HomeMy WebLinkAboutBLD2021-00487 - 01 Permit Application, Issued Permit, Certificate of OccupancyDEPARTMENT OF COMMUNITY DEVELOPMENT
www.co.jefferson.wa.us/communitydevelopment
E-dcd@co.jefferson.wa.us
MINOR RESIDENTIAL REMODEL APPLICATION
The purpose behind issuing permits over the counter is to reduce plan review time. All permits issued over
the counter are subject to field inspection with the understanding that applicants are ultimately responsible
for code compliant construction practices. General inquiries regarding specific code questions may be
made at any time; however, the applicant assumes the responsibility to correct all code deficiencies
regardless of conditions. If you prefer to waive over the counter processing, you may elect to request a
plan review by DCD prior to issuing your permit.
Type of Project:
Door Replacement, same for same Re-siding
Interior Work*Window Replacement, same for same
*Interior work under this over the counter permit type is limited to:
Replacement of sheetrock and/or insulation
Relocation non-load bearing walls
Reconfiguration/addition of plumbing/mechanical fixtures
Adding insulation and sheetrock for change of use from unfinished basement to finished basement **.
**If bedrooms are proposed to be added, a permit will not qualify for over the counter
processing
Section 1 – General Information
Description of Work:
Bid Price: $
Bid Price is the total value of labor + materials for the project.
Enter the square footage (sq. ft.) for area(s) to be remodeled:
Square Foot Area
Main floor (sq.ft.)
2nd floor (sq.ft)
Basement (sq.ft)
Garage (sq.ft)
Garage 2nd fl – unfinished storage (sq.ft)
Other:
Aug 26 2021
Section 2 – Property Information
Site Address:
Assessor Tax Parcel Number(s):
Present Use of Property:
Section 3 – Counter Complete Submittal Checklist
Required Submittal Items
1. Completed Application – 1 copy
2. Floor plan – no larger than 11 x 17 – 1 copy (Not required for re-siding or re-roof permits)
3. **If bedrooms are proposed to be added, building code review will be required and the permit will not be
issued over the counter,
AND
Septic review is required and Potable Water documentation may be required,
The documentation to submit to DCD will be one of the following:
Onsite Septic Current Operations & Maintenance performed on septic system
Section 4 – Applicant/Property Owner Information
The authorized agent/representative is the primary contact for all project-related questions and correspondence.
The County will email 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
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”). There may be instances where regular USPS or courier mail is used.
Property Owner:
Name:
Address:
Phone #: Cell Phone #:
Email Address:
Note: For projects with multiple owners, attach a separate sheet with each additional owner(s) information and signatures.
Applicant:
Applicant (other than owner)Authorized Agent/Representative
Name:
Address:
Phone #: Cell Phone #:
Email Address:
Aug 26 2021
Contractor
Washington State allows homeowners to be their own general contractor. However, when choosing a
contractor or subcontractor to perform work they are required to be registered with the Washington State
Department of Labor and Industries. For more information about choosing and hiring a contractor visit
http://www.lni.wa.gov/tradeslicensing/.
Check if this is the Authorized Agent/Representative for this project.
Name: Title:
License Number: Liability Certificate:
Address:
Work Phone #: Cell Phone #:
Email 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
ted to this application and subsequent permit issuance.
Print Name (Owner) Signature (Owner) Date
OFFICE USE ONLY
Building Permit Fees
Choose One (if your permit includes work in both categories, choose the interior work fee):
Minor Remodel Permit fee: Interior work, basement remodel ($48 .00)
Minor Remodel Permit fee: Door, window, siding replacement ($19 .00)
Project Scanning Fee $24.00
State Fee $6.50
Subtotal
Technology Fee 5% of Subtotal
Total Fees
Aug 26 2021