HomeMy WebLinkAboutBLD2018-00266 - 01- PERMIT APPLICATION AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. ______________ PLAN NO. ____________
PARCEL ID: ________________________
STREET ADDRESS: ______________________________________________________
_____________________________________________________
Please print:
Property Owner: ________________________________________________________________
Property Owner: ________________________________________________________________
The undersigned, registered property owners of the above noted property, do hereby authorize
__Tabitha Galan_____, of ____Estes Builders LLC___________ (Contractor / Agent)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner’s Address (if different than property above):
Telephone: _____________________________
We hereby certify the above information submitted in this application is true and accurate to the best of our
knowledge.
Owner Signature & Date
_______________________________
Owner Signature & Date:
_______________________________
901171004
3225 Hwy 20
Port Townsend, Wa 98325
Derek Godfrey
Marie Godfrey
1488 Kimberly Ct
San Jose, Ca 95118
408-269-6521
DocuSign Envelope ID: 3D2DCBBA-F69E-4BA7-86FA-0266F51F35B3
3/2/2021 3/2/2021
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street | Port Townsend, WA 98368
360-379-4450 | email: dcd@co.jefferson.wa.us
www.co.jefferson.wa.us/commdevelopment
BUILDING PERMIT REVISION
Date
Regarding: Building Permit Number
Address
Parcel Number
Other Case Number/s
Submitted by: Phone:
Submittal Explanation (what’s being revised?):
Please complete the following, if applicable:
Permit Type & Square Footage
PERMIT TYPE: APPROVED SQ/FT: CHANGE TO SQ/FT: TOTAL SQFT:
Commercial
Residential
Garage/Shop
Accessory
Uncovered Porch
Covered Porch
Unfinished Basement
Other (Specify)
Estimated Fair Market value cost of changes:
No change to square footage
Approved Site Plan : Replacing approved site plan with Pg AC101. AC101 is survey scaled drawing of the site plan to replace the hand drawn site plan, not to scale.
Pg. 1 : West Elevation. Moved Stairs.
New Page : Inserted page S-1.0 Foundation Plan.
Pg. 2 : Replace Garage Framing Plan with page AG101 Garage Plan. Added heating and water heater. Replaced Residence Framing plan with page AG 101 ADU Plan.
Pg. 3 : Replaced Foundation Plan with page S-2.0 Foundation Plan. Replaced Roof plan with page AG102 ADU Roof Plan.
New Page : Inserted page S-2.0 Second Floor Framing Plan.
New Page : Inserted page AG 101 ADU Electrical Plan.
New Page : Inserted page S-3.0 Roof Framing Plan.
Pg. 4 : Replaced with page A301 Garage/ADU Section.
New Page : Inserted page A 401 ADU Cabinetry Details.
New Page : Inserted page A 501 Standard Details.
New Page : Inserted page S-0.0 Structural Notes.
New Page : Inserted page SD-1 Structural Details.
New Page : Inserted page SD-2 Structural Details.
4
(Covered Deck)
Estes Builders LLC
BLD2013-00301
123
720 (above garage)
4/14/21
(Garage)
901171004 (for ADU)
(Uncovered Deck)
109
3225 Hwy 20 Port Townsend, WA 98325
360-683-8756
BLD2016-00564
823 (not) + 41 (heated)
Estimated Fair Market value cost of changes:
If the revision involves structural and/or floor plan changes, the following is required:
A narrative describing the changes and page number in set of plans where change occurs
Two copies of only the revised building plans - clearly marked by a border/bubble
Two copies of revised floor plan on no larger than 11x17
Minimum fees:
Plan Check - $97.00
Land Use - $97.00
Administrative - $97.00
Environmental Health - $141.00
Environmental Health - $71.00 - Review of resubmission before Building Permit is approved
Technology Fee - 5% of total fees
If the revision involves changes to the site plan, the following is required:
A narrative describing the changes on the site plan- if they were requested by a department
please note who requested them
Two copies of the revised site plan on no larger than 11x17 – revisions clearly marked by a
border/bubble
Minimum fees:
Administrative - $97.00
Land Use - $97.00
Environmental Health – will be invoiced by EH, if needed, after review
Plan check fees may apply if a revision to the building plans is needed
Technology Fee - 5% of total fees
Fees shall be collected at the time of re-submittal. Revisions that go beyond the minimum revision time
during Plan Check, Land Use review, and Environmental Health review will be charged an additional
hour. Any additional fees that are accrued during the revision process must be paid prior to the approval
and issuance of the revised permit.
All revisions to structural components or plans that previously included structural engineering will need
to have the revision wet stamped and signed by a design professional (engineer, architect etc.) licensed
in WA state.
Please route copy to:
EH: Planning: PW: Building:
Office use only
Please Check with DCD for total fees
0.00