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Home My WebLink AboutApplicationDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379,4450 1 Fax: 360.379.4451 -• - Web: ��nn.ccS jS �erstnr.��ni,usl«nnsnunsncicr nment +,:.; ((-` �, I ` _ ; E-mail: PERMIT APPLICATION I, J A N 2 7 2020 ..JCS Steps in the Permit Process: i -Review application checklist to ensure all information is completed prior to submitting app ication. "+ -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 # =Mo ;Z;:�_� Site Information Assessor Tax Parcel Number: 969000004 Site Address and/or Directions to Property: 621 Ludlow Bay Rd Port Ludlow, WA 98365 Access (name of street(s)) from which access will be gained: Ludlow Bay Rd Present use of property: SFR Description of Work (include proposed uses): Replace 1 +/-80' rubble bulkhead landward with new rock bulkhead and extend +/-20' SW Wastewater - Sewage Disposal This property is served by Port Townsend or Port Ludlow sewer system? If not served by sewer identified above, identify type of Type 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: Is it a complete or partial system installation: Has a reserve drainfield been designated? eptic system below: SEP16-45 YES NO _ Case #: No Complete Partial Yes �� No Date of Last Operations & Maintenance check: 6/22/16 Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: iq_lW2L_ 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 Munk mail"). Applicant/Property Owner Information Property Owner: Name: Robert and Robin Westler Address: 621 Ludlow Bay Rd Port Ludlow, WA 98365 Phone M 206-947-6762 E-mail Address: robinwestler@gmail.com ,VPlease contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: Date: 1/17/2020 Note: For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures. Applicant: Authorized Agent/Representative (If other than owner) Name: Sealevel Bulkhead Builders, Inc Address: PO Box 375 Kingston, WA 98346 Phone #: 360-297-2401 E-mail Address: Jenny@sealevelbb.com Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Sealevel Bulkhead Builders, Inc. SEALEBB9931_7 License # Address: PO Box 375 Kingston, WA 98346 *See attached owner/agent agreement* Phone #: 360-297-2401 E-mail Address: Jenny@sealevelbb.com Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer _V�' Architect Surveyor Contractor Consultant Name: Paul Austin License # 16968 Address: 2182 NE Eldon Lane Bremerton, WA 98311 Phone #: 360-698-1661 E-mail Address: austinengr@gmail.com Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor 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@coastalsolns.com 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 the County's intent to enter upon the property for visits related to this application and subsequent permit issuance. Signature: Qkw Print Name: Jennifer Rotsten Date: 1 /17/2020 I'VI ITI 11 �Iitdpr mom Rage 2 ut 2 SON DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 LP .� Tel:360.379.4450 1 Fax:360,379.4451 �-, ✓ Web: `.k.k S 1 � E-mail: 4cd @)-o ' nnwa.k:sue f N GAO SUPPLEMENTAL APPLICATION ' Jq N 2 % ' SHORELINE DEVELOPMENT If A completed application form is a requirement of submittal. Include "N/A" ins aces that do not app . MLA # Case # _- Application Type (select one): Statement of Exemption- I I Variance* Substantial Development* '] See Examples on back side I I of application Conditional Use (administrative)* Conditional Use (discretionary)* 1) Does your proposal require in water work and/or works below ordinary high watermark? Yes [ No �_ ] 2) Does your prop -cal require 1 n,000 sq/ft or more of impervious surface and/or non -single family structures of 5,000 sq/ft or more? Yes [ ] 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 #: 969000004 Name of Body of Water: Ludlow Bay Property Owner Name(s): Robert and Robin Westler Project Description Describe the existing property use and condition SFR Proposed distance from ordinary high water mark to use/development: feet Describe the proposed work that requires a shoreline permit or permit exemption: Replace existing rubble bulkhead with a new rock bulkhead, total +/-100'. oy signing inis appmation rorm, the ownerlagem aitests tnat the information prowced 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. Owner Signature: Date: Jennifer Rotsten Digitally signed by Jennifer Rotsten Print Name: Date: 2020.01.17 13:54:16 -08'00' 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 speck 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. (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. SnnP1crncmg1 Sunrdh;c AF plicarion Pn2c 2 of 2