HomeMy WebLinkAboutBLD2012-00178 *JILDING PERMIT APPLICATIL MRLeA1ew2-001e32
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00178 Received Date: 6/12/2012
SITE ADDRESS: 32 S DUQUESNE AVE
PORT TOWNSEND, 98368
OWNER: PATRICIA O'MEARA PHONE: 360-732-0689
3430 W VALLEY RD
CHIMACUM WA 98325-9751
IRONDALE
SUBDIVISION: Block: 122 Lot: 1+
PARCEL NUMBER: 962112201 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: KOZELISKY'S HOME SERVICE INC PHONE: (360)385-3215
31 HIDDEN TRAILS RD
PORT TOWNSEND WA 98368
Contractor's License KOZELHS027C3 Expires 1/6/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW M/H
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 504
VALUATION ADD'L: HEAT TYPE: PRO
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: 05783
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 1 Prop:
Total: 1 otal: 1 �--
Routing Date:
(0—t2-1.
Type Amount Paid By: Date: R- -ipt: v•a• / V
Manufactured Homes $222.00 LYK u• /12 131799
Propane Tanks/Stoves $148.00 LYK 06/12/12 131799 ,g �
Potable Water Application $64.00 LYK 06/12/12 131799 JUN O,
Total: $434.00 Jefferson County Planing
& Building Qenerfmo
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JEFFERSON COUNTY
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D-OMMU—ut yEtopmuvr
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��rilike>' ' JEFFERSO COUNTY
W ` ,4 DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�q p� www.co.jefferson.wa.us/commdevelopment
S
BINS�S
Master Permit Application MLA: 13 - 4 32
Project a ription( clude separate sheets ,ne ssary):
' / � ac
.(
, -6-►1 ,
Tax cel
Number: 96E11 11 2 Zo 1 2 11 20 2 Property Size: 100 K /S-1:) (acres/square feet)
Site Address and/or Directions to Property:
32 Pikactes e POK-7 -tovu4sFLIA 96348
Property Owner(s)of Record: ?441 .LCI4 O`voeFf<_
Telephone: 360 732- dt, '9 Fax:
Mailing Address: 3 4 30 We S/ mail:
g tic I(ey 2d Cl�tNtACuM 1,,,)A co 3Z�
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
W kind of Permit?(Check each box that applies
0 Lot or •-d Segregatio
wat ilding ❑ Critics t 7._.. u :.- Fliati
❑ Demolition Permit
❑Varia t or, •Major or Reasor�a• - is-Use)
❑Single Family ❑Garage Attached/Detached ❑Condit ■ -_ ie[C(a),C(d),or C]**
® Manufactured Home .❑ Modular - - ❑ Discr i• - "0"r, '(,tn n'�d Cla ifi on
0 Commercial* ❑Speci II ,t Essential Public Facilitie s
❑ Change of Use ❑ Boun - ,e Adustment i;
❑ Address ❑ Road Approach ❑Short plat** JEFFRSO i COUNTY
❑Home Business ❑Cottage Industry ❑Bindirig SitesRtanr*,"
❑Propane ❑Long Flat**.. - t , .i?':i.'T
❑Sign -.. ❑Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration--
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development**
❑Temporary Use ❑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:
DESIGNATION OF AGENT
I hereby designate / n - to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE / Date:4GuAsj., 2,01-2-
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 a•• -•uired later inspections. S affs access and right,of entry will be assumed unless the applicant informs the County in writing at the
time of the " ';/t a h- o s e want• • •r • IA.
ignature: �Li �1�� j Al 1.1 ' Date:
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has bee• ' ed will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)eve if yo are'n compliance-.with th- -fferson County development code.The Applicant acknowledges that he,she or it holds individual
\and non-tra fer-•1-,°-).: /, i•ili, •r adhe( • • - • -• p) in• with the ESA. The Applicant has read this disclaimer and signs and dates it below.
1kignature: _ ,I�LL _ _ Date:
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:
GEN RAL CONTRACTOR OR,' •NUFACTURED HOME INSTALLER: PHONE: FAx:
�
`_ _' ilk .. ..�.4.6.J ( ) ( )
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:
0 New 0 Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: Bank 0 Community System
0 Alteration/Remodel 0 Concrete Total: I _ Height: 0 Individual System
0 Repair ❑ Masonry SEP Permit#
0 Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: 0 Private well 0 Two Party
Type of eat: Proposed: �_ ❑ Public
(1^J Total: Name of System:
J
If this is a Commetrcia Project you must answer the following:s
Number of Parkingk a , =Current: ,Proposed: Number of ADA Parking Spaces:
Number of occuparitt(i dudes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: °IBC Type of construction: Will you have FoodSen►ice? Yes / No '
If this is a Propane T nk and/or Appliance Installation permit,mark all items below that apply:
I Underground Tank Above ground Tank
9 Size of Propane Tank: t:QO
I Heat Stove i Cook S ove 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 F Office Use 040k ;.
Main Floor Heated �� ' A
. ttlg�l�it: .ReYlsian
EH Bid App Review: 1 Y -
I Floor Heated Consistency Review:
a3
Other Heated Base fee: / -
Mezzanine _ - -Heated Basement A����naio� #L�P s
Plan Ch ck� �l-T
Unheated Basement State Surcharge fee:
Other Unheated- Pot Water Review fee: r
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $
Receipt Number: 17C 9
Cash/Check Number: t 73
ESTIMATED COST(REQUIRED) Date: �j
•Fair market value of all labor and materials foundation to finish (l- r
Initials:
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'\\141'1 JUN 1 2 2012 ,
JEFFERSON COUNTY i
DEPT.OF COMMUNITY DEVELOPMENT ' NJ
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JACK WESTERMAN MO .Jefferson Coulkourthoii c
ASSESSOR PO Ilos 1220, Port Townsend, WA 98368
(360) 385-9105
MOBILE ROME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS:
NAME: Pinni 0`41164R,4
ADDRESS: 3z130 (ales- Va/ ky 2d c l-(2 A cu/VI, (A/'4 112 S-
PHONE NO. 360 -132-66f`
Wiz, ,,
The purpose of this questionnaire is to obtain inf ripaitto0-� i •.1t-d ficr the
current location of a mobile home or the previous nerai ai rocatioi;df a mobile
home. This will help our office determine whethe the mobile ho is already on the
tax rolls in Jefferson County or if it has been movid .o this roiifitom Cher area
1)MOBILE HOME DATA: JEFFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
(A) MAKE CORONA 00 (B)MODEL 3 0 0 C0 ( 46132- (C)YEAR 2-°°11
(D) LENGTH 3& (E)WIDTH -i (F) SERIAL # 03 -2I0SCQ
(G)YOUR PURCHASE PRICE (Do not include sales tax) 3,060 PURCHASE DATE 6/12/12--
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE ?Q4-e r 80 n)1wl ii3G21-1 L-00
ADDRESS -1 CtzkvC 1 Z 12-U, tb(7 ?dcotJ Dr CO P 1SLZ
(II)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEA ' (1 No
If Yes, Previous address of mobile. 1'1p 2 Poi-A- -row✓tS-e.nd ()Jet 9 P3
If No, What County was Mobile assessed in last year. ,e eeG O14
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes
(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: PATRICIA d'M EA RA
LOCATION ADDRESS 3 2 DUGUESIE T ot l6 w vtI end, (,t)a. R f36 )
REAL PROPERTY PARCEL #/DESCRIPTION 962 11220 /o 6/11 Z 202-
° ;
• 1ff :.
Signature of applicant
THANK YOU FOR YOUR HELP!
Lauralee Kiesel, Property Technician
Contractors or Tradespeople Pritirriendly Page Page 1 of 2
General/Specialty Contractor
A business registered as a construction contractor with LEI to perform construction work within the scope of
its specialty.A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name KOZELISKY'S HOME SERVICE INC UBI No. 601765504
Phone 3603853215 Status Active
Address 53 N Gary Ave License No. KOZELHS027C3
Suite/Apt. License Type Construction Contractor
City Port Townsend Effective Date 2/23/1998
State WA Expiration Date 1/6/2013
Zip 98368 Suspend Date
County Jefferson Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Other Associated Licenses
Specialty Specialty Effective Expiration
License Name Type Status
1 2 Date Date
KOZELSM200K9
KOZELISKY'S MANU Construction General Unused 5/29/1980 12/14/1997 Archived
HOME SER Contractor
Business Owner Information
Name Role Effective Date Expiration Date
KOZELISKY,JAIME ELTON President 01/01/1980
KOZELISKY, JASCHA GABRIEL Vice President 01/01/1980
KOZELISKY, JOSEPH 01/01/1980 12/30/2010
KOZELISKY, KATHERINE 01/01/1980 12/30/2010
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
1 CBIC SE0961 12/14/2001 Until Cancelled $12,000.00 12/18/2001
Assignment of Savings Information
Savings Assignment of Savings Account Number Effective Date Release Date Assignment Type Impaired Date Amount Received Date
1 0702000143 2/23/1998 Until Bond $6,000.002/26/1998
Released
Insurance Information
Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date
Contractors
11 Bonding a C11SE0961 12/31/2011 12/31/2012 $300,000.00 11/17/2011
Insuranc
10 CBIC C11SE0961 12/31/2010 12/31/2011 $300,000.0011/18/2010
9 CBIC C11SE0961 12/31/2009 12/31/2010 $300,000.00 12/28/2009
AMERICAN CAS
8 M1250000012 12/31/2008 12/31/2009 $300,000.0012/19/2008
INS CO
ATLANTIC CAS
7 M125000001-1 12/31/2007 12/31/2008 $300,000.00 12/28/2007
INS CO
ATLANTIC CAS
6 M125000001-0 12/31/2006 12/31/2007 $300,000.00 12/27/2006
INS CO
ATLANTIC CAS
5 M088000134 12/31/2004 12/31/2006 $300,000.00 12/08/2005
INS CO
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 6/12/2012
I
MANUFAJRED/MOBILE HOME INST ATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD12-00178 Received Date: 6/12/2012
SITE ADDRESS: 32 S DUQUESNE AVE Issue Date: 6/26/2012
PORT TOWNSEND, 98368
APPLICANT: PATRICIA O'MEARA
3430 W VALLEY RD
CHIMACUM WA 98325-9751
SUBDIVISION: IRONDALE#5 Block: 122 Lot: 1+
PARCEL#: 962112201 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR/ KOZELISKY'S HOME SERVICE INC PHONE: (360)385-3215
DEALER 31 HIDDEN TRAILS RD
PORT TOWNSEND WA 98368
Contractor's License KOZELHS027C3 Expires 1/6/2013
PROJECT DESCRIPTION: M/H &A/G120 GAL PROP TANK
MAKE: CORONADO YEAR: 2004 SIZE: 36X14
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.
Office Hours 9:00-4:30 MONDAY-THURSDAY
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 0-13-12
Erosion Control
MH Foundation
Blocking&Tie Down y)) ;s:":„:4
Skirting&Ventilation ���
Gas Line:Exterior 6, -1P 1 �
Propane Tank .32)-0
Drywall/Alt Drainage 9.' c `
Address Posted �,2„�-(
(�
FINAL INSPECTION ti
r_
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
SPECIAL CONDITIONS APPLY-SEE REVERSE
•
SPECIAL CONDITIONS CASE # BLD12-00178
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on June 12, 2012 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: SARPA.
2.) 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.
3.) 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.
4.) 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.
5.) 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.
6.) The applicant is proposing to create or add 535 square feet of impervious surface and 504
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.
7.) 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.
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 site plan as submitted with the Building Permit application on June 12, 2012 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 22, 2012 shall be resubmitted for review and
approval by Jefferson County Department of Community Development.
10.) This approval is for a New 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.
11.) The parcel has been designated as Rural Residential 1:5 under the Jefferson County
Comprehensive Land Use Map effective August 28, 1998.
12.) A Declaration of Restrictive Covenant has been recorded on March 14, 2002 under AFN
453509 for the purpose of consolidating the lots to meet minimum land area requirements
for on-site septic ad to allow zero lot line setbacks. The Covenant is strictly for building
and septic purposes only.
13.) NOTICE: This permit does nccuse the proponent from complying with iikr 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
The Federal Bald and Golden Eagle Protection Act requires landowners within 660 feet
(1/8th of a mile) of an eagle nest to consult with the US Fish and Wildlife Service. This
Eagle Act prohibits anyone from "taking" bald eagles. This federal law defines the term
"take" and describes the possible legal consequences when a"take"occurs. Among
other actions, "take" includes a disturbance of bald eagles or their habitat. Under federal
law a permit may still be required for activities that impact bald eagles or their habitat.
Contact the US Fish and Wildlife Service(http://www.fws.gov/pacific/eagle/)to learn more
about how this law affects your project.
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.
14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
15.) 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.
16.) This parcel is within a no shooting area per JCC 8.50.
17.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
18.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
19.) The building height is not to exceed 35 feet.
20.) Building setbacks from Duque.Ave are no less than 20 feet. Side and setbacks
are no less than 5 feet.
\\tidemark\data\forms\F_BLD_Permit_Mobile.rpt 6/26/2012
AOINOMMMIIIIP
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4, °1- JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
9,pii/NO.CO
Date: C.-12.. Time Received: „2.5,5*-- amOart, Mon. Tue. Wed. Thur. ri.
Date: ( 13
BLD: 12-- f 7 r7P Contact Name:
Owner: Contact Number: 360 ?qp g(®m
Address: 32_ b OCie,5yte4 206
Notes:
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing Under ground Furance
Footing Rough In Air Seal Above ground Gas
Stemwall Hydronic Exterior shear Exterior lines Oil
Straps Hot Water Htr Interior shear Interior lines Ducts
Post Hole Ventilation Appliance
Underfloor Gas/Wood stove
Man-Homes Insulation
Final Inspection X,
Setbacks Floor
Foundation Wall Address Posted
Block&Tile Ceiling
N.-
•
Date _Y_—__ time received )/2 e9 pm Mon. Tue . •Wed: Tour. --Pd. -
BID: J L 2_ —118 Date:
OWNER: g I44 �.. - • Contact Name:
•
ADDRESS: _9 2 - b C.ISQt efe" Contact Number 360
206 - a
Notes:
Foundation Plumbing - Framing Propane Tank Mechanical
Setbacks Under-ground'_ Framing Underground _ Furnace
Footing Rough in Alr seal Above ground _ Gas _
Stemwall _ Hydronic Exterior shear Exterior lines Oil _
Straps Interior shear Interior lines _ Ducts .—
Post Hole Ventilation Appliance —
Underfloor Gas/wood stove
Man-Homes
Setbacks _ - Insulation. Final Inspection s't.
Foundation — `' _'
Nock&Tie floor _wall ceiling. . Address Posted
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