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HomeMy WebLinkAboutBLD2005-00585 BUILDING PERMIT APPLICAN MRLA05 00552 eview ype: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00585 Received Date: 9/13/2005 SITE ADDRESS: 2ND AVE PORT HADLOCK, 98339 OWNER: RONALD REED PHONE: 360-385-5435 BARBARA B REED 71 CHIMACUM CREEK RD PORT HADLOCK WA 98339 IRON DALE SUBDIVISION: Block: Lot: PARCEL NUMBER: 961804604 Section: 35 Township: 30 N Range: 01 W CONTRACTOR: GRAVES EXCAVATION PHONE: 360-379-8400 11 ANDERSON ST PORT HADLOCK WA 98339 Contractor's License GRAVEE*990QG Expires 11/7/2005 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP DEMO TO SFR 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: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: q I 'n 1bl \� Type Amount Paid Bv: Date: Receipt: APPROVED Permit $49.00 SLE 09/12/05 76677 State Building Code $4.50 SLE 09/12/05 76677 NOV - 2 2005 Total: $53.50 Jefferson County Planning Building Department „____cleFog FOAM> t-Oc'A 0 0 DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00585 Received Date 9/12/2005 SITE ADDRESS: 90 2ND AVE Issue Date 11/2/2005 PORT HADLOCK, 98339 APPLICANT: RONALD REED PHONE: 360-385-5435 BARBARA B REED 71 CHIMACUM CREEK RD PORT HADLOCK WA 98339 38-42 SUBDIVISION: IRONDALE Block: 46 Lot: PARCEL NUMBER: 961804604 Section: 35 Township: 30N Range: 01W CONTRACTOR: GRAVES EXCAVATION PHONE: 360-379-8400 11 ANDERSON ST PORT HADLOCK WA 98339 Contractor's License GRAVEE*990QG Expires 11/7/2005 OWNER, RONALD REED PHONE: 360-385-5435 if different: BARBARA B REED 71 CHIMACUM CREEK RD PORT HADLOCK WA 98339 PROJECT DESCRIPTION: DEMO TO SFR 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 11/2/2006. REQUIRED INSPECTION: FinalApproval: (D -2-—0-(,) 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 PF,RMIT#� ���-7 �5 ...�.---.. c:t° t �Iri" - APPROVED�.==•,r� p "" CONDITIONALLY APPR / N07 APPROVED �' 471 FOR COMPLIANCE V ITH C� u CN.4,4:,..,,tr„. ' . . . . - . ORCAA E ULA'f10N S R SEP 1 � �' , olition Perm all asbstns- em of any structure unless ro'ect ----Notification of D major renovation) demolition (or application for a won to cause or allow the demoWork shall not comm�en�T'�e�app es os the area to be`demolished.aproval from lnot co in the area of the ct It is emawful foru any person obtained material remaining containing materials have been removed fromhas the owner or operator or demolition unless a certification that there is no known asbestos-containing .�e� ��� demolition shall include � d e Coun�y structure. Zip: 3 __state: /_i Project Site Address: „______..�— Completion Date: _�-- QC City: lication) ,.__?___-------________----Completion p permit application) Starting Date; period from receipt of *(There is a 10 w�•rking day advance notification Pe � Fax: Telephone: �640 3 gS-S Property Owner: Zip: Mailing Address: C I w`o-c. , State: u�' c O�G City: r State License#: G'�k 'r� �G,v� -319"3 Demolition Contractor: pp S Zip: �rt�e�'' State: w Mailing Address: /o��< • _ Fax: City: �`�� py ( Telephone: � Contact Person: e NO � $25,(?0 fee) check#�--- --- YES Wrecking°T Dismantling department request for training fire) Demolition Fire If es, attach fire dep` Training Demolition• y Maintenance, or other Construction? _� Renovation,Alteration,Remodeling, submitted rior to any asbestos or Suspected* fee must be ---- Asbestos found TO riatc m N i�r.. c or -- Encapsulate Asbestos" form and appropriate pp p a Certified Asbestossu mi be preformed by a AA Regulation 1 Article 14 for additional removal*An o wAA "Notice of Intent lt projects i or involving demolition must . . 2 6 2005 ro cmo involefog demolition begins. Refer to ORCAA work. Asbestos removal p J' friable asbestos must be removed before any potentially o�Completed by ��. CM requirements that may apply. Asbestos Survey C p Inspector —' / 7 AHERA Certifiedp A, ® 2 -o � Certification of the Asbestos Survey must Certification# an this form Enclose$25 accompany This approved ed thejo must processing Fee be available at job site � Olympia,Washington 9850 I D 2940 5B Limited bane NW. y * fax 360-491-630 �% 360-586-1044 * 800-422 5623 a 491-6 0 • * email: info_ ` ' • u L' homepage� www.orcaa.org � Rev.07111102 n / !PERMIT#&cr 17 `�' • °4" s, • APPROVED `7-. 7-OS L. i CONDITIONALLY APPROVED, r E f _ :.CA NOT APPROVED._,_, l I :: .. .: ;; ' FOR COMPLIANCE WITH SEP 1 2 2005 ,, o=v I ORCAA E ULATIO 1 i BY: -r rU 1`S ----**-i`fiotification of Demolition Permit It is unlawful-for any person..to cause or allow the demolition (or major renovation) of any structure unless all asbestos- containing materials have been removed from the area to be demolished. Work shall not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from ORCAA. A written application for a demolition shall include a certification that there is no known asbestos-containing material remaining in the area of the structure. y'4 . Project Site Address: t v P ., _ County• Teger^so✓ti City:_ ,/� he 1< State: wig . Zip: 9/3 Starting Date; / l Q,5 Completion Date: 3 -'/_O 6 *(There is a 10 wurking day advance notification period from receipt of permit application) Property Owner: Xmi Re re Telephone: Y‘tf, 3,95:5 r5 Fax: Mailing Address: 7/ C-L}w'.o v. CK 6 r. City: 7,43 er/4,474 c/L State: 1 i - 4_ ZiP -3-39 Demolition Contractor:&CG.+i t?S -61. Gatip.-42 14 State License#: Gr v e e ar `'7p Q G Mailing Address: 11 e1s B 0 s T: / O City: c 7- /74�4 c-K State: w� � p Zip: Contact Person: le 44 Telephone: 372 - ye0 Fax: YES NO v Demolition by Wrecking ot'bismantling? ($25.00 fee) check# Training Fire Demolition? (If yes, attach fire department request for training fire) enovation,Alteration, Remodeling, Maintenance, or other Construction? 1/ Asbestos found or suspected* *An ORCAA "Notice of Intent to Remove or Encapsulate Asbestos"form and appropriate fee must be submitted 'rior to any asbestos removal work. Asbestos removal projects involving demolition must be preformed by a Certified Asbestos Co rr.;a. „•WIN 7f or potentially friable asbestos must be removed before any demolition begins. Refer to ORCAA Regulation 1 Article 14 for additional requirements that may apply. JUL 2 6 2005 Asbestos Survey Completed by AHERA Certified Inspector ] ORC Certification# U L ONO A- pp q2 --Oy /6// 76 ' This approved permit must Enclose$25 Certification of the Asbestos Survey must be available at the job site Processing Fee accompany this form tem 2940 B Limited Lane NW,Olympia,Washington 9850 A I D 360-586-1044 * 800-422-5623 * fax 360-491-630: homepage: www.orcaa.org * email: info@orcaa.orr , • 40 ,...R Rev.07/11/02 ,soN �.�w" %�\ JEFFERS. COUNTY S \s ,} DEPARTMENT OF COMMUNITY -e 621 Sheridan Street • Port Town 5: t • f ) sO. • 360/379-4450. 360/379-4451 •�' n V 8 v 8`� $S, N�� www.co.jefferson.wa.us/commd: • .. ent Master Permit Application 2005 + SEP i 2,, LA:Description(include separate sheets as necessary): ,} Tax Parcel Number: Q 60 • -I6c, - Property Size: 20 ,#0 O Site Address and/or Directions to Property: ( �''�:13�+' Property Owner(s)of Record: o,n,a�r� A�R RN- _a b Cc , Telephone:- 3Gp y3r,- Fax Mailing Address: 7t C(,� email: s & a,(�,s,�e. Cyr . ,�catv,v, C_:e&K ©pv- ii3 Applicant/Agent(if different from owner): c�7� 11 c�< L`z4 /�83 Telephone: Fax: email: Mailing Address: - What kind of Permit?(Check each box that applies) - ti,Building Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family 0 Conditional Use[C(a),C(d),or C]** ❑Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑Manufactured Home 0 Special Use(Essential Public Facilities)"* ❑Modular 0 Boundary Line Adjustment ❑Commercial'' D Short Plat** ❑Change of Use 0 Binding Site Plan** 0 AddressD Long Plat** ❑Address 0 Road Approach 0 Planned Rural Residential Development PRRO ** i ❑Allowed"Yes"Use ConsistencyAnalysisD Plat Vacation/Alteration** p ( YAmendments ❑Stormwater Management ❑Shoreline Master Program D Shoreline Managemnt Substantial �rinvlsrons'* Cl Site Plan Approval Advance Determination SPAAD * Development** ❑Temporary Use ( ) ��Shoreline Management Variance Cl Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication* D Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment Please identify any other local,state or federal permits required for this sproposal,if known: DESIGNA 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 his,her or it's knowledge. Any material falsehood or any omission of a provided herein,and in any attachments,is true and correct to the best of may result in thismaterial fact made by the owner/agent with respect to this application packet 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 ol or in consequence of the granting of this permit I further agree to provide access and right of entryto Jefferson review and any requiredprovide d later Inspections. County and its employees,representatives or agents for the sole purpose of application hours ss and right of entry to this property shall be requested and shall occur onlyduring Signature: g regular business Date: /2 —0-5 The action or actions Applicant will undertake as a result of the issuance of this of an endangeredpermit may negatively impact upon one er more threatened or endangered species and could lead to a potential-takee "Endangered Species Act"or MESA."Jeffersonno species as those terms are defined in the federal law known as the permit has been issued will not violate the ESA Any individual.group or agency can fiassurances to the applicant lawsu t onn behaalf of will endang ered ken because this action(s)even if you are in compliance with the Jefferson Countydevelopmenta species regarding dual and non-transferable responsib" herin to and code.The Applicant acknowledgese � g Y� 9 complying with the ESA. The Applicant has read this d'isda mer and signs and datesolds below. Signature: Date: i 2 -Gs-. G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • • SPECIAL CONDITIONS FOR CASE#BLD05-00585: 1.) The application was reviewed by the Jefferson County Department of Community Development staff on September 30, 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: seismic hazard, stormwater, coastal SIPZ, Susceptible Aquifer Recharge Area, and stormwater. 2.) This proposal is for the demolition of an old dilapidated house with no septic system. No new structures are proposed as part of this application. Based on the nature of the proposal aquifer recharge issues, coastal SIPZ, and seismic hazard are not a concern with this proposal. This property is located near a bluff but is not in a landslide hazard so only building code setback requirements would apply to future structures. These issues will be addressed at the time future development permits are applied for. The property is located over 200 feet from the OHWM so shoreline issues do not apply. Issues related to access such as road approach permits and open right-of-way should be addressed with this permit but would be a requirement prior to the issuance of any future development permits on the property. 3.) 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). 4.) All disturbed areas including areas where structures are removed shall at a minimum be re-seedinng with native grass and straw or mulch spread over the areas. 5.) The applicant shall contact Terry Duff at the Jefferson County Public Works Department at (360) 385-9159 to see if a Road Approach Permit and/or open right-of-way process is required for this proposal. 6.) The removal of the exsiting structures would not create or add over 2,000 square feet of impervious surface and would not result in over 7,000 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal submit a Stormwater Plan for a Small Project, which are construction best management practices (attached). 7.) 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. 8.) A Stormwater 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. • • 9.) 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). 10.) The site plan as submitted with the demolition permit(BLD 05-585)on September 12, 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 September 30, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 11.) This approval is for the demolition of a house& associated development 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. 12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 13.) 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 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). 14.) All debris from the demolition shall be disposed of at an approved landfill location. 15.) Approval of this demolition permit does not vest the applicant in any future approval for a residence or other structure provided with water. No assessment has been completed or submitted for onsite sewage suitability. I:\F_BLD_Permit_Propane.rpt 10/29/19 � goly cO JEFFERS OUNTY �� `/ • ' \s a DEPARTMENT OF COMMUNITY •._ ' ' 621 Sheridan Street• Port Town :n• • d[zir._ +•n pop L5 ^'111> 1 360/379-4450 • 360/379-4451 F2 •p� www.co.jefferson.wa.us/commdev- 9• ent 1jINc'`� SEP 12 2005 J Master Permit Application I MLA: (5--5n- Project Description(include separate sheets as necessary): , Tax Parcel `� Property Number: 9';l y 0 / O Y T 6 C.,t6 Size: 2'aa 00 0 (acre uare fe) Site Address and/or Directions to Property: '~y SO 2 v e , is 1-7-114a/C L.ky cLiil 3 3 Property Owner(s)of Record: o;n,� ( " i.64.(kii- =C} b Telephone: 3 E 0 3 a7_5 S y3S Fax: email: QF13s &.Ca tole p e&cf CCvo Mailing Address: 7/ CIA w.cac,.v..v.. C_:e,,K ©,r�_ iCr7-174e/ec (< zc-s4• /a3.21 Sr Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) lri,Building ❑Variance(Minor,Major or Reasonable Economic Use) Demolition 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 0 Boundary Line Adjustment El Modular ❑ Short Plat** ❑Commercial* ❑ Binding Site Plan** ❑Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication* 0 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 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 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 inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: iF Z__„) -- Date: /Q /2 —0 5 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 responsib'' hering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: 2/Z -0 5- , G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 1 • 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 tha. 'will be as .ling the res 'y of thr '' 'era,Contractor' - proposed project. Signature: �:,�-.a�J_ ��o-----'.s`._` — Date: ' 5"-- ,rt 1 , M 4 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: &IPG.vrS rv7, �v_v(-- sac � (5 Q ) 375 .� (Cc) ( ) y MAILING ADDRESS: /1 VIA(4..3.9 c." sr: Jay 7-VIA_t K EMAIL: '\ CONTRACTOR'S LICENSE LA/ 4, 9'.6 3 3ci WAINS NUMBER: &e&v� 9 r 061. 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 O Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System ❑ Repair ❑ 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 Prolect 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: O Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove 0 Cook Stove ❑ Woodstove 0 Fireplace Insert 0 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 T� F ire sef p f ' Current Prop -•r)` �' MW U' Amount;_ Main Floor N . -71 ste e w. 1.1 1 op 2r,u Floor .A SEP 1 26 . 3ra Floor 1 --_. A, ..- •ectior: i,'.I n Mezzanine: -- -- p ' J Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carportco.50 TOTAL: j Decks Receipt Number "7(0(0 'l 7 Other Cash/Check Number:) ESTIMATED COST(REQUIRED) Date: �;`'t ib�J *Fair market value of all labor and materials foundation to finish Initials: 1 . G:\PemritCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc i`- ,.// . 1 s IIII -- ■ _ Z. 11111111;11111k1111 immi 1. -- _ , _,..,,,_ _ i . rim . P !' iiiiiii : o-- o oIF ■_ r __ _ t i -_I ---- fi f — - _ 7 .4 _,. „ • • , , _ ___-1- -----r---- L , , f f. _ _ 7iLt_I. I ,..t ' c) L r I I .-i ! -r- t -VI •4 ii 1 — , r-- -i- - -/- 11 I t- -1 ,. I --h a r-. I 1 ■ kI - 1 11 T I`b % r 1 r I - L 7 - ; if' -r-- ---r , I ;. ...I V5-0 • . - i C53 a I - I I (7) I p 0 : , a , , -7- I, , , , , 1 . , , . 1 -- - - - T I --- �� - I N I - . 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