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MLA #pRoLecr/eppLrcANT NAME: I Laut I c-e
Tax Parcel Number: 1 tZ'3 03 - lO\
What type of hospitality establishment are you applying tor?
Bed and Breakfast Inns (4-6 units)[-l auO and Breakfast Residence (1-3 units) lXlrransient Residence or Guest House| | |S L"r, than 30 davs
Please answer all of the following questions to the best of your ability
'l . How many sleeping rooms shall be accommodated?
2. Will you be serving food to guests? N O
3. Are there cooking facilities or kitchen facilities in this rental? lf so how many? y e S L l. , tcke ^4. How many off street parking spots do you currently have? How many off street parking spots proposed? b
5. Will you have any signs advertising your business? lf yes a sign permit may be needed. N O
6. Will you make any remodels or structural changes to any building associated with the hospitality establishment? lf yes, a
building permit application may be required. V O
7. Which will you be renting (Check one;: ffiil residence ffi accessory dwelling unit
^ Does the property contain both a residence AND an accessory dwelling unit?o. reside on the oremises?
lf yes, will the owner or lesseeN0
OFFICE USE ONLY
Hospitality Permit Fees
Land Use Review DCD018 $306.00
Environmental Health - Septic EH038 $99.00
Environmental Health - Potable Water (if servinq food)Applv for Food Establishment Permit
Buildinq I nspection for Fire/Life/Safetv $204.00
Scan Fee DCD022 $25.50
Technoloqy Fee DCD003 - 5%$
Total Fees*$
*Additional fees may apply.
ACKNOWLEDGEMENT
By signing the application form, the applicanVowner attests that the information provided herein is true and correct to the best of
their knowledge. Any material falsehood or any omission of a material fact made by the applicanUowner with respect to this
application packet may result in this permit being null and void.
The life-safety review for this transient rental permit is limited to basic life safety relating to 9'1 1 locator consistency, handrails,
egress, exterior safetynlighting, and smoke & carbon monoxide detection & warning sufficiency. lt is impossible for the transient
rental permit to be{n,(xhaustive review of all potential life/safety issues.(r'Lj ' zz-
(APPLTcANT oR AU D REPRESENTATIVE SIGNATURE }(DArE)
INOTE: Representative authorization is required if application is not signed by the Owner.l