HomeMy WebLinkAbout2.0 Master Permit ApplicationDEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street, Port Townsend, W -N 98368
Tel: 360.379.4450 1 Fax: 360.379.4451
Web: www.co.Jefferson.wa.us/communitydevelQpment
E mail: dcclLco.jefferson.wams
PERMIT APPLICATION
413-27-3002, 413-27-3004, 413-27-3005, 413-27-3006, 413-27-3007
15573 Highway 101
Forks WA 98331
Highway 101, existing paved driveway
Rural Residential two existing cabins used as vacation rentals on parcel 413-27-3004
Build 24 additional 1 bedroom cabins and site improvements
to support the proposed cabins. Cabins will be used as recreational lodging.
X
X SEP -07-266
SOM07-00266
No
None known
X
X
Unknown
A Copy of the current title commitment is attached to the Lot Consolidation Application
Permit Application Page 1 of 2
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.,
Countv email is not blocked or sent to "funk mail').
Applicantleroperty :Owner information _
Property Owner:
Name: Dickinson Trust; c/o William Johnston, Successor Co -Trustee
Address: PO Box 953; Bellingham, WA 98227-0953
Phone #: E-mail Address:
Please contact Authorized Agent/Representative with project info. (select only one).
Property owner Signature: Date:
Note: For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures.
Applicant.ApthorlxedAgel7t�Represeritat7Velfotherttianownera-`
-
Name: Derek Zwickey c/o DNC Parks & Resortsat Yellowstone, LLC
Address: 8358 Huffline Lane, Suite 2
Phone #: E-mail Address: DZWicke
delawarenorth.com
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Engineer Architect Surveyor Contractor
Name: Isaac Wedam License #
Address: 451 Clovis Ave: Clovis CA 93612
Consultant X
Phone #: (559)326-1400 E-mail Address: iwedam@bcf-en-qr.com
professional:.: Is ttiis *n Authbrized AgentJRepresentative forthts projectr..
No=.
Engineer Architect Surveyor Contractor
Name: David Mowry License #
Address: 451 Clovis Ave° Clovis CA 93612
Phone#: (559) 326-1400 E-mail Address: dmoW
Consultant X
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professronaL:' lstbs"an AuthoxlzedAgentjCte�esentafivef�rtfiisprojet
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Engineer Architect Surveyor Contractor
Name: License #
Address:
Phone #: E-mail Address:
Consultant
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 vold.
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:
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