Revision Date: 02/20/2020
City of Bainbridge Island Planning and Community Development
Bainbridge Island, Washington 98110-1812
pcd@bainbridgewa.gov
206.780-3750
Page 1 of 1
#B112
AUT
HORIZATION FOR
3
RD
PARTY GEOTECHNICAL REVIEW
Permit Number:
Applicant’s name : _____________________________________ Applicant’s telephone #: ________________
Project Name & Address: _____________________________________________________________________
Applicant’s Geotechnical Engineer’s Name: ______________________________ License #: _______________
Engineer’s Telephone #: ____________________________
I hereby authorize the City of Bainbridge Island to contract with a geotechnical engineering firm of the City’s
choice to review the above referenced permit application per the below described procedures.
Applicant’s Signature: ____________________________________________ Date: ____________________
Third-Party Review fees deposit will be due at time of submittal. These fees are in addition to normal plan
review fees. If the Third-Party Review cost is estimated to exceed the deposit amount the City will notify
you and require the additional amount be deposited prior to authorizing the Third-Party Review to proceed.
All costs for Third-Party Review must be paid before the permit is issued. You will be reimbursed any
portion of the deposit not expended on the Third-Party Review upon issuance of the associated permit.
Changes in site plans, design elements or the geotechnical report may result in requiring an additional
Third-Party Review.
Third-Party Geotechnical Review Fees – Single Family Residence (SFR) [OFFICE USE ONLY]
PAID DATE
Deposit: _______________ ($2,500 for SFR due at time of submittal) ________
(attach copy of receipt)
Est. Additional Amount: _______________ (from Third-Party Reviewer) ________
(attach copy of receipt)
Actual Total Review Cost:_______________ (from Third-Party Reviewer) ________
(attach invoice copy)
Reimbursement/Fees: _______________ (reimbursement/add. fees at permit issuance) ________
(attach check or recipt invoice)
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