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Home My WebLink AboutBLD2020-00574-01- PERMIT APPLICATION 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: Access (name of street(s)) from which access will be gained: 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: Type of Sewage System Serving Property: Septic Septic Permit #: Community Septic Name of System: Case #: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete Partial Has a reserve drainfield been designated? Yes No Date of Last Operations & Maintenance check: Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: Permit Application Page 1 of 2 4 9100 - Vacant Land Property is located in the Ludlow Cove II Subdivision on Lot 26. Construction of a single family home with attached garage Anchor Lane 968900026 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 Architect Surveyor Contractor Consultant 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: 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: Date: ______________ Permit Application Page 2 of 2 276 NW Ferry Street, Poulsbo, WA 98370 cobrien@westharborhomes.com cobrien@westharborhomes.com 4 Cliff OBrien Digitally signed by Cliff OBrien DN: cn=Cliff OBrien, o, ou=Westharbor Homes, email=cobrien@westharborhomes.com, c=US Date: 2020.10.27 13:12:34 -07'00' 4 Cliff O'Brien 4 (360) 301-3179 (360) 437-2101 (206) 261-6581 Cliff OBrien Digitally signed by Cliff OBrien DN: cn=Cliff OBrien, o, ou=Westharbor Homes, email=cobrien@westharborhomes.com, c=US Date: 2020.10.27 13:11:42 -07'00' 4 Cliff OBrien PORTLAL994L8 10/27/2020 edjonson@msn.com 4 Edward Jonson Port Ludlow Associates Port Ludlow Associates Union Studio (401) 272-4724 (360) 301-3179 4 10/27/2020 70 Breaker Lane, Port Ludlow, WA 98365 70 Breaker Lane, Port Ludlow, WA 98365 70 Breaker Lane, Port Ludlow, WA 98365 140 Union Street, Providence, RI 02903 4 Supplemental SFR 1 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 SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt #: Date: Related Application #s: Payment #: Site Information Owner Name: Assessor Tax Parcel #: Type of Building New Replacement Relocated Addition Repair Demolition * *A separate permit is required Select One: Single Family Residence Modular Other list Proposed Building/Project Number of floors # new bedrooms existing total bed # new bathrooms existing total bath Heat Source Select all that apply: Electric Heating Oil Wood Propane Enter the square footage (sq/ft) that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation (Office Use) Residential / Commercial Main Floor Residential / Commercial Second Floor Additional Floors - heated / unheated Basement - unfinished Basement - finished space or habitable Detached Garage - heated / unheated Attached Garage - heated / unheated Garage 2nd fl - unfinished storage Garage 2nd fl - finished space or habitable Carport - 2 walls or less Deck - uncovered Covered porch Other (shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ $ 32 338,208 273 x 0 0 0 0 0 0 1680 0 0 0 0 0 183 Port Ludlow Associates 0 x 3 3 2 0 968900026 1 0 0 x 2 0 0 0 0 0 x 0 0 0 0 Supplemental SFR 2 List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use 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: Print Name: Date: For Department Use Only Building Permit Fees Building Base Plan Check Review Land Use Review $234.00 Septic Review $80.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt # Date: Cash/Check/CC: No NONE 234.00 Cliff OBrien Digitally signed by Cliff OBrien DN: cn=Cliff OBrien, o, ou=Westharbor Homes, email=cobrien@westharborhomes.com, c=US Date: 2020.09.23 09:14:46 -07'00' 09/23/2020Cliff O'Brien 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 _____________________________________________________________ 4 N/A No 4 Yes No None No Coastal None 9100 17-28N-1E N/A None N/A N/A No Yes No N/AN/A 4 No Yes 3 N/A N/A Port Ludlow Associates LLC N/A 0.11 Acres Anchor Ln N/A 324 Anchor Ln Port Ludlow, WA 98365-9766 49 No 968900026, BLD20-00574 968900026, BLD20-00574 No See additional notes 4 4 SUSC 4 Yes N/A No 70 Breaker Ln Port Ludlow, WA 98365-9766 No 4 No 4 N/A None No 4 See additional notes 4 7 Yes MPR-SF-4 MPR-SF-4 12/14/2020 4 No N/A No LUDLOW COVE DIVISION 2 LOT 26 none N/A 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 4 4 4 Port Ludlow Drainage District Review Letter required. The proposed NSFR w/ attached garage is located in a NO SHOOTING AREA. The proposed project is located in a SUSC CARA and Coastal SIPZ. No other Critical Areas are located on the property. According to the site plan submitted on November 15th,2020, there is a wetland and stream located on an adjacent parcel (968900100) to the proposed project. The wetland and stream are not shown on the County GIS maps. N/A N/A P-661 41%, MPR-45% Amanda Hunt Not REQ'D 4 No 4 Yes 4 No 2,361 sq. ft N/A 4 2 4 Medium Stormwater Project 2,061 sq. ft 4 4 4 4 N/A N/A Yes (see Ludlow Cove Division 2 Long Plat) No No Exempt4 4 N/A Yes 4