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Home My WebLink AboutMLA16-00094 Permit ApplicationDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 1 Fax: 360.379.4451 Web: �Mw c o.ivff \Na.uslcnsnntusti dtS clrrlt�nt't�t E-mail: dectitzco.it ffc r na.tva.tati f r OC 1' 13 2017 PERMIT APPLICATION IEFFERSON C®UIqTV®CO 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 Related Application #s: Building Permit # kO '�"'t"t MLA# ILo- DOC)R9 5DPI&-0003 1 -4 - Site Information Assessor Tax Parcel Number: 988200103 Site Address and/or Directions to Property: 351 Pleasant Harbor Rd Brinnon, WA 98320 Access (name of street(s)) from which access will be gained: Pleasant Harbor Rd Present use of property: SFR Description of Work (include proposed uses): Replace existing concrete bulkhead with sheetpile bulkhead, total 25' Wastewater - Sewage Disposal This property is served by Port Townsend or Port Ludlow sewer system? YES NO x If not served by sewer identified above, identify type of se Type of Sewage System Serving Property: x Septic Septic Permit # Community Septic Name of System Are other residences connected to the septic system? below: SOM11-01025 Unknown No Additions or repairs to sewage system: Unknown Is it a complete or partial system installation: Complete x Partial Case #: Has a reserve drainfield been designated? Unknown Yes No Date of Last Operations & Maintenance check: Unknown Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: N/A The authorized agent/representative is the primary contact for all project -related questions and correspondence. The County will mail / e-mail requests and information shout the application to the authorized agent/representative will copy (cc) the owner noted below. The authorized agent/representative is responsible for communicating the information ti olved with the applicatorl. It is the responsibility of the authorized agent/representative and owner to ensure t i my email (i.e., County email is not blocked or sent to "iunk mail"). J � Applicant/Property Owner Information ty Property Owner: UC Name: Terry and Janice Nealey � 3 20 Address: 227 N Cherry St Dayton, WA 99328-1207 Phone M 509-520-8383 E-mail Address: terryneale 65 mail. 1V X Please contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: See signed owner/applicant agreement Date: Note: For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures. Applicant: Authorized Agent/Representative (if otherthan owner) Name: Sealevel Bulkhed Builders, Inc. Address: PO Box 375 Kingston, WA 98346 Phone M 360-297-2401 E-mail Address: Jenny@sealevelbb.com Professional: Is this an Authorized Agent/Representative for this project? x NO YES Engineer x Architect Surveyor Contractor Consultant Name: Herb Armstrong License # 8894 Address: 29747 Hansville Rd Kingston, WA 98346 Phone #: 360-297-1220 E-mail Address: elda201@centurylink.net Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor x Consultant Name: Rob Cousins License # 2220 Address: 11027 Manitou Beach Dr NE Bainbridge Island, WA 98110 Phone M 206-459-7264 E-mail Address: rob@coastalsoins.com Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License # Address: Phone #: E-mail Address: 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. 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 nty's intent to enter upon the property for visits related to this application and subsequent permit issuance. Signature: Print Name: Ylf�lIfW I"�.6r&&4 Date: DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 1 Fax: 360.379.4451 Web: anv4v.crs.�;lfcrsrxi:.tsslebnununitr; etclR��sn�e��r E-mail:.dC i e s.jeffexscnn.� a.uK SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt #: Date: ?ler y1N-G0nLJ "t,-ooL1q ( Related Application #s: PtkS -000 I Payment #: Site Information _ Owner Name: Terry Nealey Assessor Tax Parcel #: 988,200,103 Tuna of Rllllrlina New Addition Select One: Single Family Residence V/ Replacement V( Repair Modular Relocated Demolition *A separate permit is required Other list Proposed Building/Project Number of floors # new bedrooms existing total bed # new bathrooms existing total bath 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 Residential / Commercial Second Floor Additional Floors - heated / unheated T1^\TM ON WPM - Basement - unfinished Basement - finished space or habitable Detached Garage - heated / unheated i 3 Tj Attached Garage - heated / unheated -K I 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.) Bulkhead: 25LF Bulkhead 25LF Estimated Cost of Project (Required): $ $ 13,000.00 $ st existing buildings on property (i,e. house arae accessory dwelling unit shed barn mobile home other): Ail Existing Buildings on Property Use Owners Home SFR Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein, that they are not licensed contractors a they will be assuming the responsibility of the General Contractor for the proposed project. Signatu Print Name:' kar) dw4 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 t application packet may result in making any issued permit null and void. Signature Print Name:1664C47 Date: For Depart&Kt Use Only Building Permit Fees Building Base Plan Check Review Land Use Review Septic Review Potable Water Technology/Scan State Fee Other Fees Shoreline Exemption Zoning Zoning Other New Address Total Fees Receipt # Date: Cash/Check/CC: ,ON DEPARTMENT OF COMMUNITY DEVELO t{ Q 621 Sheridan Street, Port Townsend, WA 98368 �i Tel: 360.379.4450 1 Fax: 360.379.4451 n ^C Web: �c�L�v.cts c.ffetsrsn. �. ,us cunt utit dcvclu lit i E-mail: dt d(i1.co.ieffe rson.wv .Its SUPPLEMENTAL APPLI_CATION SHORELINE DEVELOPMENT JEFFEF?S01V COW A compietea application rorm is a requirement of submittal. Include "N/A" in spaces that do not apply. MLA# 1(0-WtflL. Case# Application Type (select one): Statement of Exemption - See Examples on back side of application Variance* Conditional Use (administrative)* Substantial Development* Conditional Use (discretionary)* 1) Does your proposal require in water work and/or works below ordinary high watermark? Yes [ / I No [ j 2) Does your pronnral require 1n,000 sq/ft or more of impervious surface and/or non -single family structures of 5,000 sq/ft or more? Yes [ j No [ ] * If either of the boxes for 1 or 2 above are checked yes or if the permit type above has an asterisk then a pre -application conference is required prior to submitting for a shoreline permit. Site Information Assessor Tax Parcel #: Property Owner Name(s) Project Description 988200103 Terry Nealey Describe the existing property use and condition: The property is currently used as a SFR. Name of Body of Water: Hood Canal Proposed distance from ordinary high water mark to use/development: Describe the proposed work that requires a shoreline permit or permit exemption: Failed concrete bulkhead replacement with sheet piling. () feet 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 maks issued permit null and void. Owner Signature; Date: q(?,([[ Print Name:�Y#Ytfi- f3 t�-- These activities require a formal statement of Exemption issued by Jefferson Coun . Check 'Statement of Exemption' box on the front of this form and submit with Permit Application to apply for your Exemption Approval. 18.25.570 Statement of Exemptions (1) The administrator is hereby authorized to grant or deny requests for statements of exemption from the shoreline substantial development permit requirement for uses and developments within shorelines that are specifically listed above. Such statements shall be applied for on forms provided by the administrator. The statement shall be in writing and shall indicate the specific exemption of this program that is being applied to the development, and shall provide a summary of the administrator's analysis of the consistency of the project with this program and the Act. As appropriate, such statements of exemptions shall contain conditions and/or mitigating measures of approval to achieve consistency and compliance with the provisions of this program and Act. A denial of an exemption shall be in writing and shall identify the reason(s) for the denial. The administrator's actions on the issuance of a statement of exemption or a denial are subject to appeal pursuant to the appeal provisions in Article X of this chapter. 18.25.560 Exemptions listed —This is a summary from JCC18.25.560, please review the code section for detailed information regarding these exemptions. (1) Fair Market Value. (2) Maintenance and Repair. (3) Residential Bulkhead. (4) Emergency Construction. (5) Agriculture. (6) Drainage. (7) Navigation Aids. (8) Single -Family Residences. (9) Residential Docks. (10) Irrigation. (11) State Property. (12) Energy Facilities. (13) Site Exploration. EFOceRSONCOU Ngyt)r (14) Noxious Weeds. (15) Watershed Restoration. (16) "Watershed restoration project" (17) "Watershed restoration plan" (18) A public or private project, the primary purpose of which is to improve fish or wildlife habitat or fish passage.