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78 Revise Approved Plans

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Country of origin: US
File type: PDF

U.S.A. forms for City of Bainbridge Island

BROWSE CITY OF BAINBRIDGE ISLAND (WA) FORMS

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City of Bainbridge Island Planning and Community Development
280 Madison Ave. N.
Bainbridge Island, WA 98110
pcd@bainbridgewa.gov
Phone: (206) 780-3750
Fax: (206) 780-0955
Revision Date: 02/20/20
Page 1 of 2
#B107
REQUEST TO REVISE AN
APPROVED PLAN
If the permit has been issued, please be sure to submit the Approved “SITE” set with the Revision
Request
Section 1 –Contact Information
Applicant Name: ______________________________________________________________________
Permit Number: _____________________ Assessor Tax Parcel #: ___________________________
Contact Name: _______________________________ Phone Number: _____________________
Section 2 – General Information
Please provide a complete, detailed description of the proposed revisions to the approved plan:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Are two sets of the revised plans or addendum indicating the changes included?
Yes: No:
Are the revisions clearly and accurately identified on the plans or addendum?
Yes: No:
Does the plan contain an engineer’s or architect’s lateral or vertical analysis
✓ If yes, provide plans and calculations approved by the architect and/or
engineer. Please provide one set with an original wet stamp and
signature of the architect, engineer, or both.
Yes: No:
Does the proposed revision modify the footprint or location of the structure?
Yes: No:
✓ If yes, a revised site plan, drawn to scale, must be included with this
request which has been approved by the Health District.
Does the proposed revision change the total number of bedrooms?
Yes: No:
✓ If yes, provide Kitsap Public Health approval for increased bedroom load
on septic system.
Applicant’s Signature: _________________________________________ Date: __________________
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City of Bainbridge Island Planning and Community Development
280 Madison Ave. N.
Bainbridge Island, WA 98110
pcd@bainbridgewa.gov
Phone: (206) 780-3750
Fax: (206) 780-0955
Revision Date: 02/20/20
Page 2 of 2
Section 3 – Department Use Only
Approvals
Initials
Date
Building
Planning
Fire
Drainage
Other:
Additional Conditions/Comments:
Original Valuation:
Additional Valuation:
Sq. Ft. ______ x _____
Sq. Ft. ______ x _____
Total New Valuation:
Additional Fees:
Revision Fee
Additional Building Permit Fee
Additional Plumbing Fee
Additional Mechanical Fee
Other: ____________
Total Amount Due:
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78 Revise Approved Plans

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Completed 11 July 2020

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