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PRE18-OOO29
Pre-Application Conference
Tracy Williamson
Cottage Industry for Cannabis Processing
County Attendees: David Wayne Johnson DCD; Jeff Monroe DCD (if needed); Susan Porto
EH; John Fleming PWD (absent)
Time & Date: November 7, 2078 - 1:30pm
Owner/Applicant: Tracy Williamson - 360-598-1934 - tracywilliamson20l3@gmail.com
ZOOS peterson Road NW, Poulsbo, WA 98370
Legal Description: Parcel number 601-105-013 in Section 10, Township 26N, Range 1W,
WM, Wooway Large Lot Subdivision Lot 3, located on Coyle Road,
Quilcene, WA 98376
Description of Proposal: Type II Conditional Discretionary "C(d)" Use permit for a
Cottage Industry to process Cannabis, to include Single Family
Residence on a 5+ acre parcel.
ENVIRONMENTAL HEALTH - Septic and Water - Susan Porto (360-385'9444). Drill Well - source water form. Water Catchment possibility. Septic Design - consider 4 bedroom capacity for future use as ADU
PUBLIC WORKS DEPARTMENT - Roads & Stormwater - lohn Fleming (360-385-9160). Soils for Stormwater infiltration must be adequate per Stormwater manual
BUILDING DMSION - Building Plans Review - Jeff Monroe (360-379-446t)
. Consider ADA compliant bathroom
PERMIT TECHNICIAN - Submittal of building permit applications - Sally Ellis. Contact Sally at 379-4452 regarding requirements for permit submittals
DEVELOPMENT REVTEW DTVTSTON - LAND USE PERMTTTTNG - DWJ (360-379-4465)
. Zoned Rural Residential - adjacent to Commercial Forest zone - requires 250 foot
setback from property line. 20 foot setback from road, 5 foot side yard setback.. SEPA Exempt. JCC 18.20.170 Cottage Industry Regulations. JCC L8.2O.295 Marijuana Regulations. JCC 18.40.490 Conditional Use Permits (18.40.530)
. Type II Conditional Discretionary "C(d)" application requires public notice, but no
public hearing unless deemed necessary by the UDC Administratoro Public notice requires t4 day comments period. Comments must be relevant and substantive and may trigger additional information
request. Requires Operations Plan from State Cannabis License application. Parking - Two (2) Spaces for Residence - one (1) space per employee - two (2) ADA
spaces. Landscaping - ten (10) feet of Screen "A" landscaping - is a "full screen" that
functions as a visual barrier and shall at a minimum consist of :
PRElB-00029 Williamson Cottage Industry
Page 1 of 2
A mix of primarily evergreen trees and shrubs generally interspersed to form a
continuous year-round screen that grows to at least eight feet in height within two
growing seasons - or existing screening if deemed equivalent. Must be shown on
Landscaping plan or site plan.
Mapped Critical Areas:o No mapped or observed critical areas
Application & Fees:. Complete Application for Type II Conditional Discretionary "C(d)" Use Permitx:
o Master Permit Application (see PERMIT TECHNICIAN above)
o Conditional Use Permit Supplemental Application
o Cottage Industry Supplemental Application
o Operations Plan from State Cannabis License application
o Stormwater Plan (see Stormwater Calculation Worksheet and Template for a
large project)
o Building permit application (optional)
o Building permit checklist (optional)
o Site Plan (see site plan checklist)
o 911 Address
o Fees: $1,369.00 (includes EH and Public Works one hour review fees)xx
Contact Sally at 360-379-4452 for application submittal appointment
xlncomplete application may be accepted, but requires 90 days to complete or it will be
cancelled.
xx Additional review time will be billed separately.
JCC 18.40.090(5) Assurances Unavailable. It is impossible for the conference to be an exhaustive review of all
potential issues. The discussions at the conference or the information provided by the administrator shall not bind
or prohibit the county's future application or enforcement of all applicable laws and regulatlons, No statements or
assurances made by county representatives shall in any way relieve the applicant of his or her duty to submit an
application consistent with all relevant requirements of county, state and federal codes, laws, regulations and land
use plans. [Ord. 3-13 5 1]
PRE18-00029 Williamson Cottage Industry
Page 2 of 2
David W. Johnson
From:
Sent:
To:
Cc:
Subject:
Attachments:
David W. Johnson
Thursday, November 01, 2018 3:21 PM
Tracy Williamson
David W. Johnson
Pre-application Conference
stormwater calc worksheet and BMP's packet QR code.pdf; stormwater site plan
template QR code.doc; Checklist- Site Plan Checklist.pdf; PRE18-00029 Williamson
Cottage Industry.doc; EH revisions Intake and Review recreational marijuana
2-L2-L5.docx;017 MLA17-00055 odor management study February 1.pdf
Tracy,
I just realized I won't be in the office tomorrow, so l'm sending this today. See the attached outline from the meeting,
the application forms and Odor Management Plans. The Noise study was too large to send with this email - I have to
break it up and send it separately.
Let me know if you have questions. When you are readyto submit, callsallyto schedule a time
Thanks!
From : Tracy Williamson <tracywilliamson20l3 @gma il.com>
Sent: Monday, October 29,2Ot811:56 AM
To: David W. Johnson <djohnson@co.jefferson.wa.us>
Subject: Re: Pre-application Conference
Sounds great, we will see you then.
Tracy
On Thu, Oct25,20I8,4:07 PM David W. Johnson <djohnson@cojefferson wrote:
Tracy,
I've penciled in next Thursday, November 1,2018 at 1:30pm for your conference. Will that work for you? I
still need to hear from Public Works and the Health Department if that works for them.
Thanks!
David Wayne Johnson - LEED AP - Neighborhood Development
Associate Planner - Port Ludlow Lead Planner
1
Department of Community Development
Jefferson County
360.379.446s
A,lission; 'l'o preserve and enhunce tlrc qtutlttl, ol'liJb tn ,le.f/brsctrt Ootmtu hy tr.tromoting a vibrutt econon?)'.
sourul communities und ct heulthlt environment.
5f, SAVE PAPER - Pleose do not print this e-moil unless obsolutely necessory
All e-mail ntq; l1s consi<leretl sthject to the l'ublic Rec'ords ,4ct and as such nru1' he disclosccl to <t tltird-p<tt'A; rcqueslor
2
{
18.20.295 Recreational marijuana/cannab15.o sxnne B
(1) General Provisions. ln addition to all other applicable development standards of this chapter
and other applicable regulations within Jefferson County Code, the standards set forth below
shall apply to all recreational marijuana activities in the unincorporated areas of Jefferson
County. ln the event of conflicts, the more restrictive measure shall apply. ln addition to these
provisions, recreational marijuana activities shall comply with all applicable provisions of state
law (Chapter 314-55 WAC), including the rules governing recreational marijuana as
promulgated by the Washington State Liquor Control Board and other agencies with jurisdiction
(2) Definitions. For purposes of this chapter, the following definitions shall apply. Where these
definitions conflict with RCW 69.50.10'1 , as now or hereafter amended, those in state law shall
govern.
(a) "Marijuana" or "marihuana" means all parts of the plant Cannabis, whether
growing or not, with a THC concentration greater than 0.3 percent on a dry weight
basis; the seeds thereof; the resin extracted from any part of the plant; and every
compound, manufacture, salt, derivative, mixture, or preparation of the plant, its
seeds or resin. The term does not include the mature stalks of the plant, fiber
produced from the stalks, oil or cake made from the seeds of the plant, any other
compound, manufacture, salt, derivative, mixture, or preparation of the mature
stalks (except the resin extracted therefrom), fiber, oil, or cake, or the sterilized
seed of the plant which is incapable of germination.
(b) "Marijuana processo/' means a person licensed by the State Liquor Control
Board to process marijuana into useable marijuana and marijuana-infused
products, package and label useable marijuana and marijuana-infused products for
sale in retail outlets, and sell useable marijuana and marijuana-infused products at
wholesale to marijuana retailers. Marijuana processing for the purpose of this
section may or may not include drying, trimming and bagging of a recreational
marijuana product.
(c) "Marijuana produce/' means a person licensed by the State Liquor Control
Board to produce and sell marijuana at wholesale to marijuana processors and
other marijuana producers. Marijuana producing for the purpose of this section
shall include drying, trimming and bagging of a recreational marijuana product
when done in conjunction with producing.
(d) "Marijuana-infused products" means products that contain marijuana or
marijuana extracts and are intended for human use. The term "marijuana-infused
products" does not include useable marijuana.
(e) "Marijuana retaile/' means a person licensed by the State Liquor Control Board
to sell useable marijuana and marijuana-infused products in a retail outlet.
(f) "Plant canopy" means the square footage dedicated to live plant production,
such as maintaining mother plants, propagating plants from seed to plant tissue,
clones, vegetative or flowering area. Plant canopy does not include areas such as
space used for the storage of fertilizers, pesticides, or other products, quarantine,
office space, etc.
>
(3) Use Zones. Three categories of recreational marijuana activities are recognized by rules of
the state of Washington as follows: "production," "processing" and "retailing"; and each category
of such use shall be allowed in the following comprehensive plan zones and as further shown in
JCC 18.15.040, Table 3-1,and JCC 18.1 040, Table 3A-1
(a) Production. Allowed as a yes use in agricultural zoning district, rural industrial
and urban industrialzoning districts. Allowed as a conditional discretionary (C(d))
use in rural residential zoning districts and forest resource zoning districts.
Prohibited in rural commercial, urban commercial, urban public, urban residential,
county waste management essential public facility (CWMEPF) and mineral
resource lands (MRL), parks, preserves and recreation (PPR) and Port Ludlow
master plan resort zoning districts.
(b) Processing. Allowed as yes use in rural industrial and urban industrialzoning
districts. Allowed as a conditional discretionary (C(d)) use on agricultural resource
lands. Allowed as conditional discretionary (C(d))with a cottage industry permit in
forest resource lands and rural residential zoning districts. Prohibited in rural
commercialzoning districts, urban commercial, urban public, urban residential,
county waste management essential public facility (CWMEPF) and mineral
resource lands (MRL), parks, preserves and recreation (PPR) and Port Ludlow
master plan resort zoning districts.
(c) Retailing. Allowed as a yes use in neighborhood/visitor (NC), general
crossroads (GC), rural village center (RVC), urban commercial (UC) and urban
industrial (ULl) zoning districts. Allowed as a conditional discretionary (C(d)) use
on agricultural resource lands. Allowed as conditional discretionary (C(d)) with a
cottage industry permit in forest resource and rural residential zoning districts.
Prohibited in convenience crossroads (CC), visitor-oriented commercial (VOC),
urban public, urban residential, county waste management essential public facility
(CWMEPF) and mineral resource lands (MRL), parks, preserves and recreation
(PPR) and Port Ludlow master plan resort zoning districts.
(4) The following standards shall apply for all recreational marijuana activities:
(a) Producing in the forest resource lands and rural residential zones is allowed as
a conditional discretionary (C(d)) use subject to the recreational marijuana
standards and structure size limitation:
(i) Permanent and temporary growing structures on rural residential lands RR
1 :5, RR 1 :10 and RR 1 :20 and forest resource lands shall meet the following
standards in addition to all other applicable sections of the Jefferson County
Code.
(A) Rural Residential 1:5 - Temporary or Permanent Growing Structure
Size. The allowed structure size is a total combination of square footage
of gross floor area for all growing structures.
(l) Five percent of gross parcel size in square feet, up to a maximum
10,890 square feet gross floor area.
{
(B) Rural Residential 1 :10 and 1.20 and forest resource lands CF-80,
RF-40, lF - Temporary or Permanent Growing Structure Size. The
allowed structure size is a total combination of square footage of gross
floor area for all growing structures.
(l) Five percent of gross parcel size in square feet, up to a maximum
of 21,780 square feet gross floor area.
(b) Producing in agricultural zoning district is allowed as a "yes use" without size
limitations but shall be subject to the standards in JCC 18.20.030, agricultural
performance standards, and this subsection (4), recreational marijuana
performance standards.
(c) Processing in the forest and rural residential zoning districts is allowed subject
to a conditional discretionary (C(d)) use permit per JCC 18.20.170, cottage
industry standards, and as consistent with this section, recreational marijuana. ln
addition to the maximum structure size of 5,000 square feet for a processing
structure authorized as a cottage industry per JCC 18.20.170(4)(o) for cottage
industry, an additional growing structure(s) such as greenhouses may be allowed
up to the size limits per parcel size and structure size for producing only per
subsection (4XaXi) of this section.
(d) Processing and retail in the agriculturalzoning district is allowed as conditional
discretionary (C(d)) and shall be subject to the standards in JCC 18.20.030(3),
agricultural performance standards, and this section, recreational marijuana
performance standards.
(e) No recreational marijuana operation may be permitted as a home business. All
recreational marijuana activities are subject to the applicable requirements of
Chapters 18.20 and 18.30 JCC.
(f) Outdoor Producing. All outdoor producing activities in rural residential and forest
zones shall have an unlimited outdoor canopy without size limitations. All outdoor
producing activities for a cottage industry shall have an unlimited outdoor canopy
without size limitations.
(g) Landscape Screening. All recreational marijuana activities shall have Type "A"
landscape screening from adjacent parcels, per JCC 18.30.130 development
standards
(h) Setbacks. All recreational marijuana structures and activities in agriculture,
commercial forest, rural forest, rural commercial or rural residential zone that abut
residential zoned land shall be a minimum 25 feet setback from all property lines
including front road setbacks. Setback requirements for other zone combinations
are as stated in JCC 18.30.050, development standards, Table 6-1, Density,
Dimension and Open Space Standards. ln the event of conflict, the more restrictive
measures shall apply.
(i) Cameras. Any security cameras proposed for a recreational marijuana facility
shall be positioned so as to not intrude on the privacy of adjacent parcels.
b
0) Any fence eight feet or taller shall be located a minimum 25 feet from all parcel
property lines.
(k) Recreational marijuana activities and facilities shall comply with all applicable
standards of JCC Title 18 including but not limited to development standards in
Chapter 18.30 JCC, performance and use-specific standards in Chapter 18.20
JCC including JCC 18.20.010, General provisions, JCC 18.20.020, Accessory
uses and structures, JCC 18.20.030, Agricultural activities and accessory uses,
JCC 18.20.140, Commercial uses - Standards for site development, JCC
18-20,170,Cottage industry, and JCC 18.20.22O,lndustrial uses - Standards for
site development.
(l) All recreational marijuana licensees shall provide to the department of
community development and environmental health a copy of all operations plans
as submitted to the Washington State Liquor Control Board, including details of
any chemicals, processes, extraction methods, waste handling procedures and
safety measures planned for their operations. [Ord. 4-15 S 5 (Att. D)]
18.40.100 Development permit applicatiol. cl sxaRe A
(1) lnformation Required for All Applications. Applications for project permit decisions shall be
submitted upon forms provided by the administrator. A project permit application is complete
when it meets the submission requirements of this section. An application shall consist of all
materials required by the relevant section of this code or other applicable county ordinance or
regulation, and shall also include the following general information.
(a) A completed project permit application form, including a SEPA checklist unless
categorically exempt from SEPA;
(b) A verified statement by the applicant that the property affected by the application is in
the exclusive ownership of the applicant, or that the applicant has submitted the
application with the written consent of all owners of the affected property, and proof of
ownership of the property;
(c) ldentification of a single contact person or entity to receive determinations and notices
required by this code;
(d) A legal description of the site, including the Jefferson County assessor's parcel
number;
(e) The applicable fee as set forth in the Jefferson County fee ordinance;
(0 For each building permit necessitating potable water, evidence of available and
adequate water supply and, if applicable, compliance with the requirements established by
the Jefferson County department of health for the provision of water; evidence may be in
the form of a water right permit from the Department of Ecology, or another form sufficient
to verify the existence of an adequate water supply;
(g) Evidence of septic approval, a valid pending septic application, or sewer availability
and, if applicable, compliance with the requirements established by the Jefferson County
department of health for wastewater disposal;
(h) A site plan, showing the location of all proposed lots and points of access and
identifying all easements, deeds, restrictions or other encumbrances restricting the use of
the property, if applicable. All information should be accurate, legible and generally should
be drawn to a scale no smaller than one inch equals 50 feet for a plot larger than one acre
and no smaller than one inch equals 25 feet for a plot one acre or smaller; and
(i) ldentification of other local, state and federal permits required for the proposal, to the
extent known by the applicant.
(2) Commercial, lndustrial, Multifamily and Small-Scale Recreational and Tourist Uses -
AdditionalApplication Requirements. ln addition to the general information required under
subsection (1) of this section, all building permit applications involving commercial, industrial,
multifamily, and small-scale recreational and tourist uses listed in Table 3-1 in JCC 18.15.040
shall include a site plan prepared by a civil engineer, architect or landscape architect licensed in
the state of Washington that includes or graphically depicts the following information:
(a) Compass direction and graphic scale;
(b) Total gross acreage;
(c) Proposed and existing structures including building envelopes and building setback
lines;
(e) All proposed or existing uses;
(f) The layout of an internal vehicular and pedestrian circulation system, including
proposed ingress and egress for vehicles and roadway widths, and additional right-of-way
if required on substandard roads;
(g) The location of significant geographic features on the site and immediately adjoining
properties;
(h) Corner grades and existing contours of topography at five-foot contour intervals;
(i) Proposed development or use areas;
(j) Property lines, adjoining streets, and immediately adjoining properties and their
ownership;
(k) Existing and proposed grades and volume and deposition of excavated material;
(l) A preliminary drainage plan;
(m) Locations of all existing and proposed utility connections;
(n) Parking spaces and driveways;
(o) Proposed landscaping; and
(d) Distances between all proposed and existing buildings;
(p) The location and extent of wetlands, floodplains and other environmentally sensitive
areas.
/-t t\ AdditionalApplication Requirements. ln addition to the information required under
\ fbsections (1) and (2) of this section, the administrator may require additional information orvstudies in order for the application to be considered complete. Such information may include,
but is not necessarily limited to, the following:
(a) A phasing plan, acreage of phases, and time schedule, if the site is intended to be
developed in phases;
(b) Enumeration of the number of persons that will reside in a dwelling(s);
(c) Documentation of the date and method of segregation for the subject property verifying
that the lot or lots were not created in violation of the subdivision (i.e., either short or long)
laws in effect at the time of creation, or identifying whether the lots were created prior to
the advent of Chapter 58.16 RCW in 1937;
(d) A recorded survey of the subject property in order to verify property boundaries and
setback measurements.
(4) Application Requirements in Other Applicable Regulations. Applications for the following
land use permits must satisfy JCC 18.40.100(1), (2) and, if required, (3), and the following
provisions of this Unified Development Code and applicable county ordinances and regulations:
(a) Building permits under the Jefferson County building code, Chapter 15.05 JCC, or its
successor ordinance'
(b) On-site septic systems pursuant to Chapter 8.15 JCC;
(c) Reasonable economic use variance permits under JCC 18.15.220;
(d) Planned rural residential developments (PRRDs) under Article Vl-M of Chapter 18.15
JCC;
(e) Cottage industries under JCC 18.20.170;
(f) Home businesses under JCC 18.20.200;
(g) Temporary outdoor use permits under JCC 18.20.380;
(h) Stormwater management permits under JCC 18.30.070'
(i) Sign permits under JCC 18.30.150;
fi) Boundary line adjustments under Article ll of Chapter 18.35 JCC;
(k) Short plats under Article lll of Chapter 18.35 JCC;
(l) Long plats under Article lV of Chapter 18.35 JCC;
(m) Binding site plans under Article V of Chapter 18.35 JCC;
(n) Site plan approval advance determinations under Article Vll of Chapter 18.40 JCC;
(o) Written exemptions, shoreline substantial development permits for primary and
secondary uses, and shoreline conditional use and variance permits under the Jefferson
County Shoreline Master Program;
(p) Wireless telecommunications permits under JCC 18.20.130 and Chapter 18.42 JCC;
and
(q) Plat alterations under Article Vll of Chapter 18.35 JCC
All application requirements identified in other code sections that supplement or supersede the
requirements of this chapter shall be met before an application is deemed complete.
(5)Waivers. The administrator may waive any specific submittal requirements determined to be
unnecessary for review of any application. ln such event, the administrator shall document the
waiver in the project file or project log. [Ord. 8-06 S 1]
Odor Mitigation and
Management PIan
Tax Parcel lD: 601105013
11t03t2018
ilnv n * 20tg
g t EFFERSOfu SOUNTY T,CD
Purpose
The purpose of this report is to discuss how we will prevent and manage odors produced by growing
and processing recreational marijuana. Based on the size and proposed operation we will not be a
nuance or disruption to the surounding neighbors.
Odor Prevention
Activated Carbon filters
Our buildings have been designed for maximum climate control. All air entering and exiting the
building is being filtered through activated carbon filters. Activated carbon filters scrub the air that
passes through them neutralizing the odors. When placing carbon filters in front of the fans the air is
forced through the filters making sure that allthe air is cleaned and does not smell.
ln the above figure the air is being pulled from the outside of the warehouse through an intake fan
into the warehouse. Once the air enters the warehouse it circulates through a series of can filters
that are inside the warehouse. Can filters are essentially a cylindrical aluminum filter that is filled with
activated granulated carbon. Fans attach to the filters to pull air from inside the building and filter it
lnline fan
(eulls Rir
I nto
Warehouse)
Activated
Carbon
Filter
Warehouse Activated
Carbon
Filterlnline
Fan Pushes
Air Out
Exhause
To ExteriorAir lntake
so the air does not have any detectable odor. Once the air finishes circulatlng the warehouse it is
then pulled from the warehouse by an inline fan into another activated carbon filter. Once it passes
through this finatfilter it is void of any smell.
Maintenance
Changing Filter Schedule
The main component in making the above filtration plan work is the maintenance of the filters. The
filters must be changed out every 6 to 8 months to ensure no odor is detectable outside of the
facility. We will determine the exact dates to change the filters based on the conditions in the
warehouse. Once 6 months has passed we will inspect and see if the filters need to be changed. lf
they do not we will continue to monitor them until the 8 month mark at that point all filters will be
changed regardless of smell. lf smell is detected at any time the filters will be immediately changed.
Odor Mitigation Response Process
Our goal is to have zero odor detected outside of our building. lf odor is detected outside of the
building by staff or an outside source we have the following procedures in place.
1. Log odor complaint depending on who detects the smell, Iog accordingly:
a. Staff(see Form t)
b. Neighbor or outside source (see Form z)
z. Change out carbon filters immediately.
3. Monitor smell through the day to detect if the new carbon filters have eliminated the smell.
4, lf the problem is still not resolved after t day we will minimize the amount of time the
exterior fans are on, creating less air pushed out of the building.
5. The next step will be to irntall additionalfiltration lines and exhaust ports to better disperse
the air.
2
Form t
I
on of Odor Wind DirectioDate Time Filed by Location Descri d Temp. Describe activities at this time Actions taken
I
Date Time Filed Location Description of Odor Wind Direction/Speed Te Describe activities at this time Actions taken
3
a
Form z
Complaint Document Templet
Date of Complainc
Select Odor Complalnt Source:
n Regulatory Agency: Llst
! Neighbors:
Time of AM PM (Circle)
Name of person who took the report of the complaint:
Odor Complaint Description:
Wind Speed Wlnd Direction: Temp. r _ Sky Conditlons: _Humidity:_
Other detectable odors? lf yes, smell and potential source:
Officers lD#
List neighbors Name and Address:
Other:
List CONTACT INFO FOR SOURCE:
Describe geographlc location of the complaint (property line location, GPS coordlnates,
approximate dlstance from source). Use the property map in coniecture wlth this form.
n
n
Ust activities that were happenlng inslde of the faclllty t the time of the complaint:
Walk around the operation and assess odor at the tlme of complalnt Describe findings
Was an odor source identified? lf yes, what actions were token to mitigdte the odor and what was the
source of the odor
4
Based of the findlngs of the investigation, are changes required to the current odor mitlgatlon ptan
and/or additional controls needed? lf yes, desoibe actlons and a proiect timeline of completion
Follow-up with complaint source:
I Yes: List date and method
n No: List reason
SignatureandDateofpersoncompletingrePortDATE-
Name of person completing report
5
DocuSign Envelope lD: 163F0A94-E588-44BA-BDE1-3780EE26BD85
@ License Number 4L6544
UBI Number
Trade Name
6004 5 602 7002 000L
OUTBACK BUD COMPANY
Operating Plan Required Elements - Producer/Processor
Submission of an operating plan that demonstrates the applicant is qualified to hotd the marijuana
license applied for is required as part of the application process listed in Washington
Administrative Code WAC) 314-55{20. 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 descrlbe how your operating plan complies with the requirements listed in the
WACs indicated below. Additional sheets may be attached lf
1. SECURTTY (WAC 314-55-083)
a. Willallemployees wear an identification badge?NoY o B zots
YES
NO
b. Does your location have a security alann system on all perimeter doors and windows?tr yES
DNo
c. Does your video surveillance system and recording device meet the foltowing
requirements?
YES
Minimum camera resolution of 640 x470
lntemet protocol (lP) 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 Paciffc Ave. SE, Oympla WA 98504-3098, (360) 664-1600, www.liq.wa.gov
LlQ1227 05nO1B
Washington State
Liquor Control Board
x
n JEFFERSOi,
COUN?V DCi}
NO
tr
T
tril
nf
tr
tr
tr
tr
tr
E
x
x
x
Page 1 of9
DocuSign Envelope lD: 163F0A94-E588-448A€DE1-3780EE268D85
UBI Number 6004 560270020001
d. Additional description of surveillance system (how storage device is secured, vendors
used, etc.):
all cameras wi'l'l be secured to the wal1 of the bui'lding. The media storage devicewi'l'l be physical'ly secured to the wal1 in the office of the build'ing.
SAi,ISUNG Video Security System
2. TRACEABTLTTY (WAC 314-55{83(4))
a. Will you use a third party vendor for your traceability software?n yES
trNo
lf you selected YES, please list the name of the vendor/software:
lf you selected NO, please describe how you will comply with traceability requirementsr wil'l use the system set up by the wscLB and excel spread sheets,
b. ls the system listed above compatible with the LCB's traceability system?tr yES
trNo
3. QUAL|F|CATIONS AND TRATN|NG PLAN FOR EMPLOYEES (WAC 314.55.020(9))
a. Please describe the type of training you will provide t,o employees to inctude topics you will
cover:
e1'l employees wi'l'l be trained on safety of al'l equ'ipnent (ttydroponic system, trimmingequ'ipment, heat sea'ling machines, and sca'le usage), Materia'l safety Data sheet for aII
chemica1s used for fertilization, Trained on all laws and rules rlgarding init.iative502. emp'loyees will be trained on the all trace ab'i'l'ity rules to inc'lude iracking andlabeling devices.
PO Box 43098, 30(D Pacific Ave. SE, Olynpia WA 98504-3098, (360) 664-1600, unvw.liq.wa.gov
LlQ1227 05t2014 Page 2 of 9
DocuSign Envdope lD: 163F0A94'E588-44M-BDE1-3780EE268D85
UBI Number 60045602 70020001
b. Description of team/staff members related experience:
This business wi'l'l be ran and supported by the wil1iamson ramily. our son uuke will be
our first employee he has some experience grovring marijuana, our daughter lessie wi'l'ljoin us in october to oversee the business related side- book keeping, selling of theproduct to the retailers, transportation manifest, payro"l'1, genera'l manger dut'ies. rhe
th,o owners a'lso have some experience growing. we wi'|I be hiring a groyrer that has been
growing medically for some time. The bus'iness owners wi'll be in to support genera'l'labor and the oversight of the sa1es, rule fol'lowing and to make contact rr.ith the Labfor testing as well as the retailers for se'l1ing our product.
'+. TRANSPORTATION OF PRODUCT (WAC 314.55.085)
a. Describe how you will prepare prcduct for transport (packaging, sealed transport
containers, manifest, etc. ):
Notification of shipment. Upon transporting any marijuana or marijuana product.(2).neceipt,of sh'ipment. Upon receiving the shipment, the licensee receiving theproduct sha'I1 report the amount and/or wejght of marijuana and/or marijuana-products
received in the traceability system.(3) Transportation man'ifest. A comp'lete transport manifest containing all informationrequired by the board must be kept with the product at a'll times.(4) Records of transportation. Records of a'l'l transportation must be kept for a minimumof three years at the licensee's'location.(5) rransportation of product. uarijuana or marijuana products that are being
transported must meet the fol'lowing requirements:(a) on]y.the marijuana'licensee or an emp'loyee of the'licensee may transport product;(b) Narijuana or marijuana products must be in a sea'led package or container approvedby the board pursuant to hlAC 314-55-105;(c) sealed packages or containers cannot be opened during transport;(d) ttarijuana or marijuana products must be in a 'locked, safe and secure storage
compartment that is secured to the inside body/compartment of the vehicle traniportingthe marijuana or marijuana products;(e) lny vehicle transporting marijuana or marijuana products must trave'l directly fromthe sh'ipp'ing licensee to the receiving'licensee and must not make any unnecessary stops
_in between-except to other faci'litiei receiving product.
[statutory Authority: Rcw 69.50.325, 69.50.331, 69.50.1a2, 69.50.345. rrvsR 13-21-].04, g
31
b. Describe how your vehicle will meet storage crmpartment requirements:
Marijuana or marijuana products must be in a locked, safe and secure storage
compartment that is secured to the inside body,/compartment of the vehic'le transportingthe marijuana or marijuana products.
We w'ill remove the back seat of our vehic'le and instal] a'lock box that is accessib'lefrom the inside of the car. This ]ock box ui]] be secured to the f]oor of the vehic]e.
PO Box 43098, 3000 Pacific Ave. SE, Olympia WA 98504-3098, (360) 66+1600, uruw.liq.wa.gov
ua1227 0st2014 Page 3 of I
DocrSign Envelope lD: 1 63F0A94-E588.44BA-BDE1-3780EE268D85
UBI Number 6004560270020001
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?
oec will verify the 72 hour wait'ing period has been met prior to destroying seed'l'ings,plants, and marijuana. Marijuana waste to include; roots, stocks, 'leaves, and stemsthat have not been processed with so'lvent will be ground into comfortable waste. rhis
waste wi'll contain at least 50!6 non-marijuana waste. rt is to be composted on site withyard waste, paper waste, cardboard waste, and soil.
oec on'ly expects to have roots, soi1, stems, and plant trimmings, at this point in timeas waste,
b. Do you anticipate any dangerous waste? lf so, how will that be stored, managed and
disposed of?
No- we do not intend to have any hazardous waste.
111 plant waste from making extracts, waste so'lvents, and extracts that don't meetquality testing wi]] be d'isposed of in accordance with 1oca1 regu'lations. rt wi]'l bequarantined 72 hours prior to disposable.
a'l'l waste solvent will be tested at a lab periodica'l1y to verify not hazardous.
c. How will you render non-dangerous waste unusable and what materials willyou mix it with
to achieve the required 50% non-mariluana waste by volume?
oBc. intent is_to compost solid waste onsite. our intent is to m.ix ground pwith used soil waste into a compost. plant waste; stems, stock, roots wi'li
and m'ixed with soil waste and composted on site,
lant waste
be ground up
PO Box 43098, 30fi) Pacific Ave. SE, Olympia WA 985M-3098, (360) 6M-1600, wwrrv.liq.wa.gov
ua1227 05nOU Page 4 of 9
Doo:Sgn Envelopo lD: 163F0A94-E58B44BA-BDE1-3780EE268D85
UBI Number 60045602 70020001
d. Where will solid and liquid waste be taken after it has been rendered unusable?
we would like to compost our waste on site, if that is not ach'ievab'le we will take the
waste to the loca'l dump/transfer station.
6. DESCRIPTION OF OPERATION AND PREMISE
a. Standardized Scale
Please acknowledge that you will meet the requirements listed below:
YES NO
x tr Licensees are required to have at least one scale on the ticensed premise for
the traceability and inventory of products.
X The scale(s) used must have a NationalType Evaluation Program (NTEp)
Certificate of Conformance (COC). lf a scale meets this requirement it
should have an lD name plate on it with the COC number.
f] Licensees must register their scale(s) on a business license application with
Business Licensing Services through the Department.
x
b. Marijuana Production
YES NOtrntrxrT
lndoor Grow
Outdoor Grow
lndoor and Outdoor Grow
1. Size category (plant canopy):tr Tier 1
Tier 2
tr Tier 3
2. List the number of square feet you will dedicate to plant canopy:
we will eventual1y be dedicating 7300 sq ft to canopy.
3. List the number of square feet you will dedicate to other business activities (such as
office, restroom, quarantine room, etc.):
Approximately 1000 sq. ft.
PO Box 43098, 30fi) Pacific Ave. SE, Olympia WA 98504-3098, (360) 66+1600, wum.llq.wa.gw
uaj227 05t2014
x
Page 5 of 9
tr
DocuSign Envelope lD: 1 63F0AS4-E588-448A-BDE1-3780EE268D85
UBI Number 6004 560270020001
4. I acknowledge that all soil amendments, fertilizers, pesticides and other crop aids used
will be compliant with LCB standards listed in WAC 314-5$084:tr YEStrNo
5. Describe the type of eight foot fencing material that will be used to encompass your
outdoor grow or to connect exterior buildings on the licensed premise:
l.tot app'l i ci tabl e
6. Describe the material/method will you use to meet requirements for sight obscurity:
Not applicitable
c. 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):
no editab'le at this time
Various sized packages of tr,lari juana bud
eubb'l e Hash
loi nts
c'lones (smal1 plants)
BHo oi'l
2. Describe the processing methods you will use to create the items listed above:
e'11 p'lants wil'l be dried, the'lot wil'l be tested at a certified'lab, package and'l abel ed properl y.
Bubble hash wil"l be processed using marijuana bud, ice water, bubb'le bags and abucket- they will be tested at a certified'lab and packaged as required.
Marijuana joints wi'l'l be rolled on site, packaged as required and so'ld indiv'idua11y
and as a bunch in a container approved by the wscLB.
we wi'l'l a'lso be selling c'lones to other processors which will be taken on site from
mother p'l ants.
hle may use heat, screens, presses, steam distillation, ice water, and other methodswithout employing so'lvents or gases to create kief, hashish, bubble hash, or infuseddairy butter, or oils or fats derived from natural sources, and other extracts.
h,e may use food grade glycerin, ethano'|, and propy'lene g'lyco1 solvents to,createextracts.
PO Box 43098, 3000 Padftc Arre. SE, Otymph WA 98504-3098, (960) 664-1600, www.liq.wa.gov
LaQ1227 0512014 page 6 of 9
DocuSign Envelope lD: 163F0A94-E588-448A€DE1-3780EE268D85
UBI Number 6004560270020001
3. Describe the extraction equipment you will use and how it will be compliant with
requirements listed in WAC 314-5$104:
uechanica'l separation methods use physica'l action to remove the trichomes from theplant, such as sieving through a screen by hand or in motorized tumblers. The resultingpowder, referred to as "kief", is compressed with the aid of heat into b'locks of
hashish. rce-water.separation is another mechanical method of isolating trichomes.
Chemica'l separation methods general'ly use a solvent such as ethano'l or hexane to
disso'lve the 'lipophilic desirable resin. nemaining plant materials are filtered out ofthe so'lution and sent to the compost. The solvent is then evaporated, leaving behindthe desirab"le resins, cal1ed honey oi1, "hash oi1", or just "oi1". Honey oi'l sti'll
contains waxes and essential oils and can be further purified by vacuum distil'lation toy'ield "red oil". The product of chemica'l separations is more cormonly referred to as
"honey oi'l." rhis oi] is not rea'lly hashish, as the latter name coveri trichomes thatare extracted by sieving. This leaves most of the glands intact. uash oi'l is a fluid asthe contain'ing trichomes have been broken
Professional grade closed loop systems used by processors must be cornmercially
manufactured and bui'lt to codes of recognized and generally accepted good engineeringpractices, such as:(a) The American Society of uechanical Engineers (ASME);(b) american Nationa'l standards rnstitute (ANSI);(c) underwriters Laboratories (UL); or(d) The American Society for Testing and Materia'ls (asru).yve have not purchased a
4:utgiilfE f,ts daBPisfr"s%?%fitif,H6"trb?B'd,:8fS Gt'a6iEqif,ui,f,,'sTillBi,lciu'E6"frt w
they wil! be sealed:
Al1 individuals marijuana bud sa'les wi'l 1 be p'laced in 4 mi'l packaging and wi'll besea'led using a heat sea'l packaging machine.
tnfused products wi'l'l be sea'led in child proof containers or 4 mi'l heat sealed bags ora sea'led medal cork sty'le bottle cap container.
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):
we wi'll identify the product may have intoxicating effects and may be habit forminguarijuana can impair concentration, coordination, and judgement.
Do not operate any veh'ic1e or machinery under the influence of this drug.
There may be hea'lth risks associated with this product.
For use only by adu'lts 21 years or older. Keep out of reach of chi'ldren.Lot number, UBI number of producer.
rhis product should not be used by women that are pregnant or breast feeding.
infused products- a statement that discloses a'l'l pest'icides app'lied to the plant,and
grow'ing medium during production of the base marijuana used to create the extract
added to the infused product. A statement d'isclosing the type of extraction method,including any solvent, gasses, or other chemica1s or compounds used to produce theproduct.
PO Box 43098, 3000 Pacifc Ave. SE, Olympia WA 98504-3098, (360) 664-1600, wvwv.liq.wa.gov
LlQ1227 05tm14 Page 7 of 9
DocuSign Envslope lD: 163F0A94-E588-448A-BDE1-3780EE268D85
UBI Number
7. QUALITY ASSURANCE PROTOCOLS (WAC 314-55.102)
! acknowledge that all required quality assurance testing must be done by an accredited third
lab approved by the LCB:
YES
NO
DATTVtr'tr
E. 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 isattached. I
a. Phlnsical banier/perimeter fencing enclosing the licensed premise including all gates
b. Grow area(s)
c. Processing area(s)
d. Controlled access area(s)
e. Quarantine area(s)t. Points of ingresVegress to the licensed premise
g. Location of all doors and windows
h. Location of secured Surveillance System Storage Devicei. Location of all cameras and alarmsj. Designated Waste area(s)
Glick'yes'to attach floor plan YES
Click'yes' to attach continuation sheet YES
PO Box43098, 30fl) Pacific Ave. SE, Olympia WA 98504-3098, (360) 6*.1600, www.!iq.wa.9ov
LlQ1227 05/2014 Page I of 9
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DEPARTMENT OF COMMUNITY D
621 Sheridan Street, Port T<;wnsend, WA 98368
Tel: 360.379.4450 | Fax: 360.379.4451
V'eb: www.co.icffcrson.wa.us/communitvdcvelooment
E-mail: dcd@co.refferson.wa.us
[Vtr
PRE-APPLICATION CONFERENCE
The Jefferson County Code (JCC) 18.25.U0 & 18.40.090 requires that before an application is made for all Type ll
and Type lll p@ect applications and Type I applications proposing impervious surfaces of ten thousand (10,000) square
and/or non-single family structures of five thousand (s,&d)qfflnr€feet or more, or all projects involving in-water work or
work below OHWM, a pre-application consultation must be held. The consultation includes preliminary review and
administrative assistance. This service does not include extensive field inspection or correspondence. Pre-application
consultation does not limit subsequent administrative review.
At the conference, Department of Community Development personnel shall provide the applicant with:
(1) A list of the requirements for a completed application;(2) A general summary of the procedures to be used to process the application;(3) The references to relevant code provisions or development standards that may apply to the approval of the
application;and(4) A list of any applicable hourly review fees that may be charged by one or more County agencies upon the
filing of a project permit application with the County.
Discussions at the conference or the information provided by the staff shall not bind or prohibit the County's future
application or enforcement of all applicable laws and regulations. No statements or assurances made by County
representatives shall in any way relieve the applicant of his or her duty to submit an application consistent with all relevant
requirements of County, state and federal codes, laws, regulations and land use plans.
?0 BOCT11
*or.. Tracy Williamson
MAILING ADDRESS 2005 Peterson RD NW Poulsbo, WA 98370
TELEPHoNE: (noue)(360)5e8-1e34 (wonx)(360)731-7721
REPRESENTATIVE:
MAILING ADDRESSI
Tnar..r\,,J-.. \\:^r^^so nAot3 O G r\^ri.\ . Lorr1\
TELEPHoNE: (noue)(wonx)
DI RECTION S
1. Please answer all questions on this form completely.
2. Attach one sketch of the Conceptual Design for the proposed use or activity, showing the following information
a. Vicinity sketch;b. North anow and scale;c. Property boundaries and identification of land uses on adjacent properties;
d. Means of ingress and egress;e. Property/lotdrainage;f. Possible locations of sewage disposal and water supply systems;g. Location of utility easements; andh. Proposed location of buildings, including setbacks to property boundaries.
3. Attach payment of the applicable fee, as set forth in the Jefferson County Fee Ordinance.
Property Description
Project Description
General Location:
9003 Coyle RD Quilcene, WA 98376
Legal Description (from Property Tax Statement):
WOODWAY LARGE LOT SUBDIVISION LOT 3
9-Digit Parcel Number (from Property Tax Statement):601 105013
Total Acreage:5.48 Zone % Lot Coverage
n Lessee
tr Other
Applicant:E Ownertr Contract Purchaser
We plan on building a single family home on the property. We will use a cottage industry permit to build a 5,000 sq ft.
warehouse and dedicate 2,000 sq ft. to processing marijuana inside the warehouse. We will plan on moving a
prefabricated building on the property. ln the future we plan to erect another 5,000 sq ft. building for the sole purpose of
growing recreational marijuana.
Property Owner (name and mailing address)Tracy & Mark Williamson
2005 Peterson RD NW Poulsbo, WA 98370
Standard Disclosure
OCT 112018
i iliu
lnformation provided to a prospective applicant during the pre-application consultation is based on County regulations in effect at the
time of the pre-application consultation. Revised or new Countv requlations could affect a future develooment apolication. A pre-
application consultation does not vest a future development application.
By signing the application form, the applicanUowner aftests that the information provided herein is true and conect to the best of their
knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected
property. Any material falsehood or any omission of a material fact made by the applicanUowner with respect to this application
packet may result in this permit being null and void.
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities, judgments, court costs, reasonable
attorney's fees and expenses which may in any way accrue against Jefferson Coun$ as a result of or in consequence of the granting
of this permit.
I hereby designate o act as my agent in matters related to this pre-application
conference,
(LeruoowHen srorueruae)(DArE)
(storuerunr
/o-/8.)d6
(DATE)
G:\PmltCmterffiFORMS##*ADRO\Pr+App\pFapp mnf€rene fom.doc REV.'l 1i1l2013 Page2
suB 94-0007
PRIPARED FOR: J.A.L. ASSOCTATES
NOTICE TO POTENNAL PURCHASERS
1. THE LOTS CONTAINED WITHIN THIS URGE LOT SUBDIVISION HAVE NOT BEEN PROVIDED WITH A POTABLE
WATER SUPPLY, NO BUILDING PERMIT WILL BE ISSUED BY JEFFERSON COUNTY WITHOUT FIRST SATISFYING
THE POTABLE WATER REAUREMNTS CSTAELISHED BY THE JEFFERSON COUNTY HEALTH DEPARTM{NT.
2. )SNDLAL WELL''' -'- Srotl-NoTittcuMBER pRopERTtES wTroar pRtoR wRtrrEN coNsENT oF THE
^Dilc*fr{ptrpe+w owN[R(s). wELLs
'HALL
BE SERVED BY AN EASEMENT OF t1O FOOT RADTUS vlHtct1 W|LL
SERVE AS A SANITARY CONTROL.
3. APPROVAL OF THIS DIVISION DOES NOT CONSTITUTE APPROVAL OF BUILDING OR SEWAGE DISPOSAL PERMITS
ON EACH TRACT. PERMIT APPROVALS WILL BE SUBJECT TO BUILDING PLOT PUN, TYPE OF USE,
CONTOURS, SOILS ON INDIVIDIJAL TRACTS, AND DEED RESTRICTIONS. PERMITS WILL BE REVIEWED IN
ACCORDANCE WITH SITL CONDITIONS AND REGUI.ATIONS EXISNNG ON THE DATE THE PERMIT IS APPLIED
FOR.
4. NO SITE DISTURBANCE WILL BE ALLOWED WITHN THE OPEN SPACE AREAS SHOWN HEREON EXCEPT THOSE
NECESSARY TO PROVIDE A DRIVEWAY ACCESS AND UTIUflES TO EACH LOT. THE OPEN SPACE AREA ON
|ACH INDIVIDUAL LOT 6 FOR THE EXCLUSIVE USE AND BENEFIT OF THE OWNER OF THAT LOT.
5. THE LOTS CONTAINED WITHIN THB SUBOIVISION HAVT NOT BEEN APPROVED FOR THE INSTALUTION OF
AN ON-SITE SEWAGE DISPOSAL SYSTEM.
6. PRIOR TO COMMENCEMENT OF ANY UND DISTURBING ACTIVITIES AND PRIOR TO ISSUANCE OF A BUILDING
PERMIT, A STARM WATER SITE PUN SHALL BE DEVI'LOPED TO THE STANDARDS OF THE WASHINGTON
STATE DEPARTMENT oF EC1L)GY, ST)RM WATER MANAGEMENT MANUAL (CURRENT EDITION) AND
BE SUBMTTED TO THE DEPARTMENT OF PUBLIC WORKS FOR APPROVAL.
7. LOTS CRFITED HEREIN SHALL NOT BE FURTHTR DIVIDED IN ANY MANNER WITHIN A PERIOD OF FIVE YEARS
WITHOUT THE FILING OF A FINAL LONG PUT.
WOODWAY LARGE LOT "9[,
t^t srcTlclv / c, TclA/l\s11lP 26 lvcRTl-1, RAt'tG
,,) EFFIRSCIV CO U AITY, I/VAS I_11 I'IGTt
,//ot{s/{n/o/e{fi ;ty/6@/erte@fi2q,4g/fi efu
"{*FV&
AI.
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ttrcT t ocaTtoN
suB 94-0007
PREPARED FOR.. J,A,L. ASSOCIATTS
DESCRIPTION
rHAr PORToN OF THE NORTH 7/2 OF THE SOUTHEAST 1/4 OF SECT|ON 10,
TOWNSHIP 26 NORTH, RANGE I WEST, W.M., IN JEFFERSON COUNIY, WASHINGTON,
LYING WEST OF THAT STRIP OF UND CONVLYLO IO JLtT'ERSON COUNIY FOR
A COUNTY ROAD (COMMONLY KNOWN AS COYLE ROAD) BY DEED DATED MARCI..I
20, 1964, AND RECORDED UNDER AUDITOR'S FILE NUMEER 179187, RECORDS
OT JEFFERSON COUNTY, WASHINGTON.
DECLARATION
KNOW ALL PF,R.9ONS BY THESE PRTSTNTS THAT THF I.INDERSIGNFD IS OWNER IN
INTEREST IN THE UND HEREIN DESCRIBED AND DECURE THIS PUT TO 8E CREATED
BY HIS OWN FREF WIL.I. AND CONSENT. I GRANT UNTO l.OT OWNERS WITHIN THB PUT
THE RIGHT TO USE EASEMENTS AS PUTTED FOR THE PURPOSES SHOWN. I ALSO
DEDICATE TO THE OWNERS OF LOTS WITHN TH/s PUT AREAS SHOWN AS OPEN SPACE
FOR THE LIFE OF THE PROJECT, AND I DEDICATE 7'O THE USE OF THE PUBLIC FOREVER
IN FEE SIMPLE ALL STREETS AND PUBLIC ROADS SHOWN HEREON AND THE USE THEREOF
FOR ANY AND ALL PUBLIC PURPOS|S NOI INCONSISTENT WITH PUBLIC HIGHWAY
PURPOSES. FURTHER, THE UNDERSIGNED OWNER WAIVES FOR HIMSELF, HIS SUCCESSORS
AND ASSIGNS, ANY AND ALL CUIMS FOR DAMAGES AGAINST JEFFERSON COUNTY WHICH
WHICH MAY BE OCCASIONED BY THE ESTABLISHMENT, CONSTRUCTDN, OR MAINTENANCE
OF THAT PORTION OF TH,s SUBDIVISION DEDICATED TO JEFFERSON COUNTY.
WOODWAY LARGE LOT SU
l^l S[CTlOll /C, TO\/VwStllP 26 lVCl'?7-l l, l?A^l(..; l
,] FFFFR.SCA/ CC U IVTY, I/VAS Ii I I\'IGT( :
APPROVALS
APPROVI'D WTH RESPLCI TO CCJMP
THE JETFERSON COUNTY SUBDIVISIC
*l----. -:'-
DIRECTOR,
MANAGFR,
DTREC/i71,
\/{.h4
APPROVTD. BY THT JTTTTRSON (.'CI,or flpn'l , rsgla
.r.--r:- )'w
CHAIRMAN,
Y
,],A.1. ASSOCIATES, A WASHINGTON GENERAL PARTNERSHIP
BY ANDRFW J. BARBER, GFNFRAI. PARTNFR.
ACKNOWLEDGEMENT
STATE oF WASHINGT)N )
couNTY or ,-./t/rzzr/
'r) ss
THts ts To cERTtFy THAT oN rnrs /Jil DAy oF A, { t s uz., BEFIRE
ME, THI UNDERSIGNED, A NOTARY PUBLIC IN AND FOR THT STATE OF WASHINGTON,
DULY COMMISSIONED AND SWORN, PERSONALLY APPEARED ANDREW J. BARBER, TO ME
KNOWN TO BE THE GENERAL PARTNER OF J.A.L. ASSOCATES, A WASHINGTON GENERAL
PARTNERSHIP WHO EXECUTED THE FOREGANG INSTRUMENT AND ACKNOWLEDGED THE
INSTRUMENT TO BE THE FREE AND VOLUNTARY ACT AND DTED OF SAID PARTNERSHIP
FOR THE USES AND PURPOSES THEREIN MENTIONED AND ON OATH STATED THAT HE IS
AUTHORIZED fO EXECUTE THE SAID INSTRUMENT,
WITNESS MY HAND AND OFFICIAL SEAL THE DAY AND YEAR FIRST ABOVI WRITTEN.
,/k
ATTEST: C
NOTARY PUBLIC AND FOR THE STATE
TREASURER']
Iu J. t,trurrrar}.I , TREASU,
OF WASHINGTON
RESIDING lr 44-szz-,,.. ^^,,^,^,,,J ,. qA - /-^
HEREBY CERTIFY THAT TAXES ON i
rHr YEAR tsfrl unvr DrrN PAtt)
PI,EJC
suB 94-0007
WOODWAY LARGE LOT SU
llV SECTIOI\l / 0, TCI/VIVSl-1lP 26 IVCR il1 , RANC'L
,J EFI]RSCI/ CCU IVTY, I/VAS11 I I'lGT O
PREPARED FOR: J.A.L, ASSOCIATES
/
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Parcel Number 601 10501 3 1ll0ll20l8
Owner Mailing Address:
GREGORY S CHAMPION
KRISTI F CHAMPION
10076 PINE VALLEY CIR
BELVIDERE
61 008-7007
Site Address:
Section:School District:Quilcene (48)
10
Qtr Section:Fire District:Quilcene (2)
Tax Status:Taxable
Range Tax Code:0323
1W
Planning Area:South Toandos Peninsula,Coyle Area (9)
Sewer:Drainage:
Bank:View 1:
View 2:Zoningl;RR-20 - Rural Residential
2 Zoring3:Appraiser: 4
Assessor's Land Use Code:
Asscrssor's Land Use Code:
9100 - Vacant Land
],ARGE LOT SUBDIVISION LOT 3
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DEPARTMENT OF COMMUNITY DE\TELOPMENT
621 Sheridan Street, Port Townsend, WA 98368
Tel: 360.379.4450 | Fax: 360.379.4451
\7eb: www.co.iefferson.wa.us /communirydevelopment
E-mail: dcd@co.iefferson.wa.us
PERMIT FEES WORKSHEET
Parcel #
Permit #
601105013Estimated Cost of Project
Potable Water
Technology/Scan
State Fee
Other Fees
Shoreline Exemption.i{ul [< td ie
New Address
Road Approach
Tech Fee
Total Fees
Building Base Fees \
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septic Review E/ f\ res\e ..x')hr
,41 hv-
$1,,721.2s
S1,o12.oo
s149.00
s10.oo
Ssg.oo
Szs.oo
Sso.oo
s276.00
$sz.zs
Receipt Number:
Cash/Check/CC:
Date:
lnitia ls:
Office Use On
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