05-105820 •
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City
City of Federal Way BuiliPn Single FamilyPersil • 05-105820-00�-S F
Community Development Services g - g
P.O.Box 9718
Federal Wray,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: MARTIN
Project Address: 2804 SW 300TH PL Parcel Number: 012103 9130
Project Description: NEW-Construct a new 2,435 sqft,single-family residence with 2,254 sqft attached garage
and a 186 sqft deck,includes plumbing& mechanical. **3 bedrooms;Proposed selling
price: $386,000**
Owner Applicant Contractor Lender
MICHAEL&PAMELA MARTIN MATT CYR 2800 SW 300TH PL MICHAEL&PAMELA MARTIN
2800 SW 300TH PL ESM CONSULTING ENGINEERS FEDERAL WAY WA 98023 2800 SW 300TH PL
FEDERAL WAY WA 98023 33915 1ST WAYS SUITE 200 FEDERAL WAY WA 98023
FEDERAL WAY WA 98003
Census Category: 101 -New single family house,detached
Includes: #1 #2 #3 #4
Occupancy Class: R-3
U
ction Type: Type V-B Type V-B
Occupancy Load:
sq. ft.) 2,930_ 0 0 0
►c itI ai PermitInformation
New/Additional Sq.Feet- 1st Floor 495 Occupancy#1 -Class R-3
Occupancy#2-Class U New/Additional Sq.Feet-Other 0
Plumbing to be Included' Yes New/Additional Sq.Feet-Total 5370
Occupancy#1 -Use Residence(1 or 2 Zoning Designation RS 15.0
family)
New/Additional Sq.Feet-2nd Floor 2435 New/Additional Sq.Feet-3rd Floor 0
Occupancy#1 -Area(Sq.Feet) 2930 New/Additional Sq.Feet-Basement 0
Basic Plan? No Occupancy#2-Construction Type Type V-B
New/Additional Sq.Feet-Deck 186 Fire Dept.Access/Hydrant Loc.Needed° Yes
New/Additional Sq.Feet-Garage 2254 Height of Structure 25.5
Mechanical to be Included? Yes
Mechanical Fixtures
Air Handling Units 1.00 Ducts 1.00 Fans 5.00
Fireplace Inserts 1.00 Furnaces 1.00 Ranges 1.00
Gas Pipe Outlets 3.00 Hot Water Tank 1.00
Plumbing Fixtures
Bathtubs 1.00 Dishwashers 1.00 Laundry Washer Outlets 1.00
Lavatories 5.00 Showers 1.00 Sinks 2.00
Water Closets 3.00 Hose Bibbs 4.00
CONDITIONS:
1)Clearing and grading activities on this lot are prohibited between the dates of October 30 and April 1.
An automatic fire sprinkler system will be required in the new residence unless the changes required by
Public Works to the private access road and the driveway meet the Fire Department requirements for fire
_Apparatus access roads.
( 3)Prior to Occupancy,the road must be widened and paved as shown on the approved site plan. Public
rks iyspectidn'is required. Please'contot Bryan Kardos at 253-83 -273 .
-Before issuance of a certificate occupancy for the residence,an arch ical resources monitoring
report shall be submitted to the ate Office of Archeology and Historic Preservation,affected Native
American Tribe(s),and the City of Federal Way.If archeological i'esources are•encountered,work should
pause,and the owner and/or agent shall notify the Washington State Office of Archeology and Historic
Preservation,affected Native American Tribe(s),and the City of Fedenil Way Department of Community
Development Services.
6)Prior to occupancy,the new storm drainage system must be inspected and approved by Public Works
Department.
PERMIT EXPIRES Saturday, May 24, 2008
Permit Issued on Wednesday, May 24, 2006
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.Owner or agent: S9 -CjE_r)
Date:
City of Federal Way
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that
at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building
construction or use. This certificate is valid ONLY when endorsed by City staff.
Tenant Name: MARTIN Permit#: 05-105820-00-SF
Address: 2804 SW 300TH PL
Includes: #1 #2 #3 #4
Occupancy Class: R-3 U
Construction Type: Type V-B Type V-B
Occupancy Load:
Floor Area(sq.ft.) 2,930 0 0 0
Owner Name: MICHAEL&PAMELA MARTIN
MICHAEL&PAMELA MARTIN
Owner Name:
Owner Address: 2800 SW 300TH PL
FEDERAL WAY WA 98023
94/0
Burg Official Date
T e priority focu in the review and inspection made by the City prior to issuance of this Certificate was on those matters which
xperience has shown most severly affect the health and safety of the general public. Although the City has made as complete a
review and inspection as is reasonably possible(within budgetary time and personnel limitations), the City neither guarantees nor
warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every
ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon
which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises.
4 . r r ' ' f +
` THIS CARD IS MAIN ON-SITE '
CITY OF lit ommunitY p nt Develo m Inspection Record
p
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-105820-00-SF
Owner: MICHAEL & PAMELA MARTIN
Address: 2804 SW 300TH PL
FEDERAL WAY, WA 98023
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence On-going inspections
are logged on the back of this card.
. •
❑ Temp.Erosion Control(4365) �11 Footings/Setback(4110) ❑ Foundation Wall(4115)
To be done prior to breaking gr d Approved to place concrete Approved to place concrete
By On/S Date , • By , �;/ Date ACka ¢ : By . Date$ 3
•Z .�9
.❑ �
Drainage/Downspout(4040) ❑ Plumbing Groundwork(4190) ❑ Slab/Concrete Floor(4255)
Approved to backfill Approved to cover `�,.�A_pved t<o place concrete
J fil--
S v� f 5lC� �By % Dat -?/ /y /)� By Date 9/7/06 By c...03 Date, €. v cc.
.
.
Underfloor Framing (4285) �❑ Floor Sheathing(4105) ❑ - Shear Walls (4245)
Approved to sheath floor Approved to install flooring Approved to install siding
By Date By Date By G W Date//. Z2,. p cap
❑ Roof Sheathing(4220) ❑ Rough Plumbing(4230) 0 Mechanical Rough-in(4165)
Approved to install roofing Approved Approved
By esjDate/0 ./2 . c)4 ByZp, Date f y/,. . h cm By0Ze._ Date/2.4/..e. c_
0 Gas Piping(4125) ❑ Fire/Draft Stops(4095) NOTE: Prior to scheduling a Framing(4120)
Approved to release test Approved inspection;Electrical,Plumbing&Mechanical
Rough-in and Fire/Draft Stop inspections must be
signed-off and approved. IBC 109.3.4/UBC 108 5.4•
Byz . Date/1.44 phi By Date tz.yl-.a-
❑ Framing(4120) ❑ Insulation(4150) ❑Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard Approved to install mud&tape
By G-t.o..+ Date/2. /4/,a,6, By Date I — ..v7 By / 2_
Date //0/07
❑ Final-SWM(4375) El Final-Mechanical(4065) El Final-Plumbing(4075)1
Approved Approved Approved
By env Date 7/30e1 By ( Date z_.40.-7 By j Date 9.�Z
0 Final-Building(4050) ['Temp.Erosion Maintenance (7(4370) C
Approved Approved
By fl,/ Date 9/// 07 By Date
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08/08/2007 15:09 206781015 ' PAGE 02
Cultural Resources Management Services
5418 20th Avenue NW,Suite 200,Seattle,WA 98107
August 28, 2008
Pam Martin
2804 SW 300'h Place
Federal Way, WA 98023
RE: Archaeological Monitoring at 2804 SW 300th Place in the Lakota Community of Federal
Way, King County, Washington.
Dear Mrs. Martin,
Northwest Archaeological Associates, Inc. (NWAA) has completed archaeological monitoring
at the above referenced address. No pre-contact, ethnographic, or historic-period cultural
resources were identified during monitoring. The following sections briefly summarize the
project background and results of archaeological monitoring.
Project Location and Description
The project entailed construction a new residential building and associated driveway in the
Lakota Community of Federal Way, Washington (Figure 1). The project is on a hillside above
the shoreline of Puget Sound just east of Dumas Bay in southwest King County in the SW'A
of the SW %of the NE %of the SW %of Section 1, T. 21N., R. 3E. The City of Federal Way
required archaeological monitoring during ground disturbing activities associated with the
excavation of the foundation footprint and connecting driveway based on the proximity to a
recently recorded pre-contact shell midden located several hundred feet southwest. The
house foundation footprint measured 60 ft.x 40 ft. and required excavation to approximately
11 ft. below the existing ground surface. The adjoining driveway measured 100 ft.x 12 ft. and
required excavation to approximately 5 ft. below the ground surface.
Cultural Setting
Ethnographer T.T. Waterman (ca. 1920) recorded a number of Native American place names
in and around the Puget Sound region, three of which are within one-mile of the project area.
Northeast of the project is Qa'qahwEts meaning "crabapples"for a very small creek near the
community of Buenna, and Kokowi'Itsa meaning "blanket of marmot skins"for Blanket Rock.
Just west of Blanket Rock is Stsoxwa'bats meaning "chokecherry"for a low cliff and numerous
chokecherries in the vicinity (Hilbert et al. 2001).
In 1980, the University of Washington Office of Public Archaeology (OPA) conducted a survey
for a proposed outfall line related to the Lakota Wastewater Treatment plant. OPA recorded a
pre-contact shell midden (45-KI-58) approximately 0.33 miles southwest of the project area.
The site was recorded as a partially disturbed shell midden measuring approximately 25 m (82
ft.)east-west by 7 m (23 ft.) north-south (Moura 1980a; 1980b; 1980c).
Ts!(208)781-1909
Fax_(206)781-0154
Emit msha pore ,vstarch.com
08/08%2007 15:09 206781015 PAGE 03 •
Arciaeorbgrcal Morutorinv at 2804 SW 300°1 Place 2
In February 2006, NWAA identified another archaeological shell midden exposed In a wave-
cut beach terrace at 2876 SW 300th PL (Shong and Miss 2006). The site (Temp. No. 2876-06-
01) consists of a 15-25 cm (6 to 10 inch)thick deposit of crushed shell, faunal bone, and fire-
modified rocks exposed along a wave-eroded beach terrace. The observed midden is
approximately 5-20 cm (2 to 8 inches) below the ground surface and extends for approximately
6.5 m (21 ft.) before being obscured by slumping over-bank sediments. Portions of the cultural
deposit appeared to be relatively intact based on a distinct layer of shell midden bounded by
organically stained sediments. The cultural deposit likely extends northeast toward the subject
property based on the favorable landform, easy beach access and protection from erosion by
concrete bulkheads (Shong 2006).
Expectations
Based on the proximity to a marine shoreline, recorded archaeological sites and ethnographic
accounts referring to resource procurement and mythological events,the project was
considered to have a moderate to high potential for cultural resources. Pre-contact and
ethnohistoric sites were the most likely to be encountered and would likely reflect temporary
camps related to resource procurement. These site-types are typically represented by a
combination of marine shell deposits, organically-rich sediments and fire-modified rocks (FMR).
Based on the proximity to recorded archaeological sites, the possibility also existed for the
presence of Native American burials, or isolated human remains.
Monitoring and Discovery Plan
Prior to construction NWAA prepared a Monitoring and Discovery Plan (MDP)that established
policies and procedures to be followed in the event of a significant archaeological discovery.
The primary goal of the MDP was to provide a coordinated program for the identification and
protection of archaeological materials and/or human remains that may be discovered during
construction. The plan also established a notification protocol and provided a contact list with
the names and phone numbers of concerned Native American tribes, local law enforcement,
County Medical Examiner and State Archaeologist.
Methods
Prior to construction, NWAA contacted the Puyallup and Muckleshoot Indian Tribes to inform
them of the proposed project. The primary goal of archaeological monitoring was to ensure
both identification and documentation of any cultural materials that may be exposed during
construction. A protocol for identification, evaluation and treatment of cultural material and
human remains was outlined in the monitoring plan. The monitoring plan specified that an
NWAA archaeologist would be present during construction to observe any significant ground
disturbing activities. Daily documentation included recording notes and observations on
standard forms and photographing the various stages of excavation.
Monitoring Results
Archaeological monitoring was conducted over four days between June 27th and July 5th,2006
by NWAA archaeologist Josh Watrous. Once the parcel was logged and cleared of brush the
archaeologist conducted a pedestrian survey of the parcel (Figure 2). The process of clearing
Northwest Archaeoftical Associates,Inc. August 28, 2005
08/08%2007 15:09 206781015 PAGE 04
411
Arahaeolbglcel Monitoring at 2804 SW 3006 Pace 3
and grubbing exposed the underlying mineral soils allowing for an initial surface inspection
before major excavation commenced. No cultural materials were observed during the
preliminary surface survey.
Primary ground disturbing activities began with the driveway excavation extending from the toe
of the slope toward the existing residence. The monitored excavation measured approximately
30 feet in length by 3 feet deep and sloped at an approximate 6%grade. The upper A-O
Horizon ranged from one to five-inches thick and was composed of forest duff, wood debris
and loosely compacted silty loam. The sediments below the A-O Horizon was
characteristically glacial drift composed of moderately compacted, light yellowish-brown
gravelly silt loam grading downward to a slightly mottled, increasingly compact, light grayish-
brown day loam with few gravels (Figure 3).
Based on the sloping landform and initial excavation exposing predominantly glacial material,
the monitor determined that the project parcel had a extremely low potential for cultural
resources. In an effort to expedite the monitoring requirements for the project, the monitor
directed the equipment operator to excavate several exploratory trenches within the remaining
driveway alignment and proposed house foundation footprint. The purpose of the trenches
was to determine if there were any changes in sediment composition that would suggest an
increased probability for cultural resources e.g., thicker A-Horizon, organically-rich sediments,
fire-modified rocks, or marine shell fragments. The exploratory trenches revealed no
significant changes in sediment characteristics that would indicate potential for cultural
resources. The A Horizon was consistently thin with few cobbles and little or no underlying B-
Horizon (Figure 4). No cultural indicators were observed during the exploratory trenching.
Conclusions
No historic, ethnographic, or pre-contact period cultural resources were observed during
cultural resources monitoring at 2804 SW 300" Place, Federal Way, WA.
I hope this letter sufficiently addresses the methods and results of cultural resources
monitoring at your property. Please feel free to contact me or Chris Miss with any questions or
concerns regarding this letter.
Sincerely,
Michael Shong
Staff Archaeologist
OL:141L,
Christian J. Miss
Principal Investigator
Northwest Archaeological Associates, Inc. August 28, 2006
08/08?2007 15:09 206781015 PAGE 05 '
•
Archaeological Monitoring at 2804 SW 3006 Place 4
References Cited:
Vi Hilbert, Jay Miller, and Zalmai Zahir.
2001 sdaTda> GeL dibeL leSucid?acac/Lfalbix Puget Sound Geography. Original
Manuscript ca. 1920 by T. T. Waterman, edited with additional material.
Lushootseed Press,Zahir Consulting Services, Federal Way, Washington.
Moura, Guy F.
1980a Letter report dated September 30 regarding the Proposed Outfall Line for the Lakota
Drainage Facility. Submitted to Mr. Russell David, Lakehaven Sewer District,
Federal Way, Washington. Prepared by the Institute for Environmental Studies,
University of Washington, Seattle,Washington.
1980b Letter report dated November 21 regarding the Archaeological Test Excavations of
the Proposed Outfall Line at the Lakota Drainage Facility. Submitted to Mr. Russell
David, Lakehaven Sewer District, Federal Way, Washington. Prepared by the
Institute for Environmental Studies, University of Washington, Seattle, Washington.
1980c Washington State Archaeological Site Form,45KI58. On file, Department of
Archaeology and Historic Preservation, Olympia.
Shong, Michael and Christian J. Miss
2006 Letter report dated February 6th to Peter Shirner re:Shell midden discovery during a
proposed bulkhead installtion in the Lakota community of Federal Way, King County,
Washington. Northwest Archaeological Associates, Inc.
Shong, Michael
2006 Washington State Archaeological Site Form (Field Number 2876-06-01). On file,
Department of Archaeology and Historic Preservation, Olympia.
Northwest Archaeological Associates, Inc. August 28, 2006
PAGE 06
25E,
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08/08%2007 15:09 0678101
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Figure 1- Project location.
August 28, 2008
Northwest Archae°1°91Cal ASS°Ciatel4 Inc
•
08/08%2007 15:09 20678101.54 PAGE 07 •
Archy al Mon et 28104 SW 30011 Place 6
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44.
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•
Figure 2. Overview of recently logged parcel showing general topography(view NW).
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Figure 3. Overview of sediments along excavated driveway(view SE).
Northwest Archaeological Associates, Mo, August 28, 2006
08/08/2007 15:09 206781015, . PAGE 08
Ardiaeokcal Mortoih,g st 2804 SW 300"Place7
Figure 4. Overview of exploratory trench located within house footprint(view east).
•
Northwest Archaeological Associates, Inc, August 28, 2008
1011Ph.
RECEAD
III
CITY OF V `.J - / o C 3 ✓ 0
Federal Way NOV 1 0 2oo5PERMIT //
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP
33325 FEDERAL
WA WA 9•POBOX 971`8,'�u LDINM %I CATI O NA /
FEDERAL WAY,WA 9806.3-9718 CITY Th
2
253-835-2607•FAX 253-8352609 //p 0
www.cityotjederalway.com / C rJ N
The ollowin• is re•uired in ormation-an incom•lete a••lication will not be accepted. Please •rint le•ibl (in ink)or • .
• PROPERTY INFORMATION
SITE ADDRESS Not Assigned A 304 ,.51/0 U— S SUITE/UNIT#
•
ASSESSOR'S TAX/PARCEL it 0 1 2 1 0 3 - 9 1 3 0 LOT SIZE(s_j) 27,000sf
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) See Attached
(Attach separate page for lengthy Iegol description/
• PROJECT INFORMATION
TYPE OF PERMIT )0 BUILDING DI PLUMBING ® MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onit')
Construction of a 2,435sf single family residence
PROJECT NAME(Name of Business or Owner Last Name) Martin
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Michael and Pam Martin (253 ) 943 - 5234
MAILING ADDRESS CITY,STATE,ZIP
2800 SW 300th Pl. Federal Way, WA 98023
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Owner/Builder ( ) -
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
— — / / ( )
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
ESM Consulting Engineers Eric LaBrie (253 ) 838 - 6113
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
33915 1st Way S, Suite 200 Federal Way, WA 98003 ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
❑Architect ❑Tenant O(Agent ❑ Other(Describe) (253 ) 838 - 7104
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
c` `r (zs`3)g3�d 6!)3 µ,N4t-.c, r(0•Z1,14tCIV)I.C�;'hIIII
LENDER Per RCW 19.27.095:;Lender information is NAME
required lf project value exceeds$5 000 MirhiP1 and Pam Martin
MAILING ADDRESS CITY,STATE,ZIP PHONE
2800 SW 300th P1 Federal Way WA 98023 (253 ) 943-5234
■ DETAILED BUILDING INFORMATION
EXISTING USE Vacant Land PROPOSED USE Single family residence
EXISTING ASSESSED/APPRAISED VALUE $ 150,00.00 VALUE OF PROPOSED WORK $236,000.00
SPRINKLERED BUILDING? E YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? i3 YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN ❑ HIGHLINE X) TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER CCLAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
lipp
• •
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
0
FIRST
parch+ e nhil ?-4K2:.) 0 4-42,1/5 --112-4Pi
SECONDc�
0 -2-39-3 Z-i13) -2303 ?V A5
THIRD
0
FOURTH
0
ADDITIONAL FLOORS(DESCRIBE)
0
DECK(COVERED?)
0 186 186
P11:j GARAGE 0 CARPORT 0
" t
0 2254 2254
IXEXISTINGNUMBER OF FLOORS EXISTING� PROPOSED TOTALTOTAL nsarsramst TOTAL PROPOSED m TOTALSF
Lia
\:‘,TI 0 7 2 d ' ' G-875 4$75
1 ,� **NEW HOMES ONLY** NUMBER OF BEDROOMS 3 ESTIMATED SELLING PRICE $ 386,000.00
FIXTURES
Indicate number of each type officture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL $ 000.00
Value of Mechanical Work $
1 AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS 5 FANS HOODS icommerdat WOODSTOVES
BOILERS J,_ FIREPLACE INSERTS 1 RANGES MISC(Describe)
COMPRESSORS 1 FURNACES 1 GAS WATER HEATERS
1 DUCTS GAS PIPE OUTLETS
PLUMBING
1
BATHTUBS(or Tub/Shower Combo) _ 1 SHOWERS 3 WATER CLOSETS(Toilet) MISC(Describe)
1 DISHWASHERS 2 SINKS _ DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS _ — RAINWATER SYST
1 WASHING MACHINES URINALS _4 HOSE BIBBS
5 LAVS)Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of
such claim),which may be made by any person,including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reliance of th- c'ty including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. i�1bl •W`
.: .� �
NAME/TITLE `_ ,V.-5:. *, "'�' DATE ~��
(S R - -le) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑Agent ❑ Contractor ❑Architect ❑ Other
)FOR OFFICE USE'ONLY
KNEW a ADDITION a ALTERATION a REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES a NO BASIC PLAN? ❑YES ANO
ZONING DESIGNATION 1<5-, CHANGE OF USE? n YES a NO
NEW ADDRESS REQUIRED? a NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES X10 DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100-January 7,2005 Page 2 of 4 k\Handouts\Permit Application