HomeMy WebLinkAboutBLD2014-00157 II/BUILDING PERMIT APPLIC•ON BLD14-00157
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00157 Received Date: 5/2/2014
SITE ADDRESS: 9481 OAK BAY RD
PORT LUDLOW, 98365
OWNER: BRIAN L PETERSON PHONE: 360-437-8148
MARIE A PETERSON
46 VILLAGE WAY PMB 171
PORT LUDLOW WA 98365-9762
SUBDIVISION: Block: Lot: TX301
PARCEL NUMBER: 821171003 Section: 17 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP BUSINESS SIGN FOR JEFFERSON HEALTHCARE PORT LUDLOW
CLINIC
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP SGN MAIN: INDUSTRIAL:
VALUATION 5,621.00 ADD'L: HEAT TYPE:
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: NUMBER OF EMPLOYEES:
WATER SYSTEM:
BATHROOMS:
Exist:
Prop:
Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Plan Check $73.45 JLA 04/29/14 148590 APPROVED
Building Code $4.50 JLA 04/29/14 148590 APPROVED
Permit $113.00 JLA 04/29/14 148590
Total: $190.95 DEC - l 2015
Jefferson County DCD
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JEFFERSON COUNEW ,1490
DATE 1 259''?-147
RECEIVED FROM ci-0�)t•Y\ wr'rJ
BARS# AMOUNT
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•
�4��SON c%. IFERSON COUNTY
DEPA►RTlI ENT QE COMMUNITY DEVELOPMENT
4 N od 621 She idan Street Port Townsend,WA 98368 j Weir:
Tel:360.379.4450 I Fax:360.379.4451 Email:dcd aC�.co.jefferson.wa.us
Building Permits &Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
Business sign for Jefferson Healthcare Port Ludlow Clinic
Tax Parcel Number: 821171003 Property Size: (acres/square feet)
Site Address and/or Directions to Property: 9481 Oak Bay Rd/Port Ludlow,WA 98365
Property Owner(s)of Record: Brian L.and Marie A. Peterson
Telephone:360437-8148 Fax: email:
Mailing Address: 107 Ludlow Bay/Port Ludlow,WA 98365
Applicant/Agent(if different from owner):
Telephone:360-385-2200 x1500 Fax: 360-379-9234 email: koconnellljgh.org
Mailing Address: Jefferson Healthcare Attn:K OConnell 834 Sheridan/Port Townsend,WA 98368
What kind of Permit? (Check each box that applies ❑ Lot or Road Segregation
❑Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address ❑ Road Approach ❑Short Plat**
❑Home Business ❑ Cottage Industry ❑ Binding Site Plan** O Z0F
❑Propane ❑ Long Plat** /
IIG
®Sign ❑ Planned Rural Residential . - .. ent(P-- :11 f,n r
❑Allowed"Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration**
El Stormwater Management ❑ Shoreline Master Progra e fa•tion,tcApn it Revisions"
El Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management :ubs -rtial Deve"lbpt a **
0 Temporary Use CI Shoreline Managemen arianc: ' 20/¢
❑Wireless Telecommunication* ❑ Comprehensive Plan/ = /Lg. Us,.91 ' Map Amend
ElForest Practices Act/Release of Six-Year Moratorium CIJefferson County Shoreline l _ ' )? .ION�1• -•dment
*May require a Pre—Application Conference ❑Tree Vegetation Request �'IIiV . r04//y
**Requires a Pre-Application Conferen - D�E op,.
intivr
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate ,designate Ade — to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATUR i(.G 4- 1 ad Date: ''71 NI ad I`1/
By signing this appli ation 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 knowl-dge. 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 -.or'red later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time ofthe -:•I'--tion •- o he wants prior notice. fII �� ��
Signatur-: A Date: tl
The actio or actions A.plicant 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 responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
07/24/2013
• •
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
(360-97-8148 ( )
MAILING ADDRESS: 107 Ludlow Bay/Port Ludlow,WA 98365 EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE (360-4)37-8148 FAX:( )
MAILING ADDRESS: 107 Ludlow Bay/Port Ludlow,WA 98365 EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: G Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of System:
If this is a Commercial Proiect 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 Cook Stove Woodstove Fireplace.nsert rehtO f evotS telleP i knaT retaWtoH i
Is this appliance being installed in a Manufactured I 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:
2"0 Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee: O Z"^
Unheated Basement State Surcharge fee: / �," �C
7
Other Unheated Pot Water Review fee: J 1/ R
AP
Garage/Carport SUBTOTAL �4-.�H'4
29
911/Rd Approacee: oFC6Other TOTAL: $ t-OPMfNT
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish
Initials:
07/24/2013
• •
(,�sON co JEFFERSON COUNTY
�4 ° DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.waus/communitvdevelopment
• -1,SW isj fl Tel:360.379.4450 I Fax: 360.379.4451 I Email:dcdraco.iefferson.waus
Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center
03/13/2014
Brian L Peterson
Marie A Peterson
46 Village Way PMB 171
Port Ludlow, WA 98365-9762
9 in-1 4904e 6.7 ,. r�^vl+�
Mr. Peterson,
The Building Permit for 9481 Oak Bay Rd, BLD08-00509 for the tenant Improvement to the existing building is
still open, has not been renewed, and has not been finaled. This permit has been ongoing since 2008 and has
not received an inspection since 2009. Currently this permit has an outstanding balance of$1089.00. We have
made several attempts to contact you with no response. As this is a commercial medical building we believe it
is in your best interest to get your building permit finaled and we would like to help you get that done. As part of
DCD's amnesty program we are willing to waive all the renewal fees except for one year, $228.00, in order to
get this permit up to date and get a final inspection done.
The only thing that needs to be completed in order to receive a final inspection is a sign permit for the existing
sign on the building. The sign was not included in the original application and a permit is needed in order to
ensure it is to code and properly installed.
Please call to schedule a progress inspection with our inspectors by calling 360-379-4455 and we can discuss
with you what needs to be completed to get your residence finaled.
If you have any questions please call me at 360-379-4494 z--
Thank you, _-�
ce
r „ r
,rz
,4____
iAPR
II; 2 9 2014
DEpT OFCO"UNITYDESON V
Jodi Adams E(OPMENT
360-379-4494
Jefferson County Community Development
621 Sheridan St.
PortTownsend, WA 98368
cc: Brian Peterson \�
Jefferson Healthcare— Port Ludlow \Y`
Jefferson Healthcare— Main Office
Building File
• •
LEASE AGREEMENT
THIS LEASE, made and entered into this 2..• day of March, 2011,by and
between BRIAN L. PETERSON and MARIE A. PETERSON, husband and wife,
hereinafter referred to as either"Landlord"or Lessor,"and JEFFERSON COUNTY
PUBLIC HOSPITAL DISTRICT#2, hereinafter referred to as either "Tenant" or"Lessee".
1. PREMISES. Landlord hereby leases to Tenant and Tenant hereby leases of
and from Landlord the real estate and premises located at 9481 Oak Bay Road, Suite A,
Port Ludlow, WA, 98365, Washington(the Premises). The Premises are located on the
upper level of Landlord's Building. Tenant shall have exclusive use of the entire upper
level parking area adjacent to the Premises. Tenant shall also have non-exclusive use of the
parking area adjacent to the lower level of Landlord's Building. At all times, Tenant shall
have nonexclusive access to, and use of,the phone/data room located on the lower level of
Landlord's Building,of which the Premises are a part. The Premises are a portion of the
real property legally described as:
See attached Exhibit A.
2. TERM/RENEWAL. The initial term of this lease shall be for a period of
THREE(3)years,commencing on the 1st day of May,2011, and ending at the expiration
of the 30th day of April, 2014. Tenant may, at its option, renew this Lease for two(2)
renewal terms of five (5)years each. The term of each renewal period shall commence
immediately upon the conclusion of the original term of this lease or the preceding renewal
period,as the case may be. This option to renew may be exercised only by written notice
hereof no later than six(6)months prior to the expiration date of the original term of this
Lease or the preceding renewal period, as the case may be. The renewal term(s), granted
pursuant to this option to renew, shall be on the same terms and conditions as are to be in
effect during the original terms of this Lease except that: (i) Tenant shall have no further
option to renew this Lease beyond the expiration of the third renewal period created by this
Section; (ii) the rental for renewal period(s) shall be determined in accordance with Section
3 RENTAL of this Agreement.
3. RENTAL. During the first three (3)months of the initial three(3)year
term of this lease,Tenant shall pay Landlord as rental for the premises a rental rate of
$2,350.00 per month. During the remainder of the initial three (3)year term of this lease,
Tenant shall pay Landlord $1,822.50 rent per month. Rent shall be payable in lawful
money of the United States,on the first day of each month. The minimumxent_for each
successive year after expiration of the original term shall be subject to an aa 1ncb
according to the CPI index as follows: ' � J V ve
ORIGINAL • j� APR 292014
J i1'�1- U
EFFERSON OOUNTY
Pi-Pr OF COpiMUr
NiTYDFVF!OPMENT
0 0
hereunder(or if there are such defaults,specifying the same), and the dates to which the rent
and other charges have been paid.
27. TENANT'S SIGNS. Tenant may install and maintain in and about the
Premises and Landlord's Building neat and appropriate signs advertising its business.Tenant's
signs may include an illuminated or nonilluminated sign on the exterior wall of Landlord's
Building. Landlord, at no expense to it,shall cooperate with Tenant in securing all necessary
building and other permits and authority for any work by Tenant on installations.Any sign(s)
installed by Tenant shall remain Tenant's property, and may be removed by Tenant at the
expiration or sooner termination of this Lease. Tenant shall repair any damage to the Premises
or Landlord's Building caused by the installation maintenance, or removal of its signs.
28. COUNTERPARTS. The parties may execute this Lease in counterparts,each
of which is deemed an original and all of which only constitute one original.
29. ENTIRE AGREEMENT. This Lease and the Exhibits attached hereto and
forming a part hereof, set forth all the covenants, promises, agreements, conditions and
understandings between the Landlord and Tenant,concerning the Premises and there are no
covenants,promises,agreements,conditions or understandings,either oral or written,between
them other than are herein set forth. Except as herein otherwise provided, no subsequent
alteration,amendment,change or addition to this Lease shall be binding upon the Landlord or
Tenant unless reduced to writing and signed by them.
IN WITNESS WHEREOF,this Lease has been executed by the parties hereto the day
and year first above written.
LANDLORD: ,- ' ����I1.1r-...:110
c rian L. Peterson i "�
aI. A . , ` f�'
Marie • . Peterson —�
TENANT: JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT#2
By: 'I��� i . , 1
Michael Glenn, CEO 0
��) E c n 2
1 �
_e_ I , APR q 20?4
JEFFERSON COUNTY
CEPI OF COl0:7UNITY DEVELOPMENT
• •
O'Connell, Kelly
From: Jodi Adams [jadams@co.jefferson.wa.us]
Sent: Wednesday, April 09, 2014 11:08 AM
To: O'Connell, Kelly
Cc: Mary Blain
Subject: RE: Port Ludlow sign
Hi Kelly,
It looks like you have everything you'll need. You can mail the paperwork in or drop it off, or make an appt. and submit
with our permit technician. Just let us know how you would like to turn it in. The fees for the permit are listed below.
These fees should be accurate as long as the sign is still on top of the building and not in the ground.
Sign fees for a commercial sign for 5621.30 are as follows:
Bld base: 113.00
Plan check: 73.45
Scanning: 19.00
State:4.50
Total: $209.95
Thanks,
Jodi Adams
Office Coordinator-DCD
Phone 360-379-4494
All e-mail sent to this address has been received by the Jefferson County e-mail system and is therefore subject to
the Public Records Act,a state law found at RCW 42.56. Under the Public Records law the County must release this
e-mail and its contents to any person who asks to obtain a copy(or for inspection) of this e-mail unless it is also
exempt from production to the requester according to state law, including RCW 42.56 and other state laws.
From: O'Connell, Kelly [mailto:K000NNELLOJGH.ORG]
Sent: Monday, April 07, 2014 3:52 PM
To: Jodi Adams
Subject: Port Ludlow sign
Hi Jodi,
I have printed the Master Permit, and it is signed by our COO, I have the copy of the front page of the lease,the value of
the sign 5621.30, and the drawing. What else would I need and who do I need to submit to?
Thank you for your help,
Kelly
Kelly O'Connell
Materials Director
Jefferson Healthcare
360-385-2200 x 1500
1
Screen: 01 REAL PROPERTY MASTER Mode: INQUIRY
• Auto Roll : OFF
Parcel # 000821171003 eo Cd 282117107230
S17 T28 R1E Nbhd Cd 3340
TAX 30
LESS R/W #101837
Loc ID
* Taxpayer Cd PETE 2882 PETERSON, BRIAN L T/P Chg Dt 7/02/2008
* Title Owner T/P Chg Usr JA
Tax Code 0231 Status TX TAXABLE Land Use 6300 BUSINESS SER
Affidavit 111438 Vol/Page / C/U Code
COMPLETE ADDRESS WINDOW
Taxpayer
PETE2882 BRIAN L PETERSON
MARIE A PETERSON
46 VILLAGE WAY PMB 171
PORT LUDLOW WA 98365-9762
Search Key
CMD 6: End Window CMD 7: End of Job
•
114714 4 64P/PS• "i(J I
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Jefferson County g„l .c . Correction Notice
r ' G”' PERMIT NUMBER '1i1)---i-3 - 564-'‘
OWNER 'L. 5;.x.1
JOB LOCATION y- I 6/ k-Pb '14.4
Vv Inspection of this structure has found the following violations:
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You are hereby notified that no more work shall be done upon these premises until
the above violations are corrected, unless noted otherwise. yWh corrections have
been made, call UA for inspection. �1� 71>3
Date i'- i`1- Inspector
D E C E O V I BUILDING DIVISION (360)379-4450 INSPECTION HOTLINE(360)379-4455
VV 1 THIS NOTICE MUST BE KEPT WITH APPROVED PLANS ON SITE
APR 2 9 2014
L
JEFFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
• BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD08-00509 Received Date: 12/11/2008
SITE ADDRESS: 9481 OAK BAY RD Issue Date 12/17/2008
PORT LUDLOW, 98365 Expiration Date 12/17/2009
OWNER: BRIAN L PETERSON PHONE: (360)437-8148
MARIE A PETERSON
107 LUDLOW BAY
PORT LUDLOW WA 98365
SUBDIVISION: Block: Lot: TX30i
PARCEL NUMBER: 821171003 Section: 17 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: NO MLA REQ'D TENANT IMPROVEMENT
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP ALT MAIN: INDUSTRIAL:
VALUATION 20,000.00
AMYL: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: SEW
WATER SYSTEM: LUDLOW Type Amount Paid By: Date: Receipt:
BATHROOMS: Permit $321.25 KAS 12/11/08 103037
Exist: Plan Check $208.81 KAS 12/11/08 103037
Prop: State Building Code $4.50 KAS 12/11/08 103037
Total: Total: $534.56
NUMBER OF EMPLOYEES:
Directions to Site:
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
•
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD14-00157 Received Date: 5/2/2014
SITE ADDRESS: 9481 OAK BAY RD Issue Date 12/7/2015
PORT LUDLOW, 98365 Expiration Date 12/7/2016
OWNER: BRIAN L PETERSON PHONE: 360-437-8148
MARIE A PETERSON
46 VILLAGE WAY PMB 171
PORT LUDLOW WA 98365-9762
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821171003 Section: 17 Township: 28 N Range: 1E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: BUSINESS SIGN FOR JEFFERSON HEALTHCARE PORT LUDLOW CLINIC
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP SGN MAIN: INDUSTRIAL:
VALUATION 5,621.00 ADD'L: HEAT TYPE:
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: Type Amount Paid By: Date: Receipt:
BATHROOMS: Plan Check $73.45 JLA 04/29/14 148590
Exist: State Building Code $4.50 JLA 04/29/14 148590
Prop: Permit $113.00 JLA 04/29/14 148590
Total: Total: $190.95
NUMBER OF EMPLOYEES:
Directions to Site:
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455.
Request must be received by 3pm the day before the inspection is needed.
Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY
HOT LINE AVAILABLE 24 HOURS A DAY
•
Jefferson County Building Division Permit Number: BLD14-00157
Applicant: PETERSON
BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes
To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed.
Requests received after 3:00 PM will not be scheduled for the next 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
Sign l26` !a
A final inspection will not be scheduled until the following are completed and signed off by the applicable Department:
• Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing
• Land Use Conditions met and signed off • Public Works Permit Final(where applicable)
FINAL INSPECTION (Z. 'IV
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR