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HomeMy WebLinkAbout01- APPLICATIONProject Description (attach additional pages if necessary) -1 ► r� mar e L our ex► 4rl honw. WC 0-:x,,.,c ldy .a�, 50 k -Ott R { C1 C?�GcN �tC�1. iCL� GIAr � VA w ti� Curti I�Z7 ` ] c_.bo.x - We- * LJI tic ' "�`.°' CL S 1 a e l i�1 NL� VCS are —NO-v\ j &e A o Frc lrkcr"!,vc� f s 5 e55rrti- Cr�. 1 a 3rerkl . P lea- a A-v\A �1r�r err- % OLA �C3� • I�►1Lri r� e ltrw S u�o irr e� �akpetir{.t:ar K � c - r,Y, Ai Ida cLVxck-eA c2L►`e '�-41 e' -4i~.112 t pos ►nr aRt De lc�tnS _Tvk +b� +jau , 1 CV v ,,r cl rnrnn Standard Disclosure Information 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 w C u ty regulations could affect a future development a li ation. A pre - application consultation does not vest a future development application. By signing the application form, the applicant/owner attests that the information provided herein is true and correct 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 applicant/owner 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 County as a result of or in consequence of the granting of this permit. I further 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. This right of entry shall expire when the County (through the Administrator or the Administrator's representatives) concludes the application has complied with all applicable laws and regulations. Access and right of entry to the applicant's property sh requested anA shall occur only during regular business hours. (Applicant signature) I hereby designate conference. (Landowner signature) (Date) to act as my agent in matters related to this pre -application OFFICE USE ONLY Pre -Application Conference Fees Land Use Environmental Health — if requested/required to attend ($221.00) $485.00 o� "% I ' 00 Building — if requested/required to attend ($97.00) Public Works — if requested/required to attend ($136.00) Fire Marshall — if requested/required to attend ($97.00) Scan Fee $24.00 Site Visit —optional ($194.00) Subtotal Technology Fee — 5% $ Total Fees $ (Q(e . 50 Fees based on project and departments requested/required to attend. G:\PermitCenter\% % % FORMS % %4'.\Land Use\Pre-App\pre-app conference form OR code.docx REV. 2/20/2020 Page 3 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 1 Fax: 360.379.4451 Web: www.co.lefferson.wa.us/communitvdevelopinent E-mail: dcd@coJefferson.wa.us Scan the QR code to access the digital form. PRE -APPLICATION CONFERENCE Purpose The purpose of the pre -application process is to ensure consistency with the applicable sections of JCC Title 18. Process 1. Submit an application for a pre -application conference with the required items below. 2. Once submitted, staff will be assigned to the case, and they will coordinate with you on potential meeting dates. 3. Discuss project at meeting with all required departments. If necessary meeting will be held on site. 4. Receive written report from Jefferson County on process to move forward with project. 5. Submit all required applications for project; once approvals are issued, start project! Required Submittal Items I XJ Pre -Application Conference Application X' Conceptual Design plan —see pg. 2 h X' Permit Fees based on departments requested/required to attend for project type I lQ `�� 1 X J List of everybody who will be involved in the meeting and/or project �hpr�l�Vui �'�ocr oyt �lav� iC Attach any special reports already completed for the project/parcel btc� Ian i s �cxzc�rc� i e S sY, S4-0cc. 'Plav,% + 1.4outse 16 ALA 'i The Jefferson County Code (JCC) 18.40.090 & 18.25.640: When Required. Pre -application conferences are required for all Type II, Type III, Type IV and Type V project applications and Type I project applications proposing impervious surfaces of 10,000 square feet or more and/or non -single-family structures of 5,000 square feet or more. Additionally, pre -application conferences are required for industrial, commercial, and crifical area stewardship pla- applications. The administrator may exercise discretion not to require a pre -application conference if the administrator determines that the conference information is self-evident, already transmitted, or would not add value to the subsequent application. Pre -application conferences for all other types of applications are optional, and requests for conferences will be considered by the administrator on a time -available basis. 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 their duty to submit an application consistent with all relevant requirements of County, state and federal codes, laws, regulations and land use plans. Application Directions 1. Please answer all questions on this form completely. 2. Attach one sketch of the Conceptual Design plan for the proposed use or activity, showing the following information, a. Vicinity sketch; b. North arrow and scale; c. Property boundaries and identification of Jand uses on adjacent properties; d. Means of ingress and egress; e. Property/lot drainage; f. Possible locations of sewage disposal and water supply systems; g. Location of utility easements; and h. 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. Applicant Name: FrY 4- av� \ S�"U(1 Mailing address: TU -B©l( -;� J I Q F Telephone: $y email: c S1nre[�V`nc�r1 % �;Y10.► ' CS3 Representative: Mailing address: Telephone: email: representative: Telephone: email: Representative: Telephone: email.: Representative: Telephone: email: Include additional names on a separate sheet. Property Description I General Location: 'f ala1\Cen , lh-)('4 q �S'I CP Legal Description (from Property Tax Statement): a 3o T2 + 9-1%4 Tft 5 to LG5 5 �ix 210 9-Digit Parcel Number: This is the % of your property that is covered by impervious Total Acreage: '�=l7� Zone: Qe-�yrlvAa; %Lot Coverage: �;itl�4 surface. Applicant: 19 Owner ❑Lessee wf P�pos�d Add 4 u,n ❑ Contract Purchaser ❑ Other GAPermitCenter\% % % FORMS % % %\Land Use\Pre-App\pre-app conference form QR code. docx REV. 2/20/2020 Page 2 9Lf96 VM'3Nzuunb'db 3N3DIMO 3 06SZ NOIlIOOV NOW43H M N