HomeMy WebLinkAboutBLD2006-00416 BUILDING PERMIT
Jefferson County Department of Community, Development
621 Sheridan Street, Port Townsend WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00416 Received Date 07/18/2006
SITE ADDRESS: 4994 PARADISE BAY RD Issue Date 08/31/2006
PORT LUDLOW, 98365
APPLICANT: GABRIEL L FLETCHER PHONE: (360) 437-7956
PAULA K FLETCHER
54 SPARROW LN
PORT LUDLOW WA 98365
SUBDIVISION: NO CENTS SHORT PLAT Block: Lot: 2+
PARCEL NUMBER: 821351032 Section: 35 Township: 28 N Range: 01 E
CONTRACTOR: LUMBERMENS HOMES PHONE: 360-692-5511
P.O. BOX 776
SILVERDALE WA 98383
(360) 337-4078
Contractor's License: LUMBEH`011JK Expires: 5/1/2008
PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE (690 SQ FT IS HEATED
UNFINISHED PLAY ROOM)
CALL IN FOR THE REQSJIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:
UFFER: ✓/V
Footing: 7)/Z 04706/1
Foundation: D /��9/00
Stormwater FINAL Approval: DK S//duff gs/
Underground Plumbing: ,U/A
Underground Insulation: /U/A
Shear Wall : ,J,,.& DSB na 4u uA/ /x OK 0/30/61 W
Sheathing:
Framing: U/F OK 2/2707 142/EpCQ R it) 64 (cc) <<=rYT !AflA'f'LJSc,'.9 /f j/>/07
Plumbing: OK f3y3/(n7 '
Propane Tank/ Lines: ,• ,_wags• OK ///2/[�7�J CST ZWE ;uK D 49#9,
Insulation: ZX /0/0107
Sheetrock: Ok fie
Septic Sytem Finalo MUST be obtained before final of structure can be attempted.
Road Approach Final Approval:
Zoning Final Approval: "/
Final/Occupancy Approval: OK -Par 2 5/4/O , "
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 FOR CASE BLD06-00416
1.) 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.
2.) 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.
3.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
4.) Not more than 2 unlicensed or inoperable vehicles shall be stored on any lot 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 Chapter 18.30 JCC. Outdoor storage of 3 or
more junk motor 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 or Chapter 18.18 JCC, and such storage shall meet the requirements of JCC
18.20.100, Automobile wrecking yards and junk (or salvage) yards. In no case, shall any
such junk motor vehicles be stored in a critical area.
5.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
6.) Minimum setback from Paradise Bay Road right-of-way shall be 20 feet. Minimum
setback from private internal platted right-of-way shall be 20 feet. Minimum south and
west property setbacks shall be 5 feet.
7.) 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.
8.) 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.
9.) The building height is not to exceed 35 feet.
10.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
MAILDING PERMIT APPLICATI 1 ML v
Reviewiew T Ty 401
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00416 Received Date: 7/18/2006
SITE ADDRESS: 4994 PARADISE BAY RD
PORT LUDLOW, 98365
OWNER: GABRIEL L FLETCHER PHONE: (360)437-7956
PAULA K FLETCHER
54 SPARROW LN
PORT LUDLOW WA 98365 NO CENTS SHORT PLAT
SUBDIVISION: Block: Lot: 2+
PARCEL NUMBER: 821351032 Section: 35 Township: 28 N Range: 01 E
CONTRACTOR: LUMBERMENS HOMES PHONE: 360-692-5511
P.O. BOX 776
SILVERDALE WA 98383
Contractor's License LUMBEH*011JK Expires 05/01/2008
REPRESENTATIVE: LUMBERMEN'S HOMES PHONE: (360) 692-5511
ALLISON FALK (360) 337-4078
PO BOX 776
PROJECT DESCRIPTIOP NEW SFR W/ATTACHED GARAGE (690 SQ FT IS HEATED
UNFINISHED PLAY ROOM)
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,447
VALUATION 339,076.00 ADD'L: 1,447 HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: HTP
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: 690 SHORELINE:
CONST TYPE: GARAGE: 690 SETBACK:
DECK: 67 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: OTHER --
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 4
Total: 3 Total: 4
Routing Date:
'7llgf��
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $2,253.75 KAS 07/18/06 83732 At D
Plan Check $1,464.94 KAS 07/18/06 33732
State Building Code $4.50 KAS 07/18/06 33732 AUG 31 2006
Potable Water Application $55.00 KAS 07/18/06 ,33732
Jefferson Li,urr�y f'18t,n;r��
Permit $84.00 KAS 07/18/06 33733 & Btiilrt�rs Cep��,rneni
Plan Check $54.60 KAS 07/18/06 83733
•
•
G ECEl � E�(4,4c..„-,-5.0N
JEFFERSON COUNTY
ti .} �) DEPARTMENT OF COMMUNITY DEVELOPMENT +� ;� `i;
aj
/ 621 Sheridan Street• Port Townsend •Washington 98368
-eqs ,s.p, 360/379-4450 • 360/379-4451 Fax
� NG % http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
/ � 6sMLA# 0 /- ra PROJECT/APPLICANT NAME: 7/FCf� j Qe /-� A._
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 positionand relative size of proposed improvements on the
site m e ve�diorn,„4 / /6 4Lie
uIP pi7C' S' S'hfj7 di,/d�li/l1
y
Existing Conditions Summary
2. C.scribe the existin to o ra h . Indicate cont urs on the site map.
y_fy• --4(..; , , i tiu . /ye j - 61-- _di/>1--4 4t j/1.(y -(1,4:1/7 "--771#0e'
3. De •- the existing vegetation. Indicate native vegetation areas on the sit
J�0),i/ a,-7 ' P- -d. cl'a//iu ?d t. ,J . .. ii9. s
YN ei, /,I,C�1� ,& ��,� a v Lf
4. Descrjfze a existing soils. Indicate soil type on the site map.
C ,"1-9i '`
.ia i( 0CC
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 a site on th map. epict separatedrains a basins on the map, if
applica le nd i dicate acreage of each. `�� Y /"f Q / /� �a / Z i /
/ o cis al- he r , o, -- `t c/�r2 ._,1/2en
q) a-0//vreationa
v wp W2e ��rg
S' dl�P" �'f" f /A't6 i`Ae grew-d 1?,/ _ eS / /1 t2 eX/S>`7/✓ • c %i/eul 'yge*rvaag
. DF�
rc /-ol/v//tr � G// oos //t �/t, (1/7?ii���'x r�lfc.�67-•via i le/ `Di'vcrl�
6. Describe any s levels of noise generated by the proposed use or adtivity:
_____,_fY-Gi_
APPROVED
STORMWATER PLAN
stormwater site plan template.doc—rev.10/12/2003 „s, `\ _\ AUG 1 5 2006 5
Req�7g�ate v,
JEFFERSON N Y \
DEPT.OF I ):VE. . E,'T
SIGNATUR
• •
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.
4
8. Describe the general vicinity of the site,includin ad' cent!arid uses and structu es "ties, roads,and sensitive critical areas
(stream ,wetlands,lakes, p slopes,etc.). '7/ (Iy J j/‘'i}Q � c �f>4 J,}'
ri v�-7 rood e /l/df i%. PO/, ono 8 cad s
toas't n12d 1)iti/ /i/i/ Mo 6D L ct not
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.
"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. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
<_PL `
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 contaaa ],r..! 1 r
11. Describe the performance goals and standards applicable to the project.
12. Describe the flow control system.
v Ne° / 5
0 - 6
stormwater site plan template.doc-rev.70/12l2003 J E P P E R S O N C O'�l�T Y °C c 6
• •
13. Describe the water quality system./
14. Describe the conveyance system analysis and design.
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
,4ri O /v p
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
17. the proposed su m terial.
h' i"Xh /i Gci �/'/irt"Aia�/ Gtl/// C/,72:5`/5 of (1cf.L. Arr,/ re() '
18. Describe methods for restoration of the site. /
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
her
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
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.
/v ""l
sturmwater site plan tempYate.doc—rev.10/12/2003 j E f f i li S O N COUNTY
O J N___ B C- 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. •
Ao, � , ,v addI/imQ/ O' &&v/(7 is' npedp
RE E11VET
2. Establish construction Ass.
a / ✓ei,e
5V
3. Cmfrol Flow Rates.
r V/a i�sily add&L9JciOL/ 7/1/ liv/fra/ /1/a n
4. InstallAajdiment Con Is.
Ccrtie MAT ei s ij71 eef' jv/%/p"ilke/
othay /k/ cregi
5. / 7 /Lhf'' IY?//►///i)Ci/ J/h /' (N// d--mem o A ai./1
m/n//imuhl with i/( h/n/ ' a9 04die°
Theci-hOd
6. Pro lopes.
pr (3 -!
7. tect Drain Inl ts.
��ir6tra i'J/// ie .
b., 'l b
storrnwater site plan template.doe—rev.10/12/2003 8
MMMFFUSUN COUNTY CD
• •
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outle's.. /
. `./'Y . E /S' /� � > . //,51//rvq CJ�v%'' {iG zuaT
des i i e / �i oo wpr 1 :jai, i PF• r U✓//1 bz uJ.ed
re rbe)' ('A �i-i (ion tiJu .
9. �I Pollutants.
/ rtituv cs p/ S• wi i/ ,bto oa sere
10. on of De VVate 'ng(the act pf p ping groundwater or stormwater away from an active construction site).
a �� (u//)4
11. Mtain Bes Management Practice (BMPs).
e..r, v4i/C° //t/S " tt' _ "iis• /,.I//l� (C�C'i K `f�) j/zlS'l,LI WI?
C`�!/"iff`('J7 lit i��Scc 'I- G1// //)7/0, '
12. Manage the Proje / / �/ �� q
jr-NO /I. / f lI G l�! �Jc I��t L1 �lLi}C�/ � c1 /U At'
rd ro /e'f t e 1 V-he TI/u.! cS� /j 2I .
2. Adjacent Areas. i s 11.1 C E 7 1" i 7'
li AA,IL/ ' t..<, 1
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, Hrr residential
agrees, roads).
/
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
(yards).
Ji'rL )tyr /' '') ". I'.
J
3. Environmentally Sensitive Areas.
a. Descrip ion of environmentally sensitive areas that are on or adjacent to the site.
4/U ///e
stormwater site plan template.doc—rev.10/12/2003 J E F F E R S O N C O J L J 1Y 9C1 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).
A/ fa
5. Construction Phasing.
a. Cpn truction seq�u�nce ��//
j/ C//�`' disk,
bie ix
(,b'//)( / , C.0/2 / /t! d i)(,)
JaS
b. 'Construct!phasing(if proposed)
/till'?
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. tcs)rovide a proposed construction schedule. L
11 ," it:' f C/ ' i��/ �Last fri'r / �. (. ou i)77ale/ /bi pie"
II. Wet Season.l2`onstruction Activities.
_a. Proposed wet season construction activities.40 U be it r v- n'`
JAE r IR e --4 \
b. Proposed wet season construction activities for environmentally sensitive areas.
e_.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
,," -)1-
lr
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.b. Diversions. 4/ i
7
c. Waterways. 7 r/ '
d. Runoff/Stormwater Detention Calculations .
' i.F
stomiwater site plan template.doc—rev.10/12/2003 10
JEFFEHSIJPJ COUNTY 3Cf
S #
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 app ication is being made with the full knowledge and consent of all
owners of the affected pr_ erty.
1 do
(LANDOWNErL A H REPR S Ni��4TIVE SIGNATURE) (DAT
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
ECE vE
PERMIT # HIP
0 s:• 0 ,; 1 ;
stormwater site plan template.doc—rev.10/12/2003 rr([[ae ((��(\�(,�{' (+ t y BCC
12
JEFf�IIVUIiI Ir�b.)! �4I
�, JEFFE ., COUNTY D
l y ggz, ti DEPARTMENT OF COMMUNITY DEVELOPMENT
''` P '4 621 Sheridan Street• Port Townsend •Washington 98368 JUL 1 �1 QS
4� 360/379-4450• 360/379-4451 Fax
qS PRIG, ,p www.co.jefferson.wa.us/commdevelopment
Master Permit Application i ?Sil i ,Mt ill ri
pp MLA: ' w i
Project Descrii tion(include separate sheets as necessary):
V i'/ -/`/� 4fr4( h(cV r.' a✓•Gi j'L
�"7 � Property? C / /�Tax Parcel Number: G / (�(!r�
Size: (acres/square feet)
Site Address and/or Directions to Property: "7 7 / 4../////j ' /9d-t I till/(A(
,,
Property Owner(s)of Record:'` U i 1 t:L / '/t '/'J 'e OiL. /f ' I /'
Telephone:'. cO 9. ' 79` Fax: email:
Mailing Address: �� . ' / � lUl1U;< ,(_/; 7. D;;f)_ ,i(C20.( )
Applicant/Agent(If different from owner)):'OWN,) Fa//< ,�
Telephone: '(�y �/ Fax v-�b 0 .....,?i/" /0 /� email: cF<//`P/diVt`'rind i/2t;
Mailing Address: 0 ,('/1,X % ,// C. /c(C/Cfl e Gf/F9 Qk-;?( j
What kind of Permit?(Check each box that applies)
1 Building 1 Variance(Minor, Major or Reasonable Economic Use)
1 Demolition Permit 1 Conditional Use[C(a),C(d),or C]**
%1 Single Fa 1 Discretionary"D"or Unnamed Use Classification
;1 Garage ttache ''/Detached 1 Special Use(Essential Public Facilities)*"
1 Manufacture edT tome 1 Boundary Adjustment
Adjustment
1 Modular 1 Short Plat*"
1 Commercial* 1 Binding Site Plan**
1 Change of Use 1 Long Plat**
• 'Address )load Approach 1 Planned Rural Residential Development(PRRD)/Amendments**
1 Propane 1 Plat Vacation/Alteration''
1 Allowed"Yes"Use Consistency Analysis 1 Shoreline Master Program Exemption/Permit Revisions*"
1 Stormwater Management 1 Shoreline Management Substantial Development**
1 Site Plan Approval Advance Determination(SPAAD)* 1 Shoreline Management Variance
1 Temporary Use I Comprehensive Plan/UDC/Land Use District Map Amendment
1 Wireless Telecommunication* 1 Jefferson County Shoreline Master Program Amendment
1 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 ` /�/i/, rr'71 —Cl/4 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE r"/
- i------ Date: �/7�/__
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 its employees,representatives or agents for the sole purpose of application
review and any uirpd latar inspections.Access and right of entry to this property shall be requested and shall occur only during re ular business
hours. t
Signatur !l / r� _ Date: y
S ( .
i , 1 �
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit
has been 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 res , ibil" 'f r d��c mplying with the ESA. The Applicant has read this disclaimer and signsns and date it below.
Signature:_, ' ._. Date: j./ �if�-:
C:\Documents and Settings\canal\Local Settings\Temponuy Internet Files\OLK86\Master Permit Application 12-30-05.doc
07/03/2006 16:18 3603794451 JEFF CO PERMITCENTER PAGE 01/01
i4 06 01 :59p Ill i son Falk 36.37-4079 p.3
�r BUILDER STA/11MEiNT
l Thn niprior of dap:stnlerist ass he certify that they era the Ow!uts of the parcel referenced herein,that they.le net I'aernhed contractors and that
they wnl bn es th s rector for the proposed.prejset;
Sinneturn: Date: ram' ‘;'vlD
GENERAL DONTRACTOR Oft MANUFACTUR b HQee!INSTE(Lr : r PHONE: FAX: •
/(4mherMCOS 7/0/ QS• A) c•, (// oil/; �)ecv..66V q.,' 7.-Y/) 7r
MAILING At oRFsa: �.)0 /1IG . I Kref ei EMA14: if:if4//`6)//1099 het-0(7).51. r 6'Y-.
CONTPACTcR'sLICENSE �7cje?,3 wAINB
NUMRE-A: /. t 3/ /{4 Q///{/��JK Nn,�k
ARGaIrrECNENSI R; Wag- 59(m0) 06:Sr/C1/1!c_ea' fit. PIONC C:•7i(1) ere 7V_Al Ar(21654c7/-+-U)//
MAILINGADDPEse; ' II(IT .0c; AT oecytEa 9-cork EMAIL
I—Project Type: Frame Type: Bath moms: Shoreline: Typo,of ttovvege Disposal:
Now b( Wood Existing: '� 1.1 Sewer
Addition 1 Stool Proposed:
/ Bank Heinht U Community Syotom
I.1 Alteration/Remodel U Concrete Total: / /t/4 )Llndividual Syetom
I.! Ropttir U Masonry SEP Permit#._ _.._
1 i Demolition Lr Other Bedrooms: Water Supply
EkistlnS' - Sttlbaok: I 1 Private won 1.1 Two Party
Pro vod:
T ofea Ht Total: ' �� aIY P o lic
SyGtDm4lr'44n&
if tfiyi Is a Common:tat Prolog you must ensurer the fottowl1 Si •
Number of Parking Spaces: Currant _ _ Proposed: 4 Number of ADA Parking Spaces:
Number of occupants(includes owners.tenants,,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: WII you have Food Survive?XI—Li f fie
H tills a protein Vedic umdlorAppliance)nstalfatlon permit mark all Itarlts beef w Mat apt
IUnderground Tank I Above ground Tank Size of Propane Tank I ,�a �i Tr' J E I)
1 HeattSteve I Cook Stove I Woodtteve I Fireplace Moen I Hot VVolar Tank I P Stove: I Other - 1La J�
lajf t r�Lilla_ n Mataged 1n a Mgguhetutad 1 MobJ Koma7 Yes I No
Whom eppryhrly fora permit to Install a propane tank you must also submit a alto pion showing all c d the buildings,all progeny
Was,tank location and ai2e dlsfanees from the propane t onalto all proper*lines,buildings andsiptic system,farnpOAents,
Including rho reserve♦em..
Square Footage ,Curren Proposed For Office Use Only Arnow* ltavlalos
Main Floor Heated /YY-7 1 ° EH Bid Apt Review: )0
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alter L.. ( .-7L TOTAL: L-V$ !• 0ReceiptNumber: . S 3--J /83733
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ESTIMATED COST tREQUIRED) Date: / '
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