HomeMy WebLinkAbout02- Supplemental Application�c,ON
n
41 � DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street, Port Townsend, WA 98368
Tel:360.379.4450 1 Fax:360.379.4451 1 I cLiE
Web: www.co.jefferson.wa.us/communitydevelopment
I N 1 O0 E-mail: dcd@co.jefferson.wa.us
4�
TREENEGETATION APPLICATION
JEFFERSON COUNTY F)CF-1
Purpose
The purpose of the tree/vegetation app is to ensure consistency with the applicable sections of JCC Title 18.
Process
1. Submit an application for a tree/vegetation removal with the required items below.
2. Once submitted, staff will be assigned to the case.
3. Once approvals are issued, start project!
Required Submittal Items
Permit Application
Stormwater Calculation sheet
Site Plan - show structures, septic components, critical areas, and location of tree/vegetation being removed
Photographs of request (two sets)
Special report submitted, if required (i.e. geotechnical report, arborist report)
Home Owners Association request packet/CC&R's (if applicable)
Application fees
Property Information
Assessor Tax Parcel Number:
Parcel Address (if applicable): City 0 }
Directions to Property:
i-A r'i t o : L ri € A C'] '5��'Zis _ L .�
Property Owner
Name:
Address:
Phone #: 51Q - (f E-mail Address: IU �.
Please contact Authorized Agent/Re es tative with project info.
Property Owner Signature: re i Date: -
-Applicant / Contractor: Authorized Agent/Representative
Name:
Phone #: E-mail Address:
License #: Expiration Date:
'� Scan the QR code to access the digital form.
0 vd - con
Nature of Request:
ACKNOWLEDGEMENT
By signing the application form, the applicant/owner attests that the information provided herein is true
and correct to the best of their knowledge. Any material falsehood or any omission of a material fact
m�adde� ylthe appficant/owner with respect to this application packet may result in this permit being null
(APPLICANT OR AUTHORIZED REPRESENTATIVE SIGNATURE)
57- a3-
(DATE)
OFFICE USE ONLY
Tree/Vegetation Removal Fees
Land Use
$ 3okl)
Scan Fee
$ Z5.ri0
Site Visit — optional ($192:00)
Subtotal
Technology Fee — 5%
$
TotalFees*
$ 342,08
*Additional fees may apply
For Department Use Only Receipt # Date:
Related Application #s: Payment #