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HomeMy WebLinkAboutBLD2010-00158 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 #: BLD10-00158 SITE ADDRESS: 24 COCO LN Issue Date: 06/24/2010 BRINNON, 98320 Final Date: 7/28/2010 APPLICANT: LORENTZ E HOLTON PHONE: 360-796-4566 24 COCO LN BRINNON WA 98320-9714 SUBDIVISION: SEAMOUNT ESTATES DIV 3 Block: Lot: 1 PARCEL NUMBER: 993400001 Section: 31 Township: 25 N Range: 02 W PROJECT DESCRIPTION: MANUFACTURED HOME REPLACEMENT - SER# 32228 THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes n� THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/28/2010 I:\F_BLD_Occupancy,rpt 10/29/19 MANUFItTURED/MOBILE HOME INSSLLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD10-00158 Received Date: 5/17/2010 SITE ADDRESS: 24 COCO LN Issue Date: 6/24/2010 BRINNON, 98320 APPLICANT: LORENTZ E HOLTON 24 COCO LN BRINNON WA 98320-9714 SUBDIVISION: SEAMOUNT ESTATES DIV 3 Block: Lot: 1 PARCEL#: 993400001 Section: 31 Township: 25 N Range: 02 W CONTRACTOR/ OWNER/BUILDER PHONE: DEALER PROJECT DESCRIPTION: MANUFACTURED HOME REPLACEMENT -SER# 32228 MAKE: FLEETWOOD YEAR: 2008 SIZE: 44X27 Directions To Site: To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes • Setbacks 7), / Erosion Control MH Foundation Blocking&Tie Down 7' /6 Skirting&Ventilation Gas Line: Exterior Propane Tank Pressure Test Drywell/Alt Drainage Address Posted Sc-1-iP 1--tALU cLi (Thorf--o FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR SPECIAL CONDITIONS APPLY- SEE REVERSE MLA10-00186 UILDING PERMIT APPLICPOON Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00158 Received Date: 5/17/2010 SITE ADDRESS: 24 COCO LN BRINNON, 98320 OWNER: LORENTZ E HOLTON PHONE: 360-796-4566 24 COCO LN BRINNON WA 98320-9714 SEAMOUNT ESTATES DIV 3 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 993400001 Section: 31 Township: 25 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION M/H REPLACEMENT TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 1,188 CODE EDITION: 2006 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: PUD BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: 3-1 E-10 Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $213.00 LYK 05/17/10 117701 APpRovErPotable Water Application $98.00 LYK 05/17/10 117701 Total: $311.00 JUN614 2010 Jefferson County Plannin! & Building Department • • SPECIAL CONDITIONS CASE # BLD10-00158 1.) Jefferson County GIS mapping indicates the location of the proposed manufactured home is within a frequently flooded area. Staff reviewed the FEMA FIRM 5300691605E and determined this project is located within Zone C which is outside of a frequently flooded area. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on June 17, 2010 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, the following ESAs were confirmed to be present on the subject property: Shoreline Designation: Conservancy, Shoreline Slope Stability: Intermediate & Unstable, Spotted Owl habitat, Landslide Hazard: Slight, Susceptible Aquifer Recharge Area, Coastal Seawater Intrusion Protection Zone (SIPZ), Fish and Wildlife Habitat Conservation Area (FWHCA). 3.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 4.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 5.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1)All Industrial Land Uses (2) All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4) All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit(5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 6.) 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. 7.) 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. 8.) 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. 9.) 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. 10.) VOLUNTARY MEASURE* 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. 11.) 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. 12.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 13.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC) Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 14.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 15.) All construction activities shall not encroach upon the landslide hazard buffer. This includes the storage or preparation of materials. 16.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 17.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 18.) 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. 19.) The applicant is proposing to create or add 1,220 square feet of impervious surface and 1,220 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. 20.) The project shall comply w onstruction Stormwater Pollution PreveMO(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. 21.) 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). 22.) The site plan as submitted with the building permit application on May 17, 2010 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated June 24, 2010 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 23.) This approval is for a manufactured home replacement 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. 24.) The parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 25.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 26.) 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. 27.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 28.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 29.) The building height is not to exceed 35 feet. 30.) Setback from Coco Lane right-of-way is no less than 20 ft. and side setbacks are no less than 5 ft. Buffer and setback to shoreline is no less than 155 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 31.) On June 17, 2010 staff sent the proposal to WDFW for comments regarding potential conflict with spotted owl habitat. Gary Bell, WDFW, provided the following comments on June 22, 2010, "FYI -The home site location is within a Status 4 (single bird, status unknown) Northern Spotted Owl (NSO) median home range circle, so there are no concerns from the regulatory perspective for NSO. In addition, the home site is located over 1.7 miles from the historic site center and not within the Best 70-acres of NSO habitat." 32.) This parcel was created through Seamount Estates Dvision No. 3 under AFN 224234, recorded July 24, 1974, Volume 5, pages 98-99 with the Jefferson County Auditor's office. 33.) NOTICE: This permit does excuse the proponent from complying wither 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 WESTERMAN III Jefferson County Courthouse ASSESSOR PO Box 1220, Port Townsend,WA 98368 (360)385-9105 MOBILE HOMFINFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: �`�n�k.: r ti ADDRESS: . UR ttCrx>. , NNfikt ,-✓ U&A 985a/ PHONE NO. 31,1p- 44_ - ,t1,u5l The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 1)MOBILE HOME DATA: (A) MAKE V\Q Q+,kx— CA (B)MODEL_?ycM q 31r(C)YEAR c O S (D)LENGTH /I� (E)WIDTH etQ g- (F)SERIAL# 3.2228 (G)YOUR PURCHASE PRICE(Do not include sales tax)(.&p, PURCHASE DATE4/ 2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE f Qs> moo' O 1- r1s ADDRESS is f)rowt-e ss 113c14 l f'A&.✓'r rIC57 I (B)WAS MOBILE HOME ASSESSED HVJEFFERSON C MJN'I'Y LAST YEAR?Yes No If Yes,Previous address of mobile. If No,What County was Mobile assessed in last year. f^!'ej, 3)WHERE MOBILE HOME IS TO BE LOCATED: AY 1 7 %u (A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes ED (B) IF LOCATED IN MOBILE HOME PARK: NAME&ADDRESS OF PARK PY, Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: LOr -tom c*#cy-e- LOCATION ADDRESS 61 C.c LC �� 't jrt:v\ REAL PROPERTY PARCEL#/DESCRIPTION C1934 cal Signature ofiiikl cant THANK YOU FOR YOUR HELP! Lauralee Kiesel,Property Technician HGuLi to 1 r � �72 • b 9 ` + p�we.P` 1IJ ` II, '' LDfZ T Z 4 S u sAm l vaort E zit Loco t,A-NE G VI CO Co 13+ZivLA0Y1- , t.Jlk• `g3Lo �- �XtSr „ ?Paste 4 360-79 6-4E 426 3Vcj DOVE . L O1 +k 1 DiV 3 / 12J, 7:7 31 r1R,„, ,� �, , lilD /1 gio ri 27 ; I 1 - '' S1, 124,:,,i '� n r� x tsrr�mM 10 EE 22'm frthel ©Epo s' n W d N am � q -d o 1.4 Ni 4'8 P:)fr el plcu 7 •}rn,2 ..• ;t j % liti CO011ifY OC 3 .0�•8 • •to t,, _ go , 0 0 w i U A'' P. DTh w a MAY 1 7 2010 / �' • Iz A I I r • • N I h t j_Q o 0 �i�z z ..- 0 a ill S1 Q ` o1 cs, �� a:7a N 0 y �1k1 N Q LINEN ] I avoalx . III--)._ _ 1;3 .,,, Ln - ,4aOHJ z : ;. r ' flbn h �4rn Ell>C� Z U $1 ‘t\ [ t m 1I� ya tl I ILT-..Lr 0 ® SHELF �r m5 ifi . � t1 r 70 1 � '�4 F r-- O 2 - n D q 70 Z I- csi I I I ALT.DOOR LOCATION O 7t 2 1E1 [ Z SLIDING GLASS DOOR C3 Z OPT PORCH a i r or-0"X ts'-4" I o 70 CI • • �0.SON a% JEFFERSON COUNTY �} DEPARTMENT OF COMMUNITY DEVELOPMENT " 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450 • 360/379-4451 Fax 4.4 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: f 186 Project Description(include separate sheets as necessary): rrY3 o t L\ P 4- C I-tarrQA Tax Parcel Property Number: qq3LI , Size: fSFs.� F (acres/square feet) Site Address and/or Directions to Property: Cc c La,- .. t`13r t ry zw 1 elS3.1.0 Pi N wcttnl . f Cr' , J n Ln t)c Property Owner(s)of Record: Lcx-Q,,-t-7 }-(o. b:)(\c Telephone: ©= 1q�p—4Slpl0 Fax: email: Mailing Address: (,UGt) 1$1 P,htv wi i , (AA- cik3lD Applicant/Agent(if different from owner): Telephone: Fax: email: . Mailing Address: Wh31 kind of Permit?(Check each box that applies Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a),C(d),or C]** ❑Single Family ❑Garage Attached/Detached ❑Discretionary"D"or Unnamed Use Classification Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑Boundary Line Adjustment ❑ Change of Use El Short Plat** ❑ Address ❑Road Approach ❑Binding Site Plan** ❑ Home Business ❑Cottagelndustry ❑Long Plat** 0 Propane ❑Planned Rural Residential Development(PRRD)/Amendments** El Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management El Shoreline Management Substantial Development** El Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request *May require a Pre-Application Conference **Requires a Pre-Application Conference 1 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicati at he e wan s prior notice. ignature: Date: `{/Z9 -- The action or actions App t 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 itlty for adhe'ng to n complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signatur Date: y-+/Q C:\Documents and Settings\canal\Local Settings\Temporary Internet Files\OI,K86\Master Permit Application 12-19-2006.doc • III 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: 1sJcu ,›N 11,0 il, Lo..nc1 Zsurv►cam (3k) -14 ,- IQC.o,Aci (30d -i - 1o3, MAILING ADDRESS: -PC) gr t'31s-1 EMAIL:MCI,X`L►1``)17 0 C lh p , Q_Kjfq CONTRACTOR'S LICENSE e Q \Q..LC,S, 1.Ai A c �'.)" WAINS 11 NUMBER: 1rpC�-,1, t`ICDG S54- NUMBER C1 e.v4..'i LC1iw 14 ARCHITECT/ENGINEER: Vt 0 Q._ (fir- �(') t-.,C-,--, S PPHHOONE )gs 1_D-r 'j,9'`FAX:( j Oat i j ""� MAILING ADDRESS: ,'.Z-16J Pv j 1L3::, 1.3 Onar ia_tr 81 .. Q--7 I f oM.N GLO A 10'Q - @ c I E eu�-�OC. Pro ect Type: Frame Typb: Bath oms: Shoreline: Type of Sewage Disposal: • Co"m VNew ❑ Wood Existing: c2 Li Sewer ❑ Addition 'Steel Proposed: .„g Bank L. community System ❑ Alteration/Remodel ❑ Concrete Total: Height: VIndividual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: a- Setback: Li Private well ❑ Two Party Type of Heat: Proposed: v2- ) i /Public `tc iL Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: iU I A Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑Underground Tank I (Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove ❑ Fireplace Insert 0 Hot Water Tank ❑Pellet Stove 0 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: �� P Floor Heated Consistency Review: Other Heated Base fee: n 1?D — Mezzanine ?dd'N° tle(tbo� 4(-r—"7 Heated Basement Plan Check fee: �J �1 Unheated Basement State Surcharge fee: T Other Unheated Pot Water Review fee: �r Garage/Carport SUBTOTAL . x..) Decks 911/Rd Approach fee: Other i TOTAL: $ 1 (Receipt Number: I 010 t Cash/Check Number: d4 ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and materials foundation to finish Initials: • C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc