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HomeMy WebLinkAboutBLD2006-00004 • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00004 Received Date 01/6/2006 SITE ADDRESS: TROUT LN Issue Date 02/9/2006 APPLICANT: MACHAEL & ELOISE LANGEBACH PHONE: 51 CANAL LANE a CO =1� P_1a -1 BRINNON WA 98320 SUBDIVISION: OLYMPIC CANAL ADDITION 1 Block: 1 Lot: 4 PARCEL NUMBER: 980100105 Section: 21 Township: 25 N Range: 02 W CONTRACTOR: F&L PACIFIC PHONE: 360-736-6286 2510 SANDRA AVE CENTRALIA WA 98531 Contractor's License: FLPAC**283J6 Expires: 2/22/2007 PROJECT DESCRIPTION: GAR POLE BLDG -UNHTD -NO PLUMBING CALL IN FOR THE REQUIIEI� INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: `l46/Ob UFFER: Footing: n:G 1/q/D6 Foundati Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Sheathing: Framing: Plumbing: Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval 104 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 110 • MLA06.5 BUILD ING PERMIT APPLICATION Review Type:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00004 Received Date: 1/6/2006 SITE ADDRESS: TROUT LN BRINNON, 98320 OWNER: MICHAEL G LANGENBACH PHONE: ELOISE A LANGEBACH 2524 MORSE RD SE OLYMPIA WA 985013867 OLYMPIC CANAL ADDITION 1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 980100105 Section: 21 Township: 25 N Range: 02 W CONTRACTOR: F&L PACIFIC PHONE: 360-736-6286 2510 SANDRA AVE CENTRALIA WA 98531 Contractor's License FLPAC**283J6 Expires 2/22/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP GAR POLE BLDG -UNHTD -NO PLUMBING TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 35,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 2,016 SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: V/Cl/ LE Type Amount Paid Bv: Date: Receipt: e / Permit $492.25 LYK 01/06/06 78798F a` Plan Check $319.97 LYK 01/06/06 78798 State Building Code $4.50 LYK 01/06/06 78798 FEB 2006 Total: $816.72 Jefferson County Plannir- & Building Department N'1^_- • SPECIAL CONDITIONS FOR CASE # BLD06-00004 • 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.) 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. 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) 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). 10.) Maximum lot coverage is not to exceed 25%. 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.) 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. 13.) 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. 14.) Minimum setback from Trout Lane right-of-way shall be 10 feet per variance granted by DCD on August 26, 2005. Minimum side yard setbacks shall be 5 feet. Minimum setback from SR 101 right-of-way shall be 50 feet. I:\F_BLD_Permit_Buildng.rpt 10/29/1999 _�...... if' 0 /' r `� s o P © fr' _ ` �J j t s. � � �_ S �'________ K _ I o-,1/4_9 k" Ng c.). . 00. 001,, d ca Ni 3 i 6 0 { i °kit( 4- '" 1 4- I J1 __a zo, z. 4k a i ,, ti U I r I1 V) 1 ' I-. lw AL w .-.., i (0 *ill, co it 4 111. a- w m i . -�1 .Z.1\ ..s VI __1 S' cS` o IJ ( wz end M i. • • • ��gsoI ikeei JEFFERSON COUNTY ►�� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 O 360/379-4450 • 360/379-4451 Fax Ne*riNG` http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# ('L- 5 PROJECT/APPLICANT NAME: F7'� 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 snap. 2 pichi Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. j 1)C4 fiezc 6) Nr)/Li/° t X/5r5 curl Folf��/�' rx �ir-�r �:f S - is-/c`'> ri:' ��t 3. Describe the existing vegetation. Indicate native vegetatio areas on the site map. F/.- fr-eS Cad Min?ere 5/45-nd N.r al'r'/dc7ors 4. Describe the existing soils. Indicate soil type on the site map. r , (1.4/ ) ..°xzrx/q s">f plc' (:2reQ.5 _ 5i2rrJ, IJJ 4/4) (.rIQ/ Vel),/x , ri/di 5y 21c'i /2."fa' 'f e. r5 /-ezis - 49 rUJc 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. (it i/-eixi //Gc[/f_i bee. /J CJ7J /e / 4/er (, ai;7 5 X-/I��u�f� .56;/' J:ze. iL £,41. 41., APPROVED 6. Describe any excess levels of noise generated by the proposed use or activity: STORMWATER FR PLAN rEB — 2006 Stormweter JEFFERSON O NTY DE PT.OF C1NA I .VF4.0 M)NT storrnwater site plan template-rev.10'1/2003 Require SIGNATURE: }t/l 5 f� `1 Nl �l�if •` • • 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. 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.)hf /,/'/ J� [ y y- y /c pry( 2-� Ci1� (L- -�.-C f,'ir-la-/cif f�/V .' LzJi-S-/) z'/! c t� f 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. ;>i "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.it Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. fd*i/� /J . it`J z 1 Z /'' > �, 5 y �r; C 279 � t Wit_ �'! / 7 C`77�ipr' 7f�s`�/� ?� Ye, 47 5 y�//ce r-`7 `f—/�C .e./i ,- 4% • /-/ rL//7 -1 %i"%r:1,7�"1'' /2 (1/`711 c;..t --;c-41 9 ,/,/..?JLr�'CZ%L/rJ 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.] 11. Describe the performance goals and standards applicable to the project. -4e. vt/ i -) 7�� ��'G�r�<'c' u`�/1f 6=-/).f�i c` f%�C-'s�%f _4/15 .5L.t 12. Describe the flow control system. 4(1"-Mai of w-)d t' 5eC/1/i/977 r //// A:- s di- stormwater site plan template—rev.10/1/2003 6 • • 13. Describe the water quality system. f'c:t /lice.' f!rati .[.xe crf'" (h/eJ 14. Describe the conveyance system analysis and design. It's/ t' 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 9liau4J -sil / / / , yee,. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. r%C% Chd-i e!?i73/,5-Az ,4- ?1,. C=%/./3/, 17. Describe the proposed surfacing material. rung/ /c04in C 'e'U/J (/"i15lied 1Z'C'I__- 18. Describe methods for restoration of the site. .1;fr G<' it F', 14-e- ! G c�c�klt pa/ 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"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. /1)//ei — 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements, describe those conditions or restrictions here. A1/4) stormwater site plan template—rev.10/1/2003 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. • � / /rcC Uid / 6/04/MS AL E S Chd A ,1-6 h ui r 2. Establish Construction Access. ee ,5 4eou9h /rr. -cdJe. 3. Control Flow Rates./ / ) is 4. Install Sediment Controls. r j c I�C'/e5cf_zr , U 5,�� Fj7C.1e 0 i' 12vr' bezti..S c<;>i t ' (IS(-, 5. Stabilize Soils. t c i'of r-'.Sji ..VN tedii ath LY (.. .); 1 " id�,l�� 6. Protect Slopes. 711 i / I1 r ree/ ?ivoyel&;Lg�i'(4 % 7. Protect Drain Inlets. /0//9 ra.16:11 stormwater site plan template—rev.10/1/2003 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. 5-1 f N. (r1>/I he, /. erzro 24 z ,7 c2i /n 54,(4-) akz y ? ' 0 r 5 ec,rre riti9c /Yr v-,Lr( 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 41 /n 11. Maintain Best Management Practices(BMPs). c:/5 c'.) 6 I we!ev t-027.5)144 c/ f77 ., .4/l leivivarq jrr' /z S `7f) d 5 f �'. ,./(,),1;-e 12. Manage the Project. f r % /'Y./1'I aT sT - y'tekt./, titef" ,�i'? C`��/ �rs����� lC1t�%i{'�c.L.t�t'/� 1A2..L/3L- 5( seyny ''L ✓f�/ /�P b' ; M �a-A /, F'S 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). G`/�C'l/'I/ /lL i- e e,? L7G'x1 /E'.7 C1� fCl//eh'11 4 / • 'IJ f :', ' /Liar _ /a/ 41- r r p-- , lc J ,f 2' ' / n ' b. Description of t a downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). h/1r f/G)/ (7.A al&Py ,,k.)6/01 c G� , iatZ 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. //////' stormwater site plan template—rev.10/1/2003 9 • • 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). y A2'A 5. Construction Phasing. a. Construction sequence b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schgdule. . (!;-%L (JCt.l( /l s%/' / ! /9(155./,& , /a-tet II. Wet Season Construction Activities. a. Proposed wet season construction activities. 4 b. Proposed wet season construction activities for environmentally sensitive areas. / " ,/''f 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. ✓rh/r `lc / b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. / /_ / ,`/ ////cht76.4 9 / 7c-) L r a/1.1.9cy/:7lley i 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. /L'/' '9 b. Diversions. r �' c. Waterways. d. Runoff/Stormwater Detention Calculations / // stormwater site plan template—rev.10/1/2003 10 . 4111 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 affecte property. (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/1/2003 12 OJANT ' 7 JEFFERN COUNTY Master Permit Application 6 2006 i � LA' 0 ( _ -5 Project D J ption(includes a to shee as ecessary): C V'Cil 0IY, C c.//?(1_ 1 h CI 061 11 ,..g_r) t,211 uJ d io [ I cl Tax Parcel ,-'+ ,--) , CO j Property Number P ."4 l c .3 Size: /() 2c^� $7 (acres/square feet) Site Address and/or Directions to Property: /} Property Owner(s)of Record: A) C IA t 1ci � � �t9 1 S � Lc- it '.� �, a t. 1 Telephone: 2. Fax I� email: (c2 rt f r Pt Itll[r +� �;, {�c►Y`t(,'i`t Mailing Address: S � av►cr i L“,VI ,..4.A h o h C C `r 511 igfZC? , Iv Applicant/Agent(if different from owner): Telephone: Fax email: Mailing Address: What kind of Permit?(Check each box that applies) ABuilding [7 Variance(Minor,Major or Reasonable Economic Use) 0 Demolition Permit El Conditional Use[C(a),C(d),or C)— U Single Family [1 Discretionary'D'or Unnamed Use Classification Garage Attached/Detached ❑ Manufactured Home 0Special Use(Essential Public Facilities)** ❑ Modular 0 Boundary Line Adjustment Li * Cl Short Plat** o Change of Use Cl Binding Site Plan** Cl Long Plat'" Jif.Address 1 Road Approach Cl ❑ Propane Planned Rural Residential Development(PRRD)/Amendmerrts ❑ Alloweds'Use ConsistencyAnalysisEl Plat Vacation/Alteration** 0 Shoreline Master Program Exemption/Permit Revisions" ❑ Stormwater Management 0 Shoreline Management Substantial Develo ❑ Site Plan Approval Advance Determination SPAAD pni�t'. ❑ Temporary Use ( ) 0 Shoreline Management Variance ❑ Wheless Telecommunication' ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium* 0 Jefferson County Shoreline Master Program Amendment 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: I hereby designate DESIGNATION OF AGENT to act as my agent in mattpre._."-"-- • -- s application for permit(s). OWNER SIGNATURE By signing this application form,the owner/agent attests that the information ' t O n D55 his,her or its knowledge. Any material falsehood or any omission of a mat€ s true and correct to the best of may result in this permit being null and void. i 1 rect to this application packet I further agree to save,indemnify and hold harmless Jefferson County again; L,'T expenses which may in any way accrue against Jefferson County as a result onable attomey's fees and I further agree to provide -ccess and right ntry to Jefferson County and lb permit.review and ,:�•ired ter in-._ction. and rig . ent to this pn the sole purpose of application hours. my during regular business Signature: anJ/'/ 4/ #/ .:_ 444/ L.. — Date: /— ‘— d 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 Countymakes no assurances to the applicant pplignt that the actions that will be undertaken because this permit has been issued will not violate th.'•, Any individual,group or agency can file a lawsuit on behalf of an endangered species r action(s)even if re i con iance . e Jeffers C unty development code.The Applicant acknowledgess individual g yourl and non trans r res nsi ity for:.._ring to an ng with the ESA. Thethat he,she or it holds individual Signature: ..?,e n Applicant has read this disclaimer and signs and dates it below. // Date: / --0 6 G\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc • 411 OWNER BUILDER STATEME ,:," . "`''"-'—I;: _ ff M The signer of this statement does hereby certify that they are the Owners of the parcel refereri d F bre not n ens cdntradors and that they will be assuming the responsibility of the General Contractor for the proposed project , l Signature: Date: . i .. 0C GENERAL CONTRACTg R OR MANUFACTURED HOME INSTALLER: PHONE: Fax:„....,_. 4 F , L ///ckc t c-i (:360 ) '73 4 2,8'6 ( ) MAILING ADDRESS: t5/0 Sctna►"t"1 Ait 'Z cY•'IE,t'r)ta ( gr 1IL: CONTRACTOR'S LICENSE ri 8 j 3 i WAINS NUMBER: F 1- 04 c- 14 "2- 3: A NUMBER ARCHITECT/ENGINEER: f)) 1 t GL N a- 4.yicj i ri�}ti r i vl el PHONE (c ;,�) t; ,ci. j 7 Z 7 FAX:( ) MAILING ADDRESS: 97CC 4 r 5/•NEs v,_ . /y J.,/..vn 0 t"' EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: iik New $Q.. Wood Existing: Al A ❑ Sewer 0 Addition f( Steel Proposed: Bank L,A. ❑ Communi$JSys m ❑ Alteration/Remodel ❑ Concrete Total: Heigh{" ❑ Individual System ❑ Repair ❑ Masonrx SEP Permit# ❑ Demolition ❑ OthertA Bedrooms: Water Supply: n,1 l l i to- Existing: f i A_ Setback: i] Private well it 17 f. wo Party Type of Heat: J Proposed: 0 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: I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove 1 Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove I 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 I Main Floor Consistency Review: t 55. 5. CO �2Nu Floor Base fee: -cta. as 31°Floor Additional Section: Mezzanine: Plan Check fee: a Heated Basement State Surcharge fee: 4 5 p Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Ap�^ach fe4 Garage/Carport L/J, -7 n C c' I G: `15 1. &yo TOTAL: $ ( a, Decks Receipt Number: PI Z'1 g Other Cash/Check Number. 1 ( o Bl ESTIMATED COST(REQUIRED) Date: (4� .Fair mark vatic.off ne!m " s foundation to finish ( � ` 3 i - b c Initials: C\Documents and Settings\mochiI\Desktop\Master Permit Application 7-8-04.doc