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*The owner/applicant will be invoiced by DCD to compensate the Hearings Examiner for all services rendered, including, but not limited to, time spent in public hearing, travel, review of documents, research, and decision writing. Revised 01/2019
Vacation Rental License/Permit Checklist Pacific County Department of Community Development
Internet Address: www.co.pacific.wa.us
Development Application
Site Plan Checklist & Site Plan
Short-Term Vacation Rental Permit/License Application
Pre-Application Waiver (*ONLY FOR SPECIAL USE APPLICATIONS*)
Property Management Plan
Operation and Maintenance Inspection (if applicable)—An O&M inspection of the on-site septic
system (OSS) will be required prior to the submittal of the initial vacation rental application and every three
years thereafter, or more frequently as determined by the Pacific County Health Officer. O&M inspections
are performed by a third party inspector licensed by Pacific County and are completed to ensure the system
is functioning properly and is not a public health hazard. OSS systems deemed sub-optimal/failed will require
the submittal of a complete septic repair application prior to submitting the initial vacation rental applica-
tion. The approved vacation rental permit/license will be issued after the final inspection of the septic repair.
Fire & Life Safety Inspection—A satisfactory fire and life safety inspection is required prior to the issu-
ance of the vacation rental license. This inspection will ensure the minimum life safety matters are consid-ered such as adequate emergency access, working smoke detectors, stair handrails, accessible gas shut-off valves, etc. See the attached fire & life safety requirements handout included in this packet. Our office will call you to arrange a day for the inspection. If the inspection is not approved, you will need to make the nec-essary changes and call our office to re-schedule the inspection.
Declaration of Posting (*ONLY FOR SPECIAL USE APPLICATIONS*) You will receive the public notice
to post on the property from our Department once the hearing has been scheduled. The declaration must be signed and returned to our department 7 days prior to the scheduled hearing so it can be included in the staff report.
Affidavit of Mailing—After issuance of the permit, the approved property management plan must be
mailed to all property owners within 300’ of the subject parcel. The affidavit must be signed and returned to our Department prior to the license issuance. You may request a list of property owners from Department of Public Works at (360) 642-9368 or (360) 875-9368.
Special Use (R-1, R-R, R-2, RL, & MU) Permitted Use (R-3, C-C, & MU-T)
Fee: $1,300.00 Fee: $380.00
$65.00 Application Fee $65.00 Application Fee
$10.00 Technology Fee $10.00 Technology Fee
$985.00 Special Use Fee $65.00 Zoning Fee
$150.00 Fire & Life Safety Inspection Fee $150.00 Fire & Life Safety Inspection Fee
$90.00 License Fee $90.00 License Fee
TBD Hearings Examiner Fee*
Vacation Rental License/Permit Application
Pacific County Department of Community Development Internet Address: www.co.pacific.wa.us
Where allowed, vacation rentals can be authorized within Pacific County as either a permitted use or as a Special Use. Proposed vacation rentals located within the Restricted Residential (R-1), Rural Residential (R-R), General Residential (R-2), Rural Lands (RL), and Mixed Use (MU) zoning districts are only authorized through the issuance of a Special Use Permit. Vacation rentals are not allowed within the Restricted Residential (R-1) district located within the Seaview Urban Growth Area (UGA). Proposed vacation rentals within the Resort (R-3), Com-munity Commercial (C-C) and Mixed Use Tokeland (MU-T) zoning districts are authorized through the issuance of a Planning Permit. Vacation rentals are not allowed within the Com-mercial Forestry (FC), Transitional Forest (FT), Conservation (CD), Agricultural (AG), Aquacul-ture (AQ), Remote Rural (RR-1), and Industrial (I) zoning districts.
In addition to the underlying permit approval, those wishing to open and operate a vacation rental in Pacific County must also obtain an annual vacation rental annual license from Pacific County.
In order to obtain a vacation rental permit/license from Pacific County, you will need to submit the required application forms and fees, provide a detailed Property Management Plan, satis-factorily complete a Fire and Life Safety Inspection that is performed by the Pacific County Building Department, provide a copy of a current State of Washington Business License (UBI), proof that the home is, or will be, insured as a vacation rental, the Declaration of Posting (if applicable), and the Affidavit of Mailing. Vacation rentals connected to an on-site septic sys-tem, will be required to submit a current Operation & Maintenance (O&M) inspection and Op-erational Permit Application Form.
Vacation Rental Owner Contact Person
Name:
Mailing Address:
City/State/Zip:
Phone: Phone:
Email:
Property Manager Contact Person
Business Name:
Contact Name:
Mailing Address:
City/State/Zip:
Phone: Phone:
Email:
Permitted Use/Planning Permit (R-3, C-C and MU-T) complete Section 1 & 3 below:
Special Use Permit (R-1, R-R, R-2, RL, and MU) complete Sections 1, 2 & 3 below:
SECTION 1: VACATION RENTAL REQUIREMENTS AND CRITERIA Please read and provide a brief written statement as to how the proposed vacation rental meets or complies with the following vacation rental criteria: Occupancy Limits. No more than two overnight occupants per bedroom, plus two additional
overnight occupants, shall be accommodated at any one time, e.g., a one bedroom cabin
would be allowed four overnight occupants while a two bedroom cabin would be allowed six
total overnight occupants. The total number of occupants temporarily residing in a vacation
rental shall not exceed 10 at any one time and includes all occupants over the age of two (2).
Occupancy Total: ___________ Number of Bedrooms: ___________
Appearance. The exterior of the building shall retain a residential appearance with house numbers maintained on the front of the building and visible from the street or road. No junk or garbage shall be allowed to accumulate in any yards and all vehicles shall park in designated parking areas (show parking areas on site plan). Will comply with this requirement The vacation rental shall be operated in a way that will prevent disturbances to neighboring properties not typical of a residential neighborhood, including, but not limited to, loud music, loud noises, excessive traffic, loud and uncontrolled parties, junk/debris/garbage accumulation in the yards, trespassing, barking dogs, or excess vehicles, boats, or recreational vehicles parked in the streets in front of the unit. Will comply with this requirement Garbage. Provisions shall be made for garbage removal during rental periods. Explain how garbage will be handled. In addition to listing here, please include a statement in the property management plan as well. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Pets. Pets shall be secured at all times while on the property. Nuisance barking by pets is prohibited. Will comply with this requirement Phone Service. The vacation rental shall have a “land line” with local phone service. The phone number servicing the vacation rental shall be listed below and also included in the property management plan.
Phone Number.: __________________________________
Parking. The vacation rental shall have one off-street parking space per each bedroom in the unit with a minimum of two off-street parking spaces required. Please indicate the number of parking spaces below and be sure to identify the size and location of parking areas on the site plan.
Number of Parking Spaces: _________ Number of Bedrooms: _________
Signage. One sign either attached to the dwelling or placed in front of the dwelling and no larger than four square feet in size is allowed. No off premise signage or advertising is per-mitted. Please indicate the type of signage proposed and be sure to identify the location of any proposed signage on the site plan. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
On properties containing both a residential dwelling and an accessory residential dwelling only one residential structure may be rented out as a vacation rental, but not both.
Will comply with this requirement Access. The road access to the vacation rental shall be constructed to meet minimum Pacific County Road standards and shall be adequately maintained and remain clear of obstructions, including illegally parked cars, recreational vehicles, boats, trailers, junk, etc., to ensure unim-peded passage of emergency vehicles and other vehicular traffic. Will comply with this requirement Property Management Plan. A property management plan shall demonstrate how the vaca-
tion rental will be managed and how impacts to neighboring properties will be minimized. The
plan will be submitted for review and approval as part of the permitting and licensing process.
The property management plan shall include local points of contact available to respond im-
mediately to complaints, clean up garbage, manage unruly tenants, etc., shall be mailed to all
adjoining property owners within 300’ as a condition of license approval, and shall be posted
in a visible location within the vacation rental. Please attach a copy of the Property Manage-
ment Plan to this application.
Please check to indicate complete Local Point of Contact. The local point of contact will be displayed in the property manage-ment plan and be the first point of contact for complaints. Name of Local Contact:__________________________________________________________ Mailing Address: _______________________________________________________________ Phone Number: ___________________________ Phone Number: _______________________
SECTION 2: SPECIAL USE PERMIT Describe how the proposed vacation rental is compatible with the character and appearance of existing or proposed developments in the vicinity and with the physical characteristics of the subject property. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the infrastructure which will serve the proposed special use, including but not limited
to roads, fire protections, water, wastewater disposal, and stormwater control.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Describe the location, size, and height of all existing and proposed buildings, structures, sign-
age, walls, fences, and screening vegetation of the projects. Will the location, size and height
of buildings, structures, walls and fences, and screening vegetation for the vacation rental hin-
der or discourage the permitted development or use of other properties in the immediate vi-
cinity of the special use?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Describe any noise, smoke, dust, fumes, vibrations, odors, outdoor lights or other impacts that will be generated by the proposed vacation rental. How will these factors be mitigated? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe the pedestrian and vehicular traffic, and the parking areas, associated with the vaca-tion rental. Will the proposed vacation rental impact any existing or anticipated traffic in the immediate vicinity? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Describe how granting the special use permit for the vacation rental will not be materially det-rimental to the public health, safety, welfare, use or interest, or injurious to property or im-provements in the vicinity. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Is there anything else you would add which supports your application?
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
SECTION 3: VACATION RENTAL LICENSING Please read and check each box indicating that you understand each of the items below and that you will comply with the item(s) listed:
Vacation Rental licenses are issued annually and are non-transferable if ownership is
transferred.
Satisfactory completion of a life/safety inspection performed by the Pacific County Building
Division prior to the issuance of the permit/license.
Satisfactory completion of an O&M inspection of the on-site septic system (OSS) will be
required prior to the submittal of the initial vacation rental application and every three years thereafter, or more frequently as determined by the Pacific County Health Officer. O&M inspections are performed by a third party inspector licensed by Pacific County and are completed to ensure the system is functioning properly and is not a public health hazard. OSS systems deemed sub-optimal/failed will require the submittal of a complete septic repair application prior to submitting the initial vacation rental applica-tion. The approved vacation rental permit/license will be issued after the final inspection of the septic repair.
State of Washington UBI Number:____________________________________
Proof of general liability insurance for use of the residential structure as a vacation rental
(must provide written documentation from insurance company).
I hereby declare and certify under penalty of perjury under the laws of the State of Wash-
ington that all applicable local, state and federal taxes, including lodging taxes, will be paid.
Authorized Signature:___________________________________________________________ Print Name: ________________________________________ Date:__________________
SOUTH BEND OFFICE P.O. Box 68
South Bend, WA 98586 (360) 875-9356 FAX (360) 875-9304
LONG BEACH OFFICE 7013 Sandridge Rd.
Long Beach, WA 98631 (360) 642-9382 FAX (360) 642-9387
All documents and information submitted in conjunction with this application is subject to Public Disclosure in accordance with RCW 42.56
Revised 02/27/2014
OFFICE USE ONLY
PROPERTY OWNER INFORMATION Contact Person
Name:
Mailing Address:
City/State/Zip:
Phone: Phone:
Email:
Name:
Mailing Address:
City/State/Zip:
Phone: Phone:
Email:
APPLICANT INFORMATION Contact Person
Development Permit Application Pacific County Department of Community Development Internet Address: www.co.pacific.wa.us
Authorized Signature: Date:
SOUTH BEND OFFICE P.O. Box 68
South Bend, WA 98586 (360) 875-9356 FAX (360) 875-9304
LONG BEACH OFFICE 7013 Sandridge Rd.
Long Beach, WA 98631 (360) 642-9382 FAX (360) 642-9387
DESCRIPTION OF WORK
Legal Description and Tax Parcel Number can be found on your tax statement, the Pacific County web site address listed above or by calling the
Assessor’s office at 360-642-9301 or 360-875-9301. Applications cannot be processed without this information.
Printed Name:
Note: If your property is in a current use program (timber, farm, agricultural, or open space), contact the Assessor before applying, as taxes may be due.
All permits shall be picked up within 30 days of notification by the Department of Community Development that the permit is ready for issuance. Failure to pick up the outstanding permit(s) and pay all outstanding fees within the specified timeframe shall result in the forfeiture of all permit documentation and all application fees paid to date on that project. Any subsequent permitting on the same parcel by the same property owner requires the submittal of new permit application materials and the payment of all new fees at the time of application.
I authorize employees and officials of Pacific County and/or the Flood Control Zone District No. 1 of Pacific County the right to enter and remain on the property in question to determine whether a permit should be issued and whether special conditions should be placed on any issued permit. I have the legal authority to grant such access to the property in question.
I also acknowledge that if a permit is issued for land development activities, no terms of the permit can be violated without further approval by the permitting entity. I understand that the granting of a permit does not authorize anyone to violate in any way any federal, state, or local law/regulation pertaining to develop-ment activities associated with a permit.
I hereby certify under penalty of perjury under the laws of the State of Washington that the following is true and correct: 1. I have read and examined this development application, as well as the County site-plan checklist and have documented all applicable requirements on the site plan. 2. The information provided in this application contains no misstatement of fact. 3. I am the owner(s), the authorized agent(s) of the owner(s) of the above referenced property, or I am currently a licensed contractor or specialty contractor under Chapter 18.27 RCW or I am exempt from the requirements of the Chapter 18.27 RCW. 4. I understand this permit is subject to all other local, state, and federal regulations.
Note: This application will not be processed unless the above certification is endorsed by an authorized agent of the owner(s) of the property in question and/or the owner(s) themselves. If Pacific County and/or the Flood Control Zone District No.1 of Pacific County has reason to believe that erroneous information has been supplied by an author-
ized agent of the owner(s) of the property in question and/or by the owner(s) themselves, processing of the application may be suspended.
Job Site Address: Tax Parcel ID No.:
Legal Description: Township/Range/Section / /
JOB SITE INFORMATION AND LOCATION
Directions to Site:
Issued Date:__________________________
Issued By: ___________________________
PERMIT FEES:
All documents and information submitted in conjunction with this application is subject to Public Disclosure in accordance with RCW 42.56
Site Plan Requirements Checklist All site plans shall be clearly and accurately drawn to scale on paper no larger than 11”x 17” and must indicate all of the information listed below. For ease of drawing the site plan, use the graph paper provided with your application packet. For each item, mark either “shown” or “N/A” as appropriate for your project. This checklist must be completed and included with all site plans. Any site plan without this checklist may be rejected and returned to the applicant for correction.
Shown N/A
Property Lines, including dimensions.
North arrow and site plan scale.
Marine waters, lakes, ponds, streams, creeks and wetlands.
Shown N/A
Locations and dimensions of all existing structures on the property in relation to property lines.
Location of any existing wells and their 100’ well radius.
Location of all existing drainfields on the site including; the locations of existing drainfields on adjacent properties within 100’ of any well.
Location of existing drainage systems.
Location of all existing roads, driveways, utilities, easements, and bridges.
Shown N/A Location and dimensions of all proposed structures with setbacks shown to property lines, other structures, wetlands, etc.
Location of all proposed wells and their 100’ well radius.
Location and dimensions of all proposed septic systems including; tanks, drain- fields, reserve areas, and pre-treatment units.
Location and dimensions of all proposed drainage systems.
Location and dimensions of all proposed roads, driveways, parking areas, and utilities.
Location/extent of all clearing, grading and filling.
A. General Property Information:
B. Existing Property Improvements:
C. Proposed Property Improvements:
Street Name
N
Example Site Plan Follow Checklist when drawing site plan
Drawn to Scale 1” = 20ft
“X” = Distance
Note: Any changes to your site plan will require re-submittal and a re-submittal fee may be charged.
Dra
inage D
itch
Dri
vew
ay
Neighbors
Property
Proposed House
Reserve
Drainfield
Proposed
Drainfield
Test Holes
X’
Proposed
Garage
X’
Pressurized Water Line
Septic
Tank
X’ X’
X’ to Neighbors
Well
X’
X’
X’
Wetland
X’ from wetland
X’
X’
X’
X’
X’
X’
X’ to well
Revised 03/27/2019 Signature: ______________________ Date: _____________
Development Permit Applica on Pacific County Department of Community Development Internet Address: www.co.pacific.wa.us
Tax Parcel ID No.: ______________________________ Applicant’s Signature: ___________________________ Scale 1” = _____________________________________
NOTE: Any revisions to the approved site plan will require re‐submittal and approval prior to construction.
04/21/2016
Pacific County Department of Community Development PLANNING • ENVIRONMENTAL HEALTH • BUILDING
Long Beach Office 360-642-9382
South Bend Office 360-875-9356
PRE-APPLICATION CONFERENCE WAIVER GUIDELINES
A. Pre-application review is not intended to provide an exhaustive review of all the potential issues that a given application could raise. Pre-application review does not prevent the County from applying all relevant laws to the applicant. The purposes of pre-application review are: To acquaint County agency staff with a sufficient level of detail about the proposed development to enable
staff to advise the applicant accordingly; To determine general consistency with any relevant comprehensive plan and development regulations; To identify applicable regulations and permit needs, including permit fees; To identify permits/requirements from other agencies, to the extent known; To provide early identification of study requirements, issues, and potential mitigation requirements; To acquaint the applicant with the applicable requirements of local ordinances and other law; and To provide an opportunity for other agency staff and the public to be acquainted with the proposed applica-
tion and applicable law. Although members of the public can attend a pre-application conference, it is not a public hearing, and there is no obligation to receive public testimony or evidence.
B. Pre-Application review is required for Type II or III applications unless: Ordinance 177 or the review authority expressly exempts the application(s) in question from pre-application
review; or The applicant submits a completed form provided by the review authority requesting waiver of pre-
application review and the waiver is granted. The form shall state that waiver of pre-application review in-creases the maximum time for review for technically complete status and increases the risk the application will be rejected or processing will be delayed. Pre-application review generally should be waived by the re-view authority only if an application is relatively simple.
C. To initiate pre-application review, an applicant shall submit a completed form provided by the review authori-ty for that purpose, the required fee, and all information required by the relevant section(s) of County ordinanc-es and other applicable regulations. The applicant shall provide one (1) copy of information that does not per-tain to subdivisions, nine (9) copies of information pertaining to short subdivisions, and fifteen (15) copies of in-formation pertaining to subdivisions. D. Information not provided on the form shall be provided on the face of the preliminary plat, in an environmen-tal checklist, or on other attachments. The review authority may modify requirements for pre-application materi-als and may conduct a pre-application review with less than all of the required information. However, failure to provide all of the required information may prevent the review authority from identifying all applicable issues or providing the most effective pre-application review. E. Within twenty-one (21) calendar days after acceptance of an application for pre-application review, the re-view authority shall schedule a pre-application conference or exempt the application from pre-application re-view. F. The review authority shall coordinate the involvement of agency staff responsible for planning, development review, roads, utilities and other subjects, as appropriate, in the pre-application review process. Relevant staff shall attend the pre-application conference or shall take other steps to fulfill the purposes of pre-application re-view.
04/21/2016
G. The pre-application conference should be held as soon as practicable after the review authority accepts the application for pre-application review. H. Within fourteen (14) calendar days after the date of the pre-application conference, the review authority shall mail to the applicant, and to other parties who submit a request in writing, a written summary of the pre-application review. The written summary generally shall do the following to the extent practicable given the in-formation provided by the applicant: Summarize the proposed application(s):
Identify the relevant approval criteria and development standards in County ordinances or other applicable law, and delineate exceptions, adjustments or other variations from applicable criteria or standards that may be relevant;
Evaluate information the applicant offered to comply with the relevant criteria and standards, and identify specific additional information that is needed to respond to the relevant criteria and standards or that is rec-ommended to respond to other issues;
Identify applicable application fees in effect at the time, with a disclaimer that fees may change;
Identify information relevant to the application that may be in the possession of the County or other agen-cies of which the County is aware, such as:
1. Comprehensive plan map designation and zoning of the property subject to the application and of
the surrounding vicinity; 2. Physical development limitations, such as steep or unstable slopes, critical areas and natural re-
sources on site, wetlands, well-head protection areas, water bodies, and water availability that exist on the property subject to the application and on the surrounding vicinity;
3. Those public facilities that will serve the property subject to the application, including fire services, roads, and if residential, parks and schools, and relevant service considerations, such as minimum access and fire flow requirements or other minimum service levels; and
4. Other applications that have been approved or are being considered for land in the vicinity of the property subject to the proposed application that may affect or be affected by the proposed applica-tion.
I. An applicant may submit a written request for a second pre-application conference within one (1) calendar year after an initial pre-application conference. There is no additional fee for a second conference if the pro-posed development is substantially similar to the one reviewed in the first pre-application conference or if it re-flects changes based on information received at the first pre-application conference. A request for a second pre-application conference shall be subject to the same procedure as the request for the initial pre-application conference. J. A new request for, or waiver of, pre-application review for a given development shall be filed unless the appli-cant submits a counter complete application that the review authority determines to be substantially similar to the subject of a pre-application review within one (1) calendar year after the last pre-application conference or after approval of waiver of pre-application review. For additional information about the Pre-Application Conference Waiver, Pacific County Ordinance 177, please contact a Planner at our Long Beach office (360) 642-9382 or South Bend office (360) 875-9356.
04/21/2016
REQUIRED INFORMATION
OFFICE USE ONLY Pre-Application Conference Waiver Pacific County Department of Community Development Internet Address: www.co.pacific.wa.us
SOUTH BEND OFFICE P.O. Box 68
South Bend, WA 98586 (360) 875-9356 FAX (360) 875-9304
LONG BEACH OFFICE 7013 Sandridge Road
Long Beach, WA 98631 (360) 642-9382 FAX (360) 642-9387
Authorized Signature:
Print Name: Date:
I understand the waiver of a pre-application conference increases the maximum time for review for technically complete status and increases the risk the application will be rejected or processing will be delayed.
TYPE II APPLICATIONS TYPE III APPLICATIONS
Flood Plain Variance Critical Areas & Resources Lands Vari-ance /Viable Use Exception Special Use Permit Short Plat Variance Large Lot Subdivision Residential Shoreline Substantial Development Permit Wetland Mitigation Bank Administrative Variance (11-25%)
Oysterville Design Review Board Non-residential Shoreline Substantial Development Permit Zoning Variance Conditional Use Permit Binding Site Plan Subdivision Rezone (Site Specific) Vacation/Alteration of a Subdivision
Please check the box type(s) of application you are requesting a pre-application conference waiver from.
Tax Parcel ID Number:
Property Owner:
Applicant:
Phone: Fax:
Email:
All documents and information submitted in conjunction with this application is subject to Public Disclosure in accordance with RCW 42.56
Revised 09/12/2011
BUSINESS INFORMATION
OFFICE USE ONLY Opera onal Permit Applica on Pacific County Department of Community Development Internet Address: www.co.pacific.wa.us
PROPERTY OWNER INFORMATION
Business Name:
Mailing Address:
City/State/Zip:
Phone: Phone:
Email:
Name:
Address:
City/State/Zip:
Phone: Phone:
Email:
SOUTH BEND OFFICE P.O. Box 68
South Bend, WA 98586 (360) 875‐9356 FAX (360) 875‐9304
LONG BEACH OFFICE 7013 Sandridge Road Long Beach, WA 98631
(360) 642‐9382 FAX (360) 642‐9387
TYPE OF PROJECT / O&M SCHEDULE Food Establishment ‐ Every 3 years
Short Term Vaca on Rental ‐ Every 3 years
Table VI /Waiver ‐ Annually or as determined by waiver
School ‐ Every 3 years
RV Park/Campground ‐ Every 3 years
Food Est w/ a Table VI Repair ‐ Annually
Tax Parcel ID No.:
Job Site Address:
Type/Name of Water:
JOB SITE INFORMATION AND LOCATION
The Tax Parcel ID Number can be found on your tax statement, the Pacific County web site address listed above or by calling the Assessor’s office at 360‐642‐9301 or 360‐875‐9301. Applica ons cannot be processed without this informa on.
In accordance with the Pacific County Board of Health Ordinance 3E, as the owner of the on‐site sep c system which is the subject of this applica on, you are required to obtain an Opera onal Permit from Pacific County. This permit requires an Opera on and Maintenance (O&M) inspec on by a third party inspector licensed by Pacific County and is done to ensure your system is func oning properly and is not a public health hazard. In order to meet the minimum Opera onal Permit requirements please provide the following: • Current Opera on & Maintenance Inspec on (O&M) • This applica on with signature below
Note: This O&M inspec on must be submi ed and reviewed by Pacific County prior to permi ng/licensing the proposed project.
By signing this applica on, as owner, or the authorized agent(s) of the owner(s) of the property which is the subject of this applica on, I acknowledge that I will be required to submit an O&M inspec on of the on‐site sep c system as performed by a licensed Opera on & Maintenance Specialist determined by the type of project listed above. The next year the O&M Inspec on needs to be submi ed will be reflected on your license/permit.
Authorized Signature:
Print Name: Date:
Issued Date:__________________________ Issued By: ___________________________
BUSINESS OWNER INFORMATION (If on leased Land) Business Owner Name:
Mailing Address:
City/State/Zip:
Phone: Phone:
Email:
All documents and informa on submi ed in conjunc on with this applica on is subject to Public Disclosure in accordance with RCW 42.56
1216 W. Robert Bush Dr., PO Box 68, South Bend, WA 98586 ph 360.875.9356, fax 360.875.9304
7013 Sandridge Rd., Long Beach, WA 98631 ph 360.642.9382, fax 360.642.9387
Pacific “County is an Equal Opportunity Employer & Provider”
FIRE AND LIFE SAFETY REQUIREMENTS BED AND BREAKFAST‐VACATION RENTALS
1. SMOKE DETECTORS/CARBON MONOXIDE DETECTORS A. ALL DETECTORS MUST BE HARD WIRED WITH BATTERY BACK UP UNLESS PRACTICAL
DIFFICULTIES PREVENT THIS. IN THESE CASES, BATTERY OPERATED DETECTORS MAY BE ALLOWED.
B. ONE COMBINATION SMOKE/CARBON MONOXIDE DETECTOR IS REQUIRED OUTSIDE OF EACH SEPARATE SLEEPING AREA IN THE IMMEDIATE VICINITY OF ALL BEDROOMS.
C. ONE SMOKE DETECTOR IS REQUIRED IN EACH BEDROOM. D. ONE SMOKE DETECTOR/CARBONMONOXIDE DETECTOR IS REQUIRED ON EACH FLOOR
LEVEL.
2. EACH BEDROOM MUST HAVE AN ACCEPTABLE MEANS OF EMERGENCY EGRESS. A. WINDOW THAT OPENS DIRECTLY TO THE EXTERIOR
(MINIMUM 5.7 SQUARE FEET OF OPENABLE AREA OR LARGE ENOUGH, IN THE JUDGEMENT OF THE INSPECTOR, TO ALLOW A REASONABLE MEANS OF ESCAPE.)
B. OR A DOOR THAT OPENS DIRECTLY TO THE EXTERIOR.
3. EXIT SIGNS (HARD WIRED W/BATTERY BACKUP) AND EMERGENCY EXIT LIGHTING MAY BE REQUIRED IN COMPLICATED OR UNUSUAL EXITING SITUATIONS.
A. AT TOP OF STAIRS AND AT CORRIDORS/HALLWAYS. B. NEAR MAIN EXIT.
4. POST EXIT DIAGRAM IN EACH SLEEPING AREA AND AT CORRIDOR/HALLWAYS.
5. PORTABLE FIRE EXTINGUISHERS SHALL BE INSTALLED PER NFPA 10. A MINIMUM OF ONE
PORTABLE FIRE EXTINGUISHER, WITH A MINIMUM RATING OF 2‐A:10‐B:C SHALL BE PROVIDED PER FLOOR LEVEL OF A LIVING UNIT, WITH A MAXIMUM OF 40 FEET OF TRAVEL DISTANCE TO THE EXTINGUISHER. THEY MUST BE VISIBLE AND READILY ACESSIBLE, AND INSTALLED ON AN APPROVED BRACKET OR SHELF NO MORE THAN 5 FEET ABOVE THE FLOOR.
6. THE ANNUAL PERMIT IS REQUIRED TO BE POSTED IN A VISIBLE LOCATION WITHIN THE PREMISE AND MUST BE SIGNED BY THE RESPONSIBLE PERMITEE.
7. A HARDWIRED PHONE IS REQUIRED TO BE INSTALLED WITH A NOTICE POSTED TO CALL 911 IN THE EVENT OF AN EMERGENCY. THE NOTICE SHALL ALSO CONTAIN THE ADDRESS TO THE PREMISE.
8. THE PREMISE ADDRESS MUST BE PLACED IN A POSITION THAT IS PLAINLY LEGIBLE AND VISIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY.
Revised 4/24/12
Revised 1/1/2017
Declaration of Posting Type II Applications
Large Lot Subdivision, Short Lot Subdivision, Short Subdivision Variance, Special Use, or CARL Variance
I, _____________________________________ declare under penalty of perjury, under the laws of the State of Washington, that all statements contained in this “Declaration of Posting” and any accompanying documents is true and correct, with full knowledge that all statements made in this application are subject to investigation and that any false or dishonest answer to any question may be grounds for denial or subsequent revocation of permit and/or license.
The referenced property was posted on ______________ _____, ________ according to Ordinance No. 177. A picture of this posting is attached to this affidavit.
Property Parcel No.: ___________________________ Dated this _____ day of _________________, ______ ____________________________________________ Signature of Owner/Applicant
revised 01/01/2017
Affidavit of Mailing Short-Term Vacation Rental Property Management Plan
I, _____________________________________, declare under penalty of perjury, under the laws of the State of Washington, that all statements contained in this “Affidavit of Mailing” and any accompanying documents is true and correct, with full knowledge that all statements made in this application are subject to investigation and that any false or dishonest answer to any question may be grounds for denial or subsequent revocation of permit and/or license.
On ______________ ______, ________ (month, day, year) the approved property management plan was mailed to all property owners within 300’ of the parcel listed below, in accordance with Ordinance No. 178. A list of these property owners is attached to this affidavit.
Property Parcel No.: ___________________________ Dated this _____ day of _________________, ______ ____________________________________________ Signature of Owner/Applicant
