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HomeMy WebLinkAboutBLD2006-00296 a • • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD06-00296 Received Date: 5/30/2006 SITE ADDRESS: 214 8TH AVE Issue Date: 6/14/2006 PORT HADLOCK, 98339 APPLICANT: LINDA& PAUL SHIRTS 7266 STATE ROUTE 20#20 PORT TOWNSEND WA 98368 SUBDIVISION: IRONDALE Block: 54 Lot: 20-24 PARCEL#: 961805403 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ MODERN LIVING LIMITED PHONE: DEALER 6119 PACIFIC HIGHWAY EAST FIFE WA 98424 Contractor's License MODERLL972DO Expires 4/14/2007 PROJECT DESCRIPTION: NEW MFH SERIAL NO. A608 MAKE: VINDA YEAR: 1971 SIZE: 65 X 14 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 6/14/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): ?(l 64 Y Stormwater FINAL Approval:Blocking/Plumbing: 9*--// /#06 Propane Tank/Lines IJ/A Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: OK --GA -cW l/ 446 HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY- SEE REVERSE • • SPECIAL CONDITIONS CASE # BLD06-00296 1.) The application was reviewed by the Jefferson County Department of Community Development for the presence of Environmentally Sensitive Areas (ESAs). The Department conducted a review and has concluded that the property DOES NOT contain Environmentally Sensitive Areas. However, future proposals will be subject to a new ESA review and conditions may be added if new ESAs are found on the property. 2.) The applicant is proposing to create or add 910 square feet of impervious surface and 910 square feet of land disturbing activities. 3.) 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. 4.) 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). 5.) The site plan as submitted with the manufactured home installation application on May 30, 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 June 10, 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 6.) This approval is for a manufactured home installation 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. 7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 8.) 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). 9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 10.) Minimum setbacks from 8th Avenue and West Arden Street rights-of-ways shall be 20 feet. Minimum south and east yard setbacks shall be 5 feet. 11.) 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. 12.) 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. 13.) The building height is not to exceed 35 feet. 14.) A minimum of two (2) on-site parking spaces shall be provided for the manufactured home. 15.) The lots have been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 16.) An address of 214 8th Avenue, Port Hadlock has been assigned to the lot. 8th Avenue is a county local access (C674709). 17.) The site is served by PUD water. 18.) The lot was created through the Irondale No. 2 Subdivision on January 11, 1910 under AFN 29135. 19.) A Declaration of Restrictive Covenant to consolidate the lots for building and septic purposes was recorded on September 21, 2000 under AFN 437373. i 20.) A critical area review (CAR00-352) for a septic system was finaled on August 7, 2000. A septic permit (SEP00-0187) was finaled on June 9, 2003. A road approach permit (RAP02-0080)was approved on February 21, 2003. • • MLA06-00274 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00296 Received Date: 5/30/2006 SITE ADDRESS: 214 8TH AVE PORT HADLOCK, 98339 APPLICANT: LINDA M SHIRTS PHONE: (360)379-9813 PAUL W SHIRTS 7266 HWY 20 PORT TOWNSEND WA SUBDIVISION: RNAT:g3 Block: 54 Lot: 20-24 PARCEL NUMBER: 961805403 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ MODERN LIVING LIMITED PHONE: DEALER: 6119 PACIFIC HIGHWAY EAST FIFE WA 98424 Contractor's License MODERLL972DO Expires 04/14/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MFH SERIAN NO. A608 TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: VINDA SETBACK: VALUATION 7,000.00 YEAR: 1971 LABOR & INDUSTRIES APPROVAL? SIZE: 65 X 14 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: to1© 2 AJVED Type Amount Paid Bv: Date: Receipt: Manufactured Homes $163.00 KAS 05/30/06 83418 JUN 1-I 2006 Potable Water Application $55.00 KAS 05/30/06 83418 Jefferson County Planning Total: $218.00 & Building De artment CBmil resat.�he c� fMil■■IMMUMSAM■■■■■■■■Mr MEMME■■■■■ lEHEINIMIHIMEEMIIIMMINIMINIMMIONIM USUMMUEMEMENNIMMEMEMEMMIORMEMMEM ifs ,:MEMUMAMM R.. ■■■■■■■■■■■■MEMEM■■ MMMEMBWAMMEMAMM7MIMUMERIMETMEMMI AMMEMEZMIIIIMMNEMMNIMOMEMMNIMMEMME IMMIWAMMLUMBLEMEMEMMEMEME I� i _�i I !� T:7MIrIIMM■■■■ WEMMMEMNIMMEMbligiiiiiiiiMILUMEMMEMEMEM ■ihi■■E■■m■■■■m ■um■enm■E■■■■■■■■■ ■OM MEIEEE■■■■■■■■■■■■■E■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■MBEME■■ ■■■■■■■■■■M■■■■■ ■■■!■■■MEMMEM■■ ■■■■■■■■ IMMEM■■M ■■■`MME■MS■EMEM ■■■■ ■■■s■M■■■■■■■■■■■■■■I■■..■■■ IIIMMEMMEMMEMEMEMMEMEMMEMMEMMEMMII ■■■■■■■■IEEE■■MEMEM■MM■■E■I■ESE■■ ■■■■■■EMmom■■■■ ■■■i■■■■■■■vr■■ ■■i■■■■M■■ *■EEMM ■■■■■M��■■■■■■■ MMNIMMEMMEMMEMMEMMEMEMEEMMEMMM ■■■■■■M■O■■■■■■Mi MEM E■■NEMBE■■■ ■■■■■■E■■■■■■■■■ '■■■■E■■■■■■ ■■■ ■■■■■■■■■■■MI■■■ o a MEMEM■■■■ M■Ei ■■■■■■■■MMEM■■■■ ■MEMMEM■■■■EMEM ■■■■■■■■■■■M■IMM ■ii■■■■■■■■■1lEM■ E■■■■■■■EMEE■ME= _■■■■■■■■■■MEMM MINIMMEMWMUMMOIMMOIMMEMMEMEMEMMEM MEMEEMMEMMEMMINIMMEMEMMESMOIMMEM ■■■■■■■■■■E■■■■■ ■■■MUNEMM■IEEE■ ■■■■■■■■■■■■e■■■■■■I'■■ ■■■emw r]■■ ■■■■■■■■■■ ■■■■■■■MEMMEMOM■■■■■ ■■■■■■■■■■■IEEE■ ■■■ENMME �I■■■■■ IEEE■■■■■■IEEE■■ ■■■■■■■■■E■■■■■ ■ ■■■■■IEEE ■■IEEE ■■■■■■■■■■■■■■■ ■■■■■■■o■■■■■■■■■■EMMEMEU■■■■■■■ ■■■■■■■■IEEE■■MME■r■■■■■■■■■■■■■ ■IEEE■■■■■■■■■Er■■■■■■■■■■■■■■■■ MEMEMIMMEMMEMMINIMMEMMEMMEMMENIM ■■E ■■■■■■■■■! MINM■■■■■■■MEMMEME MEMEMMEMMEMMEMEMMEMMEMMEMMEMMEM ■■■E■■E■■■■I ■E■■E■■■■■■MIME■■ JACK WESTERMAN le .1effcrso tr Courthouse ASSESSOR PO Ilox 1220 i1!"tiqt(7�bn c tM1 ,T ¶ 1' � 368 (360) 385-9111. t MOBILE HOME INFORMATION OWNER'S NAME/MAILLING ADDRESS: JET ERSON COUNIY DCO NAME: nc� wVk -, ADDRESS: ;2 \L{ Ave t-Iuri tbc IC (_kYA C'CRS3 PHONE NO. 3(-O -.0e1 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 '/± at- (B) MODEL (C) YEAR /9) I (D) LENGTH (G-5 (E) WIDTH 1 (F) SERIAL # A c e (G)YOUR PURCHASE PRICE (Do not include sales tax).7 Q PURCHASE DATE4/3/0(s, 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW(IMOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE �VTLlre (4om c ADDRESS 61,20 Kt-I-se, ,LAMQ$Z i 2 (B) WAS MOBILE HOME ASSESSED N JEF RSON COUNTY 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 No (B)IF LOCATED IN MOBILE HOME PARK: NAME & ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBIL OME P RJi• NAME OF LAND OWNER: J\ 5" 5 LOCATION ADDRESS f—ky Ave i- 1cck, c.,01 ge339 REAL PROPERTY PARCEL #/DESCRIPTION q(0S �d C=12 Signatu applicant THANK YOU FOR YOUR HELP! 4C1)Ss- Q Q JO COSSELL, Property Technician iii 10111 01111 4 t 4 g iil 7`.- ltakAZz„," ."47,L.,.L7 , .,,' lii-F,"' . .. Department of Labor&Industries . • ' CTUREP/MODLE HOME . . " 'RF CEI‘. ' ' Factory Assanbled StrUCtilreS Section .. .f44-k;c. . • A• • • . . ' A. i ors . ' . 107,k'.A 4,:. ' " ''• . . ALTERATIuNPERMIT •• • ,rz... •••••••••• •! ••:,.:*;,„4:..:.*, .•••••••''''''''•:........ •,•:;;•zonr,, ,,,,%:-,," •. INSTRUCTIONS: - • ,• -...rx,. '' he al ,t'.: '.......'- • ..' ' ' ' ' --:. • , • % ft.ai..,:- . - Do o4. - . .., - 1; -Complete all spaces;;including the signature box(marked witlifilk4.':0,20[I6 1. Draw a Wag on reverse side of WHITE copy only: -. - , . .' :. - ' - •:. - . . radpecil, ' I :1,... ;::,•,,,,;•: \ '.."- :.-•:....:..i,:;-"•k:':Weit,,.14r1.,,l,r.:11..iiiiitil 3..Forward completedVermit and fees to the:nearest-L&I°Tsp.,- See list on reverse. - • - iii- - .4.=Contact and schedule.the inspeCtion(s)lifth the same I.,84,1:Ufficelier the checklist .... . ' ,ii‘.1.4n.151.1\epOraWkli • are Owner last name ' first name Day time phone - 1 Date n't144.eP Cl.c. 19./IVX-K Address.' . , City .,,, State ZIP /.5-72. Z,4'„,/c/.-...,e-7- /? /LA' 1,4-- C'4--1 •Ve) 11/''Q 9 83i 0 Installer/Contractor/Dealer - - k . Phone , .,- • - : !Contractor's registration number ...,. ---......"-e7.,... ./; .4c' ''' i • . ( i era r 1,4-7, - 647.. /1041:asyt 4.(- 97.2.4 ) Address City • State,.: ZIP+4 Y ‘-).-° ef- 73-'/ge Ps-.41/ /024 ers-e.e. . . )4744/ 9 G-1 1 - i Serial Number(s) i HUViNdmixxi, s),I /- ri-ortt ourger . , Place fee amount in proper box , Place festamount in proper box Mechanical • 9/2342005 12:20:21 P ) ,.. „ . ., - Heat Pump i • • 1 , Electrical Perint FP 1098804 Air Conditioning Heat pump TransIct 101043725 Furnace Installation(gas or electric) . - Air Conditioner vas AO i • - -Gas Piping Furnace Installatiofin.16 Pinrafigtf) ••• , Wood Stove---- ., .i.:.,•,.:.:.,::i:.•,...:. ...:',...,..,. ::::,::.i?:i::: :]:i,..i..::i .::: - Wood Stove(if applicable)• Pellet Stove c.,:-- WP.,,U :ft•:; .:hq::,a':0,„..,:':':7 ,,.,_ Pellet Stove(if applicable) '-, Gas Room Heater . ....)/ /'t 7 f Gas Room Heater Gas Decorative Appliance(if applicable) Gas Decorative Appliance Range:changing from gas to electric Range:changing from electric to gas Electric Water Heater replacement Gas Water Heater replacement - .' lect-rie•watergeatas.replacing Gas Water Heater ._ .. Water Heater:changing from electric to gas .--..,. , • . • . ,. --....... Plumbing Each added or modified circuit Fire sprinkler system (also requires a plan review) ' ti Each added fixture Hot Tub or Spa(power from home electrical panel) ,. , Replace main electricalpanel ,r' ,.• , :. . , .. ... . ,,.•:: Low Voltage Fire/Intrusion Alarm Replacement of water piping systeiii ' ' '4; ..,./ . .fire-Safety • Structural [: 11 Inspection as part of a mechanical installation ., . .• . . . . (cut truss/floorjoist sheet rocking) ...:.', , . Miscellaneous • ," .- Reroofs(rnayrequire a plan review) - '-''.- ' • Plan review ' ' .,„., ,_ Li , .. ,,,.....,.. ..:.,.:;,:....:„........:...:.: ::: Changes 0"home when additions bear loads 6nlibtne per . •------- Reinspection---- :r.".'"'0,T,0:•'::::..:.'i'..::: ::::. .: t,t0:-.: :•,,, i,i.:• :.,,, W:::W-,•••'.1.:; :,'*:.::. the design of a professional(also requircsa plan review) _ Insignia i EilOther structural changes(may require a"plan review) - Fire Safety Other . ' Note: This permit expires one year after date of purchase.. (No,ncrefundable) , - lirhr Work is completed at this time. An irispectiorastequested. . . . Work is NOT completed at thit iime,T will citli'When'ready. : ..:, : . • :. , , . , Make check payable to: Dept.of Labor&Industries , ,(Signature of applicant or authorizediepresemative , F TDUE $ LI 9 0 •L3C--.. . ..,dg-- VIA 30:4010.01:444001111D1000004#01:00:440407°,'i.:4A#0100totOorOti*toorimoitoittog Ilt:449:10.„.:,0*****04„*Oxp#:kel:Ifiltiftli.04§0.4:10111„1,.440t00)0111ifii014:#,...,XOPOPI101.,klisOli ilwolitoOtliPtionotuctiotioapor4UP* W4S414#414001:6teit#0,40togogovut.w.gettOolortnic i4 .. „.::::::::e.em....,;ilimm::.....:., .....,......................::................—,...:,.........„...--,.......,.. arip*040:iitiookiiiiiiiio*./... .vpiplite...H::44::Aiiiiiiii :mi.i.inm . .,0,.:,:.,:,iii .oi§:ii .:.A,......... .,,.*.:....:....,/e.i:...::: .*:: :::„itm..:0 .....,:::i:i,..:::::i::.:::.:-...vii.:::4;v:,,,,..m, ..-..0.::::::.:;,::::::.::: ... ::iii:iiii:litrimiiminiiii:.:*..mviiiimm 111111411010,4„,1211111111r..410210400.0)1004$10614011111111111:111111.0111111111111.11111.1 moiii..ii:figinii:wime.iihmpiimRimitimii;imiisp§mq.*.dosiintagivvoiogolo,Now",,woki,„_.*.iftgoe00.0.0*.song.;logi ,i,... 4iaii.dime§i::iiW:.::,:e:i*i;:ci'w•offiiii .: A::ig:K*i:ii;i !:1„.fS.40.0:44.i*V:441.0.49g4 w4Fk.mytAXeop.w991Af0,4.110P:porttI.Tromemilmiogoimmiiiw.im:Nisiaim.imimg: . .:!....,....:. .......,,:.... .... .,.i ,::g :i:i.: ,..:.;?:i......................................................................................:.!,,,:....:,,.,..:.:"......::Atia44:w"..... imi:imi: ,i,........., :::*1:i:. ..-. .......:.:.......:.,:::::::::::*i:::::m:imionii:i,.. ..,g F62 '36-000 mfgd/mobile home alteration permit 11-02 White-Olympia Canary-Ins. ..r Green-Contractor Pink-Purchaser Goldenrod-Purchaser ,SON c 4� o� JEFFER. COUNTY III` \g DEPARTMENT OF COMMUNITY DEVELOPMENT 14 621 Sheridan Street • Port Tow,nsenic(•Washington-$9 368 360/379-4450 • 360/379-445'1 Fax q . r0,$ www.co.jefferson.wa.us/commdevelopment .S N�, . KO 3 a VS Master Permit Application MLA: 0(0—c=?'34 Pro c Descri tion(include separate sheets as necessary): k_ei Oct ce one(1--\ c--C.511,-)0 42 tr3irl 4) McA r ,--- ,.'—or f)--) I� / �(L/ b _ Property , Tax Parcel Number: V I � O3 L103 Size: /00 ._ /' (acres/square feet) Site Address and/or Directions to Property: 2 f i �j �AvC ;,c- 1_ H;j f ,c t r �� 9633 9 Property Owners)of Record: 4t�,\ 61.,,r - C Telephon : W) 3"7 - 9813 Fax: email: Mailing Ad ss: ?2(' ' !/c ,2 o -;�o-, et.;,.•s\-- -.-ICJI VA c1 E3 4.8 y -� Applicant/Agent(if different from owner): �n,��j ���, ,r ...$ Telephone: ' - - c '2 Fax:�'; email: Mailing Address: [y f Ave �{ '�� kr (A G&33 ci What kind of Permit?(Check each box that applies) ❑ Building n Variance(Minor, Major or Reasonable Economic Use) 0 Demolition Permit ❑ Conditional Use[C(a),C(d),or C)** 0 Single Family 0 Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached 0 Special Use (Essential Public Facilities)** Manufactured Home ❑ Boundary Line Adjustment 0 Modular 0 Short Plat** ❑ Commercial* 0 Binding Site Plan** ❑ Change of Use 0 Long Plat** 0 Address [l Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane 0 Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management ❑ Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance 0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑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: /7 DESIGNATION OF AGENT I hereby designate` 11 s.t CIS to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE / c% e1 _ Date: G' '/ /6 -oh By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and'r:s employees, representatives or agents for the sole purpose of application review a -: red later inspections.Access and ri ht of entry to this p'operty shall be requested and shall occur only during regular business hours. ..-. Signatures"_ Date: /•9.' -O C, 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- transfer nsibility for erinVo nd compl ing with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signat6e• —<-- r Date: `i,2Z -06 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be uming the reeppnsi of the,peneral ontractor for the proposed project. SignatGLf v�.- _ L',. bilit "N Date: '7r / () GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: l ' `cc ''cc L-Iv(r1 CK 1.+ f�') iVNl9 (CIA) '755-`JZ,3 I ( >�) 9 "7ci— ti(ar MAILING ADDRESS: , �'LCT 1�t-i- j ti C IL: CONTRACTORS LICENSE 1r WAINS NUMBER: MOhg(j ��q�•2 NUMBER 'Z3 I 1 ARCHITECT/ENGINEER: 1 N \ J� PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ❑ Wood Existing: _ ❑ Sewer LiAddition Cl Steel Proposed: Bank Height: ❑ Community System ❑ Alteration/Remodel ii Concrete Total: IJ Ilk ❑ Individual System ❑ Repair ❑ Masonry • i SEP Permit# CO•/8~( ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: _ _ Setback: Li Private well a Two Party Type of Heat: Proposed: _2- rt' K public ^� Total: 2 !V Name of System: r t.1' If this is a Commercial Protect 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: I 1 Heat Stove 11 Cook Stove Cl Woodstove I 1 Fireplace Insert ❑ Hot Water Tank Cl Pellet Stove L1 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: Li 5 2nd Floor Heated Consistency Review: i J'� _ r ,F 1 Other Heated �f l .'.k \B'4se fie Mezzanine Additional-Section: MAY 0-2 6 , ) " Heated Basement an Check fee: Unheated Basement StIte Surcharge fee: J[TELItJt vi-�E a . Other Unheated Pot Water Review fee: CI 0 Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: k"(A'Q -` L ? P 5:f-I n 1 Other TOTAL: $ 4'7 Receipt Number: c6.321 ti% Cash/Check Number: 1113 ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish a Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc