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HomeMy WebLinkAboutBLD2009-00142 MANUFAC CURED/MOBILE HOME INSTAfLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD09-00142 Received Date: 5/6/2009 SITE ADDRESS: 61 ALDER DR Issue Date: 5/21/2009 PORT TOWNSEND, 98368 APPLICANT: JAMES OTEY hO�Q. , atb 5 a -1 - SUDO PAULA LIVINGSTON OTEY 2105 1ST AVE APT 313 SEATTLE WA 98121-2134 SUBDIVISION: CAPE GEORGE VILLAGE DIV 4 Block: Lot: 67 PARCEL#: 940800063 Section: 13 Township: 30 N Range: 02 W CONTRACTOR/ WASHINGTON HOME/LAND SERVICE INC PHONE: (360) 790-9411 DEALER PO BOX 1367 CHEHALIS WA 98532 (360) 748-6884 Contractor's License WASHIHL938PK Expires 10/12/2009 PROJECT DESCRIPTION: NEW MFH W/ATTCHED COVERED PORCH INSPECTED BY HUD MODEL FESTIVAL 4523D -SERIAL NO. 32217 MAKE: FLEETWOOD YEAR: 2008 SIZE: 62 X 28 Directions SEE MAP QUEST FOR DIRECTIONS AND MAP To Site: THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): Z _ 7-CA _CA Stormwater FINAL Approval: Blocking/Plumbing:_gm ,JA31,..,� 1 o-0?ro-7 Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/SkirtingNents/Porches!Steps: ' 1 (�`Zq� ZDOl HEALTH DEPARTMENT AND PUBLIC WO APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ON EAR OR IT MUST BE PROPERLY RENEWED • MLA09-00153 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00142 Received Date: 5/6/2009 SITE ADDRESS: 61 ALDER DR PORT TOWNSEND, 98368 APPLICANT: JAMES OTEY PHONE: PAULA LIVINGSTON OTEY 2105 1ST AVE APT 313 SEATTLE WA 98121-2134 SUBDIVISION: CAPE GEORGE VILLAGE DIV 4 Block: Lot: 67 PARCEL NUMBER: 940800063 Section: 13 Township: 30 N Range: 02 W CONTRACTOR/ WASHINGTON HOME/LAND SERVICE INC PHONE: (360) 790-9411 DEALER: PO BOX 1367 CHEHALIS WA 98532 0/0�/ 0 9748-6884 Contractor's License WASHIHL938PK Expires 1 1 REPRESENTATIVE: WASHINGTON HOME CENTER INC PHONE: (360) 7@8-8884 C/O CHUCK HAMPTON PO BOX 176 PROJECT DESCRIPTION: NEW MFH W/ATTCHED COVERED PORCH INSPECTED BY HUD MODEL FESTIVAL 4523D -SERIAL NO. 32217 TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: FLEETWOOD SETBACK: VALUATION 94,800.00 YEAR: 2008 LABOR & INDUSTRIES APPROVAL? SIZE: 62 X 28 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: CAPE GEO BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: 510 O Type Amount Paid By: Date: Receipt: Manufactured Homes $213.00 KAS 05/06/09 108409 AOPTIOV Potable Water Application $62.00 KAS 05/06/09 108409 MAY a( 2009 Total: $275.00 Jefferson County Plannint &Building Department • • SPECIAL CONDITIONS CASE # BLD09-00142 1.) Stormwater will be directed to Alder Drive based on approval and condition by the Cape George Colony Club approval of May 19, 2009. "Culvert- Either replae the exisitng driveway culvert with new pipe or install a catch basin at the connection of the new culvert to the old culvert and seal around inlet and outlet." 2.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC WILL BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE. THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE. QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER MANUAL). ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING SHALL BE REMOVED OR STABILIZED ON STIE. ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON THE ROADWAY SHALL BE REMOVED IMMEDIATELY. UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE PERMANENTLY STABILIZED. 3.) PRIOR TO OCCUPANCY & BUILDING FINAL- FINAL APPROVAL OF SEPTIC SEP08-00205 IS REQUIRED. MUST MEET ALL CONDITIONS OF SEPTIC PERMIT. 4.) A MINIMUM OF 10' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION OR FOUNDATION OR CURTAIN DRAIN AND EDGE OF DISPOSAL COMPONENT OR RESERVE AREA. 5.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS. 6.) 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. 7.) The applicant is proposing to create or add 2370 square feet of impervious surface and 3150 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require the project applicant submit a stormwater plan meeting Minimum Requirements#1 through #5 of the Department of Ecology Stormwater Management Manual for Western Washington. The stormwater plan shall address measures to control stormwater, erosion and sediment during construction and shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 8.) 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). 9.) The revised site plan dated May 21, 2009 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 May 21, 2009 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 10.) This approval is for a manufactured home w/attached covered porch 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. 11.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 13.) Not more than 2 unlicensed ales shall be stored on any lot unless totalikreened 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. 14.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 15.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 16.) The building height is not to exceed 35 feet. 17.) Minimum setback from Alder Drive right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 18.) 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. 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.) An address of 61 Alder Drive, Port Townsend has been assigned to the parcel. Alder Drive is private (P4). 21.) The parcel is served by the Cape George Colony Club public water system. 22.) A septic permit (SEP70-00007)was finaled on June 23, 1970 and an EES done on June 16, 2003 and August 22, 2006 and is now filed with SEP08-0205 that was approved on December 15, 2008. A building permit (BLD94-0656) for a mobile home was cancelled on September 19, 1994. 23.) The lot was created through the Cape George Village Division 4 Subdivision on August 26, 1965 under AFN 169199. 1 24.) NOTICE: This permit does rrxcuse the proponent from complying withd)r local, state, and federal ordinances, regulations, or statutes applicable to the proposed development, but consistent with RCW 90.58. Development pursuant to this permit shall be undertaken subject to the applicable policies and performance standards of the Jefferson County Shoreline Management Master Program and the Jefferson County Unified Development Code. If during excavation or development of the site an area of potential archaeological significance is uncovered, all activity in the immediate area shall be halted, and the Administrator shall be notified at once. The Federal Endangered Species Act rules to protect threatened Chinook and Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the ESA, any person may bring lawsuit against any individual or agency that"takes" listed species (defined as causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine Fisheries Service can levy penalties. All areas in Jefferson County are included as "critical habitat"for a listed species. Development of property along any marine shoreline, freshwater shoreline, or floodplains could harm habitat if protective measures are not taken. To minimize the potential to damage habitat, all property owners developing adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the following: -All development activities should avoid unstable slopes, wetlands, and forested areas near surface waters - Remove minimal vegetation for site development, especially large trees -Allow trees that have fallen into surface waters to remain there - Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into surface waters or roadside ditches Any individual, group, or agency can bring suit for a listed species "taking", even if you are in compliance with Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a professional fisheries habitat biologist, and following the recommendations for site development provided by the biologist. For more information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and Wildlife Service. • PLEASE MAIL TO: MAY 0 6 2009 JEFFERSON COUNTY ASSESSOR JACK WESTERMAN 1111 JEFFERSON COUNTY COURTHOUSE ASSESSOR PO BOX 1220,PORT TOWNSEND WA 98368 JEFFERSON COUNTY DCU (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME / MAILING ADDRESS: THIS/S NOTA TAX STATEMENT J NAME: am&PS QM cr Pao(a OLey — The purpose of this questionnaire is to obtain information ADDRESS: �(C`5 (� regarding either the current location of a mobile home or the u F previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already 9'( CL! on the tax rolls in Jefferson County or if it has been moved to this county from another area. Please see reverse side for TELEPHONE NO: at)co sae/ So(QC) additional information. 1) MOBILE HOME DATA: (A) MAKE r1 'e f w0CC ©2 (B) MODEL T < -('t vcl 1523 D (C) YEAR ;Z.a(78 (D) LENGTH �r1, (E) WIDTH 2-47&� '� rwc Z;2� (F ER1AL N MB 7 7 (G) YOUR PURCHASE PRKE(DO NOT INCLUDE SALES TAX) �V 41-) fg e C. (H) PURCHASE DATE �/4f/Q�f 2) PREVIOUS OWNER/ LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE i MOBILE N 1 I l ��' •`+t /( /►r ADDRESS ..T"'/` /7 1( � %1�'l��= / GC ' %0�5'�2 (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO,WHAT COUNTY? IF YES,WHAT WAS PREVIOUS ADDRESS OF MOBILE? 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES (B) IF LOCATED IN A MOBILE HOME PARK: NAME az ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK: NAME OF LAND OWNER: J(L AA S aAkk -Paula ot1Je LOCATION(ADDRESS) � 05 , c y C?0.- 6 )Wc 7( k,A DP,PI- lesuraelt., REAL PROPERTY PARCEL NUMBER/DESCRIPTION Cr4O goo C/C> ^ c21 (- c v(1'e VA. 11 ac e L ,+ ,7 J THANK YOU FOR YOUR HELP! <c�� �,SIGNA KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. i ! 0 CV N Z Lep CC >, Ai co v et Cr) _-i rrMr'eb it ;xr.., W C...D C 4...,ttCwl C� .. d cc • �eg �- ,;�I �;; NI c l. ; 1 c _ u t 1 . " H w i11 Igo S 1L. g � 3 4 11.! wrwr ii. +( �wwr�pir wiii 6 f �� fir n rowr:M: wow t�trur ;,, E Wr Ia) en a r �.. "r fz = :. i�M�l�r 1� .Y1 U 0) - ---= NIB" 1 i Z t 1my ca p LJ— I: 4 .I si ai q r U o it ''r,'"i [ ', 11 tl I . I' 0 iThrti‘-cq-I----3 /c-i.II,ec. 4-(a-L/4 04e/ 61 ,i916teA bkiu ' /3,-,-- iibiolIcenaS 6149 qk, eg TP# g'-/ o? 0606. 0 / 401 67___Csaz_czetirge ill2,1 .0)10e C:-/ kia-4, --'; t- ../ N) '1 - -...--, 1 - • , I i.i n.e. \ ----4 I•eeoc to,4,e?; -c.c., o • • a : iiiiiv-,,;.:, ,t1' 1-1) ° - ? cN ‘ . Itview isvi 4 1 q lie“)Mailafd P it I f.i‹. I I I, 0 L, fir16.- 1 'don_ Only 4- O(O I Ma Aqvi re. ce& ',.-4•• t I., \- 9 'itil'cligar.. f coot ' I c,covo El vv;v14." -)i. V-1' col- (iz' t , Avii•,... I (74 I ---- 1 .1)q) 2 - 7' 410 1 ... ... _ ) ,,,, el tIr, - .. ' . .(Ili 004 CiktHA i r,drakin t.4)1 0 CanneC-1 jr\-10 ciA11)6.3r -I-a-1- J REVISED SITZIp.,AN, : wa -1* .li dated' /09/, 1 ' i(,141,-"jt-r ii 'as been APPROVED 5--.‘zi Ai? MAY 2 1 2009 Requir ' III l'.' eb lib by JEFFERSO ,tty Ito DEPT.OF COP l E II E _, • i . . SIGNATURE: i IIM---gr% .60. -%- . ) .... r „ 4 • Ir ` 1t ,I�. YE Jul X ;-- oN cob. JEFFERSON COUNTY MAY 0 6 2009 1IA DEPARTMENT OF COMMUNITY DEVELOPMENT *4 621 Sheridan Street• Port Townsend •Washington 98368 i(C 360/379-4450 . 360/379-4451 Fax JL11(r) N COUNTY BCD. 0_ , cj www.cojefferson.wa.us/commdevelopment 't BCD Master Permit Application MLA: Ovl- IS3 Project Description(include separate sheets as n•C�' : to?i H1 (• c Avc� u yar y 0y,�, r lieu,'"Ot-r littr ed y'y`"v)-�f d`2c6o-� J,. Tax Parcel Number q r0%,0(a 0(Q 3 Property Size: r,I r 74 0 S-•-r4 • (acres/square feet) Site Address and/or Directions to Property: W[ Ald e,r cir. , Por-t. Tow-vtseY\ci , kiVilt gR307 Property Owner(s)of Record: JC_v1, e.S ctv d Pay 1a y Telephone: 2-O(p 5' -r7 �i' f) Fax: email: ectvlct eo.k o� Speasi,Nef Mailing Address: -[Oe-i- / 3 r Se iltle W 4I l a1 Applicant/Agent(if different from owner): ,ntlP _ j �u J ch frYi*fly. /U.4i i `— -Telephone: •)— 7/0 `q9/I Fax: 340 L-7 a—6 ,�rf` email:f`hack:/4h, rn,01.(,txShhome_',Ce(ay/) Mailing Address: 7 CA Ela is WA S 3 e-- What kind of Permit?(Check each box that applies $Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]" MI Manufactured Home 0 Modular 0 Discretionary'D'or Unnamed Use Classification 0 Commercial* ❑Special Use(Essential Public Facilities)" ❑ Change of Use 0 Boundary Line Adjustment ❑ Address ❑Road Approach 0 Short Plat" ❑Home Business 0 Cottage Industry ❑Binding Site Plan" ❑Propane 0 Long Plat" ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments" ❑Allowed'Yes'Use Consistency Analysis ❑Plat Vacation/Alteration" ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions" ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development" ❑Temporary Use Cl Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment 'May require a Pre-Application Conference ❑Tree Vegetation Request ""Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: 4/n d f�Af11v�rCr' DESIGNATION OF AGENT L� I hereby designate h,1 If C.i_ to act as my agent in matters relating application this for permit(s). OWNER SIGNATURE pp {� +^ . ',I� c 1 Date: / it)/L)� 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 its 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 attomey'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. Staffs t •ss and k.,ntry will be assumed unless the applicant informs the County in writing at the time of the application that he or she_wants prio�, -... I Signature: �i ,1.4 Date:4��S c,��J The action or a nt will undertake as a result of the issuance • is permit may negatively impact upon one or more threatened or endangered species and could lead to a potential`take'of an endange -• pecies 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-transfers nsibi ty r adhering to.and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: � ��C��/ "c am Date: C/5A, • G:\PemtitCcnter\###FORMS###\DAD FORMS\Mutes Permit Application 5-29-08.doc 1 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: Date: _ GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: '4, 1'i i f ) 1107-he 9-/a iefSciuvtee,arve, (510 7 y '4/ y I ( k')7yS aw MAILING ADDRESS. eo (( ) {_ 7 EMAIL: CONTRACTORS LICENSE tt WAINS 1/'j l/1 J�/C3/./ NUMBER: 1/bi i N )441-(I 3,c/23 NUMBER L,'U 7 S ARCHITECT/ENGINEER: ' PHONE ( ) • FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: * New ❑ Wood Existing: C /I/%) ❑ Sewer ❑ Addition ❑ Steel Proposed: 7 Bank 0 Community System 0 Alteration/Remodel 0 Concrete Total: z- Height: 6/Individual System ❑ Repair 0 Masonry SEP Permit# OS'- C't'eC" ❑ Demolition 0 Other. Bedrooms: Water Supply: Existing: C Setback: 0 Private well 0 Two Party Type of Heat Proposed: _ (Public riec A,,, Total: _7, Name of System:(4,QF'(act^/; Co/i / / 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: 1 Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove 1 Fireplace Insert I Hot Water Tank I Pellet Stove 1 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. ? i Square Footle '`..,f IC+G rtt a =,It' ti ita ��..• � - _ , _ a ' `` � Y, Main Floor Heated . ' ' EH Bid App Review: 2- d - :.•74 3 2h3 Floor Heated M�( 0 6 Q9 4 5-.'2 Consistency Review Other Heated - a =— Base fee: n?, '2. O t [ C�]p� { .13iV Vfi Mezzanine r1 L J1f i1 u -, •.�.,„,. Additional Section: - , y - Heated Basement 1Y7 Plan Check fee: Unheated Basement ox#$€iFn- .. State Surcharge fee: r¢__ '- Other Unheated -fi Pot Water Review fee: ' d O OD 3 ` t. Garage/Carport �" SUBTOTAL .Fs_ S L Decks ' ' 911/Rd Approach fee: Sr- Other TOTAL $ 5 c q c a ;`° .4- Receipt Number. I QSL.(9 -; -r Cash/Check Number. &-1 5 ESTIMATED COST(REQUIRED) Date: OG.Fair market value of all labor and materials foundation to finish J Initials: • • G:\Perm,tCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc