HomeMy WebLinkAboutBLD2005-00303 IllUILDING PERMIT APPLICAAN MLA05-00292
Jefferson County Department of Community Development Review Type: l
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00303
SITE ADDRESS: PUGET LOOP Received Date: 5/10/2005
PORT LUDLOW, 98365
OWNER: FERGUSON & COLE INC
9951 MICKELBERRY RD NW PHONE: 360�98 4665
SUITE225
SILVERDALE WA 98383 PORT LUDLOW NO 1 AREA 1
SUBDIVISION:
PARCEL NUMBER: 990400149 Section: 9 Township: 28 IocN: Range: 01 E Lot 49
CONTRACTOR: FERGUSON & COLE INC
9951 MICKELBERRY RD NW PHONE: (360)698-4665
STE 225
SILVERDALE WA 98383
Contractor's License FERGUCI137RH Expires 11/5/2002
REPRESENTATIVE:
PHONE:
•
PROJECT DESCRIPTIOt NEW SFR W/ATTACHED GARAGE, DECK 240 SQ FT/PORCH 64 SQ
FT &
A/G 120 GALLON PROPANE TANK
TYPE OF WORK NEW �S SQUARE FOOTAGE: q‘41 o
TYPE OF IMP
VALUATION - 15,708.00 r13o� ADD': 1,244 .E
CODE EDITION: 2003 HEAT TYPE: PRO
OCCUPANCY: R_3 HEAT BASE: 960 fa5(r HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 5N OTHER:
CONST TYPE: GARAGE: 470 SHORELINE:
DECK: 304 SETBACK:
SEWAGE DISPOSAL: SEW BANK HEIGHT:
WATER SYSTEM: LUDLOW
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 3
Total: 3 Total: 3
Routing Date: 5/ /a/
Doo
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,643.35 BAC 05/10/05 72978 APPROVED
Plan Check- $1,068.18 BAC 05/10/05 72978
State Building Code $4.50 BAC 05/10/05 72978 JUL 2 0 2005
Potable Water Application $53.00 BAC 05/10/05 72978
Total: $2,769.03 •'F•rson County Planning
Bu. ling ► .: .rtment
• BUILDING S PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD05-00303
SITE ADDRESS: 220 PUGET LOOP Received Date 05/10/2005
PORT LUDLOW, 98365 Issue Date 07/20/2005
APPLICANT: FERGUSON & COLE INC
9951 MICKELBERRY RD NW PHONE: 360 698 4665
SUITE225
SILVERDALE WA 98383
SUBDIVISION: PORT LUDLOW NO 1 AREA 1
PARCEL NUMBER: 990400149 Block: Lot: 49
Section: 9 Township: 28 N Range: 01 :60)698-4665
CONTRACTOR: FERGUSON & COLE INC
9951 MICKELBERRY RD NW PHONE:
STE 225
SILVERDALE WA 98383
Contractor's License: FERGUCI137RH Expires: 1§§4476§84665
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE, DECK 240 SQ FT/PORCH 64 SQ
FT &
A/G 120 GALLON PROPANE TANK
CALL IN FOR THE REQUIRED INSPECT! NS THAT APPLY TO YOUR PROJECT.
SETBACKS: a` b5
UFFER: 6
Footing: I(�, �� —r'c;
Foundation: D_ / /S/OS„•
Stormwater FINAL Approval: ,, u !- OIIC OS,:. ` , E ,
Underground Plumbing: � '°"
Underground Insulation: ► OS
Shear Wall :
Sheathing:
Framing:
/ N
Plumbing: OK 5���/�;
Propane Tan, / Lines: % . 'a - 'K 51/23 04 J
Insulation: i- -L ian Ado,
Sheetrock: .I ,B'
Septic Sytem Final Approv_ (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: IA • e O Ri
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY-SEE REVERSE
SPECIAL CONDITIONS FOR Cit # BLD05-00303 •
1.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
2.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
3.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
4.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
5.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
6.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
7.) An Engineered Stomwater Site Plan has been submitted and approved by the Department
of Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
9.) Not more than two (2) unlicen.or inoperable vehicles shall be stored on any lot less
than one-half acre unless totally screened from view of neighboring dwellings and
rights-of-way. Such screening shall meet all applicable performance and development
standards specific to the district in which the storage is kept, and shall be in keeping with
the character of the area. Screening shall meet the requirements of Unified Development
Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC,
and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any
such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area
(ESA).
10.) Maximum lot coverage is not to exceed 45%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
11.) The building height is not to exceed 35 feet.
12.)
13.) Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
14.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
15.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
16.) Per MPR Code Section 3.107, Accessory Dwelling Units (ADU's) shall not be allowed
within the MPR-SF zone.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
•
��.gsozv �°� JEFFER
SON RSON COUNTY
.,-, i4i., 1DEPARTMENT OF COMMUNITY DEVELOPMENT JUN 1 7 2005
4 621 Sheridan Street • Port Townsend •Washington 98368
._ a 360/379-4450 • 360/379-4451 Fax
'• [iv http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# O -- O Z T 2— PROJECT/APPLICANT NAME: FZ.y 6 US c?N * I. , INC C.
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
separate stormwater site plan map.
Project Overview
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map.
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site map.
4:;etaiDV /ie".4-/IA, -
5. Describe the existing site hydrology(i.e., drainage;behavior of water on the site—above, below,and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
applicable,and indicate acreage of each.
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6. Describe any excess levels of noise generated by the proposed use or activity:
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- stormwater site plan template—rev.10/12003 StOrniWat J U L. 5
Require ' i
JEFFERSON CnT"-,
DEPT.OFCOM i,, TS'L,'i 1„�n;..4EENT I
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.)on the site. Indicate location on the site map.
il/AL _
8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
(streams,wetlands,lakes,steep slopes,etc.).
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
9. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30
in the Manual) or,if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
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5Tg- .1" 4 r THC. I2RA.n/AG - RAre M& r DN ?7-7C i AS-7- S/D : aF i ' L-oT.
1H, S pc . oot.T L u D -a '5 Acc- F 'c,-.7,41i-7 cAnD4 T?on7.
10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for large"projects or projects that involve the potential for dispersion of contaminants.]
Al/A-
11. Describe the performance goals and standards applicable to the project.
AtA
12. Describe the flow control system.
NA —
stormwater site plan ternplate—rev.10/1/2003 6
13. Describe the water quality system.
j i11
•
14. Describe the conveyance system analysis and design.
15.
Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
ofplacement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
16. Proposed methods p
Uniform Building Code.
17. Describe the proposed surfacing material.
18. Describe methods for restoration of the site.
ohs r-
19 An large" ion and M and ance Manu
al is required for each flow control and treatment facility. [This is normally required for
projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here.
20. List here and
include any special reports or studies conducted to prepare the Stormwater Site Plan.
permits and approvals as required by other regulatory age
ncies. If those permits or approvals include
21. List other necessary
''ons that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions o
r
condtti
restrictions here.
•
' _ stormwater site plan template—rev.10/1/2003
CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during .
The
Co that follows must be rese on the ground during
templpreveatinge sedimentwand erosion installedimpacts to environmentally ground n all construction
areas and off-sites on TheBMPs indicated by the applicant
Pollution Prevention all construction phases of the project. The r
(SWPP) Best Management Practicesproponent is responsible fon r
er
development. areas. Consult the Construction Stormwntal
(BMPs) Packet for guidance, particularly with rural residential
SECTION 1—CONSTRUCTION SWppp NARRATIVE
�• Construction Stormwater Pollution Plan Elements. Describe how each
will be addressed. Identify the type and location of BMPs used to satisfy the required
to the proposal, dIinn of theq red element SWPPP memento has been t
to he justifywriting. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual
eq lred element. If an element is not applicab).
12 Required Elements—Construction SWppp (beginning on pa
1• Mark Clearing Limits.
2• Establish Construction Access.
ot4ST l o o
3. Control Flow Rates.
4. Install Sediment Controls.
5. Stabilize Soils.
6. Protect Slopes.
7. Protect Drain Inlets.
•
storm/ ter site plan template—rev.1 N ()1/ 3
8
. 12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
JUN 1 7 2005
jJPc
9. Control Pollutants.
P
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
12. Manage the Project.
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards). AI lV P
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
!V
9
- stormwater site plan template—rev.10/12003
•
b. Description of special requirements for working in or near environmentally sensitive areas. ,
4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
5. Construction Phasing.
a. Construction sequence
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30
I• Provide a proposed construction schedule. (page 2 21 of the Manual).
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
cla1/43S z.P.) 4 0-e)L.€. A.)C-•
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts. Al /
8. Engineering Calculations. Provide Desnations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps. . ..-
b. Diversions. _
c. Waterways.
d. Flunoff/Stormwater Detention Calculations
stormwater site plan template—rev.10/1/2003
10
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project-as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
SC-4' /11/ S-
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
JUN 7 7°6
12
stormwater site plan template—rev.10/12003
��g otv co�� JEFFERSONNTY •
Ilk,� DEPARTMENT OF COMMUNITY DEVELOPMENT
'1 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax MAY Q
��q ,i•O� www.co.jefferson.wa.us/commdevelopment
2005
Master Permit Application
Project Description(include separate sheets as necessary):
&Vlt-t> A n/6w S// LE PPr,vtlL.-y t-t0 cE 4/A-71AG140 CIAPACCE
Tax Parcel
c, Property
Number:
9 1 56 — 100— 0,7 Size: •4 ,i'"c- ata square feet)
Site Address and/or Directions to Property: 9011-T Lvs)a-owl OFF l,d/t{L W hY (pu cc E-r C-oo P
Property Owner(s)of Record: r eRG0S o n) * Ca L a 1 / J C-
Telephone: 3(o O (q 9$ 4(06 S Fax: 3(00 (0 9 S 554G email: Fa&GeSoni col-E. cam
Mailing Address: `erS/ /4ic,t(Ec13Wy KO. N•(.4-)- Sui-rF 225 , vti.tz.D, c ,Loh 18 3s3
Applicant/Agent(if different from owner):
Telephone: Fax:
email:
Mailing Address:
What kind of Permit?(Check each box that applies)
) Building Cl Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or CI**
),Single Famil 0 Discretionary"D"or Unnamed Use Classification
❑Garage ttache Detached ❑ Special Use(Essential Public Facilities)*"
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑Commercial* 0 Binding Site Plan**
❑Change of Use ❑ Long Plat**
❑Address 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions "*'
❑ Stormwater Management ❑Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre—Application Conference **Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
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,her or it's 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 this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspe tions.Access and right of entry to this property shall be requested and shall occur only during regular business
::;ure:
r'GQ,trj tJ SON.4 Co �' Date:
/n/G. 51 Iq
/p s
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable r pon ibirt for adhering to and complying with the ESA. The Applicant has read this disclaimer nd signs and dates it below.
Signature: Date: 5(q 20S
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
• OWNER BUILDER STATEMENT •
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
g
Signature: y t YAM Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
f 1. 01J 4. COC-E , ilk- ( %o) 6,9L 40E7 5 ( %c) (0c/b 5) -b
MAILING ADDRESS: "5/ .N1i(.icS4-irzlt:'� F O Al al ir22 EMAIL: Sc;.e.TT S L FE V`�6N C-
,c.uE - 'M
CONTRACTOR'S LICENSE 5/4-J.(�f�A° y v1/414 1 e 1>:3 WAINS
NUMBER: }=t;12i�� �t:,OCT.i J,--/PH NUMBER
ARCHITECT/ENGINEER: �1 '' ilk PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: )7ame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
NewWood Existing: A'fr )Sewer
❑ Addition ❑ Steel Proposed: Z YL Bank (" II Community System
❑ Alteration/Remodel ❑ Concrete Total: 2'Iti Height: ❑ Individual System
❑ Repair O Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: .3 N Public
Total: 7 me of System: O4-y.,rr,44
/AT 4 5ew g,
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
Cl Underground Tank X Above ground Tank Size of Propane Tank: 1205.1
I] Heat Stove [1 Cook Stove ❑ Woodstove j<Fireplace Insert )4 Hot Water Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all properly
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area. -.
Square Footage For Office Use Only
Current Proposed Amount
Main Floor
/Z 4+ I I` qq� I ! .nsistency Review: G] 9
2Nu Floor 1 Base fee: �' 1 1(013.35
3`°Floor Additional Section: 1
Mezzanine: Plan Check fee: l t �!. 9. Lp!_S l
Heated Basement 0' State Surcharge fee: L aJv
r..s..�tt�411.ro1. 9(io `OW O t.
Unheated Basement t mJect �a� i5 • Pot Water Review fee: V
Other Unheated �y 911/Rd Approach fee: r
Garage/Carport V t) TOTAL: $ Q c\c\�� 03
�70 �10`�`1 Ot
Decks / p 5 (Q g Receipt Number _ (a,1
Other Y , /L Cash/Check Number: to r
ESTIMATED,90 REQUIREC. i:1 �1g1•h'� i ' •
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