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Home My WebLink AboutBLD2021-00136 - 02 SUPPLEMENTAL APPLICATIONSupplemental 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: Heat Pump 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): $ $ Fair market value of project 0 2.50 0 0.00 1.00 $ 59,920.00 0 Aven Andersen 648.0 505.7 4 0 420.0 4 2.50 0 0 0 1439.3 0.00 95.0 0 0 0 0 0 0 2012.0 3.00 3.00 0 969,400,030 0 0 0 0 00 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 tr ue 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 $291.00 Septic Review $141.00 Potable Water $141.00 Technology/Scan $24.00 State Fee $6.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Technology Fee – 5% Total Fees Receipt # Date: Cash/Check/CC: 2/4/2021Ayden Wagner Supplemental Shoreline 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 SUPPLEMENTAL APPLICATION SHORELINE DEVELOPMENT A completed application form is a requirement of submittal. Include N/A in spaces that do not apply. 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. Owner Signature: Date: _________ Print Name: MLA # Case # Application Type (select one): Statement of Exemption: See Examples on back side of application Variance* Substantial Development* Conditional Use (administrative)* Conditional Use (discretionary)* 1) Does your proposal require in water work and/or works below ordinary high-water mark? Yes No 2) Does your proposal require 10,000 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 #: Name of Body of Water: Property Owner Name(s): Project Description Describe the existing property use and condition: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Proposed distance from ordinary high water mark to use/development: feet Describe the proposed property use: _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ SCAN ME Mar 18 2021 Mar 18 2021 Supplemental Shoreline Application Page 2 of 2 These activities require a formal statement of Exemption issued by Jefferson County. 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 specific exemption of this program that is being applied to the development, and shall provide a summary of the administra 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 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) (17) (18) A public or private project, the primary purpose of which is to improve fish or wildlife habitat or fish passage. OFFICE USE ONLY Shoreline Development Permit Fees Type I Exemption ($67 .00) Type II Conditional Use Administrative ($1,5 .00) Type II Conditional Use Discretionary ($1,5 .00) Type III Substantial Development ($2,4 .00) Type III Variance ($2,0 .00) Notice of Application; All type II and III ($149.00) Notice of Hearing; All type III ($149.00) Notice Board; All type II and III ($12.00) Scan SEPA; if required per CAM or PRE ($9 0.00) Hearing Examiner; if required per CAM or PRE ($1,2 .) Subtotal Technology Fee 5% Total Fees* $ *Additional fees may apply.