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HomeMy WebLinkAboutBLD2006-00090 • • MLA06-00089 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00090 Received Date: 3/3/2006 SITE ADDRESS: 91 E ALDER ST PORT LUDLOW, 98365 APPLICANT: DONALD E RHODES PHONE: 253-922-7906 DIANE RHODES 6216 44TH AVE E TACOMA WA 984432463 SUBDIVISION: PARADISE BAY ESTATES Block: 10 Lot: 16,17 PARCEL NUMBER: 983401016 Section: 23 Township: 28 N Range: 01 E CONTRACTOR/ JAIME KOZELISKY PHONE: (360)385-3215 DEALER: 1112 S JACOB MILLER RD PORT TOWNSEND WA 98368 Contractor's License WAINS0626 Expires 7/31/2007 INSTALLER: JAIME KOZELISKY WAINS0626 7/31/2007 (360)385-3215 1112 S JACOB MILLER RD PORT TOWNSEND WA 98368 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MH TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW VALUATION MAKE: SKYLINE SETBACK: YEAR: 2006 LABOR & INDUSTRIES APPROVAL? SIZE: 47X27 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: o,\6 ocpC Type Amount Paid By: Date: Receipt: APB' Permit $163.00 LYK 03/03/06 79132 V Potable Water Application $55.00 LYK 03/03/06 79132 APR 2006 Total: $218.00 Jefferson County Planning �p n & Building Department • MANUFACTURED/MOB ILE_= HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD06-00090 SITE ADDRESS: 91 E ALDER ST Received Date: 3/3/2006 PORT LUDLOW, 98365 Issue Date: 4/7/2006 APPLICANT: DONALD E RHODES DIANE RHODES 6216 44TH AVE E SUBDIVISION: TACOMA WA 984432463 PARADISE BAY ESTATES Block: 10 Lot: 16-18 PARCEL#: 983401016 Section: 22 Township: 28 N Range: 01 E CONTRACTOR/ JAIME KOZELISKY DEALER 1112 S JACOB MILLER RD PHONE: (360)385-3215 PORT TOWNSEND WA 98368 INSTALLER: JAIME KOZELISKY WAINS0626 1112 S JACOB MILLER RD PORT TOWNSEND WA Expires: 7/31/200; 98368 PROJECT DESCRIPTION: NEW MH MAKE: SKYLINE YEAR: 2006 SIZE: 47X27 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 4/7/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): Stormwater FINAL Approval: Blocking/Plumbing: n, r"�, , d'r' • - • Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: z , HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR 'O FINAL II THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWEC BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDL' Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY-SEE REVERSE • • SPECIAL CONDITIONS CASE # BLD06-00090 1.) A minimum of 45' is required from the east property line to the eastern edge of the home for drainfield and reserve areas. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on march 24, 2006 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 4 stream &coastal SIPZ. 3.) There was a 196 sq ft cabin established on the property in 1965. There was a100 sq foot addition to the cabin, which brought its total size to 296 sq ft. Public water and utilities are installed on the property. A septic permit (SEP 00-13)was approved on 9/5/00 that reduced the setback from the stream to 75 feet. The cabin was in existence until approximately 2/10/03 (per the Jefferson County Assessor's Office). A site visit was conducted by DCD on 3/24/06. This cabin was located approximately 15 feet from the Type 4 stream. The stream has been modified (rocked)& has grass planted to its edge, other residences are located within 10 feet of the stream, and the stream is curveted immediately to the north under Shore Drive and the south under Alder Street. The proposed manufactured home would be located approximately 40 feet from the stream behind an existing 40 inch tall retaining wall. The previous cabin was in existence prior to the adoption of the Unified Development Code (Title 18 of Jefferson County Codes (JCC)) stream buffers standards, which became effective on January 16, 2001. Environmentally Sensitive Areas - Section 18.15.215 of the JCC states that a non-conforming structure (i.e. does not meet current buffer requirements) may be restored/reconstructed. Streams - Section 18.15.300 also states that structures may be reconstructed within the stream buffers. The proposal would locate the proposed residence further away from the steam than the previous cabin in a developed area that would not require grading or clearing of native vegetation. 4.) A Type 4 Stream (Fish and Wildlife Habitat Area) has been identified on the subject property. The stream will require a setback of 40 feet(i.e. behind existing retaining wall). The reduced setback is based on the existance& location of a previous cabin (i.e. see non-conforming finding). 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. Existing lawn area may be maintained as provided by Section 18.15.300 (3) of the JCC. 5.) 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). I 6.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 7.) 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. 8.) The identified Fish and Wildlife Habitat Area (Type 4 Stream), shall maintain a vegetative buffer setback of 40 feet (non-conforming use finding). The setback shall be measured horizontally from the Ordinary High Water Mark(OHWM) to the proposed Manufactured Home. Existing lawn area may be maintained as provided by Section 18.15.300 (3) of the JCC. 9.) 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. 10.) 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. 11.) 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. 12.) The applicant is proposing to create or add 1,600 square feet of impervious surface and 1,600 square feet of land disturbing activities. Sections 18.30.060 & 18.30.070 of the Jefferson County Code requires that your proposal submit a Stormwater Plan for a Small Project, which are Construction Best Management Practices (attached). 13.) 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. 14.) 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. 15.) 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). 16.) The revised site plan dated March 29, 2006 as submitted with the Building Permit(BLD 06-90) application on March 3, 2006 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 April 6, 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 17.) This approval is for a Manufactured Home 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. 18.) This property is Lots 16 & 17 of Block 10 of the Paradise Bay Estates Subdivision recorded April 4, 1955. This property is designated Rural Residential 1 dwelling per 5 acres by the Jefferson County Comprehensive Plan adopted August 28, 1998. 19.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 20.) 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). 21.) The building height is not to exceed 35 feet. 22.) The front setback is 20 feet from the edge of the right-of-way of East Alder Street. The side (west) and rear(north) setbacks shall be 40 feet from the edge of the Type 4 stream. The side setback from the eastern property line shall be 45 feet(per septic requirement). 23.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 24.) A minimum of two off-street parking spaces shall be provided. Off Street means located outside of the county right-of-way. 25.) A Septic Permit (SEP 00-13) was issued on September 5, 2000 & septic clearance was provided by Environmental Health on 3/29/06. A Road Approach Permit (RAP 06-43) was reviewed by Public Works on 3/13/06 and an address of 91 East Alder Street was assigned to the parcel. ,...: _.i. , I : f „ ._1 . .i. ,_i_e___.. .. _. _..,..b _I . .1 :....____‘..__. 4____:_l_i .__._ _...._ _ 1 i i ! ' i , . Fr .. , . . .. , T Z W t G� 7 -: ( , t + 1 t ci,�' o t I J. .-+RI :1.. v. �im'�`�''•ti='"r7 t�n�'r.�.,� � i. ' FT'1 U -� i , , .r, . 4 moo- ` I. - ' t - ,-fir —� — , / • 1 ;- T..- _ 1 • • —# 'may —�• .._4�... i f i ; b '1 i i �3 a _ ... s r • f ' ( w* , ; - - - -- - -A : - -.1 - f may. _ _ i '1 r,. 1 ,. : .. : „,_ .,,,,, i ; .......„ ...„ ..,.. . . , .if Ott r ' fir i ►L LJ _ f f-— h -t-- 1 t , �;.. r t ate' _ i , b + ' Lp 11 t • 4 i= loi i ,i i , I \ 4 4 4 \ 1 4 i 1 r7 h - I. i i , f 4 — t . _ i I ( �, I . . c_-..-r-'"- - - , c.i: ';'"- ils-.. 4- '; • --i-• ; .',., . E i' 77HTLL * , ' t + i itt 3 r y t+ram t JI t t t4risah. • 1 T� 1 � � r ' ---i-- ` .: , - -- -- -- t — ice' - --. _ ozo 7-7 oi � 1 I s % • _ oiii , t r t JACK WESTERMAN II Jefferson Co• %t, Courthouse ASSESSOR Po Box 124pPort Townsend, WA 98368 (360) 385-9105 Jai MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: bcYI VVIOCAe� ADDRESS: ic11i -t1 V\\ -'fg .Ave Pout!SIoo qe '10 MAR — 3 2006 PHONE NO.253- S0 JEEp ey_. The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 1)MOBILE HOME DATA: (A) MAKE SK- k n (B) MODEL n S 1lntt)✓) (C) YEAR c (D) LENGTH 10 I (E) WIDTH_ 2,1 ' (F) SERIAL # (G)YOUR PURCHASE PRICE (Do not include sales tax) � PURCHASE DATE z ( 6 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: ( NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE a e<,--k A-lc>WA-Q-S ADDRESS I \ C., 4 A `a J -TU (B)WAS MOBILE HOME ASSESSED IN JEFFERSON COU LAST YEAR?Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes o\' (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: LOCATION ADDRESS r i t IkCl eY Sk • R &S 3 J REAL PROPERTY PARCEL #/DESCRIPTION -I?) -40 t " b Lp Signature of Pliktnt THANK YOU FOR YOUR HELP! SS-�X JO COSSELL, Property Technician isle .,„00240,00001.44741P)"" 1.1 \ a ?(• '. \‘,./ j t 11111111111111S. / 11117:\, C.17. -7. ._...• w r sommisie . -I. \ ... ? pp i • , r-i •........ MAR - 3 200 E6 , 1,, ' •-, JEFFERSON COUNT)/ [in -.) . i 1 , 1 I k LI IV'? F-1 1 - I) © INNLO / IIN 11111111' -t /, us ., , ) s. g' I )11h. '''''•, .. •'kir r eP1 1 1 .,... -) 1 f-- (---) 'f,== 4P .1-. ,-- I" •-1 I '--' ._._ --t Li sr ‘ e I 0 1 1 1E1 T 7..... .....4‹ r! s ( 4"... ...... lei,* 1. ,'r.ir til—c.i-Z.'.."-c::: c:3'CO •0 .......4_,C...... ai .:,-, Li• .- co CA Cu 4:- ."-' '..) I- • . ' 4. a • Z i ,G, e-46,... , ...C.:0, . -. . .. 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FEB-11-2006 15:56 FROM:000OP('' BEND RV 9283430699 TO: 13606974606 P:2/2 • • , Fey_ 1 1 . 2C05 3 :32PM 1011N,4, 177::phT)LRO Y bQ B 5 3 F . 2 ARTTCOMMUNITY DEVELOPMeNT '' "d 621 Sheridan Street• Port Towneond 360/378-4460. 3SO/ VJa�hington 98�C� p++� nn II i-i i, 879-e14S1 Fax tISlILiIQIV [; (1!�(ii Il,ti 'S'$ t3ts0 tww.cOjefferson•Wo.us/commdevelOpment Master Permit Application C _ Project Descriptionprelude separate sheets MLA: i(, ,C+ Tsa-c, AS. las ecesettr�; I Tnx Parcel Number a k — d rC Property SiteAddress and/or Directions to _ Slat, (acres/square reset Prepeny: / Property Owner(*)of Record: r a o / c? _,•_ � ��z � Q Telephone: S • _ -- .9'Go U '�'� Melling Address:�p� Fax _ A all: Applicant/Agent(if different from owner/y i� ���"� w" �� Telephone: �� Mailing Address: Fax small: What kind of Permit?(Check each box that applies) wilding �� n Dorno6tton Pernik Variance(Minor,Major or Reasonable Economic Use) 0 Single Family rj Conditional Use[C(e)•C(d),or CI 0 Dircretionetry'D"or Unnamed Use Classification Garage Attached/Oetgched •t€r-Menuhtctured Home 0 Special Use(Essential Public Par:tales)" 0 Modular U Boundary Line Adjustment Cl Commercial• 0 Short Plat 0 Change of Use 0 LBinding Site Plan" 0 Address 0 Reed Approach 0 Long Plat" ❑Propane ----1_ 0 Planned Rural Rosldential Development(PRnD)/Amonaments" ❑AIIOw@d Yea'Use Consistency AnrAlysis El Plat Vec ation/Alteratton" 0 Slowed ter Management ❑Shoreline Martin Progra m F roption/Pe3 - Revision*" A Site Plan Approval Adva►ce Determination SPAAD 0 Shoreline Management Valiance0 Shoreline Management nQe Subanpntial Development*' 0 Temporary Use ( ) 0 Tempo'Telecommunication= 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Forest Practices At t/Release of Six-Year Moratorium 0 .wfferson County Shoreline Mas4or Program Amendment 'May r ettvfre a Pre-Appflention Conics ice "Requrrtie a Pre-Appficsdion Please Identify any other local,state or federal permits required for this proposal, If knownoe I hereby dssteignety -�- (l' (�. ;NATION OF AGENT act as my agent in matters relating to this application for permfl(s)- / < OWNER SIGNATUR- i Date: ,2- /7 - �� By signing this application to a 1. ,,t,�` latter provided herein,and in a Ills,her or It's knowledge, Ai 3� V, \ m eansr tact made by the owner/agentcwith respect to thb applue,is true end �icatto to the pAckkett may result In this permit being nul I further agree to save,Indnn u yr\(1\\n(,,.1 5 I C•\A(4.`41., against all debilities,Judgments,court costs,reasonable sttomeye fees and expenses which may In any t result of or in consequence or the granting of this I further agree to provide ace C-)�k \ ,� C Q o a ��n• review and any Inquired later t and rta employees,representetivelt or agents for the sole purpose of application I hour,, lni r�PPer y shaft be requested and shall occur only during regular business Signature: Y Lk i.- Date: z' - L 8 t: 1 The action or actions Applicant will undertake Re a result of the leeunner of this permit may negatively Impactupon endangered species and could lead to a potential'Make'of an endangered species es thane tetras Are deined in the federal law knowngaslhor e "Endangered Species Act"or'ESA.'Jefferson County makes no nesuranrxa to the applicant that the 9dlone that will be undertaken snouts this has been Issued will not violate the ESA. Any individual,group or a jency can file a lawsuit on behalf of en endsh it �� even If you are In compliance with the Jefferson County development code.The Applicant acknowledAaa that he she or holds Ilncfivlduol And non- transferable arding your Ofl(s) onelbl for adh rig to and complying with the ESA, Tite Applicant Its,read this disclaimer and signs and data it below. signature: j Clato; - c G.\PeanitCenter\FORMS\DRA FORMS\Muter Permit Application 11.30-05.doc (� y C �� c/ 4 a-7 r '/-� ' 5 „ - /rJ/(l s' /r"N'r 5r-ei C /,6 BUILDER STATEMENTIII 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. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 2i-L- E'`71 f'Izit+.-t. .cc k-L)c rc.4 t NC ('�(GJ 3Ac-3 Z)S ( ) _SA-will AILING ADDRESS: HI Z S. J4C0 {L4 t L c? (L-L) EMAIL: k /N C t) CIA Q L SQt G i ( O k-2-, CONTRACTORS LICENSE ?-j 'TC::'..- NL9r'O c,4 WAINS NUMBER: NUMBER C '- ((- ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ci New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: ? Bank Height: I] Community System ❑ Alteration/Remodel ❑ Concrete Total: z N Individual System ❑ Repair ❑ Masonry /4 SEP Permit# 00— ) ' ❑ Demolition ix Other: Bedrooms: Water Supply: tti- r 1. tic-+yir: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ? / C-LF_C.7;2' c Total: 2 l'' ` it Public � 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 ❑ 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 milg Iso ObM6 site plan showing all of the buildings,all property lines, tank location and size, distances from the propane tarikla all property lines, buildings and septic system components, including the reserve area. Square Footage Current Propoaed For Officeike Only' ,'`_' • Amount Revision Main Floor Heated EH Bld App Review: (L5 C)G 2nd Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional'Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: _ ol) •OC) Garage/Carport SUBTOTAL 4'1CG () Decks 911 d Approach fee: Other 1 CQ • OD TOTAL: fr c.)0 Receipt Number: -. Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish .)5 'j n 1; Initials: / ) \G:\PermitCenterFORMS\DRD FORMS\Master Permit Application 12-30-05.doc l