE ISLAND WA 98110
SUBDIVISION: Block: Lot: T 20
PARCEL NUMBER: 802351003 Section: 35 Township: 28 N Range: 02 W
CONTRACTOR: OWNER PHONE:
REPRESENTATIVE(S):
PROJECT DESCRIPTIO SINGLE FAMILY RESIDENCE W/ATTACHED GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,256
VALUATION 163,199.00 ADD'L: 720 HEAT TYPE: WOD
CODE EDITION: 1997 HEAT BASE: 540 HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: 660 #OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: 917 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: OSS
WATER SYSTEM: PWELL PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: 3 Prop: 4 Seismic Streams
Total: 3 Total: 4 Flood Way Floodplain
F&W Landslide
Routing Date: (J f;, r V((oft(0 ( e,(-2_, . Shoreline Aquifer
Forest: Commercial Rural
Proximity_ plat Conditions
Type Amount Paid By: Date: Receipt: -Permit $1,352.15 MAM 11/02/01 42365 AFIARoVeED Plan Check $405.65 MAM 11/02/01 42365
State Building Code $4.50 MAM 11/02/01 42365 JAN U 4 2001
Potable Water Application $30.00 MAM 11/02/01 42365
Total: $1,792.30 'WO •PT
.AFC• NITY,PEYEL ENT
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SON co Jefferson County Department of Community Dev: ,1 i ment
�A. T` �� 621 Sheridan Street,Port Townsend WA 08368[360]378-4450
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Project Description: NOV — 2 2001
Building Type: Project Type: rame Type:
Ingle Family ✓�Iew JEF bi'l iN COUNTY ood
(/Garage Attached/Detached Addition DEPT. OF COMMUNITY DEVEL?P.MINTeI
7 Modular I. Alteration/Remode Concrete
- Commercial I Repair .1 Masonry
Multi-family/#of Units Demolition ._. Other:
Industrial
Other:
Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: Existing: , l Sewer Community System Electricity Oil
Proposed: t Proposed: �jlndividual System 1✓Woodstoveopane
Total: Total: —at-5—5 If not sewer,fill out the following: Heat Pump
71 Conventional _ Alternative I Other
Permit# SEP
Water Supply:
Private well , Two Party Well II Public: Name of water system:
Square Footage: OrFor Office Use Only
am Floor /I '1.D '` 1Z!1$ —" UBC OCCUPANCY GROUP lir D Floor t,° , d 1 ". q(S11- Base fee ( 3S2• lc
3rd Floor Plan Check fee 4-oS•615-
Htd Basement c4 0 ". �5 I��Zy State Surcharge fee /Lc- D
Unhtd Basement ,`66 0 ''' !ge0- 2D Subtotal 1 7b Z. 30 rak g__r p
Garage/Carport 'f Pot Water Review fee
q grit)
Decks 1 t7 "l. t) 911/Rd Approach fee95
Commercial 1 TOTAL 1-(/
'Q Z' 30
I
Industrial t„.3�� Receipt# 1l L 5
Other Cas. Check# --Q —7
Total Valuation: Ind 'als PJ
Or Date
I(2(0I 0
Estimated Cost: �^03 i� I 3C ‘00 1 ��s>,�
If within 200' of the Shoreline, �i� C
Distance to Bank or Ordinary High Water Mark ft. Bank Height ft.
l
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 am
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
iiinst JefFers.on County as a result of or in consequence of the granting of this permit.
ether agree to provide access a 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 tot plicant's property or strucm e shall be requested and shall occur during regular business hours.
Signature: Date: i dO/
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