HomeMy WebLinkAboutBLD2020-00470 - VOIDPermit Application Page 1 of 2
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street, Port Townsend, WA 98368
Tel: 360.379.4450 | Fax: 360.379.4451
Web: www.co.jefferson.wa.us/communitydevelopment
E-mail: dcd@co.jefferson.wa.us
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 Permit #
Related Application #s: MLA #
Site Information
Assessor Tax Parcel Number:
Site Address and/or Directions to Property:
Present use of property:
Description of Work (include proposed uses):
Wastewater - Sewage Disposal
This property is served by Port Townsend or Port Ludlow sewer system? YES NO
If not served by sewer identified above, identify type of septic system below:
Is it a complete or partial system installation: Complete Partial
Has a reserve drainfield been designated? Yes No
Attach last report to application
Describe or attach any drainfield easements, covenants or notices on title, which may impact the property:
983200003
248 Jimson Lane, Port Townsend WA 98368 [ADR-00035]
Access (name of street(s)) from which access will be
gained: Jimson Lane
Undeveloped Lot
New single-story, single family residence with gravel driveway.
y
Type of Sewage System Serving Property:
y Septic Septic Permit #: ^ W19Ͳ00279
Community Septic Name of System: Case
#: Are other residences connected to the septic system? EK
Additions or repairs to sewage system: EK
y
Date of Last Operations & Maintenance check:
y
n/a
Permit Application Page 2 of 2
The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail
/ e-mail requests and information about the application to the authorized agent/representative and will copy (cc) the owner noted
below. The authorized agent/representative is responsible for communicating the information to all parties involved with the
application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email (i.e.,
County email is not blocked or sent to “junk mail”).
Applicant/Property Owner Information
Property Owner:
Name:
Address:
Phone #: E-mail Address:
Please contact Authorized Agent/Representative with project info. (select only one).
Property Owner Signature: Date:
Note: For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures.
Applicant: Authorized Agent/Representative (If other than owner)
Name:
Address:
Phone #: E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Consultant
Name:
Address:
Phone #:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Contractor
Name: License #
Address:
Phone #: E-mail Address:
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 the County’s intent to enter upon the property for visits related to this application and subsequent permit issuance.
Signature: Print Name:
Veronica Smith
PO BOX 613
SMITHVERONICAK@GMAIL.COM
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Architect Surveyor Contractor
License #
Architect Surveyor
BRENT DAVIS CONSTRUCTION
INFO@BRENTDAVISCONSTRUCTION.COM
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887 E PARK AVE, PORT TOWNSEND, WA 98368
360-643-1258
E-mail Address:
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PROPERTY LINE: 319.58'5' -0" BUILDING SETBACKTO JIMSON LANE
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APPROX. 100' - 4"
E X I S T I N G S E P T I C T R A N S P O R T L I N E
W A T E R L I N E F R O M S H A R E D W E L L ,
C O N N E C T T O E X I S T I N G A T P R O P . L I N E
GRAVEL DRIVE [ NO SLOPE]10' -0" WIDE, 2,800 SF 2 CAR PARKING 24'X35'
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SHEET FLOW DISPERSION WITH VEGETATIVE BUFFER, BMP T5.12
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HIGH -VISIBILITY FENCE/SILT FENCE, C103/C233 xxxxx xxxx xxxx
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DATE:
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PERMIT 09/14/2020 Revision 1 11/2/2020 A1.0SITE PLAN -
1
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11/03/2020VERONICA SMITH PO BOX 613 PORT TOWNSEND, WA 98328 SITE ADDRESS 248 JIMSON LANE PORT TOWNSEND, WA 98368 [ADR20 -00035]983200003 PARCEL NUMBER RR -5 -RURAL RESIDENTIAL ZONING IMPERVIOUS AREAS SITE AREA:5.12 ACRES / 222,850 SF HOUSE ROOF AREA 1,325 SF BACK DECK*120 SF FRONT WALKWAY 177 sf GRAVEL DRIVEWAY 2,800 SF TOTAL IMPERVIOUS AREA 4,422 SF (0.02%)PROJECT DATA OWNERGENERAL NOTES A.PROPERTY BOUNDARIES AND DIMENSIONS GENERATED FROM JEFFERSON COUNTY GIS DATA AND EXISTING PARCEL PERMITS
1"
=
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*AREAS OUTSIDE OF THE FOUNDATION BUT INSIDE THE ROOF LINE WERE NOT COUNTED IN ADDITION TO THE ROOF AREA AS TO NOT DOUBLE AREAS.NORTHSTORMWATERSTORMWATER STRATEGY FOLLOWS BMP 5T.10B, DOWNSPOUTS TO SPLASHBLOCKS WITH 50'-0" VEGETATED FLOW PATH, TYP.DRIVEWAY FOLLOWS BMP T5.12 SHEET FLOW DISPERSION WITH VEGETATED BUFFERDSDSDS
DS
DS
M
I
N
Up Front Parcel
Review Parcel
Date Completed:
Owner Name:
Add. Name:
Mailing Address:
Site Address(es):
Parcel Number: S-T-R: --Total Acreage
Legal Description Land Use:
Flood District:Fire District:Planning Area:
Flood Map (FIRM) Panel No: School District Zoning:
[ ] Zoning ________________________________________________________________________________
[ ]Setbacks:Front:_______Left Side:__________Right Side: __________ Rear:_______________
Informed by JCC 18.30 or Title 17 for Master Planned Resorts:
Shoreline Setback:____________Critical Area Buffer__________________________________________
Building Setback: ______________________________________________________________________
Adjoining Forest Lands: Commercial/ ____________ Rural/______________Inholding_______________
[ ] Lots/Require Declaration of Restrictive Covenant YES NO, submitted: YES NO __________________
[ ] Legal Access to Property YES NO _____________________________________________________
[ ] Parcel Tags or Scanned Documents YES NO List:_________________________________________
[ ] Sepcial Reports Nearby YES NO List:____________________________________________________
[ ] Shoreline Designation: YES NO _______________________________________________________
[ ] Critical Areas
Geologically Hazardous Areas YES NO
Shoreline Slope Stability:____________Landslide____________Erosion_____Seismic___________
CMZ: none High Risk Moderate Risk Disconnected CMZ__________________________
Report Submitted________________________________________________________________________
FWHCA: YES NO Stream type: __________________________ Pond or Lake < 20 acres________
Marbled murrelet/Spotted owl_____________ marine nearshore______________
Wetlands:YES NO ___________________________________________________________________
Flood:YES NO List FIRM map:_______________________________________________________
Flood Certificate: ______________________________________________________
Aquifer Recharge Area:YES NO___________________________________________________________
SIPZ: none At Risk High Risk Coastal ________________________________________[
] Site Visit conducted YES NO _____________________________________________________
[ ]Notice Provisions/Disclosure Forest Lands:YES NO Airport YES NO MRL YES NO
Agricultural Lands: YES NO No Shooting Zone:YES NO
[ ] Archaeology:YES NO _____________________________________________________________
No
No
No
No
None
No
None
None
None
N/A
No
Yes
No
500ft100ft
No
Yes
No
N/A
112ft 154ft
Case #: BLD20-00470
No
983200003
983200003
No
Wetland Delineation Report
SUSC
No
N/A
No No
No
None
No
No
RR-5
RR-5
No
Yes
none
No
Land Use Requirements
[ ] SEPA Required:YES EXEMPT _________________________________________________
[ ] Landscaping Required: Yes No_______________________________________________________
[ ] Parking Spaces Required NO 2 Other_______________________________________________
[ ] Building Height: 35' UBC Standard __________________________________________________
[ ]Stormwater: New Impervious Surface_____________Land Disturbing Activity ________________
Min Req #1 thru #5Stormwater Req's: Min Req #2 Min Req #1 thru #9
Engineering ________________ Drainage District Review Required___________
[ ] Stormwater Pollution Prevention Plan Submitted: Yes No __________________________________
[ ] Impervious Surface coverage percentage: __________________________________________
Resource Lands & Public: 10%Rural Residential: 25%Rural Industrial: Per UDC Sec 6.7
Rural Commercial: 60%Area of Building Coverage: 60% in Rural Industrial Lands only
[ ] ADMIN: Setbacks entered in Permit Plan case N/A YES ________________________________
New Parcel Tags entered in Permit Plan N/A YES ____________________________________
Special Reports Scanned N/A YES _________________________________________________
[ ] 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: subject to septic & water constraints/None specified
[ ] Road Classification:_______________________________________________________________
Road Approach:EXISTING NOT REQ'D RAP__________________________________________
[ ] Require Final Zoning Approval/inspection YES NO __________________________________________
[ ] UGA No Protest Agreement YES NO, submitted: YES NO _____________
[ ] Recorded Date of Subdivision:_______________AFN____________________________Over 5yrs=UDC
Plat Conditions:_____________________________________<5yrs=Plat Conditions on plat or Old Ordinance
Reviewed By:
Additional Notes:
No
No
No critical areas on site that will constrain project. CARA SUSC designation will not
impose regulation on single family residence use.
Site plan and stormwater minimum requirements #1 through #5 are compliant with
proposed BMPs (T5.10B and T5.12).
Project Approved.
N/A
N/A
Private
1.8%
Bryan Benjamin
N/A
No No
4
No
5,500 sq ft
N/A
2
4,222 sq ft
N/A
No
No
Exempt
1,325 sq ft
4
N/A
Yes