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HomeMy WebLinkAboutBLD2005-00343 illUILDING PERMIT APPLICA1N MLA05-00324 Review Type:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00343 Received Date: 5/26/2005 SITE ADDRESS: 5944 CENTER RD CHIMACUM, 98325 OWNER: MICHAEL S KITCHEN PHONE: (360) 732-4204 LAURA LYNNE KITCHEN PO BOX 188 CHIMACUM WA 98325-0188 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801091004 Section: 9 Township: 28 N Range: 01 W CONTRACTOR: LD RICHERT CONSTRUCTION PHONE: (360)301-0543 PO BOX 127 PORT TOWNSEND WA 98368 Contractor's License LDRICC*066L0 Expires 5/29/2005 REPRESENTATIVE: LD RICHERT PHONE: 360-301-0543 PO BOX 127 PORT TOWNSEND WA 98368 PROJECT DESCRIPTION DEMO EXISTING RESIDENCE AS PART OF NEW SFR CONSTRUCITON TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: q//05_ Type Amount Paid By: Date: Receipt: P1313d01 F Permit $49.00 BAC 05/26/05 73220 State Building Code $4.50 BAC 05/26/05 73220 JAN a5 Total: $53.50 �Qp� Jefferson County Planning & Building Department • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00343 Received Date 5/26/2005 SITE ADDRESS: 5944 CENTER RD Issue Date 1/25/2006 CHIMACUM, 98325 APPLICANT: MICHAEL S KITCHEN PHONE: (360) 732-4204 LAURA LYNNE KITCHEN PO BOX 188 CHIMACUM WA 98325-0188 + SUBDIVISION: Block: Lot: PARCEL NUMBER: 801091004 Section: 9 Township: 28N Range: 01W CONTRACTOR: LD RICHERT CONSTRUCTION PHONE: (360)301-0543 PO BOX 127 PORT TOWNSEND WA 98368 Idrich �t(c Contractor's License LDRICC*066L0 Expires 5/29/20�7wavpoint.com OWNER, MICHAEL S KITCHEN PHONE: (360) 732-4204 if different: LAURA LYNNE KITCHEN PO BOX 188 CHIMACUM WA 98325-0188 PROJECT DESCRIPTION: DEMO EXISTING RESIDENCE AS PART OF NEW SFR CONSTRUCITON THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 1/25/2007. REQUIRED INSPECTION: FinalApproval: k-221 O tv 6c)(2/ BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. SPECIAL CONDITIONS APPLY - SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY t • SPECIAL CONDITIONS FOR CASE#BLD05-00343: 1.) The application was reviewed by the Jefferson County Department of Community Development staff on July 5, 2005 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Type 3 stream; wetlands; seismic; SUSC aquifer recharge. 2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 5.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500)feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. 6.) A Type 3 Stream (Fish and Wildlife Habitat Area) has been identified on the subject property. The stream will require a setback of 100-feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat Areas shall also have Buffers and Building Setbacks established. 7.) Stream buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of vegetation may be permitted as long as the function and character of the buffer are not diminished. 8.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis), Shore Pine (Pinus Contorta), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar (Thuja Plicata), and Western Hemlock (Tsuga Heterophylla). Among native tree species which may be used includes: Vine Maple (Acer Circinatum), Big-Leaf Maple (Acer Macrophyllum), Red Alder(Alnus Rubra), Pacific Madrone (Arbutus Menziesii), Quaking Aspen (Populus Tremula), Black Cottonwood (Populus Trichocarpa), Bitter Cherry(Prunus Emarginata), Oregon White Oak(Quercus Garryana), Cascara (Rhamnus Purshiana), Pacific Willow(Saliz Lasiandra), and Scouler's Willow(Saliz Scouleriana). Among the native shrub species which may be used are: Sevice-Berry(Amalanchier Alnifolia), Red Osier Dogwood (Cornus Stolonifera) Salal (Gaultheria Shallon), Ocean Spray(Holodiscus Discolor), Indian Plum (Oemlaria Cerasiformis), Pacific Ninebark (Physocarpus Capitus), Red Flowering Currant(Ribes Sanguineum), Wild Rose (Rosa Nutkana), Swamp Rose (Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus Racemosa), Snowberry (Symphoricarpos Albus), Evergreen Huckleberry (Vaccinium Ovatum), Red Huckleberry (Vaccinium Parvifolium). t • • 9.) The project components are more than 250'from the mapped/identified wetland. The requirement for a wetland delineation and report is waived based on maintenance of a 225' buffer from the wetland per UDC Table 3-3. 10.) The project is located in close proximity to an identified wetland and is subject to the delineation provisions of Section 3.6.9 of the Jefferson County Unified Development Code. Based upon the proposed location of the project in relation to the identified wetland, the applicant has agreed to maintain a buffer(setback)that exceeds the standard buffer requirements by fifty (50) percent. The applicant acknowledges the additional setback and agrees to maintain the extra 50 percent buffer, therefore, waiving the wetland delineation requirements of the Unified Development Code. 11.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs)and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 12.) The identified Fish and Wildlife Habitat Area (Type 3 Stream), shall maintain a vegetative buffer setback of 100 feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM)to the proposed single family residence. 13.) An additional setback of five (5)feet is required from the edge of the stream buffer area to the proposed single family residence. 14.) A permanent physical separation along the boundary of the stream buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 15.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100)feet, whichever is less. Signs shall be in place prior to and during construction activities. The signs shall contain the following statement: "Buffer- Do Not Remove or Alter Existing Vegetation." 16.) The applicant is proposing to create or add 474 square feet of impervious surface and 3874 square feet of land disturbing activities. 17.) 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. 18.) A Stormwater 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. 19.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i). 20.) The revised site plan as submitted on Juy 13, 2005 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated July 13, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 21.) This approval is for a demolition of an existing residence as part of a new single family residence construction only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 22.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. • • 23.) Not more than two (2) unlicensed 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 met 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 lin 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). 24.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 25.) The building height is not to exceed 35 feet. 26.) Minimum setback from Center Road right-of-way shall be 30 feet. Minimum setback from private ingress/egress easement rights-Of-ways shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum rear((west)setback shall be 100 feet to the adjacent rural forest lands. 27.) 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. 28.) 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. 29.) The parcel has been designated as prirrie agricultural (AP) lands 1:20 under the Jefferson County Unified Development Code and the Jefferson County Comprehensive Land Use Map. 30.) An address of 5944 Center Road, ChimPcum has been assigned to the parcel. Center Road is a county major collector(C931507). The parcel has direct access via a private easement from the parcel directly to the!south. Proof of legal access has been provided through a recorded Statutory Warranty bleed under AFN 378792 recorded on January 30, 1995. 31.) 2/7/06: Revised language for SEP04-0c60: A septic permit (SEP03-0319)was approved on May 28, 2004. A septic permit (SEP04-0060)was applied for after the previous land owner installed a septic system without obtaining Envionrmental Health review and approval. An evaluation of the existing septic system was done on February 2, 2004. A building permit(BLD05-0343) for demolition of the existing 100 year old cabin will be issued with this building permit. 32.) 2/7/06: The existing and ongoing agriculture activities on this parcel are exempt from standard stream and wetland buffers per UDC Section 4.3.2. HOWEVER, "(1) new agriculture is required to meet all applic ble provisions of UDC 3.6.5, et seq. (2) Existing and ongoing agriculture is exempt from standard stream and wetland buffers. Refer to UDC Sections 3.6.8 and 3.6.9, respectively. The exemption covers only existing and ongoing activities related to cultivating crops and grazing livestock and the land preparation associated with those agricultural activities. The exemption does not cover new structures, parking area, or other similar development activities. New development activities related to agriculture are regul ted as new agriculture. (3) In exchange for this exemption from standard stream and wetland buffers, the agricultural communities in each Jefferson County watershed are expected to establish and implement appropriate agricultural Best Management Practices(BMPs) in order to protect wetland and fish and wildlife habitat areas from adverse imps is related to the practice of agriculture. (4)The exemption from standard stream and wetlands buffers for existing and ongoing agriculture will be revisited during periodic review of the Comprehensive Plan and development regulations, pursuant to RW 36.70A.130. If the County finds through evaluation of best available science thatthe voluntary implementation of agricultural BMPs is failing to protect wetlands and fish and wildlife habitat areas from impacts related to agriculture in any given watershed or specific areas within a given watershed, this exemption will be modified or eliminated for that watershed or particular sites within that watershed. I:\F_BLD_Permit_Propane.rpt 10/29/19c vir rvr rvvv iv.r,. stars Vvv Yot VslVv VIWIlla LW Vl)I Date: Initial • •_ Date licatioM eceived loay4/ "`."a4 2940 B Limited Lane NW -9a; - Amended: ❑, — /° /-1 - 1 ' Olympia, WA 98502 a� 0 1pfj., Completion:❑ ( P Phone: (360)586-1044 .0 .. , OR:. i,: ,.Fax: (360).491-6308 :f ,, :.. ❑ $500 - �.. ' Annual: `�',v_;ef.�,'�"' wwvtii:oRCAA.Qr$ , �.ii Only Permit 4plication for an Asbestos Project A. Project Type.: - E Asbestos Removal 2.Li Renovation -3. U Maintenance 4, 1]Encapsulation 5.r:iiDemalitiouEmerRcney 7. ❑ Other: B. Property Owner: J MI �4-2ri 6. ck 4-eAI-►. Phone:04.0) 7 3 a-q 2-0 Li Property Owner's Mailing Address: 5 �1-1- C i Fal City: C h rr c-L+.rrt State a 1 Zip:`/B3.25- ^C. Asbestos Contractor: i Contractor Owner/CEO: � Mitiling Address: fL„ I Phone: S ) • . . City: , State: - Zip: I Fax: ( ) , D. Site Address: S me_. _ City: State: Zip: Project Manager or Contact Person: ('n t c-Lie,( 1.4-0 e.r., Phone:(31.e0)-7 3 a-L/a0'-( E. 12K Asbestos Survey or No.of Structures: Date Asbestos Survey Conducted: Was Asbestos Found? ❑ Mat°l Presumed: 1 1 - a -O 5 es ❑Y1f No,Attach Survey AHERA Building RNAHZM stawj.t'6APQfhx%naYPONIALL DAMOLJ?roN Certification No.: Expiration Date: Inspector Name: PROJECTS 13o b LJ'•I•4i1 cAr ic2�ye, e.F.m. •I 0 1 $ 1 LI l0—ID.-o(, • F. Demolition No.of Structures: Starr, -❑ Training Fire(List Fire Dept.as demolition contractor below) Information: l Date: - I ` °1' ❑ Ordered Demolition(attach copy of Order) Demolition PAW name him eerier malting aadnw N D...l m bath grbnit-0r s+r bum.miff name(Ore depafano hint Contractor: } Phone:(3(a 0)-7 3 -'--( P.,0"'l G. Asbestos No.of Structures: (sec Start Date: Completion Wk,Days: XI W Th F Sa Su Project back if?1) Information: �l 3 V I - 0(o The- 1 — f l.J;`.) Holes: Will all asbestos material be removed by Total Quantity to be Removed: 80-Square Feet 5-3 ' Linear Feet project complctiou?a Yes ❑No Thermal System Insulation: U Boiler/Fumace Ina L I Duct Ins, LI-Pipe Ins. other Surfacing Mat'1 1.)I Fireproofing Paints [0 Piaster U Textured Coatings other Miso.Mat'l: Cement Bd. 1.1 Cement Pipe Floorinu Man U Roofing Mat'l Other. IL Asbestos/Detoolition Project Categories: Notification Waiting Period ' ,tQNRRYUNDABUt 1. IdResidential Dvveltin Asbestos Removal Protect Prior Notice _ '5 J Yr- 2. Demolition all�-1 r" QQ 10 Working Days $25 ' )(4,r 3. Llless than 10 linear feet or less than 11 square feet Prior Notice $25 4. UIO'-2$9 linear feet or 11 -159 square feet - 10 Working Days $100 5_ L1260-999 linear feet or]60•-4,999 square feet 10 Worl ml,Days $250 G. 111,000-9,999 linear feet or 5,000-49,999_square feet - 10 Working Days $500 7. U10,000+linear feet or 50,000+square feet I 10 Working Days $1,000 S. L1Anonai Permit(Limited removal,additional permits,contact ORCAA) _ Prior to start of New Year $500 9. ❑Emergency Project ' _ Prior Notice S50 10. LJAmendrnents(no fee for 1't and 2nd amendinent) Prior Notice — $25 L I do hereby oeatity that the information contained in this notifioation,and supplemental data Payment received d,.te: • • Of-1c'-O 4'/ • described herein,is to the best of my knowledge accurate and oomplote, I shall not cause ei allow Revicwvd dart! 1./- 0 -O any asbestos pro ition activities to - until the appropriate Waiting period bat Reviewed by; A,` C�icy' t /i 3 elapses]. Pamlt Nambrr /9 D t l0 f 11/4- O/ Date tired/mailed netiipeadon to aucant:r)f a-O'--O , •Signature: _— 1 W pp..• For Compliance With Regulation I,ScMYina 14-Aa.he�ut Print Name:l'll t Gho.e„) ,�t+C-41e.vi Representing: 6 c (i Agency Use Onty Rev.07/07/04 (4ON \� � JEFFERSC�OUNTYIII 44` DEPARTMENT OF COMMUNITY DEVELOPMENT 1104 621 Sheridan Street • Port Townsend •Washington 98368 ,� ..ik - 360/379-4450 . 360/379-4451 Fax MAY 2 6 2005 -'s N��O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 05, 3 '1a Project Description(include sepAra�te sheets as necessary)• 12itiC I'�xK-'(1X'( YV,iC ,X_c k-k Z{ 1 , r Tax Parcel /�� ���"` �i��'�`�`-�C l �-�j , DUI l ' Property _ Number: C�_ Size: A.' RC. (acres/square feet) Site Address and/or Directions to Property: i'7q 4 4 (. t-�JEl2 ,e6 col I.l,V i4 IA, \ Property Owner(s)of Record: 11't C -rtt-t_ 4 IAtieA-- 190J€ jTCrit14 Telephone: 7 2 Z- '2 C-4-- Fax: — � C. , email: Mailing Address: vl Applicant/Agent(if different from owner): L�, i�. I C`r-fit,i Telephone: 'j i 7`Z Z Z- �- Fax: S►ANL- email: ki r'i Ch e oi F(v i-. Pi (i.,,i Mailing Address: [Z:4- r t Ci t1'71r- f` What kind of Permit?(Check each box that applies) Buil ' ❑Variance(Minor,Major or Reasonable Economic Use) emolition Permit ❑ Conditional Use[C(a), C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRDyAmendments** ❑ 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 ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑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: L �tC �Z r�—'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 attomey'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 ovide acce right of entry to Jefferson Countyand its employees,re representatives or agents for the sole u review and � p purpose of application Y ate inspe ' ss and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: �' Date: [ 1 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 i ued will 'olate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)a if y a e in m iance with the Jefferson County development code.The Applicant acknovidedges that he,she or it holds individual and non- e r si it Hering to and complying with the ESA. The Applicant has read this discaa' er an signs and dates it below. Signature: — i--)�l 6) signs Date: 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 •. I .•. athey will be assuming the responsibility of the General Contractor for the proposed project. Signature: >. _; Date: MAY 2 V7 2005 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: i), F) I C`t t t_Yr 11 ( -`) 977e1 5 i-z ( - --) ,.5{ "- MAILING ADDRESS: ; i`l VC 1 t✓..; yQ EMAIL: CONTRACTOR'S LICENSE �, WAINS NUMBER: L ) fC t (' C.' ; -t,,(._ NUMBER ARCHITECT/ENGINEER PHONE ( ) FAX:( ) MAILING ADDRESS: ------- EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: 0 Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Ir ❑ Masonry SEP Permit# Demolition [] Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: _ 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: ❑ Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove l_] Fireplace Insert Li 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 property 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 Consistency Review: Kgoi S re--- 2NU Floor Base fee: '1 3ra Floor fl Additional Section: 1 1Cr i 67. Mezzanine: 1'' Plan Check fee: Heated Basement t,1t State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL $ 5 3 5 Decks Receipt Number: 1 3 ao Other Cash/Check Number: („ T ESTIMATED COST(REQUIRED) Date: Os". Initials: •Fair market value of all labor and materials foundation to finish - J Initials: 1 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc cn E5 t:t Z til >3 C 8 8 0 ni CA St / •• 0 C...... 1....4 1..4 tl. _ = -- trl 73 Cn as ci" °T) --a, "CI _0 . g li rs, ____ n c.A.:3 ,--33 , ._. - r...) '_,_,_ c:_-_:::0 ..., ___ Z tlii r-n -17 --I --...—..... glM -_.----. / C". C... •' .7:a] IriR1 , rr---z- ram4, owarg• •-••• --e rTh --4 i / 1-,,-- 1 I (...... .... . ;.r 0 1....... _._____...j) w......_ )7 , Ny; ...< ,.) 1 PO —t\ Cr) \-5-‘ I CI i 1 1 _..„..-- , \:... 1 cr. I 0.... i v.( , _......._..13,7,. . / --.....- -4 • r• ') r F; t•-.) _--------- 0 X' 't ,.. ?-- v ---; 0 .' 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