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ZON2014-00025
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT UNIFIED DEVELOPMENT CODE TYPE I LAND USE PERMIT APPLICANT: TERESA CORNSTOCK 1240 W SIMS WAY#88 PORT TOWNSEND WA 98368 DATE ISSUED: ,'(c e l f DATE EXPIRES: j (p MLA NUMBER: MLA14-00059 PROJECT PLANNER: David Wayne Johnson PROJECT DESCRIPTION: Change of Use Permit Producer/Processer of Cannabis (1-502) CHANGE OF USE PERMIT Tier 1 Producer/Processor Cannabis- 1-502 PROJECT LOCATION: Parcel Number 001 212 016 S21, T3ON, R1 W, located at Unit UN 274 Otto St. Port Townsend, WA 98368 CONDITIONS: 1.) Approval of this permit does not provide any assurance of future approvals for use of onsite sewage disposal on the property. Actions taken to date and proposed as part of this project may limit or prevent future development proposals. Future proposals must meet current code at the time of application. 2.) JCPH approval for the septic system connection is approved based on the growing operation using soil as the growing medium. The use of hydroponic or water based growing media IS NOT approved. 3.) JCPH approval is based on the proponent's statement that processing of'edibles'will be limited to Teas, Dry cocoa mix, oil tonic, dry bud/trim and keif. No other processing other than the use of the crock pots as described by the licensed designer have been approved. Any change in processing or menu will required further review by this office. 4.) The existing septic system on the parcel (SEP13-85) is fitted with a pretreatment device that is intended to ensure only residential waste strength wastewater is discharged into the drainfield. Per conditions of the septic permit-Waste Strength (BOD, TSS, Grease and oils) is to be monitored EVERY 6 MONTHS for the first year of operation and annually thereafter. Responsibility is that of the owner. Results are to be submitted to the Jefferson County Public Health. 5.) Exceeding the permitted design flow of 660 gal/day max. or 435 Gal/day average, shall constitute a violation of this permit. Water usage monitoring shall be monitored monthly. These monitoring results shall be submitted to the Jefferson County Health Dept. no less than quarterly. 6.) The use requires a license from the Washington State Liquour Control Board. 7.) The applicant shall install one (1)designated and signed handicapped parking space near the overheard doors. 8.) The storage and handling of inflammable liquids, liquified petroleum, gases and explosives shall comply with rules and regulations falling under the jurisdiction of the fire marshal, the laws of the state and other local ordinances. Bulk storage of inflammable liquids below ground shall be located no closer to the property line than the greatest dimension (diameter, length, or height) of the tank. 9.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 10.) Exterior lighting for commercial and industrial uses shall not exceed thirty feet(30') in height from the finished grade. Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 11.) Loading and unloading must occur on site(off-street). 12.) Commercial and industrial developments located in all zoning districts shall screen from areas frequented by the general public, all materials stored outside buildings or structures which are not for display or immediate sale. Areas frequented by the general public shall be defined as public streets and rights-of-way, and other areas normally used by the general public located adjacent to the subject property. FINDINGS: 1.) The Administrator finds that this application complies with applicable provisions of the Unified Development Code, all other applicable ordinances and regulations, and is consistent with the Jefferson County Comprehensive Plan and Land Use map. 2.) See ZON14-00025 for zoning. The proposed use is consistent with the Light Industial/Commercial Zone. 3.) The site plan as submitted with the Building Permit application on August 8, 2014 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated September 9, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 4.) This approval is for a Change of Use to Production and Processing of Cannabis 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. APPEALS: 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 related to judical appeals see JCC 18.40.340. UDC Administrator MLA14-00059 \\tidemark\data\forms\F_MLT_IssuePermit_U.rpt 1/9/2015 Page 2 of 2 -4-- State Route 20 . . - . . . , . __________________ .. (,, , ...:.,• ., ./,,,„..,,,; ...;,. ,, -,-•- "),' `,., :.„.,-/•2•`\ ...li I.,':., . _.----' •,'''. ' '■" / '\ ‘/t - ut '.'...,[. •• ;. / : Cl) CO OD -0 c a . , . (D . . . . . / = .=.... \,.., --1 co ca m , . -•• ... ..../ (3 . -.,,,,...,,:•,...]:,,,,,,I,e,-.,1_1,., .... = . 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S. Up Front Parcel Review Parcel 001212016 Printed: September 9, 2014 AMELL FAMILY LIMITED PARTNERSH Site Address(es): 1900 LAURA CT 274 S OTTO ST PORT TOWNSEND, WA 98368 274G OTTO ST PORT TOWNSEND, WA 98368 CONCORD, CA 94521-1423 274P OTTO ST PORT TOWNSEND, WA 98368 274 OTTO ST PORT TOWNSEND, WA 98368 274D OTTO PORT TOWNSEND, WA 98368 274A OTTO ST PORT TOWNSEND, WA 98368 Parcel Number: 001212016 S-T-R: 21-30N-1W Total Acreage 2 Legal Description ZAMPERIN SHORT PLAT LOT 3 Land Use: 5900 Flood District: Fire District: 1 Planning Area: 2 Flood Map(FIRM)Panel No: School District 50 Zoning: COMP PLAN DESIGNATION: C,O,�MUNITY PLAN: UGA: UGA Trans ' [ ✓J Plot plan states "property line" [ 1,1/-- Assessor's Map (Property lines o bmitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ frr Legal Access to Property ES NO [ y. Parcel Tags or Scanned Documents ES NO [V( ESA's: Special Reports Nearby YES NO [ t/K Designated Ag YES < �J [ Shoreline Designation: YES NO [ C.]' Shoreline Slope Stability: YES ,e Stream Type:YES NO FWHCA: YES NO Wetlands: YES NO Rare Plants:YES NO Seismic: YES NO Landslide: YES NO Flood: YES NO Erosion: YES NO Aquifer Recharge Area:YES NO SIPZ: none At Risk High Risk Coastal CMZ: none High Risk Moderate Risk Disconnected CMZ Stormwater site plan submitted: YesNo [ vr Forest Lands: YES 0 Adjoining Forest Lands: Commercial/ Rural/ Inholding [ Mineral Lands: YES 45 [ IA' Agricultural Lands: YES d I' [ jir Archaeology: YES NO [ 0/ No Shooting Zone: YES X10 y [ V' Stormwater: New Impervious Surface 1 A- Land Disturbing Activity ESA's Stormwater Req's:Min Req#2 Min Req 1 thru#5 Min Req#1 thru#10 Engineering [ 14 Notice Provisions/Disclosure:Airport YES NO MRL YES NO Forest Lands YES NO [ vr Landscaping Required: Yes No [ vJ-` Parking Spaces Requir-d NO 2 Other 31111111e4m ( '1iI F Building Height: dpro UBC Standard [ V( Impervious Surface coverage percentage: Resource Lands&Public: 10% Rural Residential: 25% Rural Industrial: Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industrial Lands only [ ✓] Total Building (s) Size: RVC:20,000 SF CC:5,000 SF NC:7,500 SF GC: 10,000 SF All others:subject to septic&water constraints/None specified [ V Setbacks: Front: Left Side: Right Side: Rear: Shoreline Setback: LSHA Setback: [ a'J Road Classification: Road Approach: IsTyc�NOT REQ'D RAP [ 1,]/SEPA Required: YES [ t]' Flood Certificate: [ (4' Existing Case(s) & Condition(s): Violations: Yes No [ Recorded Date of Subdivision: AFN Over 5yrs=UDC f� Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance V [ 1 Lots/Require Declaration of Restrictiv- Covenant YE' 0 submitted: YES NO [ 4 UGA No Protest Agree ES • i submitt NO [ Site Visit conducted ES NO [ � Require Final Zoning Approval YES NO [ ADMIN: Setbacks entered in Permit Plan case N/A YES New Parcel Tags entered in Permit Plan iagv YES Special Reports Scanned 9 YES Title No es Updated Parcel tags found for parcel 001212016 1.) WSRC Coaching - 2013/09/13 09/13/2013 Other SG Parcel tags found for parcel 001212016 2.) WSRC Coaching - 2013-10-10, CZ 10/23/2013 Other Parcel tags found for parcel 001212016 3.) WSRC Coaching - 2013-11-5 12/16/2013 Other Cases Associated with APN 001212016 Review Cases Name Type Status Planner BLD00-00144 BLEAKNEY F Application Received: 3/1/2000 Permit Issued/Case closed: 4/4/2000 Case Finaled: 4/11/2001 CHANGE OF USE/COMMERCIAL RANGE HOOD INSTALLATION BLD00-00436 BLEAKNEY F Application Received: 6/29/2000 Permit Issued/Case closed: 8/15/2000 Case Finaled: 6/27/2005 COMMERCIAL BUILDING (Winery) PRJ00-00152 BLEAKNEY A Application Received: 7/3/2000 Permit Issued/Case closed: Case Finaled: CHANGE OF USE/COMMERCIAL RANGE HOOD INSTALLATION SEP00-00150 BLEAKNEY F Application Received: 7/11/2000 Permit Issued/Case closed: 8/19/2000 Case Finaled: 10/26/2000 filed to SEP13-85. BLD00-436. BLD93-00180 MINKLER F Application Received: 4/1/1993 Permit Issued/Case closed: 4/19/1993 Case Finaled: 5/25/1994 commercial office and warehouse BLD93-00272 MINKLER C Application Received: 4/30/1993 Permit Issued/Case closed: 8/3/1993 Case Finaled: mobile home installation: not tor commercial purposes BLD94-00237 BLEAKNEY F Application Received: 4/19/1994 Permit Issued/Case closed: 5/16/1994 Case Finaled: 10/4/1994 Auto Clinic :IZA94-0020 \\tidemark\data\forms\R Parcel_CRMLA.rpt 9/9/2014 Page 2 of 4 M LA14-00059 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development - t s 621 Sheridan Street Port Townsend, WA 98368 i'(t i ; _/ PERMIT #: BLD14-00289 Received Date: 8/8/2014 SITE ADDRESS: 274 S OTTO ST PORT TOWNSEND, 98368 OWNER: AMELL FAMILY LIMITED PARTNERSH PHONE: 1900 LAURA CT CONCORD CA 94521-1423 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001212016 Section: 21 Township: 30 N Range: 1V■ CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION Change of Use Permit TYPE OF WORK COM SQUARE FOOTAGE: INDUSTRIAL:COMMERCIAL: TYPE OF IMP COU MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: CONST TYPE: DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Pl-h CY ` ,\.Cr t t v"' '0n Exist:Prop: 5L i L al/ i " ) Li- Total: i Routing Date: , i c1 J . l nn S OM ' Type Amount Paid By: Date: Receipt: Approved/Date Change of Use or Occupar $456.00 SRE 07/29/14 151321 State Building Code $4.50 SRE 07/29/14 151321 Total: $460.50 1I 1 JEFFERSON PUB ' ,J .® Lid 615 Sheridan Street ° Port Townsend o Washington 98368 °J ww.je ffe rso n c o u ntypu b lic he a lth.o rg September 9, 20 14 c • AMELL FAMILY LIMITED PAR T NERSH 1900 LAURA CT CONCORD CA 94521-1423 RE: SITE ADDRESS: 274 OTTO ST CASE #: BLD 14-00289 Dear AfviELL FAMILY LIMITED PARTNERSH: We have received the above referenced application for review. We are in need of additional information and/or items as listed below to continue our review of the proposal: I will need a complete description of project intentions to determine adequacy of the septic system and to provide review by the Water Quality Division of the Department of Ecology for Industrial wastewater discharge requirements. Please provide at a minimum: 1. a copy of the operation plan submitted to LCB as a part of the licensing application. 2. how the grow operation is intended to be conducted, 3. proposal for any processing and describe 4. number of employees 5. water use records for all the facilities that enter the septic system from the first of the year I will then forward your proposal to Ecology for their review. If a Monitoring Inspection of the onsite sewage system is required please contact a certified O&M Specialist or Licensed Designer to schedule the inspection. A list of these providers can be found at our website www.jeffersoncountypublichealth.orq. Please notify this office when the inspection has been completed. Please submit the necessary items in order for us to complete the plan review process of this permit. If you should have any questions; please feel free to contact me at (360) 385-9444. >` Ll\.�j �V X3 C +�� - �, l 4., \ ,t.'i_ { V'�1��' tE`��.i{;lid■ .t t t _ tC GI�i, ' t� UL t\ i +: X11 i n A-• 4''}'> c_ 1, r_ (7_ �., 7 t (% ( (./ Iz I Nt.,mue! 60:66?6180020c A. Describe your processing operation related to the items listed below: 1. Describe the types of products to be processed at this location: Dried plant material for smoking, teas Infused oils for cooking and body care products Clones Garden Compost • 2. Describe the methods, equipment, solvents, gases and mediums used: Plants will be dried on lines, dehydrators or paper bags for making material for smoking, teas and oils. All products will be weighed before packaging Packages of smoking material will be made into two types of products; bulk buds and bud with leaves A rolling machine will be used for making pre-rolled joints for customers Dried material will be grounded using a food grade blender for use in teas and mixed with other natural non-control herbs package into bulk and individual tea bags Crockpots will be used to combine the plant material with different types of food grade oils, butter. By product of this process will be rinsed and strained plant material will be composted, any hash resins will be package for sale Clones will be made with a Clone King type method and transfer in to a growing medium before sale. Compost will be made by mixing non controlled material and with 50/50 controlled material in closed bins or drums 3. Description of packaging and labeling of products processed: Labels will be printed with all required warning and labeling by state. All products will be package in food grade plastic that will be heat sealed and label. Compost will be bagged in 1 cu ft plastic bags will all ingredients listed. tf� t� f�\t i , :\ (' Jt,''c 1 k1 1 210/ 4-- ',AA`'', i VI/ j�v i.. ll` t.._t i ,A%-‘/ L�?L t ,f_. �1� 1�) t...t"b.` • r E � f `' i / j,.ft'sl�icEiili71t3f ,stale License i�umLc __--_ 5016616180020003 F ?:CI'Oti badrU UBI Number _T-.T Trade Name Operating Man Required Elements is Producer/Processor Submission of an operating plan that demonstrates the applicant is qualified to hold the marijuana license applied for is required as part of the application process listed in Washington Administrative Code (WAC) 314-55-020. This operating plan must include a floor plan and/or site plan which illustrates the entire operation being proposed.(WAC 314.55.020(9)) Please describe how your operating plan complies with the requirements listed in the 1rtWGs indicated below. Additional sheets utilizing the same format may be attached if necessary. 1. SECURITY (WAG 314-55-083) a. Employee identification badge (yes/no) Yes b. Alarm system as shown on the floor plan you are submitting will be installed and supplied by Security Services Northwest Inc. to state requirements. 14 r`-� V ;'7 tC2.� S ih\-tiv1`) c. Video surveillance system and recording device will be supplied by security Service Northwest Inc. and kept in locked cabinet onsi te. =-: = __ __ _ Paciflo Ave. SE. Olympia WA 9850a-309S. (360)664-1600.vAA:w.liq.rra.acv Paae 'i of 9 • UE31 Number 6016616120 12003 2. Traceability: (WAC 314-55-033(4) All information will be entered into the WSLCB traceability system. All plant material will be given a code that will include: Year/First 3 letters of strain/plant number/month put into grow sample: 14KUS103. This will be tracked on an EXCEL sheet as well as a hard copy with weekly backup to a flash drive kept in fire proof safe.This code will be attached to plant by plastic tag. Batches will include each code for plants combine with additional batch number: 14KUS10301, 14KUS20301 etc will follow all packaging including outside shipping box until time of sale. Records will be kept for 12 years. With the business growth I will switch to computerize tracking system hopefully within two years. 3.Training for new employees: (WAC 314.55.020(9)) A. Employees will be given a copy of company policy and procedure which they will have to sign that they have read. Orientation will begin after employee has received state issue ID card from DMV(to be used as employee badge) and signed company policy and procedure. Employees will be mentor and monitor for first week of training by their direct supervisor to what their duties will be. Yearly employee update day will cover any new policies and procedure.The training will be in relation to WAC's and RCW's also. B.Teresa Comstock has had a lifelong interest in horticulture. Is a founding member of The Happy Valley Pea Patch in Port Townsend Washington. Has worked as a Admin Assistant in a hospital setting for 14yrs working closely with HR and writing policies and procedure for a county funded hospital. Prior to current position at hospital worked as a manager for a hand dipped candle factory in Port Townsend for 5yrs doing marketing, retail sales, quality control, packing, shipping of product. 05,2-4 • ,) U t'I i3Ol.G6 .6180020003 4. [ At 3POR NATION OF PRODUCT (WAG 3 14.55.085) a. Packaging of product for transportation Product will be boxed in cardboard boxes that will be clearly label with codes that pertains to product Inside. Product will be driven in a unmarked Toyoto pickup in locked canopy in back. Driver will not have assess to product Mille Crivina. b. Labeling of product for transportation All product will be clearly label with state required warnings as well as lab results from state certified lab and product codes on the back of product. The front will be the STAT logo and product name. Product will be then put into cardboard boxes sealed with packing tape with sticker "Do not break seal while under transportation" under tape to insure it is tamper.proof. Labels with product codes, amount will be attached under tape as well* + { j j \ e; t, '1a.vo r5 5. DESTRUCTION OF WASTE PRODUCT (WAC 314-55-097) a. Storage, security, and management of solid and liquid waste All waste will be run through a chipper and then put into compost bins with food waste and red worms to be broken down for secondary market. DU liquid will have cat litter added and take to proper off site location either Jefferson County Solid Waste transfer station or Jefferson County Hazardous Waste collection site. Transportation will be done with Toyoto pickup with locked canopy. All material will be kept inside building until ready for transportation. 1 ; • /i . ; ijkt PO Box 43098, 3000 Pacific Ave. SE,Olympia WA.98504-3098; (360)664-1600,wawv.lia.wa.gov LIQ1227 09/2013 Paae 3 of 9 601661.61800 20003 UB i Number b. Method of disposal for solid and liquid waste Chipped and composted plant material Cat litter for al liquid D,� All light bulbs will be package irl cardboard and taken to ieiferson County Hazardous waste transfer site in Port Townsend WA. c. Method of rendering plant matter waste unusable prior to leaving facility chipping and adding food compost, animal waste and red worms r: �'' A Z r iS C d. Final Destination of waste rendered unusable Jefferson County Solid Waste Transfer Site Port Townsend WA Jefferson County Hazardous Waste collection site Port Townsend WA Secondary Market for compost 6. DESCRIPTION OF OPERATION AND PREMISE Standardized scaler AC 314-55-099? Describe your scale and any other measuring devices you will use for the traceability and inventory of product Adam Equipment's Highland balances have what it takes for lab work,field use,and various industrial applications.They feature multiple weighing units, RS-232 and USB interfaces(Both Included), rechargeable battery pack and AC operation, capacity tracker,adjustable feet and level,lock down and more. Density and specific gravity determination are easy with the below balance weighing feature,and the removable draft shield eliminates wind di Indoor Grow Outdoor Grow Rigid Nail Greenhouse Size category (plant canopy): X Tier 1 — less than two thousand square feet Tier 2 — two thousand one square feet to ten thousand square feet Tier 3 — ten thousand one square feet to thirty thousand square feet PO Box 43098. 3000 Pacific,Ave.SE. Olympia WA 98504-3098. (360)664-1600,www.liq.wa.00v 1_101227 09/2013 Page 4 of 9 iJi3 `.!tlnll)e a. List the number of square feet you will dedicate to ;pant canopy r f`, t b. List the number df square feet you will dedicate to other business activities (such as office. restroom. quarantine room; etc.) c. Describe your grow operation related to the items listed below: 1 . Description of growing media(s) a combination of aeroponic and soil 2. Description of all equipment used in the production process HID lamps and LED lights,vent Fan, pots,aeroponic towers, Hose Timer Thermometer Spray Bottle PH tester Hygrometer Pruners and scissors Wire Ties Measuring cups and spoons Moisture meter Light Meter 3. List of soil amendments, fertilizers, other crop production aids, or pesticides used Liquid biodegradable soap, organic fertilizers, ODC organically derived Colloidals (aeroponics), animal and fish waste, compost,peat moss,alfalfa meal , blood and bone meal , Safer products, seaweed, Insecticial soap, Sulfur,sticky traps, d. Outdoor production only - describe the physical barrier surrounding your outdoor production areas including the method you will use to obscure public view of the grow premise PO Box 43098. 3000 Pacific Ave. SE. Olympia WA 98504-3098,9 00 wv 850 �0 8, 360( 1 66 1 4- . .1.6 � .liq.:va.gc. LIQ122 09/2013 Paae 5 of 9 Nurnher A. Describe your processing operation related to the items listed beiovd: 1. Describe the types of products to be processed at this location: Dried plant material for smoking, teas infused oils for cooking and body care products Clones Garden Compost • 2. Describe the methods, equipment, solvents, gases and mediums used: Plants will be dried on lines, dehydrators or paper bags for making material for smoking, teas and oils. All products will be weighed before packaging Packages of smoking material will be made into two types of products; bulk buds and bud with leaves A rolling machine will be used for making pre-rolled joints for customers Dried material will be grounded using a food grade blender for use in teas and mixed with other natural non-control herbs package into bulk and individual tea bags Crockpots will be used to combine the plant material with different types of food grade oils, butter. By product of this process will be rinsed and strained plant material will be composted, any hash resins will be package for sale Clones will be made with a Clone King type method and transfer in to a growing medium before sale. Compost will be made by mixing non controlled material and with S0/50 controlled material in closed bins or drums 3. Description of packaging and labeling of products processed: Labels will be printed with all required warning and labeling by state. All products will be package in food grade plastic that will be heat sealed and label. Compost will be bagged in 1 cu ft plastic bags will all ingredients listed. n UBI Number "Packaging and Labeling continued) • 7. QUALITY ASSURANCE PROTOCOLS (WAG 314-55-102) Describe your testing procedures and protocols Dried product batches samples will be taken and will be sent to state certified lab for independent testing by USPS with tracking. All batches will be label.-With information received by lab required by state. compost will be tested for nutritional values PC Box 43098, 3000 Pacific Ave. SE, Oiympia WA 98504-:098, (360)664-1600,vAvv.lia.wa.acv L IQ122r 0912013 Page 7 of 9 UM Number (Testing Procedures continued) 8. ATTACH FLOOR PLAN / SITE PLAN (architectural plans are accepted but not required). Plans must be drawn to scale. Please ensure your Floor Plan/Site Plan includes a key referencing the specific areas listed below. For your convenience, an example key is attached. a. Physical barrier enclosing outdoor grows, including all gates b. Grow areas c. Perimeter fencing or other physical barrier enclosing the processing facility d. Processing areas e. Controlled access areas f. Security rooms/areas g. Quarantine area h. Points of ingress/egress to the exterior of the licensed premise i. Location of interior doors within the licensed premise indicating which are locked or secured j. Location of Surveillance System Storage Device k. Location of Surveillance System Cameras Is floor plan attached? x YES NO Continuation.Sheet Attached? � YES NO PO Box 43098.3000 Pacific Ave. SE, Olympia WA 98504-3098. (360)664-1600,www.lia.wa.00v L1Q1227 09/2013 Pace 8 of 9 • ; . 1 • ''. i . , : ; 1 • I ', : ; ' . ' • , _ , , 1 : ----: • I --ir I :----.< _ _... ._:..,,_ I,_ -- \ • : . , , ; % -1%.-4 \ ;■.. "! : i . • , ' • ' ' i......,•\ . . i-- ::i 1----- , . : . . . . ' : : ' !'/ 1 ' ■ ____Lif ■.., ■ . 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I [---‘,...,1 ,-, ;----, ; 1 , ii ; ;, ,__-, , ,----„--,,— : ----, , , . i , ; r---- • — ,-- : . I, , . i !! 1 1-, ‘`-----. k ' , r,,,,) ,,,,......., ; , ; ', \ I I ! ,----*- . t_..-> 1 I 1 I '''''--- " I • ;-, I % 1 - I L--- 1 ; I I 1 1 1,--, i I , [-`-' I; • I ; `.4.. I I , -,.... , II I I-:`='!'r) I I (! ' ■ I r-4.-! , i I , 1 i I \--,, ; I ' , \ .t .....--- , , ' I i i I ' l I i I • . 1 I ;1 ■ ,..„... ! I 1 (\ ."-------• ' . . —1 ' • ---r..7 ,,--.._ , ! ' i i . i I i 1 ; • . i ■ --; . i j . ....,..,, , I „ - V-.----_-: BLD94-00792 BLEAKNEY F Application Received: 11/10/1994 Permit Issued/Case closed: 11/10/1994 Case Finaled: 1/10/1997 Propane Tank Installation BLD95-00255 BLEAKNEY F Application Received: 5/11/1995 Permit Issued/Case closed: 8/31/1995 Case Finaled: 7/29/1996 Veterinary Clinic BLD97-00725 POTTER C Application Received: 11/6/1997 Permit Issued/Case closed: 11/7/1997 Case Finaled: PROPANE TANK INS rALLA1 ION BLD97-00757 E.F.S. CO. INC. D Application Received: 11/21/1997 Permit Issued/Case closed: Case Finaled: APPEAL OF ADMINIS'I RA1 IVE DETERMINATION to allow the establishment of a metal plating operation within the Light Industrial/Commercial (M-C) Zoning District. Subject site is lot 3, Zamperin Short Plat, 274A Otto Street, Port Townsend, Washington, within the Glen Cove Industrial Area. BLD98-00007 BLEAKNEY F Application Received: 1/6/1998 Permit Issued/Case closed: 5/15/1998 Case Finaled: 5/5/1999 Commercial addition, uss u o linic BLD98-00777 BLEAKNEY F Application Received: 12/7/1998 Permit Issued/Case closed: 12/7/1998 Case Finaled: 2/24/1999 propane tank installation ENV95-00009 BLEAKNEY F Application Received: 9/26/1995 Permit Issued/Case closed: Case Finaled: review on zoning text amendment ZON95-0009 was published under ENV95-0009 instead of ZON95-0009 for some reason 1ZA94-00020 BLEAKNEY A Application Received: 3/17/1994 Permit Issued/Case closed: 3/29/1994 Case Finaled: OTH94-00111 BLEAKNEY A Application Received: 4/19/1994 Permit Issued/Case closed: 5/16/1994 Case Finaled: Potable Water Approval OTH94-00147 BLEAKNEY P Application Received: 5/12/1994 Permit Issued/Case closed: Case Finaled: Technical Assistance OTH95-00103 BLEAKNEY A Application Received: 5/11/1995 Permit Issued/Case closed: 5/12/1995 Case Finaled: PUD SEP95-00130 MINKLER F Application Received: 5/11/1995 Permit Issued/Case closed: 6/20/1995 Case Finaled: 4/12/2000 filed to SEP13-85 (adding pretreatment) ZON95-00009 BLEAKNEY F Application Received: 3/31/1995 Permit Issued/Case closed: Case Finaled: 3/1/1995 Change of text; zoning ordinance ZON99-00040 BLEAKNEY F Michelle Farfan Application Received: 9/17/1999 Permit Issued/Case closed: 2/28/2000 Case Finaled: 8/1/2000 Conditional Use Permit to establish a food service as an associated use in a light industrial/commercial area (Glen Cove Light Industrial). CAM14-00090 AMELL FAMILY LIMITED PARTN P Joel Peterson Application Received: 2/13/2014 Permit Issued/Case closed: Case Finaled: Lessee wants to start marijuana production/processing business (Initiative 502) CAM14-00095 AMELL FAMILY LIMITED PARTN P Joel Peterson Application Received: 2/18/2014 Permit Issued/Case closed: Case Finaled: Siting inquiry for interest in 1-502 facility, production and processing. CAM14-00441 LACEY M Donna Frostholm Application Received: 6/30/2014 Permit Issued/Case closed: 7/21/2014 Case Finaled: Leasee inquiring about zoning FEP14-00005 LULLABY WINERY-TASTING RC ACT Application Received: 2/19/2014 Permit Issued/Case closed: 3/19/2014 Case Finaled: M LA02-00581 \\tidemark\data\forms\R_Parcel_CRMLA.rpt 9/9/2014 Page 3 of 4 BLD02-00666 MLA02-00581 GLEN COVE BUSINESS PARK L I F Michelle Farfan Application Received: 11/8/2002 Permit Issued/Case closed: 12/18/2002 Case Finaled: 5/29/2003 COMMERCIAL WAREND BOAT STORAGE BUILDING M LA04-00597 ZON04-00061 MLA04-00597 JOHNSON I F Mo-chi Lindblad Application Received: 10/20/2004 Permit Issued/Case closed: 10/22/2004 Case Finaled: 1/26/2006 CONSISTENCY REVIEW- HEAL H, FIRE, SAFETY MLA14-00033 BLD14-00064 MLA14-00033 FUNK I A David Wayne Johnson Application Received: 2/21/2014 Permit Issued/Case closed: 5/1/2014 Case Finaled: Installing non-struc wali-s in existing building, sealing off two bay doors, installing security cameras/alarms and system BLD14-00065 MLA14-00033 FUNK I A David Wayne Johnson Application Received: 2/24/2014 Permit Issued/Case closed: 5/1/2014 Case Finaled: CHANGE OF USE: Commercial building to MJ grow operation/packaging, not processing M LA14-00059 BLD14-00289 MLA14-00059 AMELL FAMILY LIMITED PARTN I P David Wayne Johnson Application Received: 8/8/2014 Permit Issued/Case closed: Case Finaled: Change of Use Permit Producer/Processor of Cannabis (1-502) ZON14-00025 MLA14-00059 TERESA CORNSTOCK I P David Wayne Johnson Application Received: 7/30/2014 Permit Issued/Case closed: Case Finaled: CHANGE OF USE PERMI I Tier 1 Producer/ Processor Cannabis- I-502 SEP13-00085 AMELL FAMILY LIMITED PARTN F Application Received: 7/19/2013 Permit Issued/Case closed: 8/12/2013 Case Finaled: 10/8/2013 info from SEP88-17(draintield), SEP95-130 and SEP00-150 (tanks)filed here BLD95-00110 BLEAKNEY F Application Received: 3/13/1995 Permit Issued/Case closed: 3/14/1995 Case Finaled: 3/23/1995 Propane tank installation SEP88-00017 BLEAKNEY F Application Received: 5/12/1994 Permit Issued/Case closed: 5/12/1994 Case Finaled: 5/18/1994 filed to SEP13-85 (adding pretreatment to this existing system) SOM88-00017 AMELL FAMILY LIMITED PARTN RCR Application Received: 5/18/1994 Permit Issued/Case closed: 1/14/2014 Case Finaled: serves 5 buildings and one small mobile home. all cases associated with this system filed with SEP13-85 \\tidemark\data\forms\R_Parcel_CRMLA.rpt 9/9/2014 Page 4 of 4 ftç (gigi/i /11 cc,A I r 0C BUILDING PERMIT APPLICATION 1VILA14 Revieew w Type: ' Jefferson County Department of Community Development L ._ • 621 Sheridan Street Port Townsend, WA 98368 25 PERMIT#: BLD1400289 Received Date: 8/8/2014 SITE ADDRESS: SOTTO T PORT TOWNSEND, 98368 OWNER: AMELL FAMILY LIMITED PARTNERSH PHONE: 1900 LAURA CT CONCORD CA 94521-1423 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001212016 Section: 21 Township: 30 N Range: 1V1 CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION Change of Use Permit TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP COU MAIN: INDUSTRIAL: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY:. UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Change of Use or Occupar $456.00 SRE 07/29/14 151321 State Building Code $4.50 SRE 07/29/14 151321 Total: $460.50 \\tidemark\data\forms\F_BLD_App_Bld.rpt 8/8/2014 .?,sox\ ..i ` 06 JEFFERSON COUNTY ( j • . ,a DEPARTMENT OF COMMUNITY DEVELOPMENT ti -4 621 Sheridan Street • Port Townsend • Washington 98368 . ( L 4.r, 360/379-4450 • 360/379-4451 Fax q �O www.co.jefferson.wa.us!commdevefopment BIN,/`/ Master Permit Application MLA: 1 Project Description(include separate sheets as necessary): , 1 roauc-6v /f0 ce. s.ay Cg-Kiit o,,t s Tax Parcel Number: O 212) Z_D 1 to Property Size: {�3 r / A Q / (acres/square feet) Site Address and/or Directions to Property: c - L u J driZ ST' .p.-f- 72m-D-6A-id ii- 16 368 Property Owner(s)of ecord: ' .(4,/ Paoli.[ //yyt 11-‹d Pa.`.�ne/y Telephone: -.O ; 00 Fax: / email: Mailing Address: 19 0 b Lau roc Ca✓e- r1O-rC0.)-0( Gjj ('y c2..l Applicant/Agent(if different from owner): Pilr^� Gt (Oy�� .p Telephone: "JCQ O` 7 �( l (0 Fax: _ email:$T7t 1 proditC -5 tMd-U Mailing Address: /26/0 $lm5 ✓1MAI . ce !O r'� %DWY1 SC 1 (/ilk- '7 (pS __ What kind of Permit? (Check each box that applieslJ ❑Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .❑ Modular • - ❑ Discretionary"D"or Unnamed Use Classification 0 Commercial* ❑Special Use(Essential Public Facilities)** [ 1 Cnange of Use ❑ Boundary Line Adjustment ❑ Address ❑Road Approach ❑ Short Plat** 0 Home Business ❑Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat** ❑Ciyn ❑Planned lkurai Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑ Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Re•uires a Pre-A.•lication Conference Please identify any other local,state or federal permits required for this proposal, if known: _! 1/1,w-f w t6 (XXAAA 1\tip DESIGNATION OF AGEN/ Pry , — bi ceti' I hereby designate �J to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,;ndemnify 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 its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior notice. Signature: _ Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: .__ Date: G.\PrnnftCrntrr\##ttFrlR MCtttttd\nun pnn?,rc\r..._____ran..n__._-... . .. . .. . - __ __ . Jul 10 14 07: 37a Michael Rmell 19256858326 p. 1 � �1oti, r o,` JEFFERSON COUNTY =.; .._,... ,„,,,all DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend.WA 98368 I Web:www.co.Jefferson.wa.us/communitydevelooment �Sfrr No`- Tel:360.379.44501 Fax:360.379.4451 l Email:dcd{o?co.(efferson.wa.us Building Permits&Inspections 1 Development Consistency Review j Long Range Planning 1 Watershed Stewardship Resource Center Master Permit Application MLA: P -Description(incl eparate sheets as n ): f f eit 7 /1'0 4Lce. At oC eS5-02 ,i '' ,,L,0el Tax Parcel Number:Q I,/ 2 Q O Property SizeZ f$ � y ya .. (acres/square feet) Site Address and/or Direction to Property � � ' . f0 A 5)4 , /34D it 7; w�"t.. 4/4110388 Property Owner(s)of cord: ,•;MrMi W i nR• ,Z 11111.1: 7 ,A TelephonerSte`,s' Q Fax: email:��+t , s .- LL. a /T©G•Gaol Mailing Address: -' .. / - _ t ., .•.L • Applicant/Agent(if different from owner): _ F.Ar M i .. • Telephone 60 ^ 1 7 S t-4 X/n Fax ema s• 2172a 0b ti (. G--PV,/4,- .e,00, Mailing Address: •• • > r •? 1` _ ,4 What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family 0 Garage Attached/Detached ❑Conditional Use(C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular ❑Discretionary'Cr or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)•-* Change of Use ❑Boundary Line Adjustment Address ❑Road Approach 0 Short Plat`* ❑Home Business 0 Cottage Industry ❑Binding Site Plan** ❑Propane ❑Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)iAmendments** ❑Allowed"Yes'Use Consistency Analysis ❑Plat Vacation/Alteration ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment i •May require a Pre-Application Conference ❑Tree Vegetation Request I **Requires a Pre-Application Conference , P ease i�jntify any other local,state or federal permits requir r this propo if known: '' • • �7 . S OP L Prki AAsio A - -obi ri�AeCspot)t lGelt/S>� ��f� � ��/ S NATION OF GENT I hereby desi OAR/ �*�T/?0959,s ,f / to a =s agent in matters elating to this application for permit(s). OWNER SIGNATURE ."Le" V, Date: / f d / 4 r ' By signing this appli . on form,the owner/agent attests that the into ation provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result In this permit being null and void. I further agree to save,indemnify and ho•hannte - efferson • my against. liabilities.judgments,court costs,reasonable attorneys fees and expenses which may in any way ac •ago'.- •n C•• as a resu or in consequence of the granting of this permit- I further-•• o prow• .,»=ss //h •f e • Je•• • County% •. 'mployees,representatives or agents for the sole purpose of application review and any r.',...01,-•• .er in,. i. - d right will be assumed unless the applicant informs the County in writing at the time of the app' at he..she Signature: iv' , i, , ., •I�� / Date: to � r " The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential'take"of an endangered species as those terms are defined in the federal law known as the °Endangered Species Act'or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA Any individ -1 group or agency can fife a lawsuit on behalf of an endangered species regarding your action(s)even' ar-in li- rf h -'Jefferson,•- development code.The Applicant acknowledges that he,she or it holds individual and non- far�: -s•�/ibi h .to and.• •ylng with the ESA. The Applicant has read this claimer and signs and dates it below. Signature: ,./ , � Date: `�� . / . ' . , 07/24/3)13 i l - ;c ' j Main Sub-D-Box 1 ` D-Box ED ; SEP88-17 DrainfiE• 1 _ ; Sub-D-Box 2 ,• '• /Unit S \ Northern Parcel Boundary 440' •\ Septic Tantc{--- \\ Nibbler Blower Housing Air Pipe to\ / Unit S on 3'x3' Concrete Pad Aeration �-�� Headworks 10,/ / 57 SEP00-150 9` Electric . Unit U-Z Ar * Septic Tank) 21' Panel I 1---- -- (route uncertain) ':Septic Tank 1 10/ i 1111\ .• r. 1 •1 35' 4 29'_. 1 I `' ► Shed Junction Box 9.5' 43` Deck / 57' ite uncertain) 1 . Nibbler Aeration Mobile j 29, 78' Headworks ---� 1 21' --~ -- -- ' 1,500 gal Two-Compartment Concrete l ' c ATU Tank with Pair of Nibbler CBPs in • 1 `� first compartment, clarification in second • t compartment, access risers to-grade 1 z • Unit U-Z z Water Supplies ' °� (routes uncertain • • • • knit P ' r■•■ W Pressi .............. _Water Su. (route once (rout _ main Southern Parcel Boundary 450' FenceL Driveway ,ri 0 30 60 90 �_ Drawn By: Everett A. Sorensen, P.E. Strearriline Environmental, Inc. 715 Grant Street; Port Townsend, WA 95368-2405 Note: Parcel boundaries and rel AMLINE ' r: . 360-821-9960; everett@streamlineenv.com from Jefferson County's on-line r K °=`-EN A' - � '' Re> e r. 1-'`.7.2SY'? 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Parcel Number: 001212016 SEARCH Parcel Number: 001212016 Printer Friendly Owner Mailing Address: AMELL FAMILY LIMITED PARTNERSH 1900 LAURA CT CONCO RD CA94521-1423 Site Address: 274 OTTO ST PORT TOWNSEND 98368 Section: 21 School District: Port Townsend (50) Qtr Section: NW1/4 Fire Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 0111 Planning area:Quimper (2) Sub Division: Assessor's Land Use Code: 5900 - Other Retail Trade Not Coded Property Description: ZAMPERIN SHORT PLAT LOT 3 Tax,A/V, Sales, Photos, and Permit Data Bide Data Map Parcel Plats&Surveys Septic Monitoring Info Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH 3'' Best viewed with Microsoft Internet Explorer 6.0 or later Windows- Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel NO=001212016 7/30/2014 w4°N c-,06.. JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.Jefferson.wa.us/communitvdevelopment 9SkINGy Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd@co.jefferson.wa.us Building Permits&Inspections(Development Consistency Review(Long Range Planning(Watershed Stewardship Resource Center LIFE / FIRE AND CONSISTENCY REVIEW APPLICATION Please check one: al CHANGE OF USE fI REVIEW SITE ADDRESS: 1-q / V OTTO e Pav% .1-25A/n/ d Wffl ZIP /co (e¢> 9 DIGIT PARCEL ID NUMBER 00 12 ( 2_() I Co Legal Description: Qt Set-A-1.0-A" Subdivision Name 5 h 4" Plat Sleek N 1,3 y (}- . Lot(s) 3 Section 7-- ( Township 30/\s North, Range 1 \i WM APPLICANT 72.V .s4 00 iS iv PHONE 34'0-30S--- 6011 MAILINGADDRESS 12-40 W. !J t Alb, W w Y b .1 n 7ZYi 5e-no( WA- 70363 cal tail 3 66- -/-q-6310 ZIP PROPERTY OWNER 11 r ji&1 / PAynZ/7 144,1:--ke4 Ptv./11ecPHONE ,+ I _ ro MAILING ADDRESS 1 96 LaUv?..c, 0,01417-1- Coyr�r CA- ZIP q'ic `/ CURRENT USE(S) 3/10, 5/24a, t (W I de, / (7757 1 PROPOSED USE(S) 7e,i, .�. Pro4actr/Procio - / o , 1 ,� „ i bEP � SEPTIC PERMIT NUM ER IBC OCCUPANCY IBC TYPE OF CONSTRUCTION Classification (..)h .('e �'1 Classification OO p NUMBER OF BEDROOMS NUMBER OF BATHROOMS WATER PROPOSED /� / /p PROPOSED Public Water�!i d� v� EXISTING EXISTING ( ❑ Private Well TOTAL - CS/ ' TOTAL , ❑ 2-party Well EXISTING#OF PARKING SPACES ..3 #OF HANDICAP PARKING SPACES 0 CURRENT NUMBER OF OCCUPANTS(includes owners, PROPOSED NUMBER OF OCCUPANTS(includes owners, tenants,employees,etc) 2.. OU)ye j tenants,employees,etc) 2- owy\e, 0 CURRENT TOTAL SQUARE FOOTAGE(includes decks, porches,outbuildings,shed...etc) L C SU Sc Pi- PROPOSED TOTAL SQUARE FOOTAGE(includes decks, porches,outbuildings,shed...etc) l 0 SO S -R-- APPLICANT SIGNATURE DATE 7 13 , CJ 25 CONSISTENCY REVIEW FOR OFFICE USE ONLY BASE FEE RECEIPT# STATE SURCHARGE 4.50 CASH/CK# TOTAL DATE / / 1 ON O OG JEFFERSON COUNTY ti DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend,WA 98368 1 Web:www.co.jefferson.wa.us/communitydevelopment 9sx ) Tel:360.379.4450 Fax:360.379.4451 I Email:dcd @co.jefferson.wa.us Building Permits&Inspections 1 Development Consistency Review 1 Long Range Planning 1 Watershed Stewardship Resource Center LIFE/ FIRE AND CONSISTENCY REVIEW CHECKLIST A COMPLETE APPLICATION CONSISTS OF: MASTER PERMIT APPLICATION. Must be signed by property owner of record. FLOOR PLANS. One floor plan showing existing structures and uses. One floor plan showing proposed structure and uses. THE SITE PLAN. Please include all information requested on the site plan checklist. If the size of the site plan is larger than 11" x 17"you must provide us with 7 copies at the time of application. We cannot copy documents larger than 11"x 17". LIFE/FIRE AND CONSISTENCY REVIEW APPLICATION. The application asks for number of employees, number of bathrooms, number of parking spaces, square footage, heat source, and water source. Please sign and date. LANDSCAPE PLAN. Please include location and type of signs, vegetation, parking spaces, including handicap parking and route of travel. PRE-APPLICATION CONFERENCE. The Development Review Division will determine if your project requires a zoning permit or a pre-application conference. This may be accomplished by phoning the Planner of the Day. PERMIT FEES. Payable at time of application. Jul 10 14 07: 37a Michael Amell 19256858326 p. 1 0': JEFFERSON COUNTY - DEPARTMENT OF COMMUNITY DEVELOPMENT % 621 Sheridan Street Port Townsend.WVA 98368 I Web:www.co.iefferson.wa.uslcommunitydevelooment 5"i`6: Tel:360.379.4450 j Fax:360.379.4451 j Email:dcd{lco.iefferson.wa.us Building Permits&Inspections I Development Consistency Review 1 Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: P option(loci eparate sheets as ny}: ..t tit 7 �Z A 7Th o04tc� oC essirit 6,44.4.091674r Tax Parcel Number:Q a/2., Z 6/6" Property Size2 f c ar v S/Q (acres/square feet) Site Address and/or Direction to Property 1 .Pit - Direction 0 a'p . � . /71.0411- T���w� r y w.�Y>g�`s Property Owner(s)of cord: w' i — i =;Z� • Telephone: ; ' et ill Fax: email:* I .�∎ I - L . "4 AOG•e Mailing Address: • . . " _ r . _ L J �i�r Applicant/Agent(if different from owner): _ r.- 4rmlnrar,Int • Telephone:_ - i " ' . / - Fax: ema • Zr.la Mailing Address: • > ♦. ' I * _ — ' _ •. What kind of Permit?(Check each box that applies ❑Lot or Road Segregation °Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family C Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]" ❑ Manufactured Home ❑ Modular ❑Discretionary'D"or Unnamed Use Classification ❑ Commercial' ❑Special Use(Essential Public Facilities)" Change of Use ❑Boundary Line Adjustment Address ❑Road Approach ❑Short Plat'"" ❑Home Business C Cottage Industry ❑Binding Site Plan`• ❑Propane ❑Long Plat'" Cl Sign ❑Planned Rural Residential Development(PRRD)lAmendments" ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration" ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions" ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development•" ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication` ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment •May require a Pre—Application Conference 0 Tree Vegetation Request "Requires a Pre-Application Conference P ease i nti any othey local,state or federal permits requir= •r this propo -/i if known: • 444- ` , F '" i A r ,(i O!A L,oC / •'S NATION OF •GENT I hereby desi. '!!":' '/ 4/Jr ' 411 to a =s agent in matters -latinlg to this application for permit(s). OWNER SIGNATURE _ai.V Date: /— /e /R y By signing this appli«: on form,the owner/agent attests that the info ation provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and no-harmle • efferson • my against- liabilities,judgments,court costs,reasonable attorneys fees and expenses which may in any way accr -age' -t - - •n •• 'as a resu or in consequence of the granting of this permit. I further-• •prov•- ..ss h • e . Je•- • County - " ployees,representatives or agents for the sole purpose of application review and any r,� ,er in•.0 I. . • d right. • II be assumed unless the applicant informs the County in writing at the time of the app' SS• • at he.-"she Signature: �� /, , . - •I. Date: The action or actions Applicant will undertake as a result of the Issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act'or"ESA.°Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA Any individ -I group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even' ar-in•• •I'- e h, ��Jeffersan,•- y development code.The Applicant acknowledges that he,she or it holds individual and non- er. : -s••/ibi r,/ h to and•.p ying with the ESA. The Applicant has read this 3aimer and signs and d t below. : Z� � "4� •• / 07/24/2M 3 1 ....„ x C° JEFFERSON COUNTY N 11-1 il.-, . d ,\ rA DEPARTMENT OF COMMUNITY DEVELOPMENT y `4 621 Sheridan Street • Port Townsend •Washington 98368 ti� 360/379-4450 • 360/379-4451 Fax lG� 4.p' www.co.jefferson.wa.us/commdevelopment�`IIN� Master Permit Application MLA: sc Project Description(include separate sheets as necessary): , I 1 0d� Cam✓ t - soy I Vl.a11,s Tax Parcel Number: (2 D j 2-) 20 1(# Property Size: ),l5 j K / (acres/square feet) Site Address and/or Directions to Property: c -gLi VI 6i SI-- xhd kill- 6368 Property Owner(s)of Record: ' -64/ fur ..u/ /lit i,kc1 PQd%�e/v. Telephone: >.0 00 Fax: email: Mailing Address: 190 o I;au l Copwt- Co-ne-x) -d Cpl qg c2 I Applicant/Agent(if different from owner):_ 'Vtt (.O In S'tV I� Telephone: *5(00- ?q- L (O Fax: _ email:51 rpr- ((.IC;�S� 44tf�u Mailing Address: C2y0 J. $irn$ w9 y 4 80 pc rF j i �.t�- 99J36 �""'` What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached/Detached ❑ Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home .❑ Modular - ❑ Discretionary"0"or Unnamed Use Classification 1 ri Commercial* ❑Special Use(Essential Public Facilities)** [ Change of Use ❑Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑Short Plat** ❑ Home Business ❑ Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat** O Sign ❑Plannea Rurai Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify yany other local,state or federal permits required for this proposal, if known: \N��A, �V V l 6`, 6 oackvbkAbmot Q � � P(oc, c Lc�� DESIGNATION OF AGEN I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: l By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent 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 its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior notice. Signature: Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:\PemvtCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New 0 Wood Existing: Sewer C Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual s S m ❑ Repair ❑ Masonry — SEP Permit#y g, Li Demolition ❑ Other: Bedrooms: Water Supply: Existing: _ Setback: ❑ Private well ❑ Two Party Proposed:Type of Heat: Pro p Total: ❑ Public Name of System: • If this is a Commercial Protect you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants, employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food'Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank Above ground Tank Size of Propane Tank: H• eat Stove i Cook Stove Woodstove Fireplace Insert i Hot Water Tank i Pellet Stove ! Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use-Only: _ Amount Revision Main Floor Heated EH BId App Review: 152:O f7 21-4 Floor Heated Consistency Review: a.ae .0 O Other Heated 45(o- UU Mezzanine ' Additional ction: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: ° Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL tl (�Q(05• co Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: / 513 c Cash/Check Number: / ESTIMATED COST(REQUIRED) Date: 2 `� 'Fair market value of all labor and materials foundation to finish 0 //,( Initials: A VA SE FEE so PIiN CHELL_ — G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08-doc C reate 1 v'L,1- • IMINEMINITMENMNIMININIMINEMEMEGTAMO 111111111111111111111111111111101MENIMIMMOMMEEMIMMENI 1!7■■■■■■■i■11■■■■■■■1 ■■■■��■ !1111■■ 11■■11111111■■■■■11■1 �■■■■■■ER■ri■■■ UMEIINNNNMMMIIMIEIIMINMMMIERIMINFBIIBEIIMIMII 111 ■■■■■■■■■M■■■■■■■■ 6EIMOM E■; 1111111111111111111111111111111111111111111111MMEMILIMEM 1■1S■1111■■■■■0■■■M■■■■■■'ii■i■0i: ■■i I1' 111111■■■11■■■■■■■■ MINENIEMES 1111■■■ Slli■■■■11 ■111■■■■■■■■1111■ 1 ■aroma■■ imu■■■■■■■■■■■■■■gym■■ ernumi■■■■■■ -womm■■■11■■■■■■■■■■■■■usomm■1111 o1!■■■m■■imm ■■■■f■ummu momm 113■■■■■■■■►N■■NIMIEN ■■■ I■■■■■■■ 1111MIIMMINMMENEINIMW 11111111111110111111•111111 ■■1111■■■■i■1111■11 ■ M■■■■■■■■■■ I ■ 111 E11■■■■■ MINI.11■MM■■11M■■11■EM al ■■■■■mommomuna 111111■■■■■■■ 04. 1111111111111111111111111111111411MILINNEMIMMINENI VAINIMMINMIENUMBENIMEMENNIMENIMMONNI ■liM■■■■■■■■■■■MM ■11■■■■■■■■■■E ■ 1■1111■■■■t11111■■■■■1111■ REMI ■■■■M■■ ■1■1111■■■■■■■■■■11■11 MINA■■ ■■ MIAMI 11l■■11■1111111111 ■11■■■1111■■■11■ 111111■■1111■ 11111111111111111111111111111111111111111111111111111111111=111 1111111111111111111111111111111111MMEMIMEN MaiiiENEEMEREMMUMMImmmaimmum 1111111111111111111111111111111111111111111111011111111119 ■1111111111■■11 . 11■11■■11■'.'�:i11■■ri■■■■■! 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