YAVAPAI COUNTY Development Services Prescott Office 1120 Commerce Drive, Prescott, AZ 86305 (928) 771-3214 Fax: (928) 771-3432 Cottonwood Office 10 S. 6 th Street, Cottonwood, AZ 86326 (928) 639-8151 Fax: (928) 639-8153 Addressing Building Safety Customer Service & Permitting Environmental Land Use Planning PERMIT APPLICATION SHEET COMPLETE ALL THE FOLLOWING INFORMATION AS IT PERTAINS TO YOUR APPLICATION. PROPERTY INFORMATION Assessor s Parcel Number PROPERTY OWNER INFORMATION OWNER ADDRESS CITY SUBD LOT TYPE OF WORK TO BE DONE RES COMM INDUST MAILING ADDRESS CITY STATE ZIP PHONE APPLICANT ADDRESS VALUATION # OF EXISTING STRUCTURES FIRE DIST SPRINKLERS? Owner Agent Contractor CONTACT PHONE CONTACT EMAIL CONTRACTOR INFORMATION Is Owner using Contractor? Yes No For projects not exempt under ARS 32-1121, the contractor must possess a current and valid Arizona license. The following Contractor information MUST be completed prior to issuance of permit. Is Contractor currently licensed under provisions of ARS 32-1169? Yes No Contractor Name: Address: City: State: Zip: License # Class License Expiration Date: State Tax # Is Project being done as Owner Builder? Yes No I am the Owner/Builder of the property. I will follow in strict compliance with ARS 32-1121A.5. The property is intended for sole occupancy by the owner, not intended for occupancy by members of the public, owner s employees or business visitors. The structure(s) are NOT INTENDED FOR SALE OR RENT WITHIN 1 YEAR AFTER COMPLETION. I am the Owner/Developer of the property. I will follow in strict compliance with 32-1121A.6. I will contract with a licensed General Contractor pursuant to this chapter. I am the property owner / or acting on authority of the property owner and I hereby certify that I have read and examined this application and submittal documents and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Signature: Date: Owner Agent Contractor Other Applicant Picture ID Provided? Yes ID Type No Reason CLERK APPLICATION # PLEASE PROVIDE A PLOT PLAN, DRAWN TO SCALE, PER THE CHECK LIST; A DIRECTIONS TO SITE MAP; AND ANY ADDITIONAL INFORMATION, INCLUDING PLANS, THAT IS REQUIRED FOR YOUR PARTICULAR TYPE OF PERMIT. ADDITIONAL APPLICATION FORMS/PERMITS MAY BE REQUIRED FROM OTHER UNITS, DEPARTMENTS, OR AGENCIES
PLOT PLAN CHECKLIST NOTE: PLOT PLAN MUST BE DRAWN TO SCALE IN BLACK INK ON THE FORM PROVIDED THAT INCLUDES ALL OF THE FOLLOWING INFORMATION. ( ) Property dimensions ( ) Indicate scale used (Engineer's Scale-l"=20'; 30'; 40'; 50'; 60') ( ) Indicate North with directional arrow ( ) Proposed structures with all dimensions, including pools, fences, walls, etc. ( ) Existing structures with all dimensions, including pools, fences, walls, etc. ( ) Distances between structures ( ) Distance from all structures to property lines ( ) Description of each structures use ( ) Adjacent streets/roads ( ) Driveway (s) and material used (i.e. gravel, concrete...) ( ) Location, Size, Dimensions of Septic System with Leach Area Perc test holes 100% Expansion Area (minimum distance from septic and leach) Length and slope of outlet lines (5 foot min.) Distribution Box/Diversion Valve Inspection Pipe (s) Length, width and number of leach lines; distance between trenches Degree of slope in leaching area Length and slope of building sewer line (max 100 feet) Cleanout pipe in building sewer lines Setbacks from property lines, buildings, wells, dry washes, other sewage systems, water lines. (NOTE: If individual wells provide water, maintain minimum septic setbacks of 50' from property lines and 100' from all wells including neighboring wells) ( ) Location of all utilities, poles, meters and lines ( ) All easements, regardless of purpose (i.e. roads, utilities) ( ) Slope Information Indicate High and Low points Indicate by arrows direction of slope Indicate difference in elevation between high and low points ( ) Distance from the closest structure to the top of bank of any watercourse (s) (i.e. washes, streams, creeks, arroyos, rivers, drainage ways, drainage easements and slews) ( ) Indicate elevation difference of proposed building site to the lowest wash elevation adjacent to the building site. ( ) Location of existing roadside ditches and road culverts with size ( ) Layout of parking spaces, including handicapped, per use requirements (pertains to all except single family dwelling permits) ( ) Signage must be identified but requires a separate permit (non-residential permits) ( ) Location and type of exterior lighting (non-residential permits) ( ) Location where orange will be posted
YAVAPAI COUNTY DEVELOPMENT SERVICES DIRECTIONS TO SITE Instructions: An actual detailed line map along with written directions is needed. Add any significant buildings, land marks, main highway, mileage markers, street names, cross streets and north arrow. If the map is not adequate, it could cause a delay in inspecting your project. Please provide a contact phone number for difficult to locate parcels: SEE EXAMPLE: Main Street --1 Mile-- N Easy St. ASSESSOR S PARCEL NUMBER ADDRESS Contact Phone # Written Directions: (Example: Highway 69 to Cordes Jct., right onto Stagecoach, turn right at Maverick ½ mile etc.
Yavapai County Development Services Prescott Office 1120 Commerce Drive, Prescott, AZ 86305 (928) 771-3214 Fax: (928) 771-3432 Cottonwood Office 10 S. 6 th Street, Cottonwood, AZ 86326 (928) 639-8151 Fax: (928) 639-8153 Addressing Building Safety Customer Service & Permitting Environmental Land Use Planning RESIDENTIAL OUTDOOR LIGHTING FACT SHEET Complete all the following information as it pertains to the parcel referenced below: APN Applicant or Owner Address Parcel size (net acres or square feet) Allowable Lumen parameters: Parcels larger than 1 acre are allowed 20,000 shielded lumens Parcels between ½ and 1 acre are allowed 10, 000 shielded lumens Parcels less than ½ acre are allowed 7,500 shielded lumens Examples of lumen output or typical incandescent bulbs (W=Watt, Lm=Lumen): 60 W = 840 Lm; 75 W = 1125 Lm: 100 W = 1600 Lm; 150 W = 2780 Lm; 300 W = 4620 Lm Exemptions: Fully automatic, motion sensing lights and decorative landscape lighting utilizing 4 Watt bulbs or smaller. QUANTITY LOCATION WATTAGE TYPE of BULB (Example) 1 Front porch 100 Incan EXISTING: FIXTURE Shielded or Unshielded* INDIVIDUAL LUMENS LUMENS TOTAL 1600 1600 NEW: Total Shielded Lumens: Total Unshielded Lumens: (Incandescent=Incan, Halogen=Hal, Fluorescent=Fl, Compact Fluorescent=Com, Motion Sensing=MS, Shielded=S, Unshielded=U) * All fixtures installed after April 2006 must be fully shielded. Remaining allowable lumens for this parcel: Shielded I attest that the information on this sheet is correct to the best of my knowledge. I understand that Yavapai County has a Light Pollution Control Ordinance (Section 603) and the lighting on this parcel is, or will be, in full compliance with this Ordinance. I acknowledge that if it is not, then it shall be my responsibility to bring it into compliance. Owner or Authorized Agent Date
ATTENTION On March 20, 2006 the Yavapai County Board of Supervisors approved H5257 to amend section 603 C.3b and 603 C.3.c (Light Pollution Control) of the Yavapai County Planning and Zoning Ordinance. Effective April 20, 2006 FULLY SHIELDED FIXTURES ARE REQUIRED FOR ALL EXTERIOR LAMPS INSTALLED ON A RESIDENTIAL STRUCTURE. All permit applications submitted on and after April 20, 2006 must reflect the outdoor lighting as fully shielded. Total allowable lumen parameters have not changed and are allowed as follows: Parcels larger than 1 acre are allowed 20,000 fully shielded lumens. Parcels between ½ acre and 1 acre allowed 10,000 fully shielded lumens. Parcels less than a ½ acre are allowed 7,500 fully shielded lumens. Examples of lumen output of typical generic incandescent bulbs (W = Watt, Lm = Lumen): 60W = 840 Lm; 75W = 1125 Lm; 100W = 1600 Lm; 150W = 2780 Lm; 300W = 4620 Lm Note: Fully automatic and properly adjusted motion sensing lights (as defined in Section 120) are not restricted as to number by the Yavapai County Zoning Ordinance. Decorative landscape lights utilizing 4 watt bulbs or less, down lit recognized flag lighting (ie: USA, State, POW, Service Connected Flags, etc.), and shielded street lighting are also exempt. Examples of fixtures that are Fully Shielded (Note: to be fully shielded these fixtures must be closed on top and mounted such that the bottom opening is horizontal.): Examples of fixtures that are NOT Fully Shielded: This type of fixture will not be allowed for new installations