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Home My WebLink AboutBLD2010-00267 • 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 #: BLD10-00267 SITE ADDRESS: 44 A GARTEN RD Issue Date: 11/1/2010 PORT LUDLOW, 98365 Final Date: 10/28/2011 APPLICANT: JOSEPH F STILEY PHONE: (509) 710-0596 44 GARTEN RD PORT LUDLOW WA 98365-9514 SUBDIVISION: IDA MAE TESTER SHORT PLAT Block: Lot: 1 PARCEL NUMBER: 821344061 Section: 34 Township: 28 N Range: 01 E PROJECT DESCRIPTION: M/H ADU - SER#-09L16299 THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON10/28/2011 I:\F_BLD_Occupa ncy.rpt 10/29/19 • • 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#: BLD10-00267 Received Date: 7/28/2010 SITE ADDRESS: 44 A GARTEN RD Issue Date: 11/1/2010 PORT LUDLOW, 98365 APPLICANT: JOSEPH F STILEY 44 GARTEN RD PORT LUDLOW WA 98365-9514 SUBDIVISION: IDA MAE TESTER SHORT PLAT Block: Lot: 1 PARCEL#: 821344061 Section: 34 Township: 28 N Range: 01 E CONTRACTOR/ OWNER/BUILDER PHONE: DEALER PROJECT DESCRIPTION: M/H ADU -SER#-09L16299 MAKE: ALLEGRO YEAR: 1980 SIZE: 66X14 Directions To Site: k\AsiLb ( )'1 s 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 Erosion Control MH Foundation 10/26/2011 Blocking&Tie Down Skirting&Ventilation Drywell/Alt Drainage 11/18/2011 (verify placement of splashbloci Address Posted 10/28/2011 FINAL FINAL Building FINAL INSPECTION `e L (� � n - n ^ �� FINAL INSPECTION MU-&T-BE PPROVED IPRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR SPECIAL CONDITIONS APPLY-SEE REVERSE •UILDING PERMIT APPLICION M 290 Revv iewiew T Tyype: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00267 Received Date: 7/28/2010 SITE ADDRESS: 44 A GARTEN RD PORT LUDLOW, 98365 OWNER: JOSEPH F STILEY PHONE: (509) 710-0596 44 GARTEN RD PORT LUDLOW WA 983659514 IDA MAE TESTER SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 821344061 Section: 34 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE PROJECT DESCRIPTIOI' M/H ADU TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP ADU MAIN: 924 VALUATION CODE EDITION: 2009 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 Pam_ �_. Total: 2 Total: 1 Routing Date: �___ � v7_,)-IC Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $213.00 LYK 07/28/10 118049 APPROVEr Potable Water Application $98.00 LYK 07/28/10 118049 Total: $311.00 NOV I Alt/ Jefferson County Planning & Building Department • S SPECIAL CONDITIONS CASE # BLD10-00267 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 FRC)M 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.) NO SUPPORTS FOR THE DECK ARE ALLOWED ON OR NEAR THE SEPTIC TANK 4.) Per owner the deck that is over the septic tank is to be a minimum of 36" above ground. This will allow access for tank pumping and maintainance. 5.) The application was reviewed by the Jefferson County Department of Community Development staff on November 1, 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 and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: slight landslide hazard area; SUSC aquifer recharge area; high risk SIPZ. 6.) 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. 7.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 8.) 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. 9.) Marine shorelines and islands.susceptible to a condition that is known 3awater 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. 10.) The parcel is located within a High Risk SIPZ(seawater intrusion protection zone) according to the County GIS map. There are 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 High Risk SIPZ is defined as: areas within 1,000 feet of a groundwater source with a history of chloride analyses above 200 milligrams per liter(mg/L). 11.) 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. 12.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 13.) 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. 14.) The applicant is proposing to create or add 1692 square feet of impervious surface and 1692 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. 15.) 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. 16.) 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). 17.) The site plan as submitted with the manufacture home application on July 28, 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 November 1, 2010 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 18.) This approval is for 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. 19.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 20.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 21.) Not more than 2 unlicensed veils shall be stored on any lot unless totally eened 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. 22.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 23.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 24.) The building height is not to exceed 35 feet. 25.) Minimum setback from Garten Road and private ingress/egress easements rights-of-ways shall be 20 feet. Minimum side and rear yards setbacks shall be 5 feet. 26.) 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. 27.) 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. 28.) An address of 44A Garten Road, Port Ludow has been assigned to the parcel. Garten Road is a county local access (C504409). 29.) The parcel is served by the Bywater Bay public water system. 30.) The parcel was created through the Ida Mae Tester Short Plat on July 5, 2000 under AFN 435122. 31.) A water review (OTH94-0113)was approved on April 8, 1994. A building permit (BLD94-0244) for a manufactured home was finaled on November 28, 1995. A septic permit(SEP94-0144)was finaled on August 30, 1994 and EES on December 14, 2007. A septic permit(SEP08-0162)was approved on October 3, 2008. 32.) NOTICE: This permit does no•use the proponent from complying with o 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 • Jrffermon County urAwusc ASSESSOR PO Ilox 1220. Port Townsend, WA 98368 4360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: _\ o 5 EP N Cs. S-c L Y "I ADDRESS: `{`t &-"NJZ*-t'v i-a- PHONE NO. Soc - ?! o - 0 59(o 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. I)MOBILE ROME DATA: (A) MAKE Fl l`t c-R- (B) MODEL I 1+-7 63 g C (C) YEAR 1160 (D) LENGTH (P Co (E) WIDTH `i` (F) SERIAL # et' i' 2 9 9 (G) YOUR PURCHASE PRICE (Do not include sales tax) (006 PURCHASE DATE 1 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE M ic.5 � Tr-e- v IO ADDRESS 41-G &'K -'' N1 fad• Q LT ,�, (AP\ (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR Yes No If Yes, Previous address of mobile. 4( ektN VA If No, What County was Mobile assessed in last year. UNow:S 3)WHERE MOBILE 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: --) ? St/4 �. S-+ t Y t NAME OF LAND OWNER: LOCATION ADDRESS 44 &MAI Rd REAL PROPERTY PARCEL #/DESCRIPTION S 2.( -54`f ( 0 \ aer of applicant THANK YOU FOR YOUR HELP! Lauralee Kiesel, Property Technician /Pi Goolei �u�cr Yawl � a 7,.1/ . .91„. , .'.(.1,,....t. lif.b'.,� rn„k aSS 9G .7" • Ior-- — 'Sr— -----\ — — — .---7' 1 Ex�sf�iy access Dr .n�,� N x3�aq el i _�-- L.), j 4o C=55'4 -- - ,Nk ay-et V i \ :r raw 4.«14 --•, Al —v `f. 'i` 1 SP1tts ex. 20. u. % 't?%Oct', Ai ( r r�`3 ,� �� , tio‘"I: 1 ) , •�� 5 p StormW i , :: r �: I - Requ , • w I t r . ,. K a ' APPROVED 1 • , I ` SITE PLAN t _ es; I '151 Z NOV -- 1 2010 Li I t 41.44.- aiir IC N ` I JEFF .00 Y ` /sta T:: i' :• J KcikrgQ Nd ' JO 01 )). 0' aat�4 �yV ,i� nsfid risks l-0 grc�c V P 1 . "•i : o:, I.�r� Ewe 1?-1 07,,.;y`111,1 , 0VCo T b♦O )(5 Se ��Mf qq'/`W I Owner.Ja.is1S4jje , 1 Parcel# g),11 344 06 t �k icy • besigned by: Crie.sert f esj4 4,,.e�'"4e I sale, a"= 60` E • 0 8Z9S-L9t' (609) 1IVIN '3 Void — 8L8Z-L9tI (609) —80Z66 VM `3NV>10dS — .19 1:131N30 8Z9 'M r aC ...,., J �t. � v r . -•1 r 7. il----- to ,-s A',) , -- 1 ...„ , 1..: II Ir--_ , 4�. ,..- N., t- 1 71.i. sr- G ,,-, , !, xx 01 _ X -ri 1G Lis • s,- • w_i 7. 4 . J IL • J E __, ,- :2 • ...... , } '0N1 `S31VIOOSSV '8 A3111S III • e450N co G JEFFERSON COUNTY A DEPARTMENT OF COMMUNITY DEVELOPMENT ` `4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax p'� www.co.jefferson.wa.us/commdevelopment �%NG Master Permit Application MLA: I() '- ' !t_ Project Description(include separate sheets as necessary):Setup 14'x66' mfg home as ADU Tax Parcel Property Number: 821 344061 Size: 65975 sq. ft. (acres/square feet) Site Address and/or Directions to Property: 44 Garten Rd. Port Ludlow, WA 98365 Approx. 1/4 mile off of Route 104, 1 mile East of Shine Rd. On private road. Property Owners)of Record: JoseDh F. Stiley Ill Telephone:(509) 710-0596 Fax: email: ioestilev p gmail.com Mailing Address: 44 Garten Rd.Port Ludlow,WA.98365 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: at kind of Permit?(Check each box that applies Wit_., ❑Variance(Minor, Major or Reasonable Economic Use) ❑v�Demolition Permit ❑Conditional Use[C(a),C(d),or C]** ❑Single Family ❑Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification 0 Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** El Commercial* ❑Boundary Line Adjustment ❑ Change of Use El Short Plat"* El Address ❑ Road Approach El Binding Site Plan*" ❑Home Business ❑Cottagelndustry ❑Long Plat** ❑Propane ❑Planned Rural Residential Development(PRRD)/Amendments*" El Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis El Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use 0 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 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 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 agr: o provide access and ri. t of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and -ny required later inspe ;�•..�..�� Staff cess and right of entry will be assumed unless the applicant informs the County in writing at the time of the:pp ication that he or s nts • for n. ..� / (2_c3 Signature: .Lelz.t� A�� __ Date: 7 / '-'7 I O The a on or.ctions Applicant will undertake as a result o e issuance of this permit may negatively impact upon one or more threatened or en•angered •ecies and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "E danger-. Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this per " -s 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( -v-• if you are in complia 461101-Je� ,County de •ment code.The Applicant acknowledges that he,she or it holds individual and no -transf:rable responsibili • :. - •. o an: . • e ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: . • Date: 7/Z 7/2-0 I a C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\0LK86\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT The signer• ais statement does her-• certify that •- are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be ing the res onsi•lity••t - .-n:CID trac• e proposed project. Signature: \ Ate` _ ilatP 7/2 7 f 2-0 re) GENE-•L CONT'ACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILIN". ' "DRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New Li Wood Existing: _ ❑ Sewer 0 Addition ❑ Steel Proposed: I Bank LI Community System ❑ Alteration/Remodel 0 Concrete Total: I Height: 1 I Individual System ❑ Repair ❑ Masonry SEP Permit#SEP08-00162 ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: • Setback: Private well Two Party Type of eat: Proposed: I I Public 1( Total: ,� 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: 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 °Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove ❑Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 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 r}aLl EH Bld App Review: 13 2n0 Floor Heated ``�� Consistency Review: 1 Other Heated Base fee: 9 13 — Mezzanine Additional Section: �,( Heated Basement Plan Check fee: ._ ' :) L`J^' Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: `i` , ` A ,�I I n f-` (CoJ Other TOTAL: $�( 5I CO Receipt Number: 11 SOLI -f — Cash/Check Number: Z" ESTIMATED COST(REQUIRED) Date: `J / ; .Fair market value of all labor and materials foundation to finish 1,s Initials: C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc