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HomeMy WebLinkAboutZON2015-00006 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT UNIFIED DEVELOPMENT CODE TYPE I LAND USE PERMIT APPLICANT: GABRIEL GREENSTEM 1014 NW 178TH ST SHORELINE WA 97177 DATE ISSUED: July 08, 2015 DATE EXPIRES: July 04, 2016 MLA NUMBER: MLA15-00014 PROJECT PLANNER: David Wayne Johnson PROJECT DESCRIPTION: CHANGE OF USE COMMERICAL BUILDING 1-502 MANUFACTURING & PROCESSING CHANGE OF USE COMMERICAL BUILDING 1-502 MANUFACTURING & PROCESSING PROJECT LOCATION: Parcel Number 986 701 902 in Section 16, Township 30, Range 01W, located at 205A Otto St., Port Townsend, WA 98368 CONDITIONS: 1.) The Applicant shall obtain and maintain a State License to process cannabis. 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.) Building and site approved and permitted under MLA08-00298. 3.) See BLD15-00078 for Building Change of Use permit. 4.) The site plan as submitted with the Zoning Change of Use Permit application on March 12, 2015 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 April 2, 2015 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 5.) This approval is for a Cannibis Processing Facility 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 MLA15-00014 \\tidemark\data\forms\F_MLT_IssuePermit_U.rpt 7/8/2015 Page 1 of 1 ■ I-1 K D h O zr000D -I - ° N _ Oj jD -I m > ZG o o F a 2 Fiy � ON � r (DjO � � �i D CO.RD.PROD.CR1148 n `� b o E 03 C,.. to D _ ...i C7 x x x x II 75 - Cj MI v -9 -1 rn -PN - Nj � 1 a N 04°56'34" E 8Li 0 180 290.45' _ N + o ir z #203 � OD G 5 S HB T° \ N. A = �^ SB#E2D0 . 2 w ,N N n'.;p \ o ig 0 00 v A .' r P j p e. 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M O O CD CD C cOOJ G A CA CD 1., cn -a M;g 0 ..---, a% trk rn ''d Q ICO N o o r�- s r 4t04 d 3/18/2015 ' CCEL P - Conditions Associated With 1:25:52PM Case #: BLD08-00269 Condition Status Updated Code Title Hold Status Changed By Tag Date By Maximum lot coverage is not to exceed 55%. Lot coverage is defined as amount of impervious surface which includes roof tops,driveways,concrete,etc. D101 SEPTIC CONDITION None NOT MET 9/10/2008 MKF 10'SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE,TANKS,TREATMENT AND DISPOSAL COMPONENTS. ?001 SR 20 CORRIDOR None NOT MET 9/10/2008 MKF TO IMPLEMENT THE INTENT OF LNG 19.0 OF THE COMPREHENSIVE PLAN TO PROTECT THE FOREST CORRIDOR AND TREE CANOPY IN THE GLEN COVE AREA,THE SETBACK FROM THE RIGHT-OF-WAY OF SR 20 SHALL BE 50 FEET ON EACH SIDE OF THE HIGHWAY(COMPRISED OF A 30-FOOT BUFFER AND A 20-FOOT SETBACK FROM THE BUFFER),FOR NEW DEVELOPMENT,FROM THE INTERSECTION OF OLD FORT TOWNSEND ROAD AND SR 20 TO THE INCORPORATED BOUNDARY OF THE CITY OF PORT TOWNSEND. W001 PWD-STORMWATER None NOT MET 9/10/2008 MKF THE PROPONENT SHALL IMPLEMENT THE BMPs FROM THE STORMWATER MANAGEMENT TEMPLATE DATED JUNE 18,2008 !001 PWD-STORMWATER None NOT MET 9/10/2008 MKF THE PROPONENT SHALL CONTACT THE PUBLIC WORKS DEPARTMENT(385-9162)FOR AN INSPECTION PRIOR TO BACKFILLING THE INFILTRTION TRENCH. !001 PWD-STORMWATER None NOT MET 9/10/2008 MKF THE PROPONENT AND SUBSEQUENT OCCUPANTS SHALL ENSURE THAT MATERIALS USED AND STORED ON THE SITE DO NOT CONTAMINATE STORMWATER RUNOFF. THIS MAY REQUIRE, AS APPROPRIATE, ADDITIONAL BEST MANAGEMENT PRACTICES SUCH AS COVERED STORAGE,CONTAINMENT STRUCTURES,AND/OR A SPILL RESPONSE AND CLEANUP PLAN. :001 PWD-STORMWATER None NOT MET 9/10/2008 MKF IN ORDER TO ENSURE THAT THE APPROVED STORMWATER MANAGEMENT FACILITIES ARE APPROPRIATELY MAINTAINED FOR THE LIFE OF THE PROJECT,THE PROPONENT SHALL ENTER INTO A STOMRWATER MANAGEMENT FACILITY MAINTENANCE AGREEMENT WITH JEFFERSON COUNTY. PRIOR TO FINAL APPROVAL OF THE PROJECT,THE DEPARTMENT OF PUBLIC WORKS WILL SEND A COPY OF THE AGREEMENT THAT HAS BEEN SIGNED BY THE PUBLIC WORKS DIRECTOR TO THE PROPONENT. THE DEPARTMENT WILL NOT GIVE FINAL APPROVAL FOR THE PROJECT UNTIL THE AGREEMENT HAS BEEN SIGNED BY THE PROPONENT AND FILED WITH THE JEFFERSON COUNTY AUDITOR. 001 PWD-STORMWATER None NOT MET 9/10/2008 MKF THE DEPARTMENT OF PUBLIC WORK'S FEE FOR REVIEWING STORMWATER SITE PLANS AND CONSTRUCTION STORMWATER POLLUTION PREVENTION PLANS AND INSPECTING IMPLEMENTATION OF BEST MANAGEMENT PRACTICES IS$62 PER HOUR. FEES MUST BE PAID PRIOR TO FINAL PROJECT APPROVAL. 001 ALL WEATHER SURFACE None NOT MET 9/11/2008 MKF All parking areas shall be provided with an all-weather surface. 001 PARKING None NOT MET 9/11/2008 MKF Parking requirements are based on a formula of one space per employee and one space per 300 square feet of associated retail. Additional parking to meet physically handicapped needs shall be provided at a rate of not less than 2%of the total number of parking spaces, or a minimum of one parking space. 001 PARKING-WHEEL STOPS None NOT MET 9/11/2008 MKF Wheel stops, striping,or similar measures are required where a parked vehicle would encroach on adjacent property, pedestrian access or circulation areas,rights-of-way, or landscaped areas. 001 HANDICAP PARKING None NOT MET 9/11/2008 MKF Parking for physically handicapped needs shall be provided consistent with state standards at a rate of not less than two percent of the total number of parking spaces, or a minimum of one parking space,whichever greater. Parking spaces for physically handicapped needs shall comply with ANSI 117.1-2003 (502.2 and 502.4.2). Such spaces shall be not less than 12 feet,six inches wide. DO1 JOINT PARKING None NOT MET 9/11/2008 MKF Page 2 of 4 CaseConditions.rpt JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitvdevelopment Tel:360.379.4450 I Fax:360,379.4451 I Email:dcd1 co.iefferson.wa.us SquareONE Resource Center'Building Permits&Inspections I Development Review I Long Range Planning April 16, 2015 GABRIEL GREENSTEM 1014 NW 178TH ST SHORELINE WA 97177 RE: SITE ADDRESS: 205-A N OTTO ST CASE#: BLD15-00078 Dear GABRIEL GREENSTEIN: We have started the plan review process on the subject permit. Unfortunately,we are unable to finish the necessary plan review. We are in need of additional information and/or items as listed below: 1. Building permit application to allow the approval of the existing non-permitted configuration of the subject building originally permitted under BLD08-00269. No further review or issuance of the Change of Use permit BLD15-00078 will not be processed prior to approval of#1. 2. Mechanical Permit application for installation of the CO2 Extraction Machines. Fees will be based on commercial valuation of the project. 3. Occupancy-number of employees proposed in each of the three units identified for Building 205. 4. All applications and modifications shall be submitted through the Permit Technician. 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) 379-4450. Sincerely, Plans Examiner c: File MICHAEL ANDERSON DAN TITTERNESS Susan Porto David Wayne Johnson \\tidemark\data\forms\F_B LD_Add Info_PInChk.rpt 11/3/1999 �l 1 \p 1 /yam 1 J i` L' -'_ ��i4'''�i�'������'''������'�� x w� a °� _ ' i! �►ii�ti �0��►� �� �►�0►►� �I° o ° , e • 1 '61 Qwa z m.^ \,(\ -i, Le Pe z U z. e m a•o� xWa I o u �/�\ o na a V m et- O 2 , no 0 p 0 I III p --.. V3— i ---.._ _. Iii�,., O .T ON n! <N S 2 w O oO L 3 4.1. m w V` V v \ :SR o a w SIT rc 4.- -L, [0 °OO z mo p- u F p l- it o Q p m NS30 V S 8 p N LL, p 4 ;W O K �O 0 0 0 m0 O O x a i N t<t4 z J r G O to L o Q N `� ,, Q O n I„as. ZU'V L OF :',Ai b t pz= m}¢III ry N . a r Q ` m7j V6 Oy NQ I I n I ••I ❑ • {/1 I 5'ldM 301SNI Ol 301SN1 _ S. - AL S ,SS Cc-- k.r i t- gip ►� ,,- Washington State ',,, y�;) Liquor Control Board • November 24, 2014 I Jefferson County Commissioners ATTN: Commissioners PO Box 1220 NOV 2 6 2014 Port Townsend, WA 98368 JEFFERSON `'QMMISSIONERS RE: Notification of Pending Marijuana Extraction Operatfo Trade Name: PDT Technologies License Number: 415704 Contact Name: Gabe Greenstein Phone Number: 206-327-0149 1 Location Address: 205 Otto St, Ste A, Port Townsend, WA 98368 Dear Sir or Madam, In accordance with Washington Administrative Code (WAC) 314-55-104(5), the WSLCB is sending notifications to local authorities (LA)when a marijuana processor plans to perform extractions of marijuana requiring the use of a professional grade closed loop extraction system • at a facility within their jurisdiction. This letter is to inform you that the above mentioned applicant/licensee has indicated in their operating plan that they intend to extract marijuana using a Extraction Method process. In accordance with the law, "Professional closed loop systems, other equipment used, the extraction operation, and facilities must be approved for their use by the local fire code official and meet any required fire, safety, and building code requirements." For additional information on extraction requirements please see WAC 314-55-104. Meeting the required fire, safety and building code requirements is a process between the LA and the applicant, and a requirement for the applicant to begin operation. The WSLCB does not verify local fire code approvals as part of the application process. If you have additional questions, you may contact us via email at: MJExaminer a(�lia.wa.gov. Thank you, Timothy Gates Marijuana Examiner Washington State Liquor Control Board 360-664-1614 • 3000 Pacific Ave. SE, P.O. Box 43098, Olympia WA 98504, (360) 664-1600, www.liq.wa.gov I � 15 - bW 8 MICHAEL J.ANDERSON t Civil Engineer &Land Surveyor 330 Cleveland Street Port Townsend,WA 98368 MEMO ` ' Lff' ► MI S DATE: April 2, 2014 — – , - , TO: Jefferson County Community Development Dep el<1t APR - 2 2015 ID Attention: Ms Sally Ellis,Permits <] j ` Ji ;(tifY FROM: Michael J. Anderson / 1 ( T OF COMMUNITY DEVELOPMENT PE&PLS / SUBJECT: PDT Technologies(Tenant: Mr. Gabriel Greenstein) 205 A No. Otto Street, PT APN 986 701 902 RESPONSE TO: 1) March 19. 2015 e-mail from Ms Mary Blain, Building Dept. 2) March 24, 2015 letter from Susan Porto, Health Dept. 3) March 25,2015 letter from David Johnson, Planning Dept. BLAIN MEMO: In response to the question regarding the floor plan,the only change from the original approval of the building was the addition of the wall separating the 205 A and 205 B units. Attached is a revised building and site plan showing the wall. The unit 205 C walls were part of the original construction and final inspection. Units 205 A and 205 B has a man door and a garage door that provide two exits. The building plan shows the details for the interior security fencing required by the State. An explanation of the use was in the transmittal of a revised building plan on March 26, 2015 by this office. The attached plan dated March 31, 2015 now illustrates these improvements. The following is an updated description of the proposed business operations: The business activities occurring at 205-A N Otto St, Port Townsend WA 98388 will be marijuana processing. This will include the extraction of raw cannabis material, and the packaging of the ensuing essential cannabis oils into retail products. Raw, pre-ground material will arrive securely from a legal i-502 farm, and be received into a caged, secured"Quarantine" (see attached PDT Technologies Site Plan)area within the facility. As per WSLCB regulations, the material will sit in the designated Quarantine for a period of no less than 24 hours upon receipt. After the required waiting period,the material will be taken from the secure storage area and moved into the CO2 extraction vessel, where it is converted into oil. This equipment is commonly used in the food industry to produce clean, non-volatile, non-hydro carbon solvent based food extracts. The CO2 extraction works, by forcing high pressure gas through the plant material in the extraction vessel, causing the material to separate into essential oils and plant matter residue. The organic waste residue is then stored in the Quarantine/ Controlled Area where it will eventually be mixed with a 50%blend of organic material, and taken to a composting facility. The essential plant oils, will then be stored in Quarantine, while a sample of the oil is sent out and evaluated at a 3`d party QA lab for potency and pathogen testing. Once the oils are determined by the lab to be safe for consumer consumption, the oil will be taken from Quarantine and placed into retail packaging. The final products will be placed in Quarantine where inventory will be available for sale to licensed 502 retail stores. To summarize,this application is for a change of use only. No improvements to either the existing building or utility systems are required. PORTO LETTER: Item No. 1. The new attached plans dated Mar. 31, 2015 show the demising wall as noted above. There are two employees at the existing 203 Building and both buildings are served by the same water and sewer system. The attached plans show the existing wall constructed without a permit or inspection. Item No. 2. The current use in the 205B Unit is"un-occupied" at the present time. Item No. 3. Attached is a copy of the water billing dated Feb. 20, 2012 from the City of Port Townsend that illustrates that the average consumption is about 1000 gals per month with the exceptions where the toilet overflowed and the summer months of irrigation of the plantings. Item No. 4. In a review of the operation plan submitted by PDT,there will be 4 employees. Item No. 5. The existing sink is for personnel hygiene only.Not a part of proposed business operations. Item No. 6. The ORCAA responded to today indicating that they are not a party to this permitting at this time and will respond to any complaints in the future. As indicated,any waste material from the operation will be mixed with compost and delivered to the JC plant. We will be responding to today's e-mail from Gary Lee,Engineer from DOE and provide an answer ASAP. Item No. 7. The water line location has been added to the site plan and is located consistent with the Health Dept. regulations as shown on the approved septic permit plan. JOHNSON LETTER: The attached site plan has been revised to list the employee number currently planned for 6 people and the plan illustrates how 11 parking spaces can be provided, including one handicap space. SUMMARY: Please review this summary of our responses and provide us with your comments. As indicated, we will be contacting DOE and will provide update ASAP. Thank you for your prompt responses in processing this application for change in use. c: Dan Titterness,Property Owner Gabe Greenstein, Tenant Z 2 s R � \ �.\ PP J �-✓ t— UEE�o t �on�a10‘t CITY OF PORT TOWNSEND Account 250 Madison Street#1 Statement '. 1c) Port Townsend, WA 98368 ACCOUNT INFORMATION ACCOUNT: 012383-000 SERVICE ADDRESS: 203 OTTO ST SERVICE PERIOD: 1/1/2015 to 1/31/2015 BILLING DATE: 1/31/2015 DUE DATE: 2/20/2015 MGR 4075 1 MB 0.432 4276 / 4075 19-20-16 page 1 of 1 MOS DAN TITTERNESS Previous Reading Current Reading 9 Reading Cons Serial No Date Reading Date Readin 101 KIWI LN SEDUM WA 98382-8550 68098458 12/102014 1240 1/20/2015 1320 8000 I lliI'iliiuiuiI'II Illrililllrlll1Ir11.1111Illilur11i'l111111urlrl IMEIMEMINIMMEM1111. C=1111.1111. -If not paid by the due date,a$5.00 minimum penalty or a Water 46.75 1-1/2%penalty,whichever is greater,will be applied to the 10%General Services Tax 4.68 account. 10%Public Safety&Streets Ta 4.67 -GO PAPERLESS,GO DOXO. See reverse side of CURRENT CHARGES 56.10 statement for payment options and billing in_ forltla'•n. —" Water Capital Surcharge 21.60 TOTAL CURRENT CHARGES 77.70 USAGE HISTORY BILL SUMMARY 12000 - - PREVIOUS BALANCE 43.58 d e wow P PAYMENTS RECEIVED -43.58 s � 't •DJUSTMENTS 0.00 8000 i St u J 4 v — •DDITIONAL BILLING 0.00 'cm 1_ j URRENT CHARGES 77.70 '000 I — , 1.., - 1 TOTAL AMOUNT DUE ' 77.70 D I IIL _ .�r.I _ JAN EEO y MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN /,d T J 1, /fr Prior Cons Cunard Cone .rj �� /- ' ^ 1 t1 7) ?O'°-1 t � o ' s0',' \ , -' ae ___ _ IN i4 w r.n. t e ,. J .a a „i n rp s, ik,y - ;`T ,.)ep r a . 5{ c ..L -. tiv ,3t a.,.> yam— a t +, { y.tV'1N '" f trl�J tfT t, Mifhj 4t,r.�.: 9n`35,1-; v t:91 n:=:.,,tpai/°. �1�.-/", >sc, ;,s ter n::.:_: f Rio tte .etir ieis, ..-:2-7., C ou ;:y :ghiF'er October 1,2009 Dan Titterness Glen Cove Properties LLC PO Box 1142 Port Townsend, WA 98368 Re: BLD08-00269 Commercial Warehous Jefferson County,StWA y,,, ;;ount� Auditor Stormw_ater Management Facility Man erson c.,,,- ::id,WA 98368 Dear Mr.:Ti?ttetiess: ,--,,._.: pt:09-01439 In order to meet the requirements of the Jeffers fended Washington Department of Ecology Stormwate Product Name Extended stormwater management facilities are appropria AGR Agree7;ert on County requires project proponents to enter into 547624 tY e9 Proj P Po Document 3 e Agreement with the County. o Pages $64.00 Please sign the attached Agreement before a Not Total • You should keep a copy of the Agreement for o $64 00 P PY gre Y Tv .- . �3 Also attached is a bill for the Department's fees f EN COVE preparing the Agreement. ,,,_OPERT;ES LLC The Department cannot give final sign off on the 1 has been paid. Thank You! _,Sincerely,--- 10126)0910:33 AM bonnie James W.Pearson l 2 Dv '.. . Project Manager Attachment � ; � /o';G°�)��!E�oe �� \1� v✓ \t-,A0a.,v, \ 0,C C. _� f tlii • zm nl <- 1 1 CC i o �a � O ›. O Mot i'Sl 1_i ez 1 co ■ffiwy,3 u i N r= .r-. tll � � 9 C'"7 1Z t= is ..►,sue O b � 00 1 1 •� ,�� . I i — ,. ,,y` b la tV i ¢ 1`.•:1 a (. , T . P " (p c Fin 0 � z 1 ;g T; • [ ••• 1 . Cn .....- r9 111.1 ttD ire stn O ®> I 'a. .>• !p •� C?) '`mod 9 -I .� , ' ' o on.• Z- o r� cn rAi A -r" n i Q . -e czn := „ 1 1 1 t �, . 1 nro v j , i,lt , , . j a x 1� 'S7 ,� -�'1 .1: �r�IL 1 z ; 71 I 1}, a p 3'0 m F - - _'c` m _. ... n r y 1 on A 3 tr� ?o ,,s......- _ w f- o I .� 1'� �nea o o. ,GF K — 4 as; 1.1 8 ,c 3 �+�+ 6::::192 ts L. OM ........,-,mg s . :,,, 7 a_.2.:.MAI j_PO"' 1 nil 0v 3�K i O �� Q . -o DA l � ) 'i "" 0 ` ` \� , �6 ua V % ` 1' l / I U V_ Cr C , F^j e.,--m 4MU 'lc PI CO ut co co 1. I CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 Al Scaif, Building Official PERMIT#: BLD08-00269 SITE ADDRESS' 205 N OTTO ST Issue Date: 09/11/2008 PORT TOWNSEND, 98368 Final Date: 4/8/2010 APPLICANT: GLEN COVE PROPERTIES LLC PHONE. 101 KIWI LN SEQUIN WA 98382-8550 SUBDIVISION: PHILLIPS BAY VIEW ADDITION Block: 19 Lot: 3+ PARCEL NUMBER: 986701902 Section: 16 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NEW 4959 S.F. UNHTD COMMERCIAL WAREHOUSE THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING_- CODE 2006 EDITION. ' `.,� L' r OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes (• no TNP-PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 4/8/2010 JEFFERSON COUNTY RECEIVED FROM DATE , !°` --"--a-- I 3 ; DESCRIPTION d Ef f' S. - CURRENCY AMOUNT GIN CHECKS MOM RECEIVED BY JEFFERSON COUNTY ,zs''"° `-«,Z DEPARTMENT OF COMMUNITY x " DEVELOPMENT y `'� "- ' 621 Sheridan Street, Port Townsend,WA 98368 Web:www.co.jefferson.wa.us/communitydevelopment ,�,' '',, Tel: 360.379.4450 I Fax: 360.379.4451 I Email:dcd a co.iefferson.wa.us SquareONE Resource Center I Building Permits&inspections I Development Review I Long Range Planning March 26, 2015 GABRIEL GREENSTEM 1014 NW 178TH ST SHORELINE WA 97177 RE: SITE ADDRESS: 205-A N OTTO ST CASE#: MLA15-00014 Dear GABRIEL GREENSTEIN: The Department of Community Development is in the process of reviewing your application. The following information is needed to continue review of your project. Please submit a revised site plan to show designated parking spaces for 6 employees, with one space designated and signed for ADA handicapped use, that are all weather surfaced per the attached conditions of approval for the original building permit BLD08-00269. Please submit the above information to the Department of Community Development within 90 days of the date of this letter which would be 6/24/2015. As required by Jefferson County Code, JCC 18.40.110(3) and (6), if the information is not submitted or additional time to submit the required information within the ninety (90) calendar day period is not requested, the application would be considered abandoned and therefore withdrawn and application fees will be forfeited. Jefferson County Code provides that the Department of Community Development shall not be responsible for notifying the applicant of an impending expiration, thus any further notification would not be forthcoming. Sincerely, gCIaLCL Werlf/le Qn Department of Community Development Staff c: File MICHAEL ANDERSON \\tidemark\data\forms\F MLT_Addlnfo_Requst.rpt 3/26/2015 MICHAEL I. ANDERSON f� �S I Civil Engineer &land Surveyor LI 330 Cleveland Street Port Townsend.WA 98368 MEMO 1 n I 5 1V ;P DATE: March 26, 2015 I WAR 2 TO: Jefferson County Community Development Department Attention: Building Department TY0[V LOPM NT FROM: Michael J. Anderson / of PE& PLS SUBJECT: BLD15-00078: CHANGE OF USE PERMIT 205 A North Otto Street, Port Townsend Reference: BLD08-00269 APN 986 701 902 Attached are two (2) copies of the existing building floor plan that shows the revisions to the interior of the South half of the building which was assigned the address of 205 A as noted.No structural changes to the building or its utility systems are proposed. The plans have been prepared in response to the e-mail from Ms Mary Blain of March 19, 2015. The change of use is from an industrial to the I-502 Processing and Manufacturing designation which can be described as follows: 1. The raw material will arrive by truck and be delivered directly into the Security Area which is fenced and locked as per Washington State regulations 2. The material is then transferred to the CO2 extraction vessel equipment which converts it to an oil. This equipment is commonly used in the food industry to produce clean, non-volatile, non-hydro carbon solvent based food extracts. The high pressure gas is forced through the extraction vessel causing the material to separate into the essential oil and leave a residue. The residue is then stored in the Quarantine/ Controlled Area(see attached PDT Technologies Site Plan) and removed from the site after being mixed with 50%organic material that is taken to a composting facility. To summarize, this application is for a change of use only. No improvements to either the existing building or utility systems are required. Please indicate if you need any additional information to complete your review of this project. Attachments: 2 c: Dan Titterness, DBA Glen Cove Properties LLC, Owner Gabriel Greenstein, DBA PDT Technologies, Tenant 0 0 0 0 ``hr.! m CO (D 143 y^.� o . 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OI X x ® O ' o co 00 Opm m o O X N r r 1 (n U1 -. 0 cc DESK Z z II XI 0 p - r m o Z o r X 0 03 ICIO y.M 0 X ��X O X -0 r ' Of in C (--- ,., o0 Z M D w y = X . 0) O o CA 0 0 bzi 55 t 8 41.7,- 4-N 71 N -0 W n ➢ o e O X O v= D r -U • co IA 'n N0 O D O I r s � yy h P o m .o � n� n + • T t o ii xi 0 o a OHO cN _ ...................�r. {z o g � � � ♦.������������������♦ - 0_ to co C4 I et - -h V-1 P(�, O 111111 U I Wn i OS — rf) JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street • Port Townsend • Washington • 98368 w m.jeffersoncountypublichealth.org March 24, 2015 T. GABRIEL GREENSTEM 1014 NW 178TH ST SHORELINE WA 97177 RE: SITE ADDRESS: 205-A N OTTO ST CASE #: BLD15-00078 Dear GABRIEL GREENSTEIN: 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: 1. Bt.D08-269 (the building that is the subject of this permit application)was approved for a warehouse to serve the adjoining business,with no additional employees on the site other than the 2 from the adjoining business. Additionally the floor plan showed the entire building open with no division as shown in the new submittal. Please provide a current floor plan of the building included the adjacent space that appears to have a wall installed that divides the building. 2. Please describe the current use of the adjoining warehouse space. 3. Please provide current water use records for the last year, for all of the buildings connected to the septic system. 4. Provide the number of employees this business will serve. The operation plan indicates 5, will those 5 be the only employees for this business? 5. What is the intended use of the sink to be installed in the "common area". 6. I will be forwarding your operation plan to Orcaa, JC solid waste and ECY for their comments. If there are none, you will need to contact a licensed septic designer to address waste strength associated with your proposed extraction process into vaporizor cartridges and stand alone oils. 4. 14 -20 LwC Lo Y1 J- TD SITE � f`'J1'4l7 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. Sincer- 1 Jefferson County Public Health Environmental Health Specialist �'�;w 3/18/2015 CCCEL/ ' Conditions Associated With 1:25:52PM Case#: BLD08-00269 Condition Status Updated Code Title Hold Status Changed By Tag Date By Maximum lot coverage is not to exceed 55%. Lot coverage is defined as amount of impervious surface which includes roof tops,driveways,concrete, etc. 0101 SEPTIC CONDITION None NOT MET 9/10/2008 MKF 10'SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM;EFFLUENT TRANSPORT LINE,TANKS,TREATMENT AND DISPOSAL COMPONENTS. 2001 SR 20 CORRIDOR None NOT MET 9/10/2008 MKF TO IMPLEMENT THE INTENT OF LNG 19.0 OF THE COMPREHENSIVE PLAN TO PROTECT THE FOREST CORRIDOR AND TREE CANOPY IN THE GLEN COVE AREA,THE SETBACK FROM THE RIGHT-OF-WAY OF SR 20 SHALL BE 50 FEET ON EACH SIDE OF THE HIGHWAY(COMPRISED OF A 30-FOOT BUFFER AND A 20-FOOT SETBACK FROM THE BUFFER),FOR NEW DEVELOPMENT,FROM THE INTERSECTION OF OLD FORT TOWNSEND ROAD AND SR 20 TO THE INCORPORATED BOUNDARY OF THE CITY OF PORT TOWNSEND. 2001 PWD-STORMWATER None NOT MET 9/10/2008 MKF THE PROPONENT SHALL IMPLEMENT THE BMPs FROM THE STORMWATER MANAGEMENT TEMPLATE DATED JUNE 18,2008 2001 PWD-STORMWATER None NOT MET 9/10/2008 MKF THE PROPONENT SHALL CONTACT THE PUBLIC WORKS DEPARTMENT(385-9162)FOR AN INSPECTION PRIOR TO BACKFILLING THE INFILTRTION TRENCH. 2001 PWD-STORMWATER None NOT MET 9/10/2008 MKF THE PROPONENT AND SUBSEQUENT OCCUPANTS SHALL ENSURE THAT MATERIALS USED AND STORED ON THE SITE DO NOT CONTAMINATE STORMWATER RUNOFF. THIS MAY REQUIRE, AS APPROPRIATE, ADDITIONAL BEST MANAGEMENT PRACTICES SUCH AS COVERED STORAGE, CONTAINMENT STRUCTURES,AND/OR A SPILL RESPONSE AND CLEANUP PLAN. 2001 PWD-STORMWATER None NOT MET 9/10/2008 MKF IN ORDER TO ENSURE THAT THE APPROVED STORMWATER MANAGEMENT FACILITIES ARE APPROPRIATELY MAINTAINED FOR THE LIFE OF THE PROJECT,THE PROPONENT SHALL ENTER INTO A STOMRWATER MANAGEMENT FACILITY MAINTENANCE AGREEMENT WITH JEFFERSON COUNTY. PRIOR TO FINAL APPROVAL OF THE PROJECT,THE DEPARTMENT OF PUBLIC WORKS WILL SEND A COPY OF THE AGREEMENT THAT HAS BEEN SIGNED BY THE PUBLIC WORKS DIRECTOR TO THE PROPONENT. THE DEPARTMENT WILL NOT GIVE FINAL APPROVAL FOR THE PROJECT UNTIL THE AGREEMENT HAS BEEN SIGNED BY THE PROPONENT AND FILED WITH THE JEFFERSON COUNTY AUDITOR. 2001 PWD- STORMWATER None NOT MET 9/10/2008 MKF THE DEPARTMENT OF PUBLIC WORK'S FEE FOR REVIEWING STORMWATER SITE PLANS AND CONSTRUCTION STORMWATER POLLUTION PREVENTION PLANS AND INSPECTING IMPLEMENTATION OF BEST MANAGEMENT PRACTICES IS$62 PER HOUR. FEES MUST BE PAID PRIOR TO FINAL PROJECT APPROVAL. 2001 ALL WEATHER SURFACE None NOT MET 9/11/2008 MKF All parking areas shall be provided with an all-weather surface. 2001 PARKING None NOT MET 9/11/2008 MKF Parking requirements are based on a formula of one space per employee and one space per 300 square feet of associated retail. Additional parking to meet physically handicapped needs shall be provided at a rate of not less than 2%of the total number of parking spaces, or a minimum of one parking space. 2001 PARKING-WHEEL STOPS None NOT MET 9/11/2008 MKF Wheel stops,striping, or similar measures are required where a parked vehicle would encroach on adjacent property, pedestrian access or circulation areas, rights-of-way,or landscaped areas. 2001 HANDICAP PARKING None NOT MET 9/11/2008 MKF Parking for physically handicapped needs shall be provided consistent with state standards at a rate of not less than two percent of the total number of parking spaces,or a minimum of one parking space,whichever greater. Parking spaces for physically handicapped needs shall comply with ANSI 117.1-2003 (502.2 and 502.4.2). Such spaces shall be not less than 12 feet, six inches wide. 2001 JOINT PARKING None NOT MET 9/11/2008 MKF Page 2 of 4 CaseConditions.rpt 3/18/2015 c-kCCEL/ Conditions Associated With 1:25:52PM Case #: BLD08-00269 Condition Status Updated Code Title Hold Status Changed By Tag Date By Owners of two or more adjoining uses, structures or lots may utilize jointly the same parking or loading area when the hours of operation do not overlap. In the event that owners of one or more adjoining uses, structures or lots desire to utilize jointly the same parking concurrently,the total requirement for parking spaces shall be the sum of the requirements for each individual use, unless the applicants can demonstrate to the Administrator that a lower number of parking spaces are justified through implementation of transportation demand management strategies, off-peak use,availability and use of public transit or alternative modes of travel or other measures. 2001 SCREEN B LANDSCAPING None NOT MET 1/12/2009 MKF An average width of ten(10)feet of Screen-B landscaping shall be provided along N Otto St. Screen-B landscaping is a"filtered screen"that functions as a visual separator. This landscaping is a mix of evergreen and deciduous trees and shrubs generally interspersed to create a filtered screen that grows to at least eight feet in height within two growing seasons. 2001 LANDSCAPING-MAINTENANCE None NOT MET 9/11/2008 MKF All landscaping and necessary support systems shall be maintained for the life of the project. All landscape materials shall be pruned and trimmed as necessary to maintain a healthy growing condition. Landscape areas shall be kept free of trash. 2001 LANDSCAPING INSTALLED None NOT MET 9/11/2008 MKF The required landscaping shall be installed prior to project occupancy. However,a temporary certificate of occupancy may be issued prior to landscape installation at the written request of the owner that identifies a time line for plant installation. 7001 CASE HISTORY None NOT MET 9/10/2008 MKF A stormwater permit subject to SEPA(BLD07-0065)to disturb 152,460 square feet of land was approved on June 1,2007. A pre-application conference(PRE07-0020)was held on June 11,2007 for construction of a 10,000 square foot warehouse. A road approach permit(RAP07-0079)was finaled on December 11,2007. A septic permit(SEP07-0159)was finaled on December 19,2007. A building permit(BLD07-0310)for a 10,000 square foot warehouse was finaled on March 25,2008. 7202 F-Confirmed ESAs None NOT MET 9/10/2008 MKF The application was reviewed by the Jefferson County Department of Community Development staff on September 10,2008 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:SARPA&SUSC aquifer recharge area. 7204 F-Aquifer Recharge Area None NOT MET 9/10/2008 MKF Aquifer Recharge Areas in Jefferson County are characterized by porous geological 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. 7205 F-Susc.Aquifer Recharge Area None NOT MET 9/10/2008 MKF Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 7207 F-Critical Aquifer Recharge Area None NOT MET 9/10/2008 MKF Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas,and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas(1)All Industrial Land Uses(2)All Commercial Uses(3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit(5) Unsewered Planned Rural Residential Developments(6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 7401 F-Stormwater None NOT MET 9/10/2008 MKF The applicant is proposing to create or add 4959 square feet of impervious surface and 4959 square feet of land disturbing activities. 7701 F-SEPA Exempt None NOT MET 9/10/2008 MKF Page 3 of 4 CaseConditions..rpt 3/18/2015 CEL Conditions Associated With 1:25:52PM Case #: BLD08-00269 Condition Status Updated Code Title Hold Status Changed By Tag Date By 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)(c)(iii). 7751 F-Site Plan Changes None NOT MET 9/10/2008 MKF The revised site plan dated August 29,2008 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 10,2008 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 7752 F-Approval for Only None NOT MET 9/10/2008 MKF This approval is for a 4959 sqare foot warehouse and parking and stormwater facilities 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. 7754 ZONING None NOT MET 9/10/2008 MKF The parcel has been designated as LI/C under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 7755 DECLARATION OF REST COV None NOT MET 9/10/2008 MKF A Declaration of Restrictive Covenant has been recorded on June 24,2007 under AFN 523790 for the purpose of consolidating the lots to meet minimum land area requirements for on-site septic and to allow zero lot line setbacks. The Covenant is strictly for building and septic purposes only. Page 4 of 4 CaseConditions..rpt 3/18/2015 Conditions Associated With 1:25:52PM CCEL Case#: BLD08-00269 Condition Status Updated Code Title Hold Status Changed By Tag Date By 0022 Bld Final Zoning Approval None NOT MET 9/10/2008 \IKF The applicant and/or representative shall contact the Development Review Division of the Permit Center(360-379-4450) regarding a final inspection for compliance of zoning permit conditions prior to scheduling a final building inspection. 0051 Bld Storage of inflammable liquid None NOT MET 9/10/2008 MKF 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. 0053 Bld Outside Storage None NOT MET 9/10/2008 MKF Commercial and industrial developments located in all zoning districts hall 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. 0054 Bld Noise None NOT MET 9/10/2008 MKF The intensity of sound emitted by any commercial or industrial activity shall not exceed levels estabished by the Washington State Department of Ecology under WAC 173-60,and by Jefferson County under Resolution No. 67-85, "Establishment of Environmental Designations for Noise Abatement Areas for Jefferson County." 0055 Bld Noise Abatement None NOT MET 9/10/2008 MKF All noise emitting machinery that cannot in any other way operate below the maximum permitted noise level shall be housed in a sound-attenuating structure. 0056 Bld Sign Permit Required None NOT MET 9/10/2008 MKF Signs shall be reviewed administratively by the Department of Development Review. An administrative determination to approve a sign application shall be made when the proposal is consistent with the goals,policies,and provisions of the Comprehensive Plan,and/or applicable community development plan,and this ordinance. 0057 BId Off Street Parking None NOT MET 9/10/2008 MKF Off street parking shall be provided in accordance with the minimum standards set forth in Tables 6-2&6-3 of the Jefferson County Code or one(1) space per employee and one(1) space per 300 square feet of any associated retail sales area. No retail sales is proposed for the project. (The submitted site plan identifies two(2)parking spaces and one(1)handicap parking space). No less than 2%of the total number of parking spaces or a minimum or one(1)space,whichever is greater, shall be designated handicap parking and be no less than 12'6"wide. 0060 Bld Security/hooded lights None NOT MET 9/10/2008 MKF 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. 0061 Bld Exterior height lights None NOT MET 9/10/2008 MKF 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. 0062 BId Exterior flashing lights None NOT MET 9/10/2008 MKF Exterior flashing,moving, or blinking lighting is prohibited,except as required by local,state,or federal standards. 0066 Bld Setbacks None NOT MET 9/10/2008 MKF Minimum setback from North Otto Street right-of-way shall be 20 feet. Minimum side yard setbacks shall be 10 feet. Minimum setback from SR 20 right-of-way shall be 50 feet. 0069 Bld loading/unloading None NOT MET 9/10/2008 MKF Loading and unloading must occur on site(off-street). 0070 Bld building height None NOT MET 9/10/2008 MKF The building height is not to exceed 35 feet. 0075 Bld tot coverage None NOT MET 9/10/2008 MKF Page 1 of 4 CaseConditions..rp1 The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail/ e-mail requests and information about the application to the authorized agent/representative and will copy(cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email(i.e.,County email is not blocked or sent to "junk mail"). Applicant/Property Owner Information Property Owner: ----,Name: C ( t?rlf\,e�S Address: lot ie,M.i% t. Virvt ' Phone#: — 364 • 31( ' 177( -mail Address: _ — PI ontact Authorize. Agent/Representative with project info. (select only one). Property Owner Signature: �(, / / `�1 Al f �� Date: ,l"/i�� Note: For projects with multiple ners,attach a separa eet with each owner(s)inform/ton an signatures. , Applicant: Authorized Agent/Representative(If other than owner) Name: /4/1/ M-ez --ems /Wiper' " ip 'SQI J �/ Address: 6,3C7 G ' e, p .7--_ v i'4-- . g'15 eg Phone#: -Alai 9669 —5,3-3/ - /01/ E-mail Address: Pro ' r+al. Is this an Authorized Agent/Representative for this project? NO YES nginee Architect Surveyor I),Contractty�r `` Consultant ame: / `j ` „`bey' \3� . (aS dc� ; er / r Address: / Ar / Phone#: E-mail Address: / j dryoZo2eath.g Goya 4- Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architet Surveyor Contractor Consultant u Name: \Q.Cl e eks.�c ��p l , �/ 7 Address: ill'C' N 17 A In S`t . �/'V i"' 1 0 C J r /_ Phone#: Aju E-mail Address: rI�e i\I nkn(1 r'(p3,t. J __,---Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary Builders Statement The signer of this statement certifies 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: Print Name: Date: Q f Habilis Construction,LLC P71� r HABILCL92IC6 / 31 Petes Spur Port Hadlock,WA 98339 360-301-5230 August 1, 2008 Jefferson County Public Health Habilis Construction, LLC 615 Sheridan Street HAB1LCL921C6 Port Townsend, WA 98368 Casey McKinney Re: Permit Number MLA08-298 233 Otto Street 31 Petes Spur Port Townsend,WA 98368 Port Hadlock,WA 98339 360-301-5230 or 360-379-9617 Casey-Susan @msn.com Attn: Angela: Thank you for your message and conversation this past week. I understand you need water usage history of the subject property,correction of the site plan water line location to be re-routed at leastl0 feet from septic lines, a brief description of the intended use of the facility, and number of employees intended to work in the facility. Following please find my response to these issues. Enclosed please find copies of the water bills showing consumption for the buildings utilizing the existing septic system,from start(12/13/07 through 6/13/08. Total consumption is 4,000 gallons over 6 months for an average of 667 gallons per month.. Please review the enclosed copy of amended site plan that has been provided to DCD in triplicate. I hope this meets the requirements of your department. If not,please let me know and I will provide any further correction required. The intended use of the facility is to provide the main tenant of the property owner additional warehouse space. The tenant has reported to the property owner that the tenant does not project any increased employment to the 2 employees currently employed in the existing 10,000 foot warehouse. On rare occasion,between 1 and 2 employees assist in the 10,000 foot warehouse on a very part-time basis, in durations of 1 to 3 hours and less than weekly on the average. Based on intended use and within current plans,the property owner is not planning to complete the restroom unless commercial interests change and altered use requires the completion and connection of the restroom. Prudent planning is the cause, at this time,to install the infrastructure to the building as there is no additional employment being created and the 2 fte's are serviced by the existing restroom in the 10,000 foot warehouse located less than 100 yards from the proposed facility. I hope this brief narrative provides you with the necessary information to complete your review of the environmental portion of our building permit application. I look forward to addressing any other comments or corrections required and thanks again for your time on this issue.Please do not hesitate to call me. S. ce ely 77, RECEIVED Casey McKinney AUG 0 5 2008 Manager, Habilis Construction. LLC Jefferson County Environmental Health JEFFERSON COUNTY rs " DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 I Web:www.co Jefferson.wa.us/communitvdevelopment Tel: 360.379.44 0� Fax:360.379.4451 Email:dcd a(.co.jefferson.wa.us 5 S 9 uareONE Resource Center I Building Permits&Inspections I Development Review I Long Range Planning March 18, 2015 GABRIEL GREENSTEM 1014 NW 178TH ST SHORELINE WA 97177 RE: SITE ADDRESS: 205-A N OTTO ST CASE#: MLA15-00014 Dear GABRIEL GREENSTEIN: The Department of Community Development is in the process of reviewing your application. The following information is needed to continue review of your project. Please submit a count of regular employees who will be working on-site. Please submit the above information to the Department of Community Development within 90 days of the date of this letter which would be 6/16/2015. As required by Jefferson County Code, JCC 18.40.110(3) and (6), if the information is not submitted or additional time to submit the required information within the ninety (90) calendar day period is not requested, the application would be considered abandoned and therefore withdrawn and application fees will be forfeited. Jefferson County Code provides that the Department of Community Development shall not be responsible for notifying the applicant of an impending expiration, thus any further notification would not be forthcoming. Sincerely, n/l -Da €d Wa ae7an/LJatt Department of Community Development Staff c: File MICHAEL ANDERSON \\tidemark\data\forms\F_MLT_Addinfo_Requst.rpt 3/18/2015 Up Front Parcel Review Parcel 986701902 Printed: March 18, 2015 GLEN COVE PROPERTIES LLC Site Address(es): 101 KIWI LN 205 N OTTO ST PORT TOWNSEND, WA 98368 205-A N OTTO ST PORT TOWNSEND, WA 98368 SEQUIM, WA 98382-8550 203 N OTTO ST PORT TOWNSEND, WA 98368 Parcel Number: 986701902 S-T-R: 16-30N-1W Total Acreage 1 Legal Description PHILLIPS BAY VIEW ADDITION BLK 19 LOTS 3,4,9 & 10 Land Use: 2000 AND TAX 73 LS PTN TAX 75 Flood District: Fire District: I Planning Area: 2 Flood Map (FIRM) Panel No: School District 50 Zoning: 1 COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans [ Vt... Plot plan states "property line" [ VT,.......Assessor's Map(Property lines on bmitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ Legal Access to Property 401P NO [ 141, Parcel Tags or Scanned Documents YE NO [ Vr ESA's: Special Reports ■ - • by YES [ Designated Ag YES NO [1,4"-- Shoreline Designation: YES [L horeline Slope Stability: YES NO Stream Type:YES NO FWHCA: YES NO Wetlands: YES NO Rare Plants:YES NO � cl Seismic: YES NO T, r L� 2-& 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 RiskDisconnected CMZ Stormwater site plan sub, itted: YesNo [V( Forest Lands: YES NO Adjoining Forest Lands: Commercial/ Rural/ Inholding [V Mineral Lands: YES [ 1i1" Agricultural Lands: YES [ ►i]'- Archaeology: YES (" [ No Shooting Zone: YES d• [ 14 Stormwater: New Impervious Surface $ Land Disturbing Activity ESA's Stormwater Req's:Min Req#2 Min Req#1 thru#5 Min Req#1 thru#10 Engineering [ VNotice Provisions/Disclosure:Airport YES NO MRL YES NO Forest Lands YES NO [ LA—' Landscaping Required: Yes No - [ ler Parking Spaces Required NO 2 Other) (,(�t4O(„t l�� f IX Building Height: 35' 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 f Building Coverage: 60%in Rural Industrial Lands only [ v 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 [ c."1 Setbacks: Front: Left Side: Right Side: Rear: Shoreline Setback: LSHA Setback: [ Road Classification: Road ApproachxisTl Q'D RAP [ VI SEPA Required: YES EXEMPT.) [ v-- Flood Certificate: [ nY Existing Case(s) & Condition(s): Violations: Yes No [1„,K Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: ____ Conditions on plat or Old Ordinance [ V Lots/Require Declaration of Restrict' -- Covenant YEVO..�ubmitted: YES NO I UGA No Protest Agree YES s • submitte YEIS [ Site Visit conducted YES 414 3 1 1. IGILt) [ t.4K Require Final Zoning Approval ' S NO [ ADMIN: Setbacks entered in Permit Plan cas YES New Parcel Tags entered i rmit Plan N/A YES Special Reports Scanned YES Title Notes Updated Parcel tags found for parcel 986701902 1.) Custom Warning Flag TO IMPLEMENT THE INTENT OF LNG 19.0 OF THE 06/28/2006 COMPREHENSIVE PLAN TO PROTECT THE FOREST CORRIDOR AND TREE CANOPY IN THE GLEN COVE AREA, THE SETBACK FROM THE RIGHT-OF-WAY OF SR 20 SHALL BE 50 FEET ON EACH SIDE OF THE HIGHWAY (COMPRISED OF A 30-FOOT BUFFER AND A 20-FOOT SETBACK FROM THE BUFFER), FOR NEW DEVELOPMENT, FROM THE NTERSECTION OF OLD FORT TOWNSEND ROAD AND SR 20 TO THE INCORPORATED BOUNDARY OF THE CITY OF PORT TOWNSEND. Parcel tags found for parcel 986701902 2.) WSRC Coaching - 2012-04-25, SG 09/06/2013 Other Cases Associated with APN 986701902 Review Cases Name Type Status Planner ADR09-00017 GLEN COVE PROPERTIES LLC F Application Received: 2/23/2009 Permit Issued/Case closed: Case Finaled: 911 DUP X 2 ADR15-00008 ATTN: GABRIEL GREENSTEM P Application Received: 3/10/2015 Permit Issued/Case closed: Case Finaled: Original permit BLD08-00269 for Commerical Warehouse- Dup. plate CAM15-00070 TITTERNESS NA M Colleen Zmolek Application Received: 2/10/2015 Permit Issued/Case closed: 2/11/2015 Case Finaled: Proposed change-of-use from warehouse to manufacturing MLA07-00073 BLD07-00065 MLA07-00073 DISCOVERY TIMBER CO I F Michelle Farfan Application Received: 2/15/2007 Permit Issued/Case closed: 6/1/2007 Case Finaled: 2/9/2012 Stormwater with SEPA consisting of 152,460 square feet of land disturbing activity and 6,000 yards of on-site fill material. M LA07-00318 \\tidemark\datalforms\R_Parcel CRMLA.rpt 3/18/2015 Page 2 of 3 BLD07-00310 MLA07-00318 GLEN COVE PROPERTIES LLC I F Michelle Farfan Application Received: 6/12/2007 Permit Issued/Case closed: 8/6/2007 Case Finaled: 3/25/2008 NEW COMMERCIAL WAREHOUSE-W/PLUMBING -NO HEAT `,,� MLA08-00298 (,tvr V �Vc� .0 �(1 (�j/`-1 -. BLD08-00269 A08-0 298 GLEN COVE P OPERTIES LLC I F Michelle Farfan Application Received: 6/18/2008 Permit Issued/Case closed: 9/11/2008 Case Finaled: 4/8/2010 NEW 4959 S.F. UNHTD COMMERCIAL WAREHOUSE MLA15-00014 BLD15-00078 MLA15-00014 GREENSTEIN I P David Wayne Johnson Application Received: 3/12/2015 Permit Issued/Case closed: Case Finaled: CHANGE OF USE PERMI I 1-502 PROCESSING & MANUFACTURING SEP07-159 PRJ15-00010 MLA15-00014 GREENSTEM P Application Received: 3/12/2015 Permit Issued/Case closed: Case Finaled: CHANGE OF USE COMMERICAL BUILDING 1-502 MANUFACTURING & PROCESSING ZON15-00006 MLA15-00014 GREENSTEIN P David Wayne Johnson Application Received: 3/12/2015 Permit Issued/Case closed: Case Finaled: CHANGE OF USE COMMERICAL BUILDING 1-502 MANUFACTURING & PROCESSING PRE07-00020 GLEN COVE PROPERTIES LLC F Michelle Farfan Application Received: 5/29/2007 Permit Issued/Case closed: 6/11/2007 Case Finaled: 10,000 sq ft warehouse RAP07-00079 GLEN COVE PROPERTIES LLC I F Application Received: 5/25/2007 Permit Issued/Case closed: 6/1/2007 Case Finaled: 12/11/2007 RAP & 911 - N. Otto St SEP07-00159 GLEN COVE PROPERTIES LLC F Application Received: 5/18/2007 Permit Issued/Case closed: 7/16/2007 Case Finaled: 12/19/2007 SOM07-00159 GLEN COVE PROPERTIES LLC RCR Application Received: 12/19/2007 Permit Issued/Case closed: 2/16/2015 Case Finaled: 11tidemark\data\forms\R_Parcel_CRMLA.rpt 3/18/2015 Page 3 of 3 O O mf h N N "l'' C 4, O .- L II . 4 b o CO.RD.PROD.CR1148 m r• op L� N 04°56'34" E o 0 on 290.45' _ CO z r- Z-c5i 2c5 A f 2C5 00 f n C.-) Cei I BLDG'GI B •o o N • 0 <^ u' - O / \ CO O T �� Ca 1 N DRIVEWAY r. Oa u �,,- ot 180 - - - m-- 170 00 O 1 - _ SEPTIC �- 0 __ _ �- _ { -- ---"MESERVE I r S 00°55'07" W / _. i 290.00' - -' - -- /o WA-TE02 /14.44A-, -. - __._ 1 NORTH OTTO STREET t 1 1 1 N -' Z -0 -iam - - mmn 00 trig) -0 M D D < pZ - r- O m OOx . O xx0 = m m9 ; 77 z mn ,' � x fTl lc) -1 U) -I y m D Dm C � Z � DrOC C) y r= m Fri 0 - IOW < r- r- WD Qr __ C� - coo = mooO D 'Zj m _ c D m di rrn� D «7D0 Z °° � o D , __. W (n n 71 `� ZO D < -0 U) D C --I w ° o Crop = (� , coo � � 0 - � U) °N° m O N _ � � O C7 " 7, cn � � K U) C0� m mm � D0S -ul O D Z II � Z0 D 0 w Cr) Z < m0C co o (� K 7J - o r . . nzm -0 = O u-i mD Z n DDZ7p `- Mme zm m N 0 0 � g � Z cn cll h„ D co Z Z < H - p � W - P � Crr z z b o q cn w cn 0M � JCO CO UrOp � ~ O O < O r -1=, 0 0 � 0 0 co n O r� Z cn to Xi 0 Ct CID m CO N.) 0 O CIZ 1 O 15 -DLO w LA is coo 1 L, - (,u)15 -00078 D20 2_0N115 0000(CI M LA15-00014 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 ° � t PERMIT #: BLD15-00078 Received Date: 3/12/2015 SITE ADDRESS: 205-A N OTTO ST PORT TOWNSEND, 98368 OWNER: GABRIEL GREENSTEM PHONE: 206-327-0149 1014 NW 178TH ST SHORELINE WA 97177 9867 SUBDIVISION: Block: 19 Lot: 3+ PARCEL NUMBER: 986701902 Section: 16 Township: 30 N Range: 1V1 CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: MICHAEL ANDERSON PHONE: 360-531-1011 330 CLEVELAND ST PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOI CHANGE OF USE PERMIT 1-502 PROCESSING & MANUFACTURING TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: 2,500 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: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: 3OUP f Anl� �' .-a Exist: ��-���fff �/`�- Prop: 1 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Change of Use or Occupar $468.00 SRE 03/11/15 154202 State Building Code $4.50 SRE 03/11/15 154202 Potable Water Application $0.00 SRE 03/12/15 Total: $472.50 \\tidemark\data\forms\F_BLD_App_Bld.rpt 3/12/2015 e ON coG DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4130 Fax:360.379.4451 Web:www.co.jefferson.wa.usilcommunitydevelopment E-mail:dcd a co.ietferson.wa.us �qs®"INOrc0 PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting application. -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit# Related Application#s: MLA# Site Information Assessor Tax Parcel Number: - 7[} ( — ^'t1rrt Site Address and/or Directions to Property: V5ei Jv 8 16 6,)' Access (name of street(s)) from which access will be gained: Present use of property: L.>p,.Ikst E Description of Work(include proposed uses): ( k j*y 1ff \iyi r e s o c k A cft -r-- Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES _ _ NO If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: Septic Septic Permit#:' 0 7 - c)0 / Sct Community Septic Name of System: Case #: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete Partial _ Has a reserve drainfield been designated? Yes No _ Date of Last Operations&Maintenance check: — a 4a Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: 7---0\05 ocOO( - 1 b-J5- 15 The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail/ e-mail requests and information about the application to the authorized agent/representative and will copy(cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties Involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email(i.e. ,County email is not blocked or sent to "junk mail"). Applicant/Property Owner Information Property Owner: Name: C erne. S Address: tot ..lc tANV Vii'' Phone#: — SO a 3(51 - 117 ( -mail Address: — PI-. - ontact Authorize. Agent/Representative with project info. (select only one). ,r Property Owner Signature: / �1 / / '� Date: 3l!!//� Note: For projects with multiple. ners,attach a separa e.' eet with each owner(s)inform/[ion an signatures. Applicant: Authorizzed�Agent/Representative(if otherthan owner) Name: M / /[ /1-e4--yt • easo. J Address: 3d 'G G.1.-JY -- p 7---- /WA- . ql�` g Phone#: lap 960 --!.:,--7,/ --"0// E-mail Address: v' Pro ' flab / Is this an Authorized Agent/Representative for this project? NO (' YES nginee .- Architect Surveyor Contract r AB Consultant ame: l aC. ` A.&€11' �.`.r\ r► / r / Address: / rAiiii Phone#: E-mail Address: /C pYyDOCLGe4 gpaa=k041 ---.. tit Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Archite t Surveyor Contractor Consultant -v Name: ��(�� ?115 p,,, A� v -7 CZ Address: 1,:(1'1- /v W IT A St . iu yi- Q o / C Phone#: . ∎ f c . 1 �V E-mail Address: 6cAp b) (/M rCkn(97 3, c sA ^ ,,--Vrofessional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary Builders Statement The signer of this statement certifies 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: Print Name: Date: wc 00G JEFFERSON COUNTY < DEPARTMENT OF COMMUNITY DEVELOPMENT ,� $ 621 Sheridan Street I Port Townsend, WA 98368 Web:www.co.Jefferson.wa.us/communilvdevelopment gsktNO.o Tel:360.379.44501 Fax:360.379.4451 I Email:dcd @co.jetferson.wa.us Building Permits& Inspections/Development Consistency Review(Long Range Planning 1 Watershed Stewardship Resource Center LIFE / FIRE AND CONSISTENCY REVIEW APPLICATION Please check one: MCHANGE OF USE I I REVIEW SITE ADDRESS: -LOS S" N • 0-/T0 S 64 9 DIGIT PARCEL ID NUMBER 4 G ? o { 9. C ` ZIP Legal Description: / Subdivision Name l Block Lot(s) Section Township North, Range WM APPLICANT P.. Lhdj6 0 iS PHONE RO6 - 5 /) 7 - 0(4i MAILINGADDRESS _-.---v=.- 5 I-dvr ryf a t„, 4 ZIP ^ ' I I -•V PROPERTY OWNER V(1 ■ 1 1 &>v y(\/( ` PHONE A-0 •'' '” I77C� MAILING ADDRESS b" kNev1 S it V -- Q ZIP l E �Cl CURRENT USE(S) VJ6leAtOt_ PROPOSED USE(S) - >6), ({)( YyS„ix" t 4.7,0' liv,, 'T„ it SEPTIC PERMIT NUMB R IBC OCCUPANCY '-`("/) IBC TYPE OF CO RUCTION Ste 0 7 -00 I Classification Classification NUMBER OF BEDR MS NUMBER OF BATHROOMS WAT PROPOSED PROPOSED ubtic Water EXISTING EXISTING 1 ❑ Private Well TOTAL TOTAL ` ❑ 2-party Well Q fJ 1.O-1-- EXISTING#OF PARKING SPACES #OF HANDICAP PARKING SPACES • L ((S>r t.,-ib 4-. CURRENT NUMBER OF OCCUPANTS(includes owners, PROPOSED NUMBER OF OCCUPANTS(includes owners,, tenants,employees,etc) h tenants, employees,etc) CURRENT TOTAL SQUARE FOOTAGE(includes decks,porches,outbuildings,shed...etc) a� t) d PROPOSED TOTAL SQUARE aOTAGE(includes decks, porches,outbuildings, shed...etc) . 6 APPLICANT SIGNATURE /'(4,��' I. ��/ , , DATE 3 t 1 I / 1S- t CONSISTENCY RE EW $ / FOR OFFICE USE ONLY BASE FEE RECEIPT# �-154 -1 b`l STATE SURCHARGE 4.50 CASH/CK# 1 0 F,Li L TOTAL DATE 3 r t I /t S ZN15 -0000(to esoy caG JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.Jefferson.wa.us/communitydevelopment tisK ° Tel:360.379.44501 Fax:360.379.4451 I Email:dcd@co.leflerson.wa.us Building Permits& Inspections J 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 I 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. �5orr c DEPARTMENT OF COMMUNITY DEVELOPMENT 06. 621 Sheridan Street,Port'Townsend,WA 98368 Tel:3603794450 I Fax:360.379.4451 ti Web:www.co.letferson.wa.us/conununitvdevelopment E-ma l: dcd@co.iefferson.wa.us /SNINO,co� SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: 'l iti 64k:/ nr Assessor Tax Parcel #: AlsQ • 7��• ie Type of Building New Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence Modular Other list Proposed Building/Project Number of floors f # new bedrooms ) existing 0 total bed U� # new bathrooms existing i total bath J Heat Source Select all that apply: Electric Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation (Office Use) Residential/Commercial Main Floor o 6 Residential/Commercial Second Floor Additional Floors- heated/ unheated Basement- unfinished Basement-finished space or habitable Detached Garage- heated/ unheated Attached Garage - heated/unheated Garage 2nd fl - unfinished storage Garage 2nd fl-finished space or habitable Carport- 2 walls or less Deck- uncovered Covered porch Other(shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ $ List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property �1-� Use `nfaCC kJ 14:A �'t1 t�V �JC`rt,, xe, Uf i tr Builders Statement The signer of this statement certifies 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: Print Name: 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 or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respectZo this application packet may result in making any issued permit null and void. Signature: .' /u Print Name: 44/6"01- 4 ✓iiA/l T50/-J Date: 3/////5 For Department Use0 iii (il ( (lr!Il� = �il�i (j4 Building Permit Fees Building Base Plan Check Review Land Use Review $234.00 Septic Review $80.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt # Date: Cash/Check/CC: tiSON co� e, DEPARTMENT OF COMMUNITY DEVELOPMENT W •�� 621 She idan Sric�r,Por Townsend,AVA 98368 —, .0 TeL 360.379.4450 Fax:360.379.4451 , ; y Web:nww.co iefferson ma.us/communitydevelopment �{l E-mail dcd taco Iefferson.wa.us {. A/16 NEW ADDRESS APPL Steps in the Permit Process: 2 4 W - ZCI „ -Review required submittal items to ensure all information is completed prio. -Make an appointment to meet with the Permit Technician by calling 360-379- -Fees will be collected at intake. Additional fees may apply after review and pay i. New Address Correction ❑ Change xob 1 For Department Use Only Receipt 4: Related Application#s: Payme. n. 0 ✓ New Driveway must be flagged with striped and yellow flagging tape received from DCD. Required Submittal Items—use column on left to check off items included with your submittal Current copy of parcel map from Jefferson County Assessor's Office, showing: Yttp://www.co.jefferson.wa.us/idms/mapseer.shtml . North Arrows b. Road names in the area c. Existing access easements d. Parcel driveway location, label any driveways as new or existing e. Addresses of neighboring properties f. Travel path from main named county road to the driveway,then the structure Copy of a site plan, showing: a. If there are multiple structures,the addresses of all existing structures b. For commercial permits, identify suite numbers for all existing and proposed businesses and identify the business names. Property Information Assessor Tax Parcel Number: ,j l,:t (, 7 O ( / 0 Z Directions to Property: Name of street(s)from which access will be gained: n). OTC 0 Cross Street Is this a private road? Yes I I No M Neighbor's Name &Address if known: Name/Address: 90) slit) tO • e ( t 0 Name/Address: Do you need to construct a driveway from road onto your property? Yes E No X _ County or State Permit it: ROAD APPROACH OR STATE HWY ACCESS PERMITS ARE REQUIRED IF YOUR DRIVEWAY IS OFF A COUNTY OR STATE ROAD IN ORDER TO PROCESS ADDRESS REQUEST. PLEASE CONTACT PUBLIC WORKS WITH QUESTIONS 360-379-9160 Property Owner Name: Address: Phone #: E-mail Address: Please contact Authorized Agent/Representative with project info. Property Owner Signature: Date: Applicant/ Contractor: Authorized Agent/Representative Name: Phone #: E-mail Address: License #: Expiration 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 making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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. Applicant may request notice of the County's intent to enter upon the property for visits related to this application and subsequent permit issuance. Signature: Print Name: Date: Jefferson County will notify the appropriate postmaster, fire district, and emergency services of your new address. We will provide you with a new fire plate and you will be required to install it on your property once the address is assigned. FOR OFFICE USE ONLY DIFF LEFT M.P. RIGHT DIFF Notes Tidemark Entry: Road database entry: Post Office: New Address Date plates mailed: # Plates: OFFICE USE ONLY Permit Fees New Address Permit Fee $234.00 * *Additional fees may apply • *itie°N.---6 ., JEFFERSO N COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend • Washington 98368 ,. 360/379-4450 • 360/379-4451 Fax http://www.cojefferson.wa.usicommdevelopment/ Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required. PARCEL SIZE(I.E.,SITE) Size of parcel /• Z 3 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet "Ill sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar,alder, big-leaf maple,and vine maple;shrubs such as willow,elderberry,salmonberry, and salal; herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY.CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared,graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert'/.acres or more of Construction site for structures sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes No Well, utilities,etc. sq/ft Does the project convert 2'V acres or more of native vegetation to pasture? Driveway,parking, roads,etc. sq/ft Circle: Yes No Lawn, landscaping,etc. sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance sq/ft Cut Fill (cu/yd) [over) slormwater ado worksheet—REV.2/20/2008 1 Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) sq/ft Structures(all roof area) /���� sq/ft Sidewalks sgffl Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway,parking,roads,etc sq/ft Driveway, parking,roads,etc sgtft Other sq/ft Other 7/0 sq/ft Total New sq/ft Total Existing /5-16 sq/ft TOTAL NEW+TOTAL EXISTING* / ao"� sq/ft "This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: '3% Does the site have 35%or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all ,owners of the affected property. / ./F e ! / , //( za/5 (VN00WNER OR AUTHO-Zi F,.b REPRESENTATIVE SIGNATURE) (DATE) f'' !' r a5 t f };� i "hi e r., s �cs., �,g . �fifT .W"•hr a } atrrd` "rcki' {� " fKr frt etormwater talc worksheet-REV.212012008 2 Washington State Licensing and Regulation 15:11 3 Liquor Control Board PO Box 43098, 3000 Pacific Ave SE Olympia WA 98504-3098 Phone—(360) 664-1600 Fax—(360) 753-2710 March 3, 2015 PDT TECHNOLOGIES LLC 1037 NE 65TH ST # 348 SEATTLE WA 98115-6655 Re: PDT TECHNOLOGIES 205A N OTTO ST PORT TOWNSEND WA 98368-9780 LICENSE No.: 415704-7D UBI: 603-307-697-001-0001 Your license has been approved for the following: MARIJUANA PROCESSOR This license is valid through June 30, 2015. You must post this letter in a public service area as your temporary operating permit. If you do not receive your Business License with marijuana endorsement(s) within 15 days, please contact Department of Revenue's Business Licensing Service/Specialty Licenses at(360) 705-6744. This license allows you to process,package, and label usable marijuana and marijuana-infused products for sale at wholesale to marijuana retailers. You may only puchase from a licensed marijuana producer. Persons under 21 years of age are not permitted on the premises. A sign reading"Persons under twenty-one years of age not permitted on these premises"must be posted in a conspicuous location at each entry to the premises (WAC 314-55-086). The licensee must ensure required information is entered into the traceability system and kept completely up-to-date as stated in WAC 314-55-083(4). Changes in ownership, alterations to your operating and/or floor plan, and business relocation require prior Board approval. If you wish to make such changes, please contact our office for assistance. In accordance with WAC 314-55-020(11) the issuance of a license by the WSLCB shall not be construed as a license for, or an approval of, any violations of local rules or ordinances including, but not limited to: Building and fire codes, zoning ordinances, and business licensing requirements. Marijuana 9/4/14 DEC I S I 0'. S TO: Marijuana Producer, Processor, and Retail Licensees RE: Washington State Liquor Control Board Notice to Licensees on Firearms This notice is meant to help clarify federal laws about possession of firearms on licensed premises and while transporting marijuana. Federal Law on Firearms Federal law prohibits users of controlled substances from possessing firearms. 18 U.S.C. § 922(g)(3). Marijuana remains a controlled substance under federal law. 18 U.S.C. § 812. Federal regulations provide that current use of controlled substances may be inferred from evidence of recent use, possession, or a pattern of use or possession. 27 C.F.R. § 478.11. Furthermore, the federal Bureau of Alcohol, Tobacco, Firearms and Explosives, an agency of the U.S. Department of Justice, stated in an Open Letter September 21, 2011 that any person in possession of marijuana is prohibited by federal law from possessing firearms or ammunition. In addition, it is illegal under federal law to carry or use a firearm in furtherance of a federal drug trafficking crime, which includes selling marijuana. 18 U.S.C. § 924(c). CAUTION: Federal law prohibits the possession of firearms by any person on premises where marijuana is present or being transported. Persons who are prohibited by federal law from possessing a firearm may be prosecuted in federal court. A state license is not a defense to a federal prosecution under federal firearms laws or the federal Controlled Substances Act, 21 U.S.C. Chapter 13. Disclaimer This notice regarding federal laws is not intended to provide legal advice nor does it provide a legal defense to a violation of any federal laws or rules. Licensees are advised to consult an attorney if they have questions or concerns regarding federal laws. Security Services Northwest P 0 Box 660 sERvicEs Port Townsend,WA 98368 PDT Technologies — Site Plan LEGEND SECURITY Ccie Secunty Camera Phone:800-859-3463 NORTHWEST INC. *. Security Alarm www SSNWHQ com 205 Otto St.,Port Townsend,WA 98368 XX security System Storage (Roan Closet Loatat or other secured beam) t 42'43' ..., "4." C II - - . , 1 C -0- gutri.tineicomotiett Arta 'L , \t, OVA WASTE **I C . COMelltatte*reel XX t ) C ..dilkw &too torage l!' f1,0=\11Sh t Cy C , . Stattri \it' ---____ Seturity Fence flooc tb cCMg P*ckaging t wtrotbon&Paiiii&watedlit Somess&&& 6 &Adminstretion gli 4, ‘), .,o "......N..... Location of two Co2 Machines I 40:76.) Product f Mt&km& &&tpoictg/Itetzeiviog t Phr,o 2) (C!r. 71/4--''' ..'71>A■7 1k,C) Prepared by: John Alden, Business Development&Project Manager Sally Ellis From: Gabriel Greenstein <gabe @pdttechnologies.com> Sent: Friday, March 13, 2015 9:47 AM To: Sally Ellis Subject: Re: Invoices&Potable Water form for new business at 205-A N Otto St. Port Townsend Attachments: operatingplanapplication-PDT.pdf; ATT00001.htm Hi Sally, Thanks for contacting me, and following up over the phone earlier. Attached a copy of our operating plan application as submitted to the WSLCB. I will put a check in the mail today for the consistency review fee, and get started on water review, and the drawing for the Fire Marshal. Please let me know if I need any additional information. Thanks again for all your help, and have a great day! i DocuSign Envelope ID:E3B9C29D-222D-4465-B54D-87F785CC257A i _ Washington State License Number 415704 •'' Liquor Control Board UBI Number 6033076970010001 PDT TECHNOLOGIES Trade Name Operating Plan Required Elements - 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 WACs indicated below. Additional sheets may be attached if necessary. 1. SECURITY (WAC 314-55-083) a. Will all employees wear an identification badge? © YES ❑ NO b. Does your location have a security alarm system on all perimeter doors and windows? © YES ❑ NO c. Does your video surveillance system and recording device meet the following requirements? YES NO © ❑ Minimum camera resolution of 640 x 470 © ❑ Internet protocol (IP) compatible © ❑ Recorded images clearly and accurately display the time and date © ❑ Surveillance system storage device is secured on-site © ❑ Camera recordings must be continuously recorded twenty-four hours a day © ❑ Surveillance recordings must be kept for a minimum of forty-five days © ❑ System includes image acquisition, video recording, management and monitoring hardware and support systems © ❑ Camera placement allows for the clear and certain identification of any individual or activity on the licensed premises including all areas where marijuana is grown, cured or manufactured PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600, www.liq.wa.gov LIQ1227 05/2014 Page 1 c18 DonnSign Envelope ID:E3B9C29D-222D-4465-B54D-87F785CC257A UBI Number 6033076970010001 d. Additional description of surveillance system (how storage device is secured, vendors used, etc.): DVRS will be kept in locked boxes within an enclosed secure storage area. 2. TRACEABILITY (WAC 314-55-083(4)) a. Will you use a third party vendor for your traceability software? © YES E] NO If you selected YES, please list the name of the vendor/software: Biotrack TMc If you selected NO, please describe how you will comply with traceability requirements: b. Is the system listed above compatible with the LCB's traceability system? U YES U NO 3. QUALIFICATIONS AND TRAINING PLAN FOR EMPLOYEES (WAC 314.55.020(9)) a. Please describe the type of training you will provide to employees to include topics you will cover: All of employees PDT Technologies will receive special training and instructions regarding the following topics and activities: 1) understanding of i-502 regulations, State law, and internal company policies. 2) Understanding of traceability and traceability software 3) Understanding of general safety procedures, and safe usage of processing equi pment 4) Understanding of security protocols and procedures 5) Employees that run processing equipment will receive special training from the manufacturer, Apek Supercritical Additionally all employees must be over 21 years of age, and will be required to pass a background check. PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600,www.liq.wa.gov LIQ1227 05/2014 Page 2 of 8 DocuSign Envelope ID:E3B9C29D-222D-4465-B54D-87F785CC257A UM Number 6033076970010001 b. Description of team/staff members related experience: Gabriel Greenstein Experience in business administration and computer science Marina Bykowski Experience in business administration and computer science Boris Anukhin Experienced lab tech and engineer igbal Gill PHD chemist, with over 20 years of experience in biotech field Charles Mitchell Production manager with experience in machine operating, and construction 4. TRANSPORTATION OF PRODUCT (WAC 314.55.085) a. Describe how you will prepare product for transport (packaging, sealed transport containers, manifest, etc.): Products will be packaged in child resistant boxes and/or impluse sealed mylar bags, with all compliant labeling. Sealed and labeled units will be placed in sealed "ready order" boxes prior to placement in Quarantine. Products will be prepared in Quarantine for a minimum of 24 hours, along with a manifest and sales order prior to transportation. b. Describe how your vehicle will meet storage compartment requirements: All products will be transported in a locked compartment within the delivery vehicle. vehicle will have current registration, and insurance. Additionally, PDT Technologies delivery vehicle will have a burglar alarm. Furthermore vehicle will have a discreet appearance, with no exterior advertisements or indication of our company identity or the products contained within. PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600,vnvw.liq.wa.gov LIQ1227 0512014 Page 3 of 8 DocuSign Envelope ID:E3B9C29D•222D-4465-854D-87E785CC257A UBI Number 6033076970010001 5. DESTRUCTION OF WASTE PRODUCT (WAC 314-55-097) a. Where will non-dangerous solid and liquid waste be stored prior to destruction and how will it be managed and secured? cot extracted plant waste, along with finished products that have failed to meet quality assurance testing, will be ground up and mixed with at least a 50% mixture of organic waste material , after which time it will be available for use as compost. Once waste has gone through the traceability process and the THC has been rendered inert, barcoded lots of waste will be placed in secure storage until they are ready to be composted. b. Do you anticipate any dangerous waste? If so, how will that be stored, managed and disposed of? Our process will not produce any dangerous byproducts. c. How will you render non-dangerous waste unusable and what materials will you mix it with to achieve the required 50% non-marijuana waste by volume? All non dangerous waste will be run through a wood chipper and will then be mixed with 50% blends of saw dust, wood chips, and/or raw soil . PO Box 43098, 3000 Pacific Ave, SE, Olympia WA 98504-3098, (360)664-1600, www.liq.wa.gov LIQ1227 05/2014 Page 4 of 8 DocuSign Envelope ID E389C29D-2220-44658540-87F785CC257A UBI Number 6033076970010001 d. Where will solid and liquid waste be taken after it has been rendered unusable? once all plant matter, as well as non hazardous solid and liquid wastes have been rendered unusable as composting mixtures, they will be transported and donated to a local composting center, or disposed of as organic waste material, at the county dump. 6. DESCRIPTION OF OPERATION AND PREMISE a. Standardized Scale Please acknowledge that you will meet the requirements listed below: YES NO E Licensees are required to have at least one scale on the licensed premise for the traceability and inventory of products. © n The scale(s) used must have a National Type Evaluation Program (NTEP) Certificate of Conformance (COC). If a scale meets this requirement it should have an ID name plate on it with the COC number. © El Licensees must register their scale(s) on a business license application with Business Licensing Services through the Department. b. Processing Operation 1. List the types of finished products that will be created on your licensed premise (such as useable marijuana, infused products and edibles): Refined c02 extracted cannabis oil will be available for sale in two different product form factors including vaporizor cartridges, and stand alone oil containers. PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600, www.liq.wa.gov LIQ1227 05/2014 Page 5 of 8 DocuSign Envelope ID:E3B9C29D-222D-4465-854D-87F785CC257A UBI Number 6033076970010001 2. Describe the processing methods you will use to create the items listed above: All products will be made from cot extracted cannabis oil . Finished oil will be tested for Quality Assurance and then packaged into the product categories listed above. 3. Describe the extraction equipment you will use and how it will be compliant with requirements listed in WAC 314-55-104: We will be using the following Apek Supercritical closed loop CO2 extraction system: 1500-20L Botanical Oil Extraction System •Programmable, Fully Automated CO2-Based System 4. Describe the packaging for all finished products (usable and infused) to include how they will be sealed: All products will be sold in 502 compliant packing. The following is a per product breakdown of the packaging. vaporizer cartridges: vaporizer cartridges will come filled with cannabis oil . The cartridges will come packaged in plastic outer boxes with a child resistant seal. Stand alone oil: Oil sold separate from vaporizer cartridges will come packaged in small glass containers, within an outer layer of an impulse sealed mylar bag. PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600, www.liq.wa.gov LIQ1227 05/2014 Page 6 Of 8 DocuSign Envelope ID:E3B9C29D-222D-4465-854D-87F785CC257A UBI Number 6033076970010001 5. Describe what information will be listed on labels affixed to your finished products (please indicate any differences between usable marijuana and marijuana-infused products): All product labels will include the following information: 1.Statement that discloses all pesticides applied to the marijuana plants and growing medium during production of the base marijuana used to create the extract added to the infused product,2.Statement that discloses the type of extraction method,including any solvents,gases,or other chemicals or compounds used to produce or that are added to the extract, 3. UBI and License#,4. Lot numbers of all base marijuana used to create the extract,5.Batch#,. manufacture date, and best by date,6. Total milligrams of THC and other cannabinoids,7. Net weight in ounces,grams or volume,8. List of ingredients and allergens All product labels will include the following warnings: 1."There may be health risks associated with consumption of this product",2. "This product is infused with marijuana or active compounds of marijuana",3."Should not be used by women that are pregnant or breast feeding",4."For use only by adults twenty-one and older.Keep out of reach of children",5."Products containing marijuana can impair concentration,coordination,and judgment. Do not operate a vehicle or machinery under the influence of this drug", 6. "Cauton:When eaten or swallowed,the intoxicating effects of this drug may be delayed by two or more hours",7."This product has intoxicating effects and may be habit forming",8."This product may be unlawful outside of Washington 7. QUQrATY ASSURANCE PROTOCOLS (WAC 314-55-102) I acknowledge that all required quality assurance testing must be done by an accredited third oarty lab approved by the LCB: x YES NO 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/perimeter fencing enclosing the licensed premise including all gates b. Processing area(s) c. Controlled access area(s) d. Quarantine area(s) e. Points of ingress/egress to the licensed premise f. Location of all doors and windows g. Location of secured Surveillance System Storage Device h. Location of all cameras and alarms i. Designated Waste area(s) Click 'yes' to attach floor plan C YES Click 'yes' to attach continuation sheet YES PO Box 43098. 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600,www.liq.wa.gov LIQ1227 05/2014 Page 7 of 8 DocuSign Envelope ID:E3139C29D-222D-4465-B54D-87F785CC257A UBI Number 6033076970010001 KEY FOR RETAIL/NON-RETAIL MARIJUANA FLOOR PLANS 0.04 Security Cameras(draw arrow to indicate which way the camera is pointing) A Retail Display Case POS Retail Point of Sale XXX Sight Obscure Fence - - - - Fencing Security Alarm(this would be the sensor that is required on all doors and windows) 'A♦A, Security System Storage (Room, Closet, Lockbox or other secured location) D Door or entry point into a Retail and Non-Retail premise W Window -I- 1 - Gate through fenced area LABEL THE FOLLOWING AREAS • Quarantine Area—the area that Marijuana or Marijuana Infused products are kept before they are removed or transported • Security Room/Controlled Access Area—all areas restricted to the general public • Grow Area—area where Marijuana is grown Note: If architectural plans are submitted or other form please ensure a key is included PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600,www.liq,wa.gov LIQ1227 05/2014 Page 8 of 8 DocuSign Envelope ID:E3B9C29D-222D-4465-B54D-87F785CC257A (�p��p��y Security Services Northwest LEGEND J1G4VAf( ► P.O.Box 660 ,`�� Security Camera SERW,ES Port Townsend,WA 98368 PDT Technologies — Site Plan NORTHWEST,INC Security 800-859-3463 -, � Security Alarm vtiuw.SSNWHO-com 205 Otto St., Port Townsend,WA 98368 xx Security System Storage Poore Claud lotaMY or M K, 51xuxa,.Y.45.1) ?v w• i• `j 'C Qom+=aantL*/cwntoatd area Lam DYk WASTE Coatroom Are* C -►• secure st:wave 1 Eye+kash i C • C � Staten Security Fence Flax to caitt to beraWsan&Reneesnc t Proessing Paxfcapiap a artadnstration Location of two Cot Machines • rnorttua rarrlp SB, n,..7ReootwNw XG {Phase.2) Q C iJP. r Roll-up Ooce Prepared by: John Alden,Business Development&Project Manager Sally Ellis From: Gabriel Greenstein <gabe @pdttechnologies.com> Sent: Friday, March 13, 2015 9:47 AM To: Sally Ellis Subject: Re: Invoices & Potable Water form for new business at 205-A N Otto St. Port Townsend Attachments: operatingplanapplication-PDT.pdf;ATT00001.htm Hi Sally, Thanks for contacting me, and following up over the phone earlier. Attached a copy of our operating plan application as submitted to the WSLCB. I will put a check in the mail today for the consistency review fee, and get started on water review, and the drawing for the Fire Marshal. Please let me know if I need any additional information. Thanks again for all your help, and have a great day! i DocuSign Envelope ID:E3B9C29D•222D-4465-B54D-87F785CC257A Washington State License Number 415704 r'• Liquor Control Board UBI Number 6033076970010001 PDT TECHNOLOGIES Trade Name Operating Plan Required Elements - 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 WACs indicated below. Additional sheets may be attached if necessary. 1. SECURITY (WAC 314-55-083) a. Will all employees wear an identification badge? © YES ❑ NO b. Does your location have a security alarm system on all perimeter doors and windows? © YES ❑ NO c. Does your video surveillance system and recording device meet the following requirements? YES NO © ❑ Minimum camera resolution of 640 x 470 © ❑ Internet protocol (IP) compatible © ❑ Recorded images clearly and accurately display the time and date © ❑ Surveillance system storage device is secured on-site © ❑ Camera recordings must be continuously recorded twenty-four hours a day • ❑ Surveillance recordings must be kept for a minimum of forty-five days © = System includes image acquisition, video recording, management and monitoring hardware and support systems ❑ Camera placement allows for the clear and certain identification of any individual or activity on the licensed premises including all areas where marijuana is grown, cured or manufactured PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600,www,liq wa.gov LIQ1227 05/2014 Page 1 of 8 DocuSign Envelope ID:E3B9C29D-222D-4465-B54D-87F785CC257A UBI Number 6033076970010001 d. Additional description of surveillance system (how storage device is secured, vendors used, etc.): DVRS will be kept in locked boxes within an enclosed secure storage area. 2. TRACEABILITY (WAC 314-55-083(4)) a. Will you use a third party vendor for your traceability software? © YES ❑ NO If you selected YES, please list the name of the vendor/software: Biotrack THC If you selected NO, please describe how you will comply with traceability requirements: b. Is the system listed above compatible with the LCB's traceability system? © YES NO 3. QUALIFICATIONS AND TRAINING PLAN FOR EMPLOYEES (WAC 314.55.020(9)) a. Please describe the type of training you will provide to employees to include topics you will cover: All of employees PDT Technologies will receive special training and instructions regarding the following topics and activities: 1) understanding of i-502 regulations, state law, and internal company policies. 2) Understanding of traceability and traceability software 3) understanding of general safety procedures, and safe usage of processing equi pment 4) understanding of security protocols and procedures 5) Employees that run processing equipment will receive special training from the manufacturer, Apek Supercritical Additionally all employees must be over 21 years of age, and will be required to pass a background check. PO Box 43098, 3000 Pacific Ave. SE,Olympia WA 98504-3098,(360)664-1600,www.liq.wa.gov LIQ1227 05/2014 Page 2 of 8 DocuSign Envelope ID:E3B9C29D-222D-4465-854D-87F785CC257A UBI Number 6033076970010001 b. Description of team/staff members related experience: Gabriel Greenstein Experience in business administration and computer science marina Bykowski Experience in business administration and computer science Boris Anukhin Experienced lab tech and engineer Iqbal Gill PHD chemist, with over 20 years of experience in biotech field Charles Mitchell Production manager with experience in machine operating, and construction 4. TRANSPORTATION OF PRODUCT (WAC 314.55.085) a. Describe how you will prepare product for transport (packaging, sealed transport containers, manifest, etc.): Products will be packaged in child resistant boxes and/or impluse sealed mylar bags, with all compliant labeling. Sealed and labeled units will be placed in sealed "ready order" boxes prior to placement in Quarantine. Products will be prepared in Quarantine for a minimum of 24 hours, along with a manifest and sales order prior to transportation. b. Describe how your vehicle will meet storage compartment requirements: All products will be transported in a locked compartment within the delivery vehicle. vehicle will have current registration, and insurance. Additionally, PDT Technologies delivery vehicle will have a burglar alarm. Furthermore vehicle will have a discreet appearance, with no exterior advertisements or indication of our company identity or the products contained within. PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098,(360)664-1600, www.liq.wa.gov LIQ1227 05/2014 Page 3 of 8 DocuSign Envelope ID:E3B9C29D-222D-4465-B54D-87F785CC257A UBI Number 6033076970010001 5. DESTRUCTION OF WASTE PRODUCT (WAD 314-55-097) a. Where will non-dangerous solid and liquid waste be stored prior to destruction and how will it be managed and secured? CO2 extracted plant waste, along with finished products that have failed to meet quality assurance testing, will be ground up and mixed with at least a 50% mixture of organic waste material , after which time it will be available for use as compost. Once waste has gone through the traceability process and the THC has been rendered inert, barcoded lots of waste will be placed in secure storage until they are ready to be composted. b. Do you anticipate any dangerous waste? If so, how will that be stored, managed and disposed of? Our process will not produce any dangerous byproducts. c. How will you render non-dangerous waste unusable and what materials will you mix it with to achieve the required 50% non-marijuana waste by volume? All non dangerous waste will be run through a wood chipper and will then be mixed with 50% blends of saw dust, wood chips, and/or raw soil . PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600,www.liq.wa.gov LIQ1227 05/2014 Page 4 of 8 DocuSign Envelope ID:E3B9C29D-2220-4465-854D-87F785CC257A UBI Number 6033076970010001 d. Where will solid and liquid waste be taken after it has been rendered unusable? Once all plant matter, as well as non hazardous solid and liquid wastes have been rendered unusable as composting mixtures, they will be transported and donated to a local composting center, or disposed of as organic waste material , at the county dump. 6. DESCRIPTION OF OPERATION AND PREMISE a. Standardized Scale Please acknowledge that you will meet the requirements listed below: YES NO © Licensees are required to have at least one scale on the licensed premise for the traceability and inventory of products. © [] The scale(s) used must have a National Type Evaluation Program (NTEP) Certificate of Conformance (COC). If a scale meets this requirement it should have an ID name plate on it with the COC number. Licensees must register their scale(s) on a business license application with Business Licensing Services through the Department. b. Processing Operation 1. List the types of finished products that will be created on your licensed premise (such as useable marijuana, infused products and edibles): Refined CO2 extracted cannabis oil will be available for sale in two different product form factors including vaporizor cartridges, and stand alone oil containers. PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098,(360)664-1600, www.liq.wa.gov LIQ1227 05/2014 Page 5 of DocuSign Envelope ID:E3B9C29D-222D-4465-854D-87F785CC257A UBl Number 6033076970010001 2. Describe the processing methods you will use to create the items listed above: All products will be made from CO2 extracted cannabis oil . Finished oil will be tested for Quality Assurance and then packaged into the product categories listed above. 3. Describe the extraction equipment you will use and how it will be compliant with requirements listed in WAC 314-55-104: We will be using the following Apek Supercritical closed loop CO2 extraction system: 1500-20L Botanical Oil Extraction System •Programmable, Fully Automated CO2-Based System 4. Describe the packaging for all finished products (usable and infused) to include how they will be sealed: All products will be sold in 502 compliant packing. The following is a per product breakdown of the packaging. vaporizer Cartridges: vaporizer cartridges will come filled with cannabis oil. The cartridges will come packaged in plastic outer boxes with a child resistant seal . stand alone oil: oil sold separate from vaporizer cartridges will come packaged in small glass containers, within an outer layer of an impulse sealed mylar bag. PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600,www.liq.wa.gov LI01227 05/2014 Page 6 of 8 • DocuSign Envelope ID:E3B9C29D-222D-4465-354D-87F785CC257A UBI Number 6033076970010001 5. Describe what information will be listed on labels affixed to your finished products (please indicate any differences between usable marijuana and marijuana-infused products): All product labels will include the following information: 1.Statement that discloses all pesticides applied to the marijuana plants and growing medium during production of the base marijuana used to create the extract added to the infused product,2.Statement that discloses the type of extraction method,including any solvents,gases,or other chemicals or compounds used to produce or that are added to the extract,3. UBI and License#,4.Lot numbers of all base marijuana used to create the extract,5.Batch#, manufacture date,and best by date,6.Total milligrams of THC and other cannabinoids,7. Net weight in ounces,grams or volume, 8.List of ingredients and allergens All product labels will include the following warnings: 1.'There may be health risks associated with consumption of this product",2. This product is infused with marijuana or active compounds of marijuana",3."Should not be used by women that are pregnant or breast feeding",4."For use only by adults twenty-one and older. Keep out of reach of children",5."Products containing marijuana can impair concentration,coordination,and judgment. Do not operate a vehicle or machinery under the influence of this drug",6. "Cauton:When eaten or swallowed,the intoxicating effects of this drug may be delayed by two or more hours",7. "This product has intoxicating effects and may be habit forming",8. "This product may be unlawful outside of Washington 7. QUAL LTY ASSURANCE PROTOCOLS (WAC 314-55-102) I acknowledge that all required quality assurance testing must be done by an accredited third 3arty lab approved by the LCB: x YES (l NO 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/perimeter fencing enclosing the licensed premise including all gates b. Processing area(s) c. Controlled access area(s) d. Quarantine area(s) e. Points of ingress/egress to the licensed premise f. Location of all doors and windows g. Location of secured Surveillance System Storage Device h. Location of all cameras and alarms i. Designated Waste area(s) Click 'yes' to attach floor plan C YES Click 'yes' to attach continuation sheet (1 YES PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600,www.liq.wa.gov LIQ1227 05/2014 Page 7 of 8 DocuSign Envelope ID:E369029D-222D-4465-B54D-87F785CC257A UBI Number 6033076970010001 KEY FOR RETAI LMON-RETAIL MARIJUANA FLOOR PLANS OA Security Cameras(draw arrow to indicate which way the camera is pointing) R Retail Display Case POS Retail Point of Sale XXX Sight Obscure Fence - - - - Fencing Security Alarm (this would be the sensor that is required on all doors and windows) Fr' Security System Storage (Room, Closet, Lockbox or other secured location) D Door or entry point into a Retail and Non-Retail premise W Window -I- 1 - Gate through fenced area LABEL THE FOLLOWING AREAS • Quarantine Area—the area that Marijuana or Marijuana Infused products are kept before they are removed or transported • Security Roorn/Controlled Access Area—all areas restricted to the general public • Grow Area—area where Marijuana is grown Note: If architectural plans are submitted or other form please ensure a key is included PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360)664-1600,www.liq.wa.gov LIQ1227 05/2014 Page 8 of 8 DocuSign Envelope ID:E3B9C29D-2220-4465.8540.87F785CC257A Security Services Northwest LEGEND ` L+ �r`/ P.O.Box 660 �+ ERV ES Port Townsend,WA 98368 PDT Technologies — Site Plan �G, Security Camera NORTHWEST,INC.. Phone:800-859-3463 .F, ty Securi Alarm www.SSNWHQ.com 205 Otto St., Port Townsend,WA 98368 XX Securey System Storage Irmo n Cb%d.I oe*mx u mr.. 30...4 K,C4taIN 4. • 2 v All""(c) ) 3 1 c.. QuentntinejtoritoOtet Arleen Latatory DAY WASTE '0.1 C' Cowman&re* (' ,-i Secure Scviregpt t C 4 Eyre sh , reism . ,'� cw„rtty Fence L Floor to ceding retraction&Refinement Procaaing S Admtastrautlon Location of two i Cot Machines € C, Product Moo Anse pip/Receiving (Phase 2) 1C 7A ''-7-, L,' ROII-e3".'i)005. Prepared by: John Alden,Business Development&Project Manager r Sally Ellis From: Sally Ellis Sent: Friday, March 13, 2015 8:24 AM To: 'gabe @pdttechnologies.com' Subject: Invoices & Potable Water form for new business at 205-A N Otto St. Port Townsend Attachments: Invoicing for 205-A Otto st..pdf; Building Permit Application- Potable Water.pdf Good Morning Gabe Please see the attached Invoices and the Potable Water form. The Invoices are for the following- One Invoice is for the Consistency Review$234.00,this is the fee I discussed with you when you submitted your Change of Use Permit. This fee is for a Land Use Planner to review your permit. The second Invoice is for Potable Water review- I know there is currently water to this building- however this is a new Commercial business and all New Commercial Business but take the attached form to your Water Company and have them fill it out- and pay for Potable Water review of$109.00 Please take the attached form and to The City of Port Townsend Water Department and have them fill out the second page. As I discussed with you at your appointment,this form is not a new thing to the Water Companies-they are used to it. Once you have that form complete please drop it off to our office to my attention so I can routed it to the Department that does the Potable Water review. It was also brought to my attention that you did not provide a copy of your"Operation plan" that you submitted to WSLCB (Washington State Liquor Control Board.) You will be required to provide this- before your permit will be approved. Final- I do think that our Fire Marshal is going to want to see details on how the Cot Machines are being attached in your building, but I am not positive about this- but thought I should give you a heads up that information may be required. If you have any questions regarding the above and or have additional questions for me- please feel free to contact me. Our office is not open to the public today but you can reach me by email today if needed. Thank you a coluct C�c - v do(w3A I t - ig 1 1040 -V1 xv3 sintetia wl V\i /0 ;?, Ii )i 1 Sally I. Ellis jcllcrson County Community Development Permit.Technician 621 Sheridan St., Port Townsend, WA 98368 Mon-Thurs 9am-4:30pm, closed from 12-1 Ph: 360-379-4452 Fax: 360-379-4451 sellis @co.jefferson.wa.us http://www.co.iefferson.wa.us 1 INVOICE Date: 3/12/2015 Invoice ID: DCD15ZON15-00006 .— ON <a JEFFERSON COUNTY w ( DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Port Townsend, WA 98368 360-379-4450 I email: dcd©co.jefferson.wa.us ��`sH1 N�. o� www.co.jefferson.wa.us/commdevelopment Date Due: BILLING ADDRESS: 4/11/2015 GABRIEL GREENSTEM 1014 NW 178TH ST SHORELINE WA 97177 Consistency Review 234.00 REMIT TO: Total Amount Due: $234.00 Jefferson County DCD 621 Sheridan St. Port Townsend, WA 98368 Please return the above portion with your payment Permit Number: ZON15-00006 Consistency Review 234.00 Total Amount Due: $234.00 Payment is accepted by cash, check, debit or credit card (Visa, Mastercard, Discover, American Express) To pay by credit card, go to www.co.jefferson.wa.us/commdevelopment, and click on the "Online Credit Card & echeck Payments" link on the left side of the page. (questions: call 360-379-4450) �+� //y �/ Security Services Northwest LEGEND SERVICES 4N SGCURI I P.O.Box 660 Port Townsend,WA 98368 PDT Technologies — Site Plan Cj Security Camera NORTHWEST.INC. Phone:800-859-3463 * Security Alarm www.SSNWHQ.com 205 Otto St.,Port Townsend,WA 98368 ;XX Security System Storage se Closet.Lola=or Miler secured waw,> t4214.7 ar ` { C.,)i ...., "j puawszettee/Cantotlad Ate* 1I I t'varoary 11 i XX ' WASTE • (, eamerw»e Area ; � ' C'''4' 5 Cure 5ixxspe - MOW s 3Y trOkiSh C Ell SUMO Aiocr it ceigse,g extraction A ihtfliterment Prorisio9 Padcsp/ep 8 AdmiNstrstloe 40 46. AO 1 Location of two Co2 Machines C - Product fiNirl9 Area SJtliSpkep/Reoeivinp ;Ehtse 2: C r -A 11/4464T':" lit C `-4"---- 10r Pod-up Dewy Prepared by: John Alden,Business Development&Project Manager 0 v O 0 0 ^ 3 y o h O 0 '0 r4- II b 0 CO.RD.PROJ.CR1148 74 00 m 1! N 04°56'34" E . 0 0 ____ 290.45' CD z s , 26). - CD co G) a BLDG B 0) 0 D I I 0) r _. o cn N �tvn v' � .uoii 00 itt O �1 DRIVEWAY N' O,, as `� 1 / 0 1 � — L� 00 0 ----- 1 6 0 _____ - SEPTIC , --` _ ---- "".�-- RESERVE r_ _,---- S 00°55'07" W —.Ns., 290.00' ^ — _ NORTH OTTO STREET 0 N Z -p -Io > R OO XXO In m0 m 70 z r<TinO n 73 Fri fTl 00 , p z DrC Dgim <o - DO � < > WW > ( � Flo -0 rn Do ° oo > m mU) � C -0 - --16-- 0 r- CO > fTl DDm p D0W0O 0 I'll X -0 Z < U) rTi � r' c Om z o —i 1Al� � m fTl c < m �' DD < < � � D c --I c� -00 a 00r -o 0 C�co 0 � p0 -Cm 000 '3.-. x • CA , m • N � -i = 0 73 -0 ''. • (D i (1) 0 . n 01 Z m -. -I O mD „-r1 II O o r � � m� _ N CID r. o L•rl ►~J ti -1 m m N 0 oz m rlJ > 7' f<TI I 'Z^ I - b � xi o � cn mow V. I O mn D p0 � � OCJ� o O a m z J co ', � Lc) �+. cn -fit, . ; .fir- r-r ' : ,ter ca ° ° CO K m 03 IQ C4 N o O Co A P-D L- S -oorne tkAt 15-0001q \S -0000 MLA15-00014 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00078 Received Date: 3/12/2015 SITE ADDRESS: 205-A N OTTO ST PORT TOWNSEND, 98368 OWNER: GABRIEL GREENSTEM PHONE: 206-327-0149 1014 NW 178TH ST SHORELINE WA 97177 9867 SUBDIVISION: Block: 19 Lot: 3+ PARCEL NUMBER: 986701902 Section: 16 Township: 30 N Range: 1■t CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: MICHAEL ANDERSON PHONE: 360-531-1011 330 CLEVELAND ST PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOt CHANGE OF USE PERMIT 1-502 PROCESSING & MANUFACTURING TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: 2,500 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: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: 1 Total: 1 Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Change of Use or Occupar $468.00 SRE 03/11/15 154202 State Building Code $4.50 SRE 03/11/15 154202 Potable Water Application $0.00 SRE 03/12/15 Total: $472.50 11 tidemark\data\forms\F_BLD_App_Bld.rpt 3/12/2015 • • Michael From: Dan Titterness<dantitterness @gmail.com> Sent: Thursday, March 05, 2015 12:15 PM To: santiago2 @cablespeed.com Subject: authorization To whom it may concern: Michael Anderson is authorized to sign for me in matters of permitting. Thanks, Dan Titterness i • • rrsoN coG DEPARTMENT OF COMMUNITY DEVELOPMENT 6'1 Sheridan.?rreet.Pon Townsend;W. 983U Q LT-/ Tel: 360.3-9.4--130 Fax:3603794-1-51 \\'eb: v w.co.icrrerson.wa.uslcommunin-dcvelapmcnt E-mail dcd,i.co.iefferson_wa.us �9S t i N G`SO$ PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting application. -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit# Related Application#s: MLA# Site Information Assessor Tax Parcel Number: 4 b ' f �' Site Address and/or Directions to Property: \95"X .1 bt6 f•k- 0.„./AfIA(k Access(name of street(s)) from which access will be gained: Present use of property: a ;,.. Description of Work(include proposed uses): oC� ( Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES NO — — If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: Septic Septic Permit#:' 6 7 j _ Community Septic Name of System: Case#: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete Partial Has a reserve drainfield been designated? Yes No _ Date of Last Operations& Maintenance check: — '.A Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: OC:CO(C \\A.' k5 — t L-1 5 `7 • • The authorized agent/representative is the primary contact for all protect-related questions and correspondence. The County will mail / e-mail requests and information about the application to the authorized agent/representative and will copy (cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email (i.e..County email is not blocked or sent to `junk mail-). Applicant/Property Owner Information Property Owner: 06L V\ \ i r fek e yin P`�..S Address: 1Ot }c, ,,J% k s� usvL '" Phone #: — "S‘10 • 36 t * r77q mail Address: Plse ontact Authorize. Agent/Representative with project info. (select only one). Property Owner Signature: _LG ,� _// `f- Date: �/f/�l Note: For projects with multiple ners,attach a separa e beet with each owner(s)inform/lion an signatures. Applicant: Authorized Agent/Representative (if other than owner) Name: /22 1`-et--"e �"ilpirzst71� ' �/ Address: �r-3d '' 4 b /- .7---_ WA- . qe. -�.z7 Phone#: 3ed / -,.`p// E-mail Address: Prciaifirla ,l4 /' Is this an Authorized Agent/Representative for this project? NO YES nginee Architect Surveyor — contract r Consultant Address: Phone#: E-mail Address: C hf09D2 Ge2.6/✓.V 4.9 Professional: Is this an Authorized Agent/Representative for this,project? NO YES Engineer / `� Archite t Surveyor Contractor Consultant V Name: 1�6('l+�l�'Atr � fr ,- _ Address: l4 /v W )( A G\ ,St NA RA), l,�,4- (n 7 . Phone#: a t f s. ILA E-mail Address: • / \ ,- ,tfl',Li. ,� ', q-c ` _____---Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary Builders Statement The signer of this statement certifies 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: Print Name: Date: w�so\ coo JEFFERSON Y • 2j DEPARTMENT OF COMMUNITY DEVELOPMENT $ 621 Sheridan Street I Port Townsend, WA 98368 I Web:vh�rv.co ieflerson wa us/communitvdeveiooment ISHrNo1.0 Tel:360.379.44501 Fax:360.379,4451 I Email:dcd@c0.'eff_______Lvia.us Building Permits&Inspections J Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center LIFE / FIRE AND CONSISTENCY REVIEW APPLICATION Please check one: LH CHANGE OF USE I (REVIEW SITE ADDRESS: -Lb c ti • 0 O (_ ` 9 DIGIT PARCEL ID NUMBER t t±" ZIP 1�. a,r Legal Description: Subdivision Name AJ 7 4 Block Lot(s) Section Township • _ North, Range WM APPLICANT L A , 0 t PHONE Di(lJ6 .. ) 7 - dl 4i MAILINGADDRESS =;;��_-'; """,'*"'0"'- A _ , • . .;c' ZIP PROPERTY OWNER J' C∎ tr PHONE MAILING ADDRESS I .0 L 1 p �, .1 1.4 CURRENT USE(S) r \ bl - ZIP PROPOSED USE(S) —I)( ''',{0( .rSC SEPTIC PERMIT NUMB R IBC OCCUPANCY / 0 ~ao Classification IBC TYPE OF CO RUCTION Classification NUMBER OF BEDR••MS NUMBER OF BATHROOMS PROPOSED WATF� " - PROPOSEDT EXISTING r ( Private Water EXISTING ❑ Private Well TOTAL TOTAL EXISTING#OF PARKING SPACES 2 0 2-party Well i.„q r #OF HANDICAP PARKING SPACES __ IL. f SiCr LA-P0 `-k--- CURRENT NUMBER OF OCCUPgp�TS (includes owners, PROPOSED NUMBER OF OCCUPANTS(includes r d tenants,employees,etc) tenants, employees, etc) CURRENT TOTAL SQUARE FOOTAGE(includes decks, porches,outbuildings,shed...etc) 5 '� y PROPOSED TOTAL SQUARE FOOTAGE(includes decks, porches, outbuildings, shed...etc) . - , APPLICANT SIGNATURE rt` • 7,..----"" DATE ,./ / 1 ( 7 ( 1 CONSISTENCY RE EW / FOR OFFICE USE ONLY 5_________ BASE FEE RECEIPT# I C� ✓-'t 2-0 2_ STATE SURCHARGE 4.50 CASH/CK# 1 d L-1 TOTAL DATE 3 / t ( / I C • • ¢sON coG JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Pot Townsend,WA 98368 j Web:vNr w.co.jeflerson.wa.ustcommunitydevelopmen ° Tel:360.379.4450 j Fax:360.379.4451 j Email:dcd @co.iefferson.wa.us Building Permits& Inspections Development Consistency Review f Long Range Planning I 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. • • _SON e DEPARTMENT OF COMMUNITY DEVELOPMENT �Q �r 1".. 621 Sheridan Street,Port Townsend,WA 98 368 4y a Tel 360.379.4450 1 Fax:36x7.379.1951 .-' C Web:\vww.co.icffersoa.wa.us/cotnmunitvdevelopment E-mail:dcd(<tco.iefferson.w'a.us 1s'h'I NG�� SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#5: Payment#: Site Information Owner Name: ` h, �° s r 3__S____ Assessor Tax Parcel#: D� . 74 i_ p f'�� Type of Building UUVV t { Jt7�` New Replacement Relocated Addition Repair Demolition Select One: `A separate permit is required Single Family Residence Modular Other list Proposed Building/Project Number of floors _r_______ # new bedrooms( existing } total bed # new bathrooms existing I total bath j Heat Source Select all that apply: Electric 1 Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft g q/ Proposed Sq/Ft ICC Valuation (Office Use) Residential/Commercial Main Floor a l D a Residential/Commercial Second Floor Additional Floors- heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage- heated/unheated Attached Garage- heated/unheated Garage 2nd fl- unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less Deck-uncovered Covered porch Other(shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ • • List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home,other): All Existing Buildings on Property Use V Builders Statement The signer of this statement certifies 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: Print Name: 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 or her 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 making any issued permit null and void. Signature: d/ / / e Print Name: /—~i. ,4/1/4--1W-522,-) Date: -9 /5 For Department Use Orfhf Building Permit Fees Building Base Plan Check Review Land Use Review $234.00 Septic Review $80.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees I I Receipt # Date: Cash/Check/CC: • • SON C, tiw 0 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,\\1.1 98368 < Tel:360.379 4-130 Fax:360.3'9.-1451 \Veb:www.co.iefferson.wa.us/commuthrydevelopment f { j E-mail:dcd r,co.icfferson..wa,us k{ I,1-(�IQ' �G�S�IING,,° Lh co/16 G \ NEW ADDRESS APPL. Steps in the Permit Process: 2 4 — 2-S(473— -Review required submittal items to ensure all information is completed prior -Make an appointment to meet with the Permit Technician by calling 360-379 -Fees will be collected at intake. Additional fees may apply after review and pay J, New Address Correction Change For Department Use Only Receipt#: Related Application#s: Paymtm„. J 0 ✓ New Driveway must be flagged with striped and yellow flagging tape received from DCD. Required Submittal Items—use column on left to check off items included with your submittal Current copy of parcel map from Jefferson County Assessor's Office,showing: 0 thttp://www.co.jefferson.wa.us/idms/mapserver.shtml a. North Arrows b. Road names in the area c. Existing access easements d. Parcel driveway location, label any driveways as new or existing e. Addresses of neighboring properties f. Travel path from main named county road to the driveway,then the structure Copy of a site plan, showing: a. If there are multiple structures,the addresses of all existing structures b. For commercial permits, identify suite numbers for all existing and proposed businesses and identify the business names. Property Information Assessor Tax Parcel Number: ,1( C r ` 7 p ( i 0 Z Directions to Property: Name of street(s)from which access will be gained: p,). C5-71 } Cross Street Is this a private road? Yes I I No M Neighbor's Name&Address if known: Name/Address: 7 b r) . 671 0 Name/Address: Do you need to construct a driveway from road onto your property? Yes 0 No yi County or State Permit#: ROAD APPROACH OR STATE HWY ACCESS PERMITS ARE REQUIRED IF YOUR DRIVEWAY IS OFF A COUNTY OR STATE ROAD IN ORDER TO PROCESS ADDRESS REQUEST. PLEASE CONTACT PUBLIC WORKS WITH QUESTIONS 360-379-9160 • • Property Owner Name: Address: Phone #: E-mail Address: Please contact Authorized Agent/Representative with project info. Property Owner Signature: Date: Applicant/Contractor: Authorized Agent/Representative Name: Phone#: E-mail Address: License /4: Expiration 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 making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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. Applicant may request notice of the County's intent to enter upon the property for visits related to this application and subsequent permit issuance. Signature: Print Name: Date: Jefferson County will notify the appropriate postmaster, fire district, and emergency services of your new address. We will provide you with a new fire plate and you will be required to install it on your property once the address is assigned. FOR OFFICE USE ONLY DIFF LEFT M.P. RIGHT DIFF Notes Tidemark Entry: Road database entry: Post Office: New Address Date plates mailed: # Plates: OFFICE USE ONLY Permit Fees New Address Permit Fee $234.00 * *Additional fees may apply • • 14 6 JEFFERSON COUNTY tiDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax http://www.cojefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or'large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required. PARCEL SIZE(I.E.,SITE1 Size of parcel 1• Z.5 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 3 4-7°! sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover (both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation, and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species, other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar,alder, big-leaf maple,and vine maple;shrubs such as willow,elderberry, salmonberry, and salal; herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded,filled, Answer the following two questions related to excavated, and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert%acres or more of Construction site for structures sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes No Well,utilities,etc. sq/ft Does the project convert 2'/z acres or more of native vegetation to pasture? Driveway, parking, roads, etc. sglft Circle: Yes No Lawn, landscaping, etc. sq/ft Other compacted surface, etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance sq/ft Cut Fill (cu/yd) [over] stormwater talc worksheet—REV.2/20/2008 1 • 0 Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS-IMPERVIOUS SURFACE NEW EXISTING r Structures (all roof area) sq/ft Structures(all roof area) /`�'1 J f sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks --^ sq/ft (without infiltration below) (without infiltration below) Driveway, parking,roads,etc sq/fl Driveway,parking, roads, etc sq/ft Other sq/ft Other 7<o sq/ft Total New sq/ft Total Existing /r176- 19 sq/ft TOTAL NEW+TOTAL EXISTING* /44 � sq/ft "This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 3 % Does the site have 35%or more of existing impervious surface? Circle: Yes No / FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. rs`r'i s•:,„. ~ ' ;'4 ,I i.-�C (,-'.` , z_ 4/ tkt ,. , ( , i. -/ /71" • //r}r 3Y,.Z en 7((ANDOWNEER ORAUTHORIZED REPRESENTATIVE SIGNATURE)f , (DATE) I'.'.I"-f•Pq'PCg:ggfl'Ar , Ia 4,V - I,y n T 5°.e'T r =n. t G i ,1' � „' " :r tf $ ' S Il rp ` . T r tY t " :;,:10,04/M'' ° . .,u T , y` slormwstar calc worksheet-REV.2/20/2008 2 'C / P.O.Box 660 �vicEJ Port Townsend,WA 9i0 PDT Technologies — Sian CJ Security Camera i�NKJ Phone. 800-859-3463 NORTHWEST,INC. Security Alarm www.SSNWHQ.com 205 Otto St., Port Townsend,WA 98368 Security System Storage (Room,Closet Lockbo,v oar sitcom)location) Ci ' 'F"l C.yl = }' It tiF i C `'► QusrantisalcantoWd Area taiiliteff X WASTE \C ' common u., C Saturn storage �' "'s A qtr £ye+ra:r � `i) • },k .Sa tzhan Moor to cedog txtractlon&Iteeinesnent Proasairtip Dectayta� t Adroit Location of two Cot Machines Product Ming Area 5400pitiq/RayMtng p. 9htxe Y` is Imo-Oect Prepared by: John Alden, Business Development&Project Manager