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HomeMy WebLinkAboutBLD2007-00009 • • 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 #: BLD07-00009 Received Date: 1/16/2007 SITE ADDRESS: 120 SENTINEL FIRS RD Issue Date: 2/15/2007 PORT HADLOCK, 98339 APPLICANT: GEORGE EDWARDS KAREN EDWARDS 3051 PARADISE BAY RD PORT LUDLOW WA 983659760 SUBDIVISION: Block: Lot: TX 30 PARCEL#: 921194034 Section: 19 Township: 29 N Range: 01 E CONTRACTOR/ OWNER/BUILDER PHONE: '431-q(i:CO DEALER PROJECT DESCRIPTION: REPLACE M/H MAKE: YEAR: SIZE: THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 2/15/2008. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. ji' Setbacks/Footing (CONTINAOUS FOOTING, SLAB or PADS USED): SEtn-At'us PADS nA //p/c 7,i Stormwater FINAL Approval: Blocking/Plumbing: A llfria 611 Propane Tank/Lines AS Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: ,4 ZiG�DB 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 I • • MLA07-00017 BUILDING PERMIT APPLICATION Review Type: l Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00009 Received Date: 1/16/2007 SITE ADDRESS: 120 SENTINEL FIRS RD PORT HADLOCK, 98339 OWNER: GEORGE EDWARDS PHONE: 360-437-9606 KAREN EDWARDS 3051 PARADISE BAY RD PORT LUDLOW WA 983659760 SUBDIVISION: Block: Lot: TX 30 PARCEL NUMBER: 921194034 Section: 19 Township: 29 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' REPLACE M/H TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: 1 1 1 l0 1Orl Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $163.00 LYK 01/16/07 87173 APPROVED Total: $163.00 FEB 15 2007 Jefferson County Planning &Building Department • • SPECIAL CONDITIONS CASE # BLD07-00009 1.) SEPTIC TANK AND RISERS MUST BE INSPECTED FOR WATER TIGHTNESS BY ENVIRONMENTAL HEALTH STAFF PRIOR TO FINAL OF THE BUILDING PERMIT. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on February 9, 2007 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: Sesimic Hazard Area, Level I Landslide Hazrad Areas and Coastal Seawater Intrusion Protection Zones (SIPZ). 3.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 4.) The property is located within a mapped geohazard area (Level I Landslide Hazard Area) The building area of the property does not contain any identified bluffs or steep slopes. 5.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 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.) 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. • •9.) 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. 10.) 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. 11.) The applicant is proposing to create or add 1344 square feet of impervious surface and 7144 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require your proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of Ecology Stormwater Management Manual for Western Washington 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. 12.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP) Elements#1 through #12 of the Department of Ecology's Stormwater Management Manual for Western Washington 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. 13.) 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). 14.) The revised site plan as submitted on January 26, 2007 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 February 12, 2007sha11 be resubmitted for review and approval by Jefferson County Department of Community Development. 15.) This approval is for replacement of 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. 16.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 17.) Not more than 2 unlicensed 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 autormobile 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 requriements 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. 18.) Minimum setback from Sentinel Firs Rd right-of-way is 20 ft. Minimum side and rear setbacks are 5 ft. 19.) 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. 20.) 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. 21.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 22.) The building height is not to exceed 35 feet. 23.) A minimum of two (2) on-site parking spaces are required for the single family residence. 24.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. • • 25.) A septic permit (SEP75-00407) was finaled on October 20, 2006 for a system of 240 gallons per day. 26.) Sentinel Firs Rd (C567009) is a county local access road. The road approach is existing and an address of 120 Sentinel Firs Rd has been assigned to the parcel. RETURN RECORDED DOCUMENT TO: All About Escrow, Inc. 2012 E. Sims Way Port Townsend, WA 98368 WASNINCIONSTATE Manufactured Home Please check one: di. LICENSING Application ®Title Elimination For full instructions on completing this form, see Manufactured Home Application ❑Transfer in Location Instructions, form TD-420-730. ❑ Removal from Real Property 0 Manufactured Home TPO/Plate number Year Make Length/Width(feet) Vehicle identification number(VIN) +49493 1986 OAKBR 54'/24' 09L21260XU © Land Manufactured home will be Real property ®Affixed ❑ Removed Tax parcel no. 921194034 Legal description on page 4 Lot Block Plat name or Section/Township/Range Quarter/Quarter section 19/29N/1E SW1/4 of the SE1/4 © Grantor(s) Registered/ Legal Owner(s)-Additional names on page County number No.registered owners No legal owners Grantee name(if applicable) ad' Name of registered owner Washington driver license or UBI number George Edwards Name of additional registered owner Washington driver license or UBI number Karen Meeker-Edwards Address(Address, City,State,ZIP code) 3051 Paradise Bay Rd., Port Ludlow,WA 98365 Name of legal owner Washington driver license or UBI number Same as Registered Owner Name of additional legal owner Washington driver license or UBI number Address(Address,City State,ZIP code) Same as Registered Owner I declare under penalty of perjury under the laws of the state of Washington that I am/we are the registered owner(s) of this manufactured home and the foregoing information is true and correct. X Signature of registered owner and title,if applicable X Signature of additional registered owner and title,if applicable Notarization/Certification State of Washington ,County of Jefferson Signed or attested before me on (Seal or stamp) by George Edwards by Karen Meeker-Edwards Print registered owner name Print registered owner name X Notary printed or stamped name Notary signature and Title Dealer/county office number or notary expiration TD-420-729(R/4/12)WA Page 1 of 3 Continued on next page Manufactured home TPO/Plate number(from Section 1) +49493 a Title Company Certification PRINT or TYPE Name of person signing Title company name Position (Area code)Telephone number I certify that the legal description of the land and ownership is true and correct according to the real properly records. X Signature Date © Building Permit Office Certification I certify that $ the manufactured home has been affixed to the real property as described. ❑ a building permit has been issued for this purpose and the attachment will be inspected upon completion. PRINT or TYPE Name of person signing Building permit office Building permit number ho ' c i•C • pc-D. BLD-0700009-92 Position (Area code)Telephone number 4/4/( Sign ure Date Signature of Legal Owner(s) Signature of legal owner indicates consent for Elimination of Title or Removal from real property. X Signature of legal owner and title,if applicable X Signature of additional legal owner and title,if applicable Notarization/Certification State of Washington , County of Jefferson Signed or attested before me on (Seal or stamp) by George Edwards by Karen Meeker-Edwards Print registered owner name Print registered owner name Notary printed or stamped name Notary signature and X Title Dealer/county office number or notary expiration 7 Land Description Legal description of land FULLY DESCRIBED IN EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF. TD-420-729(R/4/12)WA Page 2 of 3 Continued on next page JACK WESTERMAN II Jefferson Col, CourA►ouv►•. ASSESSOR PO Box 1220, Port Townsend, IVA 911368 (� ii tl�pp(360) 385-9105 YLft'SNAME/MAILING ADDRESS: NAME: ' eccge aara' Xidrert gclet-e i eL5 ADDRESS: <30116"/ Farad e.'Sc 3u_y it'd•/ Pert 1-ced/o tl, C�4 9eg ,5— PIIONE NO. (' 60, 1 3 _ 166), e//: (5 cy) 30a 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 Ai mobile home. This will help our office determine whether the mobile home is already 'iI the tax rolls in Jefferson County or if it has been moved to this county from another area. >C MOMEf ATA: INN 1 2007 (A) MAKE -% -I,8Ek jy (B) MODEL 'CA afee (C) YEAR / 9f (D) LENGTH . 9-$' (E) WIDTH S' (F) SERIAL # /a.(oO x u 14 (G) YOUR PURCHASE PRICE (Do not include sales tax) /J,L/a/ c� PURCHASE DATEllig/02. 0 ;h/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE� MOBILE 4.10 h vl 'S V all ae NO M65 U ADDRESS (-, 3 u p ). Mai a i i2 5?-.� e he Act 1 i S l J,q (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes To' If Yes, Previous address of mobile. % If No, What County was Mobile assessed in last year. A-)p'f" A.55 sue. eJ— %Cc t-c'c( /.t !�:`y'�ety CC as Sp( Cad,-C, ctnit` . )."'' 'E'` '� 8I.L'E 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 MOBILE HOME PARK: NAME OF LAND OWNER: G e.Qr9C Ctit d ka re-Kt d s LOCATION ADDRESS 1a U 6p/1zti.IIGI I F/'1,5 -, Pt, t CA" REAL PROPERTY PARCEL #/DESCRIPTION f� J % 9i/ o / � '= - ' , THANK YOU FOR YOUR HELP! A3zLT: LtSIFQ r OSSELL, Property Technician -- 11- 0 13 m 3 N> n N :cJL� �� ex N _' �N COrp• M9l ON i 1 y v __... _.— _ \J_ i ) 6".Pi9 cCG L ) 1 1 o. m 1 \ ' J1 / y'�: � ',�\®off/b• ,4.- :�� 6 ,. -_-12. i/ ,R.,,,\;..„,. Ai 0/.„ \,.,.>/.: :1,-1:ix' .'-'('-'-:.: : ‘\ \'' 1 C..)........1...... p 1)0 0 -o d (A%'.( v.' if '0 w n lD \ b O b 1 co ` m-_ \\ • --. --\-ik a q a. Cn u,„ A .„ ,...„. --„,. sr. _-,---- ... ,,,...q 1- 1 T Q � a N �,:.....:� Yo7w0 �-."1... r e. r o w A \ 9. �" o 'p to —� CD N a Cil C I ,. _�---•_..J— — �_/ o ON � 'oO we Q` I � w //Ra �S / P. 1 , ( 1 m .L I*I. /' , , .4, N O P N a) � N n ci o m- / • n Co CO xt 7 m i CO --. 5 i N N co / -O _ (0 11 :.✓ y CD m A ti no Z W -3� "1 _ Iv g r' o � � 0Co • m cj0 '0 r (� n;=a 0 J .. .. ._rn.... . b Cn D " i ii Np (x] iv ro 0 I o 4 !1 i 7.' z �u --23 M • rn 0 • iti,- . oN co& JEFFERSON COUNTY ELF r✓17� Ln.� 11.1-1 y� DEPARTMENT OF COMMUNITY DEVELOPMENT >��� �' v o 621 Sheridan Street • Port Townsend • Washington 98368 M 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment� J ArJ 1 b Lu 1 _ Master Permit Application MLA: �'�' I] ject Description(include separate sheets as necessary): Property ,Tax Parcel dumber. '. 5J(l / elf/ 131/ Size: ,,? 3� 9 219 Si, (acres/square feet) Site Address and/or Directions to Property: /,-A Q o 5ei-zt,i9G/ �r,5. , Perz /--/Ze//oram Property Owner(s)of Record: j E C I"J 'c' a r7 d Jl--L1 rc'7 �cf r.CJct i'- ' 5' Telephone: ( .36,:-0 43 7 9 6 i Fax:(.36e) i 3')--S'i % r email: /9 ec iiz,a r64.5 6.) Cet.Jr oac !Veiling Address: 3C" / Tit ra 6/(.5 e uJ ncl• P P J..u,-//c-c, /,'/4 9„k.=3,;,S e Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) Building ❑ Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** r JManuflactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** O Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance 0 Temporary Use ❑ 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: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable 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 required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signatu G G r r l� r Date: ? / " l - C' 7 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 responsibility for adherri�ing,to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: „,:_7/(/ /til—c: L"c:-!1, ..--G'S Date: /-/ `0 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 assuming the responsibility/of the General Contractor for the proposed project. Signature: —G'L�';..,. , 4. -tt. Date: `( _ C 7 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: Fax: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS '',' NUMBER: NUMBER ' ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: - Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 17 New Wood Existing: C] Sewer ❑ Addition ❑ Steel Proposed: .. Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: .`-: i ❑'Individual System ❑ Repair ❑ Masonry SEP Permit# 75.- 0 7 ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: Private well ❑ Two Party IlliPpe of Heat: ! Proposed: = ❑ Public el e lit-r ,,. �, Total: - N,rf� 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: Nutrd,er of occupants(includ3s vwriers,tenants,employees,etc) Curren: •Props. rt% - 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 I 1 Woodstove Li Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove Li 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: (p5. CCU 2fa Floor Heated Consistency Review: 153 00 Other Heated Base fee: 1(4,3. on Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL (3SI. oc Decks 911/Rd Approach fee: h6/S4-l n C1 Other TOTAL: $ 5�l vi3 Receipt Number: o 9 r3 Cash/Check Number: (�17 ESTIMATED COST(REQUIRED) Date: /(a •Fair market value of all labor and materials foundation to finish t 11(0)0-7 Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc