HomeMy WebLinkAbout080923 Smith, Steve re: Letter to be read / KPTZ attchmnt 1DILTARTMEPNIT OF COMMUNITY DEVELOPMENT
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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: 101324015
Site Address and/or Directions to Property: 35 Rainshadow Drive, Port Townsend, WA 98368
Access (name of street(s)) from which access will be gained:
35 Rainshadow Drive, Port Townsend, WA 98368
Present use of property: Rural residential vacant land
Description of Work (include proposed uses): Clearing and developing ingresslegress, bringing in power and fiber utilities, pouring -
foundation pads for new radio tower and future construction of an emergency broadcast facility, including an office, studio and transmitter housing.
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 m_m_m_m 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:
Not applicable - no sewage disposal facilities will be established or used.
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 "Funk mail"
Anolicant/Prooertv Owner Information
Property Owner:
Name: KPTZ Radio Port Townsend (Easement Grantee)
Address: 1925 Blaine St, Port Townsend, WA 98368
Phone #: 360-672-0645 E-mail Address:- defm*nie@kpt-orT—
Please contact Authorized Agent/ Representative with project info. (select only one).
Property Owner Sigr
Note: For oroiects with m
a separate sheet wititeach
Applicant: Authorized Agent/Representative (if otherthan a
Name: �,���—
Address: rsz j
Phone #: - 72864-LET:?ao
Date:
wner(s) information and signatures.
-mail Address:
P4-<� UCa
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer ✓ Architect Surveyor Contractor Consultant
Name: Jeff _St ler / Magnum Towers Inc. License #
Address: 9370 Elder Creek Road, Sacramento, CA 95829
Phone #: 916-381-5053 E-mail Address: jeff@magnumtowers.com
Professional: Is this an Authorized Agent/Rel
Engineer Architect Surveyor
Name:
Address:
Phone #:
Professional: Is this an Authorized Agent/Rel
Engineer Architect Surveyor
Name:
Address:
Phone #:
for this project? NO _1( YES
Contractor Consultant
License #
E-mail Address:
:ntative for this project? NO YES
Contractor Consultant
License #
E-mail Address:
c.CG
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 o,f application review and any required later inspections. Applicant may
q his applica ion and subsequent permit issuance.
y P property y car visits related to this 7 Date
request notice of ke Co nt 's intent to enter upon the ro art I 'sits e
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