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Home My WebLink AboutBLD2019-00259 - 01 PERMIT APPLICATIONI JEFFERS.N couNrY e DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Port Townsend, WA 98368 360-3794450 | email: dcd@co.jefferson.wa.us www.co.jefferson.wa. us/commdevelopment BUILDING PERMIT PERMIT #: SITE ADDRESS: OWNER: SUBDIVISION: PARCEL NUMBER BLD19-00259 91 WEST VALLEY RD CHIMACUM SCHOOL DIST #49 PO BOX 278 CHIMACUM WA 98325-0278 901151013 ReceivedDate: 61712019 lssue Date 71512019 Expiration Date 71512020 PHONE: Section: 15 Township: 29 N Range: '1\ CONTRACTOR:OWNER/BUILDER PROJECT DESGRIPTION: PAVILION- COVERED OUTDOOR CLASSROOM FOR HORTICULTURE PROGRAM TYPE OF WORK TYPE OF IMP VALUATION CODE EDITION: OCCUPANCY: OCCUPANCY: CONST TYPE: CONST TYPE: COM NEW 15,354.00 2015 u-1 COMMERCIAL INDUSTRIAL: HEAT TYPE: HEAT TYPE: # OF STORIES: SHORELINE: SETBACK: BANK HEIGHT: 5N SQUARE FOOTAGE: MAIN: ADD'L. HEAT BASE: UNHEATED: OTHER: GARAGE: DECK: SEWAGE DISPOSAL: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: NUMBER OF EMPLOYEES HEALTH DEPARTMENT AND PUBLIC WORKS APPRO VAL REAUIRED PRIOR TO FINAL INSPECTION Amount Paid Bv: Date: Receipt: Permit Plan Check Consistency Review Scanning Fee State Building Code Tech Fee Total: $460.00 $92.00 $282.00 $24.00 $6 s0 $43.23 SRE SRE SRE SRE SRE SRE 06/05/19 06/05/1 9 06/0s/1 I 06/05/1 I 06/05/1 I 06/05/1 9 1 83900 1 83900 1 83900 1 83900 1 83900 1 83900 $907.73 Type R105.5 Expiration. Every permit issued shall become invalid unless the work authorized by such permit is commenced within '180 days after its issuance, or if the work authorized by such permif is suspended or abandoned for a period of 180 days after time the work is commenced THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 3794455. Request must be received by 3pm the day before the inspection is needed. Final lnspections require 24 hour notice. Office Hours 9:00 am - 4:30 pm MONDAY - THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY. SEE ATTACHED Jefferson County Building ision Permit r: BLD19-00259 Applicant: CHIMACUM SCHOOL DIST #49 BUILDING PERMIT INSPECTION APPROVALS Appticabte code: 2015 tnternationat Buitdins codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor & lndustries. The electrical permit must be signed off by the State lnspector prior to the County's Framing lnspection lnspection ltem Date Approval Signature Notes Miscellaneous Setbacks Post Holes Straps (hold downs) Framing final inspection will not be scheduled until the following are completed and signed off by the applicable Department; o Building Permit Conditions ore met c Septic Permit Final/Complete for ony building containing plumbing o Lond lJse Conditions met and signed off . Public Works Permit Finol (where opplicable) FINAL INSPECTION r lu/zoo,LL-- MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR FINAL INSPECTI 2.) The site plan as submitted with the Building Permit application on June 5, 2019 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 June 19,2019 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 3.) This approval is for a Pavilion 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. The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater 9-00259 1.) DWJ DITIONS for Building Permit # and drain control S. \\tidema rk\data\forms\F_BLD_Perm it_Bldg. rpt 7t512019 t,,-r, *e PERMTT APPL,"or,f,BLD19-00259 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: SITE ADDRESS: OWNER: SUBDIVISION: PARCEL NUMBER: BLD19-00259 91 WEST VALLEY RD CHIMACUM SCHOOL DIST #49 PO BOX 278 CHIMACUM WA 98325-0278 901151013 Section Received Date: 61712019 PHONE: Block: 15 Township: 29 N Range: 1\ Lot: CONTRACTOR OWNER/BUILDER PHONE REPRESENTATIVE:PAUL WYNKOOD 30 GOLDFINCH LANE PORT LUDLOW WA 98365 PHONE: 724-272-9688 PROJECT DESCRIPTION: PAVILION- COVERED OUTDOOR CLASSROOM FOR HORTICULTURE PROGRAM TYPE OF WORK TYPE OF IMP VALUATION CODE EDITION: OCCUPANCY: OCCUPANCY: CONST TYPE: CONST TYPE: COM NEW 15,354.00 2015 BATHROOMS: Exist: Prop: Total: SQUARE FOOTAGE: MAIN: ADD'L: HEAT BASE: UNHEATED: OTHER: GARAGE: DECK: COMMERCIAL: INDUSTRIAL: HEAT TYPE: HEAT TYPE: # OF STORIES SHORELINE: SETBACK: BANK HEIGHT: Amount Paid Bv: Date: ReceiPtType Exist: Prop: Total: Approved/Date APPROVED JUL - 5 20le Jefferson CountY DCD NUMBER OF EMPLOYEES: Permit Plan Check Consistency Review Scanning Fee State Building Code Tech Fee Total: $460.00 $92.00 $282.00 $24.00 $6.50 $43.23 SRE SRE SRE SRE SRE SRE 06/05/1 I 06/05/1 I 06/05/1 I 06/05/1 I 06/05/1 9 06/05/1 I 1 83900 1 83900 1 83900 1 83900 '183900 1 83900 $907.73 SEWAGE DISPOSAL: WATER SYSTEM: o O DEPARTMENT OF COMMI.INITY 621 Shcridan Sucet, I,ort -I'()wnsc"nd, W,\ 98368 'l' el 360.379.1450 | I,'ax: 360.379.4151 Wcb: www.co.icffcrson.wa.us /communiqvdcvclopment [')-mail: dcd@co. ic ffcnion.wa.us -ri{\*ig rwU /l ?0p PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting application. -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application; it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permh # MtA #Related #s: VSite lnformation (l -o Site Address and/or Directions to Property: Assessor Tax Parcel Number: t &#$cAccess (name of (l )) from which access will be gained: $ Present use of property: Description of Work (incl Aude proposed l'llvilion Wastewater - This property is served by Port Townsend or Port Ludlow sewer system?YES lf not served by sewer identified above, ide ntify type of septic system below TNO -" Tyoe of Sewage System Serving Property: _ Septic Septic Permit #: _ Community Septic Name of System: Are other residences connected to the septic system? Additions or repairs to sewage system: ls it a complete or partial system installation: Has a reserve drainfield been designated? Date of Last Operations & Maintenance check: Describe or attach any drainfield easements, covenants or notices on title, which may impact the property nol on {h'r Attach last report to application Case #: (cf Complete _ Yes _ _ Partial No_ $rc rq*Oo Zlq ta 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 wiil copy (cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. lt is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email (i.e., Cou email is or sent to "mat 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 Jefferso and any required later inspections. n County and its employees, representatives or agents for the sole request the Cou intent to enter upon Signature Applicant may visits related to this application and subsequent permit issuance Date: purpose of app the property for Print Name lication review Applicant/Property Owner lnformation ple owners, attach a separate sheet with each owner(s) information and signatures. Q.r 1Property Owner nature: '1 E-mail dress Please contact Authorized Agent/Representative with project info (select only one). Note: For projects with multi Property Owner: Date Name: Address: Phone #: , Applicant: Authorized Agent/Reprdsentative (rf other than owner) Name: Address: ihone #:E-mail Address Professiona!:ls this an Authorized for this project?NO YES Engineer Name: Address: Phone S: Architect Su rveyor _ Contractor License #-v Consultant O. .'.teo h* f .t"r- E-mail Address ls this an Authorized for this ?NO YES Architect _ _ Surveyor Contractor _ Consultant h/ll,t-tAtvt (raff l.r-r4rr!1\License #It Address: Phone #: c.a tg(Al LH,ra u+ qg tto E-mailAddress: \tu-LrAtn;( O USr,t E),b.Cort4, Profussiona!:ls this an for this NO YES Engineer Architect _ _ Surveyor _ _ Contractor License # Consu lta nt Name: Address: Phone #:E-mail Address , ) t) >ad I \rr/vxt kooDb GotctFi A q R.1A< ( zot) voz- </rslt1 CHIMACUM SCHOOL DIST #49 PO BOX 278 CHIMACUM, WA 98325-0278 Op Front Parcel Review O Btlzsa Parcel 901151013 Printed: June 19, 2019 Site Address(es): 91 WESTVALLEY RD , WA Parcel Number: 901151013 S-T-R: 15-29N-1W Legal Description Sl5 T29 RlW TAX NO. 10 ENLARGED LESS R/W Flood District: Fire District: Flood Map (FIRM) Panel No:School District 49 Total Acreage 7 Land Use: Planning Area: Zoning: 6800 1/ zonirg rrr\t t rA Setbacks: Front: Left Side:Side:Rear: Informed by JCC 18.30 or Title 17 for Master Planned Resorts: Shoreline Setback: Critical Area Buffer Building Setback: AdjoiningForestLands:Commerciall-RuraV--Inho1ding- Lots/Require Declaration of Restrictive Covenant YES NO, submitted: YES NO Legal Access to Property {r) No Parcel Tags or Scanned Do-ilments yES 6q-)ist: Sepcial Repons Nearby YES *O Lirt' j- Critical Areas tv( tL(tv(lrflr{l.( Geologically Hazardous Areas YES Shorel ine Slope Stability:_Erosion Seismic DisconnectedCMZ @ Landslide CMZ: none High Risk Moderate Risk Report Submitted FWHCA: YES Wetlands: YES Flood: YES Stream type: Marbled murrelet/Spotted owl_ Flood Certificate: Pond or Lake < 20 acres marine nearshore st FIRM map: Aquifer Recharge Area:yBS No 4td SIPZ: none At Risk Site Visit conducted YES Risk Coastal Notice Forest Lands: YES Agricultural Lands: yrs No No Shooting Zone: No Airporl vns No MRZ vss No YES NOtr(Archaeology: YES NO Stormwater Pollution Prevention Plan Submitted: t)Impervious Surface coverage percentage: Resource Lands & Public: l0% Rural Residential: 25%o Rural Industrial: Per UDC Sec 6.7 Rural Commercial: 600/o Area of Building Coverage: 60% in Rural Industrial Lands only I lZ ADMIN: Setbacks entered in Permit Plan New Parcel Tags entered in Permit Plan YES YES Special Reports Scanned Land Usetltltltltltl Landscaping Required: Yes No SEPA Required: YES ExEMPT Parking Spaces Required No 2 Other Building Height: 35' UBC Standard ADU Proposed YES NO Square Footage: Total Building (s) Size: RVC:20,000 SF CC:5,000 SF NC:7,500 SF GC: 10,000 SF All others: subjecttoseptic&waterconstraints/Nonespecified Road Classification: Road Approach: ExrsnNG Nor REQ'D RAP Require Final Zoning Approval/inspection YES NO UGANoProtestAgreement YES NO, submitted: YES NO Recorded Date of Subdivision Plat Conditions: AFN Over 5yrs:UDC tl tltltl No parcel tags found for parce! Cases Associated with APN 901151013 Review Cases Name TvPe Status BLD00-00328 CHIMACUM SCHOOL DIST #49 F Application Received: 512512000 Permit lssued/Case closed: 512612000 Case Finaled: 611612000 Planner PROPANE TANK & HA]VGINdHE?TER INSTALLATION BLDO3.OO172 CHIMACUM SCHOOL DIST #49 F Application Received: 3/1412003 Permit lssued/Case closed: 412412003 Case Finaled:1211312006 SEISMIC RETROFIT BLD14.OO171 CHIMACUM SCHOOL DIST #49 F Application Received: 5116/2014 Permit lssued/Case closed: 7ll0l20l4 Case Finaled:t0/1512014 RENOVATION OF GYMNASIUIVTAT CHIMACUM HIGH SCHOO L Plat Conditions on plat or Old Ordinance N/A \\tidema rk\data\forms\R_Parcel_CRM LA. rpt 6t19t2019 Page 2 of 4 Engineering t ] Stormwater: New Stormwater lr{ Disturbing oo Min Req #1 thru #5 Drainage District Review Min Req #l @rs BLD19-00242 Application Received: 61512019 TENANT IMPROVEMffiTTEIVI-ODEL. ALL WITHIN EXISTING COMMERICAL BLD MIDDLE SCHOOL & HIGH SCHOOL. - IMPROVEMENTS INCLUDE MINO LAYOYUT CHANGES, SAFETY CONCERNS AND TO ADDRESS SPACES THAT ARE NOT CURRENTLY CODE COMPLIANT /ADA ACCESSIBLE. BLD19-00259 CHIMACUM SCHOOL DIST #49 P David Wayne Johnson Application Received: 617/2019 Permit lssued/Case closed: Case Finaled: PAVI LI ON- COVEREDOT]TDOOR CLASSROOM FOR HORTI CU LTU RE PROG RAM BLD78-00098 CHIMACUM SCHOOL D|ST #49 F Application Received: 9l12/1978 Permit lssued/Case closed: Case Finaled: 3113/1979 Mechanical and plumbing BLD78.OO1O6 CHIMACUM SCHOOL DIST #49 F Application Received: 812311978 Permit lssued/Case closed: Case Finaled: 812211979 High School BLD8l-00096 ApplicationReceived: 8/311981 Permitlssued/Caseclosed:Case Finaled Wood shop/paint BLD00-00227 spray b66th-hr!h CHIMACUM SCHOOL DIST #49 Application Received: 41512000 Permit lssued/Case closed: 412412000 Case Finaled: 812011999 R EMO D E LI N G A STO RAGSHED I NTO A CO NC ESS I O N STANT BLD97.OO478 CHIMACUM SCHOOL DIST #49 F Application Received: 712211997 Permit lssued/Case closed: 7/24/1997 Case Finaled: 812611997 P ROJ ECT CO N STR U fiTOFIOFFI C E BLD98.OO22O CHIMACUM SCHOOL DIST #49 F Application Received: 4ll4ll998 Permit lssued/Case closed: 7/2711998 Case Finaled: 1112812000 M od e rn ization a n d ad dili6h-t6Thi-macu m Schoo I s BLD97-00487 CHIMACUM SCHOOL DIST #49 F Application Received: 712911997 Permit lssued/Case closed: 6/1211998 Case Finaled: 313012000 GREENHOUSE 24'X 4B', BLD98-00255 CHIMACUM SCHOOL DIST #49 F Application Received: 412811998 Permit lssued/Case closed: 512711998 Case Finaled: 8124/1998 RELOCATE PORTABLHrcHIMACU M SCHOOL BLD98.OO256 CHIMACUM SCHOOL DIST #49 F Application Received: 412811998 Permit lssued/Case closed: 5/2711998 Case Finaled: 812411998 RELOCATE PORTABLHrcHTMACU M SC HOOL BLD98.OO672 CHIMACUM SCHOOL DIST #49 F Application Received: 1012111998 Permit lssued/Case closed: 1012611998 Case Finaled: 812011999 sprinkler system - ph asEl BLD98-00673 CHIMACUM SCHOOL DIST #49 F Application Received: 1012111998 Permit lssued/Case closed: 10128/1998 Case Finaled: 812011999 sprinkler system - ph aseZ BLD98-00711 Application Received: lll2l1998 fire alarm system BLD98-00765 Application Received: lll24l 1998 sprinkler system p BLD99-00153 Application Received: 312311999 sprinkler system phaseT- BLD99-00287 Application Received: 511911999 install modular office BLD99-00437 Application Received: 71711999 sprinkler system phase-- BLD99-00486 Application Received: 7/2611999 sprinkler system ph ase 6 P CHIMACUM SCHOOL DIST #49 P F CHIMACUM SCHOOL DIST #49 F Permit lssued/Case closed: lll9l1998 Case Finaled: CHIMACUM SCHOOL DIST #49 F Permit lssued/Case closed: 121711998 Case Finaled: CHIMACUM SCHOOL DIST #49 F Permit lssued/Case closed: 712911999 Case Finaled: CHIMACUM SCHOOL DIST #49 F Permit lssued/Case closed: 611511999 Case Finaled: CHIMACUM SCHOOL DIST #49 F Permit lssued/Case closed: 7/1211999 Case Finaled: CHIMACUM SCHOOL DIST #49 F Permit lssued/Case closed: 712911999 Case Finaled: ,",t r.u"?ilH".',JicHooL Drsr #4e c"Oir"r"a 8lt8/1999 812011999 3 812012000 811812000 2t19t1999 211911999 \\tidema rk\data\forms\R_Pa rcel_CRMLA. rpt 6t19t2019 Page 3 of4 BLD99-00509 Application Received: 81911999 _oPerm ;" CHIMACUM SCHOOL DIST #49 it lssued/Case closed: 8l11l1999 CHIMACUM SCHOOL DIST #49 closed: 1012911997 Case Finaled F Finaled: 8120/1999 sprinkler system BLD99-00695 7 F Application Received: 101 1211999 Permit lssued/Case closed: 1012611999 Case Finaled: 10/11/2000 Readerboard sign cAR98-0OlO5 CHIMACUM SCHOOL DIST #49 F Application Received: 412811998 Permit lssued/Case closed: Case Finaled: 71211998 lmprovements to existifr-fTaTrfily r-rncluding: reroute bus traffic, create fire/emergency access lanes]m1rt-ffi't-er main, improve underground electrical main, provide stormwater facilities, approximately 38,000 square feet of renovation, approximately 33,800 square feet of new construction, modernize and improve the multi-purpose building. PREg7.OOO3O CHIMACUM SCHOOL DIST #49 F M GREWELL Application Received: 1011611997 Permit lssued/Case new construction and im-FEvernenls to existing facility xMP97-00071 GHIMACUM SCHOOL DIST #4s A Application Received: t2l17l1997 Permit lssued/Case closed: 71711998 Case Finaled: new construction and im-BEvemefrIs to existing facility ZON97.OOO47 CHIMACUM SCHOOL DIST #49 F M GREWELL Application Received: 1211711997 Permit lssued/Case closed: 71211998 Case Finaled: lll1612000 lmprovements to existing-TSTilt[ncluding: reroute bus traffic, crea-te fiFdFEigency access lanesTrmirlT6-WbEr main, improve underground electrical main, provide stormwater facilities, approximately 38,000 square feet of renovation, approximately 33,800 square feet of new construction, modernize and improve the multi-purpose building ZON98-OOO32 CHIMACUM SCHOOL DIST #49 F M GREWELL Application Received: 91211998 Permit lssued/Case closed: 10/8/1998 Case Finaled: 1l/1612000 Sign permit. BLD99.OO818 CHIMACUM SCHOOL DIST #49 F Application Received: 12116l1999 Permit lssued/Case closed: 1212011999 Case Finaled: 111912000 1 OOO GALLON ABOVrcROUNINA/ASTE OI L TANK cAMlg-00200 CHIMACUM SCHOOL DIST #49 NA P David Wayne Johnson Application Received: 4ll5l20l9 Permit lssued/Case closed: Case Finaled: Application submittal pavilonfor garden cAM19-00274 THOMAS NA M Shannen Cartmel Application Received: 5ll3l20l9 Permit lssued/Case closed: 511312019 Case Finaled: **UPDATE 5123119 CUSTOMERCI-ARIFIED THAT NO NEW SURFACESARE BEING CREATED, JUSTADDING NEW SURFACTNG. REQUEST FORMAL LETTER INDICATING lF PERMIT lS NOT REQUIRED. maintianing and upgrading the chimacum high schooltrack and what stormwater is required SEP9O.OO729 CHIMACUM SCHOOL DIST #49 F Application Received: 71911990 Permit lssued/Case closed: Case Finaled: 41811992 serves the Chimacum SChoolEh-pus, Large OSS permitted by WA DOH this is an incomplete file, info only. \\tidemark\d ata\forms\R_Pa rcel_C RM LA. rpt 6t19t2019 Page 4 of 4 I o DEPARTMENT OF COMMUNITY DEVEI,O 621 Shcridan Street, Pr>n'['os,oscod, \t(ir\ 98368 'l' cl 360.31 9.4450 | [:ax: 360.379.1,151 \t'eb: rvrprr,.co. ieffcrson.rva.us/comm unit).,dcycl, rpmcn t [',-mail: dcd@co.icffcrson.wa.us SU PPLEMENTAL APPLICATI ON RESIDENTIAL OR COMMERCIAL BLDG PE for Department Use Only Receipt #:Date: Related ication #s:#: Enter the square footage (sq/ft) tfrat applies in each field Ut cn Attached Gara - heated / unheated Site lnformation Owner Name:Assessor Tax Parcel #: of Bu Modular listOther ?.' Replacement Repair Relocated _ Demolition _ _ * rA separate permit is required New/ Addition Select One: Single Family Residence existing existing Number of floors # new bedrooms # new bathrooms total bed total bath Heat Source Select allthat apply: Electric Heating Oil Wood Propane Structure Pro ICC Valuation (office use) Residential / Commercial Main Floor Residential Commercial Second Floor Additional Floors - heated I unheated Basement - unfinished ent - finished or habitable r,tCl<o 2nd fl - unfinishedGa 2nd fl - finished or habitable rt - 2 walls or lessCa Deck - uncovered Covered rch Other (shed, ba etc. Estimated Cost of prolr Existing Sq/Ft F{qn -..p:--'<<- rl* ltr)as,L{ o" r', . F rrtrqull tru S a o .e. hou All Existing Buildings on Property Use List existi buildi on mobile home other 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 rint Name:Date For Use 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 Technology Fee - 5% Total Fees Receipt # qfa vL .' Date Cash C: ul tro oo qe oo S282.oo \>d Br-( 524.00 So.so \7-zb ut\sl rrl a\1rt\tv,o Q.asl J.fft"*" G (.,obb Estimated Cost of Project Building Base Fees Building Base SxqZ oo o ?o\=-I5!* (}l* Sgoz.zg I DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, !7A 98368 Tel: 360.379.4450 | Fax: 360.379.4451 Web: www.co. j efferson.wa.us /communitydevelopment E-mail: dcd@co.j efferson.lva.us PERMIT FEES WORKSHEET Parcel # Permit # Plan Check Review "*."**i*%w} Land Use Review Septic Review Potable Water Technology/Scan State Fee Other Fees Shoreline Exemption Zoning New Address Road Approach Tech Fee Total Fees S46o.oo Sgz.oo S282.oo s24.00 So.so iqt.zE Receipt Number Cash/Check/CC: Date: lnitia ls: l+6 uo Office Use On