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HomeMy WebLinkAboutBLD2009-002721 • • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 Al Scalf, Building Official PERMIT #: BLD09-00272 SITE ADDRESS: 4611 S DISCOVERY RD Issue Date: 09/29/2009 PORT TOWNSEND, 98368 Final Date: 4/1/2010 APPLICANT: STEVEN SHORT PHONE: 360-379-9215 REBECCA SHORT 4611 S DISCOVERY RD PORT TOWNSEND WA 983689020 SUBDIVISION: EARNEST SHORT PLAT Block: Lot: 1 PARCEL NUMBER: 001321050 Section: 32 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NEW M/H THE PROJECT LISTEDABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 4/1/2010 I:\F_BLD_Occupancy.rpt 10/29/19 MANUFAC,RED/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 #: BLD09-00272 Received Date: 8/17/2009 SITE ADDRESS: 4611 S DISCOVERY RD Issue Date: 9/29/2009 PORT TOWNSEND, 98368 APPLICANT: STEVEN SHORT REBECCA SHORT 4611 S DISCOVERY RD PORT TOWNSEND WA 983689020 SUBDIVISION: EARNEST SHORT PLAT Block: Lot: 1 PARCEL#: 001321050 Section: 32 Township: 30 N Range: 01 W CONTRACTOR/ OWNER/BUILDER PHONE: DEALER PROJECT DESCRIPTION: NEW M/H MAKE: MARLETTE YEAR: 2009 SIZE: 57X27 Directions SEE DIRECTIONS&MAP IN FILE 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 THATAPPL<.XIQYOUR PROJECT. ' 'N Setbacks/Footing (CONTINUOUS FOOTIN PADS USED): ,�3 /04.---- Stormwater FINAL Approval: Blodcing/Plumbing: :3-"tc-_LU_ Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/SkirtingNents/Porches/Steps: h 3t) I© HEALTH DEPARTMENT AND PUBL C WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR BUILDING INSPECTION HOT-LINE 379-4455. Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY-SEE REVERSE To Schedule inspections, call (360)379-4455 by 3:00 PM prior day. NOTE: Monday inspections by • 3:00 PM prior Thursday. ',B UILDING PERMIT APPLICSION MRLA09-00276 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00272 Received Date: 8/17/2009 SITE ADDRESS: 4611 S DISCOVERY RD PORT TOWNSEND, 98368 OWNER: STEVEN SHORT PHONE: 360-379-9215 REBECCA SHORT 4611 S DISCOVERY RD PORT TOWNSEND WA 983689020 EARNEST SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 001321050 Section: 32 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW M/H TO ZER.Ace EXtSrtr TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 1,539 CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: AptiPrived/Date w= Manufactured Homes $213.00 LYK 08/17/09 110738 L. Potable Water Application $62.00 LYK 08/17/09 110738 Total: $275.00 SEP, )9 2009 Jefferson County Planning &Building Department • • SPECIAL CONDITIONS CASE # BLD09-00272 1.) DESIGN CRITERIA FOR SPLASHBLOCKS: A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED BETWEEN THE DISCHARGE POINT AND ANY PROPERTY LINE, STRUCTURE, STEEP SLOPE, STREAM, WETLAND, LAKE, OR OTHER IMPERVIOUS SURFACE. SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS. A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH SPLASHBLOCK. A SPLASHBLOCK OR A PAD OF CRUSHED ROCK (2 FEET WIDE BY 3 FEET LONG BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE POINT. NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT. FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFILED AREAS. 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.) The new home may not move any further west w/o locating the nearest drainfield lateral. Health department to verify. 4.) 10 FOOT MIN SETBACK REQUIRED BETWEEN WATER LINE AND ANY PORTION OF SEPTIC SYSTEM 5.) The application was reviewed by the Jefferson County Department of Community Development staff on September 29, 2009 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: coastal SIPZ. 6.) Marine shorelines and islands.susceptible to a condition that is known 4bawater 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. 7.) 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. 8.) 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. 9.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 10.) The applicant is proposing to create or add 1539 square feet of impervious surface and 1539 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. 11.) 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. 12.) 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). 13.) The site plan as submitted with the manufactured home and deck permit applications on August 17, 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 September 29, 2009 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 14.) This approval is for a manufactured home and deck permit 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. 15.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 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 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. 18.) A minimum of two (2) on-site piling spaces shall be provided for the singleeily residence. 19.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 20.) Minimum setback from South Discovery Road and Milo Curry Road rights-of-ways shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 21.) 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. 22.) 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. 23.) An address of 4611 South Discovery Road, Port Townsend has been assigned to the parcel. South Discovery Road is a county minor collector(C602577). 24.) The parcel was created through the Earnest Short Plat on April 11, 1983 under AFN 283082. 25.) The parcel is served by the Quimper public water system. 26.) A septic permit(SEP85-0042)was finaled on May 22, 1985 and EES on March 3, 2006 A building permit(BLD90-0594)for a mobile home was finaled on September 21, 1990. A building permit(BLD05-0773) for a pole building was finaled on September 14, 2007. 27.) NOTICE: This permit does not excuse the proponent from complying with other 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. JACK WES'TERMAN Ill • Jefferson Count rthouse ASSESSOR PO Box 1220, Port Townsend, WA 98368 4360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: t ell e` ,t I e6 e CcA- S La)27- ADDRESS: 9 1/ S, 01scd, 2D 'a2t-7- e-L Lt/ 9.'368 PHONE NO. 3f o - 3 29 — g2-1,S e, - c9FTg2 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 deterniilic Whet- „ 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 •/(1O J (B) MODELL Ecifi 9 5 V/ (C)YEAR °E), (D) LENGTH kik' 5-7'1' 4E) WIDTH Zee (F) SERIAL # .V f /" (). p 4 (G) YOUR PURCHASE PRICE (Do not include sales tax)d /Jfa — PURCHASE DATE 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE ADDRESS (B) WAS MOBILE HOME ASSESSED IN JEFFERSON 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 TILE MOBILE HOME BE IN MOBILE HOME PARK? Yes J (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: LOCATION ADDRESS 7 (O"/ S, l?iSco T Poe-Tot,'"5€"ce w A. Ffl36�f REAL PROPERTY PARCEL #/DESCRIPTION 2.zZ $L, v'%51- S►+oe f f t 'r 11 ! Signature of applicant THANK YOU FOR YOUR HELP! Lauralce Kiesel, Property Technician r 1.. w- i 441 g OD M 4 Fill oic 46x40 wo ID x80 36 V 0 � iii 0 L . .... ç1r; T 'jO t� II sib i, N3NI1 - /I` 2 INK MU We X s3n13H5 CO I1 -■■ •B o •V y VI I W ymf I_n _■ 1 ^-J14.3 .b -'-- —� OD GC1 IA -- .. I _ P • • 4 r x ■ � �� D OD I C. O{�J VI O r GbC l P P n I 0 x *� N C • • moo, NI T n HILL ZZ yyy N h I xx x -4x� O a' m�' al g x n ru II III .No o ^' • N -- J r rn i r r p4. m x O • + I mu, o RIG � I . , 'A N x I i x �n -t '� C 'm No °` ® .1x ' L .___j N .c I .x"' 1 y I i_ �av o. to to �b ob o cob G' v 1S3fq 1-� x x N N _, �W I a C.,, , �1 CD • . __' 46 x 52 46 x 52 46 x 52 • .0 - • • °N co rt. JEFFERSON COUNTY al 4 >a DEPARTMENT OF COMMUNITY DEVELOPMENT '' r4 621 Sheridan Street• Port Townsend •Washington 98368 �$ 360/379-4450 • 360/379-4451 Fax �t� www.co.jefferson.wa.us/commdevelopment SWING Master Permit Application MLA: O c 6 c Project Description(include separate sheets as necessary): __ Tax Parcel Number: 0 O I - 3 Z,/- 0.5-6 Property Size: Z, 2'Z A�e"e.S (acres/square feet) wael - Site Address and/or Directions to Property: z `4 s F 5 Lott t r , #c ' 16 // 5. 1>15cc. FD, Tor-1 I p,.)1,se,tal 0 4- 9 $g374 Property Owner(s)of Record: ,5 i"4.-, '4" 2e6eccA t0Z-1- Telephone: / - 36 v- 3 Tq- 9Z/5"" Fax: email: Mailing Address: ` '6// s. Disco, /z.p LA) A- ct 81 37e Applicant/Agent(if different from owner): Telephone: Fax: email: A, Mailing Address: 1 7 cuJy t kind of Permit?(Check each box that applies 0 Lot or Road Segregation Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** NManufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat'" ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 0 Propane 0 Long Plat** 0 Sign - 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** 0 Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Vegetation Request **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 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 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior notice. —'Signature: :-,-_— iI Date: --/Z--0,- The action or actions Applicant will undertake as a result of the Issuance of this pennit 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 adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 2 �. hl. Date: -/ Z -©cj • i 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 responsibili of the General Contractor for the proposed project. --Signature. -�- _., 4 Date: Si_/Z 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: X New ❑ Wood Existing: V; ❑ Sewer ❑ Addition ❑ Steel Proposed: 7 Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _- Height: NyLlndividual System ❑ Repair ❑ Masonry SEP Permit# Water Supply: CI Demolition ❑ Other: Bedrooms: pp y: Existing: RC Setback: ❑ Private well C] Two Party Ty of Heat: Proposed:Total: :. Name Public System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i 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: ,7 2"tl Floor Heated Consistency Review: 313 _ Other Heated Base fee: '"�( 1 5 Mezzanine F Additional Section: Heated Basement Plan Check fee: — Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: t 00 Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: tX1Si?1 - Other TOTAL: $c'- G Receipt Number: ( ( l 3� Cash/Check Number: 1Gg0 ESTIMATED COST(REQUIRED) Date: � .Fair market value of all labor and materials foundation to finish J LJ"1 Initials: � ._____ ifs . v J UJ n • (I -f n 1) • .a { 53 h7CN- X oe 4 W • C h cqt ?l O :Z �- W (n 1> V `� _ - W On I o d, ` U1 r ,,,\.....,. .. ,.,,..,,,..,.,..,,,,, . (-N.' 110 er..........._._________.___> \'''H 3 1. ell �- l i t---0. 1 a J F co .___________j ie I a 0 ,...., i. -, �;.q • -°r. � . r's I ri.,„‹ I 1 I F !a I* • \ A C ' T � � - cr t -- .-"---- \) o. I. zo +�� C. �, ri Ti- VI eri p'• 2 rri C.". � � z idXrri MI Cn M m N`- , � V co '7 C\ c . wkdo �n N.,afl" ` 01 CZ) til 1_ MP'-' CO • ~� 1 v CV L. Alb 0 ' ^* 0 -r.-~osmmw.... „,, Z1 .CI) G. .0 G L' o