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HomeMy WebLinkAboutpitkin.planning.273520101003 (2)DOCUMENT LAYOUT THIS FILE MAY OR MAY NOT CONTAIN ALL OF THE INFORMATION LISTED BELOW IN THE FOLLOWING ORDER Summary Sheet Resolution for the BOCC and/or P&Z Ordinance for the BOCC and/or P&Z Determination for the Hearing Officer Administrative Determination Staff Memo Application Public Notice, Acceptance Letter, Referral(s) Letter Site Plan Miscellaneous Plat copies (llxl'n ;^~^, ~*•, 'a~b~ P188-04 iseAnn Sullivan R~+T~Brooke Johnson c/o Radical "AF}R~~702 E. Speer Blvd ~iS/2f«~Denver, CO 80203 FEES C1U~~ $4 0 ... . ................ ~~S'RG•SICY $430 #18289 .:.:.:>, ;;.; : ..:.:: ; ,~ ~ ~tn~ N B fm~>V ~: ~.C'T`~i1V°` 1'::;..~...._.....::..-:x:11/4/2004 ?J4~G.[2eS~-'' l~ . ......... :..:Temporary Use Permit '. ':r '2~Special Event Permit -Minor ".1 . ~. D~~e ~ File ~~cs+ attF'„]File Finders Box#74 %.. ~i ooouo~ ADMINISTRATIVE DETERMINATION OF THE COMMUNITY DEVELOPMENT DIRECTOR OF PITKIN COUNTY, COLORADO, APPROVING A TEMPORARY COMMERCIAL USE/SPECIAL EVENT PERMIT FOR @RADICAL MEDIA, INC.'S TEMPORARY COMMERCIAL USE OF CERTAIN WHITE RIVER NATIONAL FOREST LOCATIONS AND OTHER SITES, ON NOVEMBER 5 & 6, 2004 Determination No.~-2004 RECITALS 1. Pursuant to Subsection 3-200-030 of the Pitkin County Land Use Code, the Community Development Director of Pitkin County, Colorado. ("Director") may approve a Temporary Commercial Use/Special Event Permit for commercial activities or special events. 2. @Radical Media, Inc. (hereafter, the "Applicant") has applied to the Director for approval of a Temporary Commercial Use/Special Event Permit to shoot a commercial for Nissan at the following sites: (a) USFS Road 106 -Lincoln Creek and Independence Pass/Hwy 82 (if access is permitted by CDOT, subsequent to road closure), (b) USFS Road 123 - Richmond Hill (accessing from Little Annie Rd), (c) USFS Rd 102 -Castle Creek, and (c) North Hayden Road. Staging on November Stn will be at the Highway 82 west side gate and Weller and Difficult Campgrounds. On November 6tn, staging will be at the turnout on Castle Creek Rd. across from Little Annie Road, the Cathedral Lake trailhead parking area; part of the Ashcroft parking lot, the junction of Castle Creek Rd. and USFS Rd. 121, and the paved sections of USFS Rd. 121. The shoot will commence at 6:45 AM and conclude at approximately 5:30 PM each day. A helicopter will be used for filming in the Independence Pass/Lincoln Creek area, if access is permitted and weather allows, on November Stn 3. Applicant will allow public access at all locations. There will be no road or area closures.. Neither the County Engineer, nor the Airport, expressed any concern with any aspect of the .application. 4. Applicant will. have two members of the Colorado State Patrol with the crew to deal with traffic and security issues on Hwy 82 at all times during the shoot. Applicant will have a Pitkin County Sheriff's Deputy with the crew to deal with traffic and security issues in the Castle Creek area at all times during the shoot. The Pitkin County Sheriff's Department has approved the application and authorized "contract overtime." 5. Applicant has been working with the USFS, Aspen Ranger District, on necessary authorizations from the USFS in connection with its shoot. 6. Applicant has provided a Certificate of Insurance naming Pitkin County as an Additional Insured. ooooov ~n_ ~ . ~*, 7. The Director finds that, to the extent applicable, the application complies with the standards in Subsection 3-200-030 of the Land Use Code. THE DIRECTOR HEREBY APPROVES the Temporary Commercial Use/Special Event Permit for @Radical Media, Inc., subject to Applicant's compliance with each of the following conditions: 1. Applicant shall adhere to all material ,representations made in, or in connection with, the application. 2. Applicant shall obtain approval from the Castle Creek Valley Ranch ' HOA in connection with any use of N. Hayden Road. 3: Applicant shall obtain all necessary permits from the U.S. Forest Service in connection with its shoot on National Forest lands. 4. Failure to comply with the conditions of approval may result in revocation of this permit. APPROVED this ~l ~ day of November 2004. i dy Houb`en ~. Community Development Director P 188-04 PID 273520101003 ooooo~ 10/31/2004 23:39 3037331670 COLOFILMLOC PJTKiN COUNTY CONWIUNITY Dk'VE€.OPMENT DEPARTMENT 7'EM~'ORARY COMN~RCIAL USIi=/5PECfAi., EyENT PERMIT ..~. iNF012aiATION ON THE PERMiT PROCESS AND APPUCA'J"JOhi PAGE 04 The temporary use and occupancy of public or private properties andfor roadways for commercial activities or special events that are trot otherwise permitted within a specific Zone District may be permitted by the Community Develapmer:t pirector. The Community Developr~nt Department coordinates the review of these activities/events by various referral agencies ~ order to ensure that the activities/events are conducted in a safe manner, and tha# any impacts on the community or on public resources are mitigated by the permittee. The permittee is required by the Code #o demonstrate that adQquate provisions have been made for police supervision, public parking, insurance, site set-up, maintenance and dean-up, emergency services, and safety of operations, A permit wlI! not be issued unless these requirements are satisfied. Special Events include, but are not limited to thQ following: ~ Public events for amusement or entertainment, suds as concerts or festivals; ~ Fund-raising or non-commercial events #o benefit nonprofit religious, educational, or community service organizations; and ~ Foot races and bike races. Temporary Commercial Uses include, but are not limited to the folloyi~ng: ~ Filming of movies, comrrser~cials, or promotional spots; and ~ Trade shows, EXEMPT ~; Is this afund-raising ar non-commercial event for a nonprofit ~ o Yes religious e dpcatio al ~ ~( ~ ~ n , or community service arganizativn? Will the event be conducted entirely (indudtng parwngj in a Y ^ es permanent faaiity on private property owned or leased by the ,~ No sponsorincl entity? Will the event have a maximum duration c+f 7 day and be limited to ^ Yes the hours between 8:00 AM d 9 00 P ~ No $n ; M? If you answered YES to ALIT of the questions above, then a p®rmit from the Community Developrment Department is NCT REQUiftED. However, you must still obtain any other required permits or approvals, such as a special event liquor license, pyrotechnics permit, etc_ Contact Community Development at (970} 920-5526 far assistance in determining what other permits may be required. 1n addition, you must notify the Sheriff and the County Engineer of the time, place and estimated attendance for your event a# least 72 hours prior to the event. Di'HER EVENTS AND USES; if you answered NO to ANY or ALL of the questions above, you must complete the attached application and submit the required fee and application (with all required attachments) to the Community Development Department for review, ~ Community Development ©epartment will be the primary contact for the applicant during the proms. Once the completed application and fee are submitted, Community Development will distribute the application to the necessary referral a9®nc~es and, if necessary, Wrilf schedule See Subsection 3-2aap30 of the Pttkin County Land Use Cade (the "Code"). 1 fLl1C..n4 o~ouo 10/31~200d 23:39 3037331870 COLOFILMLOC PAGE 05 "*, a date for the referral agencies to review the application with applicant and/or put the referral agencies directly in touch with applicant. Following review of the application, the Commugity ©evelapment Director will issue an Administrative Determination grarrtirtg or denying the penFnit. The f3oard of County Commissioners reviews events of duration longer than 72 hours. Special. event permi# applications and temporary commercial use permit a plications shelf be submitted to the Community bevelopment Departmeat-~f less than''6q days prior to the event date, along wi#h the following, ~~` ~ \ 9. IMAe for application; S72T6 (Majgr Even , S43D (Minor Events}; a check payable to Pitkin County Treasurer, Whether or ~ event constitute "Major Event" or a "Minor Event" will be determined by staff ak the time ~ ' a . The fee is based on 2. hours of staff time, for Minor Everts, and 6 hours of staff time, for Major Events; if staff review time exceeds 2.4 hours for Minor Events, or 7.2 hours for Major Events, the applicant will be charged for time in excxass of 2/6 hours at a rate of $29 5 per hour. 2. Map (ske#ch or site plan) of event site, detailing any temporary or permanent structures, street closures, all impacted properties (identifying awnars), and parking. 3. Vicinity map. 4. Schedule of events/activities. 5. Detailed Safety and Operations Plan (see Attachment). 6. Proof of Genewal E.iability insuranoslndemn~catlon (naming Pitlun County as an "Additional Insured") and proof of Liquor l..iabifity insurance (if applicable). 7. E.Btter of authorization/executed contract granting approval. #o use the specific site(s) from public or private property owner(s). 8. Written approval of any applir~ble Caucus(es)/Homeowners' Associatian(s). 9. Copies of all other applicable permits. (Some helpful contac#s and references are included in Attachments f'3 and C.) Other permits may be processed concurrently with the application. ~~LfYLJkd iJ V ~~ 10f31f2004 23:39 3037331870 ~"*, COLOFILMLOC r~""'*, TEMPORARY COM ERCA ~USE/SP~CUIL ENT iPE~M T ~ LICA't14N Pl'eese answ®r the fivUo~ng questions in detail. !f an ifQm does npt pertalR 10 your activity/event, pease marfc it "N/A. " 1. Name of evertt/ecGivity: ~lacE r ~ ~ ( j~ ~~ ~ ?~ ~ ~}~,. t g S ~a ~ PAGE 06 .-. ~. L lion of ever-tJactivity: ~~ v 9j2.. >r'S t~R~ L~ i,caotvl CP:~I~c ~ t=s rg~y. (Z,G{~,ka„~ ~.; lt,t ~-~~`~.~ Creek r ~, - ~ s 3~a '~ ~ l~ - ~' ' 2i. Nev-tf, t~~s~Q~,,~Qa~d, 3. T of event/activ#ty {Parade, assembly,,s ortina, event, tilmin 'etc.: ~ i r 2.K ~' v u G (~G:~ ~ri +~',~~~ ~ t'-~ S rr e.~s-'t ~~a-~ ~ ~n If the eventlacdvity involves movement (e.g., parade, foot race}, describe the route, induding starting and dispersal locations, and attact€ a map. 4. Name of applicant (sponsoring organiaation/event coordinator): Ga radccaf. fi•eQia ~-ri.! . - address: t ~~,© t 2.E ~ ~.t. Phones}: , _ 3 t o -_{~~~~~le oc E ma~f: Name and title of person prims~ril responsible for oversight of event/aetivity: lresvle~ 3't+tnngen ~ ~ec am V1'tron2gev --- Address: 7'02 ~ • - t~wD. 'D~,uv~tz. n2o ~ Phone(s): X2'7 „~_~ ~k t • 3 Z'7~ ,nit . 3a7 • ~", ~• - ,~ 722. cr~ ~ .~ ~-mail;~Yppkt ~ colaw _ a~;Ewr loc~#•ccas.~~m t;etl phone, radio frequency or other means of oo act during the event/acctivity. 5. Qate(s} of sver-#factivity: ~15~/ „~ ~- (~ ~,rpp ~,L Starting ~ime(s}: ~~k~ ~-t b''~T- ;-F~u ~'2 S~ ~ :;(5 i4- Ending time(s):', _ 30 ~ +M 6. Number of people involved (induding participants, staff {including volunteers), and 5pectetors):..~.~ ....q.p '[QTM4L If you will be using volunteers, what type of advance training will they be receiving and when? ~~~ ?. Wil! you provide notiflc~tion of the eventlaetivity to the public andtar to adjacerttJaffeded property owners? if YES, describe who you rnril! notify, when, arfd how: ~.a ikon n~~d~ef,' : a n Toes or- Wed -'Tt~vrsd~.{ , - ~ -l- (+ P ~~ ~ tsc 7s^~-~,r~, •~, '~/l,~aev e ~ev~ ~~ -~ rt ~{ ~ v4~ P~-c~' ~-^ i ct~ '~~pS -~{rG~~a -2s~rG W~.uS-~-la`Jt~ ~~ rs'3~c 71~u'1-v~ ~I~CT1+h ~Y1 J .l vbt~ ~' ©v 1 _ ` ..JJ ~3r 11~ ~'~'e ~v 4ev-{~yL. ~p ~- l~ ~ ~ fha{ ~r ri ~vFal a e. act ss ~-t-• ~ C` ~ ~ ~ ~ 00000 10/31/2004 23:39 3037331870 COLOFILMLOC PAGE 07 ,,~""*, 8. Are you plartnir~ to ~,~ temporary structures or #erY#s? if so, describe Location, size, purpose, and if #hey wilt be heated/air conditioned: ~~ ~ - ~-__ _- Temporary structures shall coniim~ ~ any and all applicable building codes and other County regulations. The applicanf shall obtain any required building permits from the County Building Department. !f a :feet is to be erected, the Fire Marshal shall be contacted to complete a fife safety inspection prior to the event_ g. Do yoU require electricty; if so, what is the source of your electric power? ,_.~,g n ~ Temporary electrc power cvnnectian(s) shall conform ib any and all applicable electrical codes and other County regulations. The applicant shelf obtain any required electrical permits from the County Building Departmenf. 'EO_ Wit! there be amplified sound, music, or fireworks? tf YES, please describe; N ~ lll~ if fireworks are planned, the applicant shelf obtain approve! and a perr»it from the applicable ;Fire Marshal and the Sheriff, and shall comply with the County regulations on !Noise Abatement (Code Title 6, Chapter t>'.36), 19 • WiH any food be sold? ~( (~~, if YES, the applicant w1ll be required to submit an Event Information Application to County Environments! Health. Applicant may also be required to submif an Event Coordinator's Applicgi'ion and, in connection with Its food vending, applicant shaft submif, or require e$Ch of its independent caterers b submit, aSpecial Event flood Service Application to Couniy Envlmnmenfai Neatth. In connection with safes transactions, applicant maybe requited to h,~ve & CO Standarof Sales Tax Ueense or CO Special Event Sales Tax License. Contact the CO ~pertment of Revenue for infotrnation. 92. Will you be providing portable tale#s and/or hand-washing stations? ~5 if so, where 'll they be located and how many will be provided? ,.,.,2„ ,n,~e~-E~o~ o ~„~ ~ ~„_~..o # ll W~ribe~he typeumber~nd~ ~ ~ ~o ~~cyde containers tope provided; Ti~ash/recy+c% r,~ontainet~ nd foilets/hand washing stations must be .removed wlihin 24 hours of the svent/actrvi Name, title, address. a--mail and telephone number(s) of person responsible for clean up: _ ~~~"ain n ~~o ~'3wt . t oc~~e n rt iL ~1-,rQAke ~ ..~~ ~ s _ Corp -_ 13. will peer, w+n®, or o#her alcoholic beverages be dispensed art your event? 1~ If YES, complete Att~hptent D end c~ontect the County Clerk ~& Recorafer's Of9~lce to determine If you need to obtain a State of Colorado Specie/ Event E.iquor License Permit. ~~~~~~ 10/31/2004 23:39 3037331870 COLOFILMLOC PAGE 08 14. Are you requesting use of any County properties (e.g ,parks trails)? Y ~S tf YES, please spe~~~ ;~w-i-r.~,~e,-i_~ a ,-tc cn~ ~o-~ ~-t-' ~r~,G~t~ra~ The County mad requi pp ieartf to na ci carffy to ensure u r t oa e-v~ c~ns (Ga- restoretxon/revegeta~on of County property, ~inGe(c,. i~Q - ~~,~ ~„c.ftt~ ~.nne. row i5. Rr~ou requesting road closures? ~p tf YES, please include date(s) and times: ~~ To ,Date Road .. _ from To .gate if road Closures are approved, the pemritt~ee will be required to publish notice of the closures in focal daily newspapers st least 2 days prior to the closures 1G. if you do of require road closures, wilt your event/activity use any prabilc or priwte roads? if YES, describe: ~;~ ~ a(„~ X5.1 d2?, ~ f`14.~-r-~-G2~~'~. ~) Z rev A Z. . r , - _ ___ _..... _ 17. Where will you provide parlcing? u ~. &a~'r~ :.>=°~ r~P~rRG~.-*+ DS . Number of spaces available at each location: -~a describe any arrangements made for towing illsgally_parked vehldgs: 'ice ~e~g~ 1113- '~.+i~;r cGur•vt ~a~ ~.,r~7~ os• 18, Will shuttle service be provided? '~O If YES, descrtbe shuttle service (including hours of operation) and methods to be used to encourage use of public transit: 19. I~esoril~e traffic control measure to be insti#uted: t ~ n e~p_ ~ w~ 'W t t~ 1' ..Z~F'i '~~ ~ t in S i~,v ~ _. _.t.~- l.~¢~ . r d, .. -~,r ~r a ?,~~ g.~. _.~ ~n -,r~~-' ~ 1rti,~- vim. ~, m~•~~T.~ r c. --- t ~ H~ ~Xy personnel will be pr -clad for securiijr, and trafti~c and parking control? ._...... Identify any subcarrtracted security and trafficlparking contra! service providers (name, address, oc,rrtacx person, tetep one number(s), and e-mail): ~~~ C.~..-t-i, 5l~ .-~-~~ ~ss2 ~A A;~ of o,oe.~a~;,a,,~s _aw enforceme»t services will be charged out at the current hourly rate e~sfablished by the Sheriffs Departmenf end ONLY if resourr~s permit. The She,~'reserves the right to place officers anri staff at the event, at the permittee's expense, if deemed necessary in the interest of pubfic safety For further information, contact the Sheriffs Office. 29. Haw many and what size vehicles and equipment da you plan to use to stage the evint/a~'~ s~ provide tha.iocation for stagi~g of ail vehicles andequipment- ~ro~! a ~~n.i ~t_~nn ~.. Qc'~-~^r a ~, i u~c(v~ ti it t ~~ 1 - 2. vin rZ-l~v ~I~t~~,-~'~-~e~ h n~ ^~'Ya i 1e.1.~ + ~"u ~r ~~ a v-~ ~ µ .~ ~~~UQ~ 10!31/2004 23:39 3037331870 COLOFILMLOC PAGE 09 3i"Lt~lrna- Z+re~s. ih e~tud~t ~ -•~ ~„ r.a~'-~ tr .eiY aj?~er,,,~ 7 ~t..Q.1/1"sYL~ r 22. Are you planning to use fxed wing or rotor wing,aircraft for ap3~ asp of the event/activit - tf YES please describe:. l-~erl ~cc,,.. -~ ' ~~ _ _ 2. ~ r~cQ ~.i ~ ~,Q,j„ F~ vie, ~ ~~ ALL APPLICANTS: Please, complete the attached afct and O y Aerations Plan or provide a separate document containing all of the required information (see A~t,,achmc~nt A~, ,q Safety and Operations Plan is required for planned events/activities because the emergency service infrastructure Is funded by the Pitkirt County taxpayers to offset unplanned events that pose a threat to life and property. AS a result, any demand for services generated by a planned eventlactlvity shoutd be alleviated ahead of time by th8 event sponsor or organizer. The posting of fnancial security, In an aeccptabfe form, may be deemed necessary by the Pitkin County Sheriffs Otfsce upon review of the Safety and Operations Ptah. 23. Describe any speaal requirements or aspects of your event/activity that h8ve not been covered above: certify that l am an authorized representative of the applicant, _~ZadtG~ t 11ked~ ~, ~~,~ and have the power to execute this application on behal€ pf the abave- named organization. Alt of the above statements arse true to the best of my knowledge, information and belief. I acknowledge That any Temporary Commeraal Use/Specisl Event Permit that l receive shall be subject to the following terms and conditions, in addition to those specified in the Administrative E7etermination/SOCC Resolution grantlrtg the permi#; A. The County may revoke a Temporary Commerr.~ial UselSpeaai Event l'emtit prior to ar during the event if the perrmttaa violates any of the conditions of the permFt- B- The County may require the pemnittee to partiapate in a post-event debriefing with referral agencies, affected citizens and other interosted/involved parties to address issues that arose during the event. C. The County may require the permittee to post financial security to ensure compliance with any of the oondi#ions of the permit. A. if a mayor inr.~dent or emergency ocxxars in the County during the event, the Shertiff reserves the right to remove ar;y and all emergency medical, l'fre and law resources from the event. E The permittee shall adhere to all representations made in the application and in public meetings- `~~~~- Signature of A on Represetttetive of Applicant `~rodtl~ C • ~a h n So r~ Print Name _. Tate ~ ' 7oz ~ 5 P~~ rZ, T3~v ~ . `fir V ~2 . Cra , __ ~oZ.o ~..,..~. Address ~ _ ®~~~. 10/31/2004 23:39 3037331870 COLOFILMLOC PAGE 10 A"r"!`AGHMENT A SAPETYAND ()PEI2ATrpN3 PLAN REIIUIRE,i!liENTS The purpose vfi this part of your appticativn process is to promote public safety m the conduct of special events in Pitkin County. Please proYlde ttte following information as it appNes to your evetrt. Note that some questions will not be applicable, or appropriate, given the nature and/or scale of your even#_ Contact the Public Safety Couneii for additional information or direction regarding these requirements. + is this acorporate-sponsored avant for profit? ~' or a non-profit event? ~ (Check one.) The following statements assess the level of risk to the partiapant/atizens of ,the County by the event and its potential to affect normal public safety resources, (Ch®c~c appropriate boxes) © YES '~Q, NO A) toes the event pose risks to the indlvlclual participants and public safety? Q YES ~[ NO B) Ooes the event occur in wilderness, swift waterlopert water or mountainous terrain and have the potential #a affect Hormel public safety resources? if either A or B were answered YES, then the applicant may be required to post financial security with the Sheriff's Office. Ali paRiCipanfs of an ®vent are encouraged fb purchase artd carry during the evenf a hikir:g, rshing, hunting, snowmobile, Boat registration or ,back County certiTicate, which may cover costs of an emergency through fhe Coloreds Departmerrf of Local Affairs-D4~,A Grant. The Safety and Operations Plan can be written in outline format. It should: ~. Outline, in detail, all of the activities, risks, or other safety issues assoaa#ed with staging or participating in your event. 2. Outline, in detail, the safety measures you will have Irt plats for the event: A. Name the single point of contact public safety offidals will be in communication with at all times during the event. List all means of communication and numbersffrequencies (e.g., cell phone, radio). where wil! this individual be located during the event? B. tM1o has overall responsibility far the safety of the event? C. Describe (bullet topics) your safety briefing for event staff. D. Outline, in detail, your safety preplans. 9) is your written safetylsecurity plan developed and distributed? Please provide a copy. It should address the following items: a) Dispatch procedures #or your internal emergency response resources. Drawings (flow chart) may be helpful. b) Requests far assistance procedures. c) Even# communications plan. Drawings may be helpful i(Lfuq.M OOOOIl 10!31/2004 .23:39 3037331870 COLOFILMLOC sertsr # Az068 A4N1AL8ERT (3, ItUBEN INSURANCE , SERVICES, INC. 46 WEST25Tt•18T., 12TH FLppR ~~ NEW YORK, NY 10010 X03 ~ ~-~1 CONTACT; FtRISTI JONES TELEPNDNE: (2Q~) 827-7400 coMPANY IN3U(~p A a~RADtCAL MEDIA, INC. ~ c0~4NY 126012TH STREET 8 SANTA MONICA, CA gA404 C~ANY C ~_ . OOMPANY ~°""~,, 15 !3$UE;p iR3 IYO F COMPANIES PAGE 11 ,~~ 'vw~ (iNtYiiealti~ COVERAQE GULF INSURANCE COMPANY GENERAL TAS R NAl7t3NAL CLAREDON NATIONAL TOCERTtFYTHATTHEPOLIdESOFItVSIJF~.::.c..;:'x`•:~,.,;~:.~ ~.~...~1.',f.'a'~t .:ri:'.:'1:",.~~.•~•r.~.•1S'~~,.%:`,~:;::5~'~Syud..';~~..^~C~°~zrT:.'~~e~'~,:.~~..~~: ' tNDICA'PED, NO'rynTHSTANDING ANY R~ [ p~ ~ t E GI MREMeNT, TEfiM OR CO Ttpf~ OFAN 1( p DOCUM ~ A~VE tOR THE PG pNTRACT OR OTHER ~ER1'IFtCATE MAY f'JE ISSUED OR MAY PERTAIN, THE fN3URANCE At°FORDED t3 Y THE POI,-q~ DE3CFi EXCLUSIONS ANO CONDITIONS OF S h j - W 9~~ p~ ~ IBED HfsREl UCH POLICtk S S q1 S, Llluln'S gypy~rN MAY HAVE BED( REp~ED BY PAIp CLAIMS, LTR T~'Pa:OFINSCIRANCE POLICYNUiRBER FOLrCYEPPEC77vE POIJCY®CPlRATION ~ GENERAL LIABILIry DATE tMMiDD~YY) DATE IMMIDpIYY) ~ LIMITS A CLPT/52974 X CDMMERCIALOENt~tALiJABH,i?Y /9104 1/1/05 GBNERALAC30UiE6ATf ~ GtJ41MSMADE ~OGCUR PRObUCTS-CONP/OPAGG ~$ ~~as a corrrPAC'roR~ P~aT P~SOHIIL a ADV IIVJURr f s -^. w_ ~ FrOCH OCCURRENCE ~ g _. P1JiE DAMnGE (Af1y OAlfitp} I S Auro>HO®rLe Lweum CLP7752974 MED sxP V~hr c~.Pthewq i s . A ANYAUTO 1/1104 1/1/05 f ~ ALL OWNf~ A1171jS 1 COMB/NEp SINGLE UMIt• S ~ 3CMEDVLED AUT09 ~ @OD1L Ry X Ii1RED AUTOS P~ l~ ~ s X NON~OWN6DAUTOS $ 1,t1D0,000 LIMIT `"' $ 2,000 DEDUCTIBLE OILYIMtAIgv ~ o X ( ervoaoo q Is PHYSICAL DAMAGE GARA~e LIABILITY PROPERTYDi4MAGl: s A-uv °uT0 I Auro ONt.Y - FA Acat>srlr ~ s _ ~ OTMER ~{AN AuTO ONLY_ ~ `` 1 EACH ACCIpEI~ Z EXCESS Lwt31LITY ~.. GUTt102048 t I AG3REC~ITE• ~ i A X uMgRG.La>;oma tVXG3t30256B 1/1/04 1h/05 ~EACHOCCURRENCE ly 8 OTNFJ2'~HAIY t1M9RELLA FOfa~ EX00002l301 ~ A4GREGAI'E I S ~k~'8 COMPeNHAnON AND ' I ~; EMI ROYERS'UABIUTY ' I I'TORYuMri8 ` 1 ER, t rME PAOPplc~pp/ ~T„~~DtECUTIVE INCL . EL FAGH ACCIDENT Ig oFFNxlta rte; D(CL Fzl. DISEASE - POUCY iiMIT 15 A PRf)PS/3ET5NYARDRpBl; t:LDtseASE-~" etdPLOY~Is CLPT752874 MISC_ EQllll?MENT 1/1!04 1/1105 LIMIT: $ 1 000 000 3RD PARTY PROP. DAM. , , >_tM1T: $ 2,000,000 LIMIT; $1 000,000 ~NIPIION OF on~anoNanLOeanoxwvLxlCL , 1,000,000 1,UOO,OQp 1,ooaooo 1,000.000 7,(x10,000' f 9,000.000 19,000,000 Rl:;NISSAN JOB# t37451 ONLY. CERTIFICATE HOf.DER IS ADDITfONAL lN5URE0 FOR GENERAUAUTp LIABELII'Y AND LOSS PAYEE AS RESPECTS PRODUCTION PACKAGE BUT ONLY AS RESPECTS CLAIMS ARISING FROM THE= NEGLIGENCE OI? 7HE NAMED INSURE=D AND A$ REQUtRE;D t3Y WRTiTEN CONTRACT. Fittcin. County arld Its' .~mpZoyees Pitkan County Slaeri~~'s 4f~ce 506 E..iu Suite 10I Aspam, Ca. 8I6I2 8NDU1-D ANY OF 1'HE ADgV6 DESGRIRED POLIdE$ QE CANCELLED 6~•'ORE 71~ EIggRA710N OPTE YxeitEpry T-,E 1S6UIIY~9 COMPANY YNLL BxDEAV!Olt TO MAR DAYS 1KfgTTEN NOVICE n] THE CERTIFICATE HOI.DEft NAMED TO THE LEFT. BIYr PA~6URE TO MAIL SUCH NDtIGE BIIALL IMPOSE NO ODLIOATION OR LIABILRY OF ANY iWD UPON TFfE COIr~ANY, -7'g AOENTS Oq REPi1E0BNTA~6, N~Itl>~b ~>NAI7AnVE OF NdDEPENDlxY 3,3rYuvE AGENCY ..~ ~~~~~ 10/31x2004 23:39 3037331870 COLOFILMLOC PAGE 02 ~ ~pur~ ~V . ~,. FAX FAX ~TCI: Jim Staar~, USFS Aspen ~.tanger Aistrict (974) 925-3445 office (970) 925-5277 fax k'ROM: BROOKE C. JOHNSON of COi.oRADO ELM LOCATZO~Ta.Com LOCA'1'14N MGR. for :@radicai.z~xedia- Nissan conuaaercial Cif: 303-733-5722 Fax: 303-733-1$70 Mobile 303-94.1-3774 e-mail: brooke@ColoradoFilrn.Locations.co~ ~) PAGE(S) WJCOV~R, DATE: i0l31/04 MME: Jitn, Here is the application we spoke about for the Nissan ~lrrain.g. ~ canna over to scout all the locations last Saturday with the Director (we znet two hunters on the road to Monte~urna. mine, one on Richmond Hill and no one in Lincoln Creek) axtd here is a recap of what we hope to do. dC .~klday, Nov. Su". Begin Blming in Lincoln Creek on FS road 1.46 and Hwy 82- I~ndependence Pass. The shooting there includes helicopter shots on both goads. I am trying to contact the reservoir folks & caretaker to see if they can open the gate on the dam road for landing/staging. For Independence Pass I would like to have permission to land at the top where a pickup truck can get next to it for fueling. If not the top perhaps you can recommend a location close to the bottom, of the grade on the West side. We have very few shots to do on the Vass so we may only need to la;~d once. ~ ,Fox staging areas I'd like to use the parking near the West side gate ( and the Weller Campground circle if we can get it opened. If plowing is needed we hope tive can contract with the Forest Service or privately. Saturday, Nov. 6"'. Begin filming in the Castle Creek area including; Richmond Hill-FS road 123 and its' off shoots (accessing on Little Anne toad}, Castle Creek FS 102 from the junction of Cooper Creek going up (we only made it up 2 miles Saturday), and the road to the Cathedral Lake trail head. For staging areas we would like to use the turnout on C ek road across from L,,,,~' tle ,A,nne Road the Cathedral Lake trailhead parking, a - o )~ ~ S n o cro and the area at the ,unction of Castle ~OT- Creek & FS road 121. ~VVe so need the paved sections of FS 1.2 ~--_ d t~ ~ S ~~u c~~ (from the sign to the gate?) so we can leave some public parking at the junction, area, Of course, will ,allow public access at all locations. ~~ -~'e-~~. 4n the pplica ' n I also tin E,x ss Cr oad 122 and the dh.l~. Cooper F road 121(ab a the .These e o if you feel we should there ' tead oft a other `--- ~~ OUOU1 10!31/2004 23:39 3037331870 COLOFILMLOC PAGE 03 -~ USFS fax page 2. Rcgaxding the helicopter. I know we are in a small corridor outside the wilderness areas surrounding Lincoln Creek Road and tl~e pass. I have worked with.the pilot, Craig Hoskirtg on quite a few jobs and know he is well aware of the restrictions and has no desire to push there. ,A.lso the fuel truck is a pickup truck with a small tank of fuel and other support items. We do think the Lincoln Creek area is a good place for it's rise rather Irian; Richmond Dill where we axe nearer to homes and we only have the helicopter for use part of orte day, currently planned for .Friday. V~eather issues are a co~;cern for flying so I hope we can permit all of these areas fox Firlday or Saturday just in case. (I did that already with CSI' & CDOT). Can we do it that way and will this affect the costs on your pexxnit? I have completed the ~I'itkin County temposry use permit and spoken with them se'vexal ti.tnes in advance too. I wi11 be coming up to Aspen f rorn I~envex tomorrow (Monday) to meet with you and the county to work out arty details or chaa,ges needed. I can be there anytime in the afternoon to meet as it looks like it is going to be a snowy drive. Meanwhile I can be reached most of the drive time on my cell phone at 303-941-3774. ' ,~--~ dope to speak with you soon and thanks again, `7~~ ~~ Brooke Johnson Location Manager for @xadical.media /Nissan commercials OOOU1~ 130 S. Galena"' Aspen CO 816 (970) 920-552E (970)920-543 ~'~_` To: Tom Grady, Steve .Knowles (for Janice From: Martin), Cheryl McCul och End Van alrave ~~, Fax: 920-5307/1544-1590//920-5378// Pages: 920-4451,/ SN ~t ~- t~ ~ ~ ~ Phone:. ~ IDate: Ree Pitkin County Temp Comm'I Use/Special CC: Event Permit Appln ^ Urgent x For Review x Please Comment %~ Rose Ann Sullivan 12 ~ 11/1/04 Ellen Anderson (interoffice), Kris Jewkes (interoffice), Bud Eylar (interoffice or pick- up) ^ Please Reply ^ Please Recycle • Comments: This application for a Nissan truck commercial shoot was just received. The shoot is on November 5t" and 6' . In addition to staff on the ground, they plan to use a helicopter for filming. The applicant has already been in contact with some of you directly. Given the time period involved, I would appreciate receiving any comments you may have on this application ~ay noon on Wednesday. Thank you for your assistance. UUUU.~ Page 1 of 1 X-Sender: tg70@pubsaf2 X-Mailer: QUALCOMM Windows Eudora Pro Version 4.2.0.58. Date: Mon, Ol Nov 2004 09:28:42 -0700 To: Rose Ann Sullivan <roseanns@ci.aspen.co.us> From: Tom Grady <tg70@ci.aspen.co.us> Subject: Re: Permit request -- Nissah Truck Commercial Cc: Ellen W Anderson <ellena@ci.aspen.co.us>, tg70@co.pitkin.co.us At 08:59 AM 11/1/2004 -0700, you wrote: I have just forwarded to you an application for a permit to film a Nissan truck commercial (11/5 and 11/6) that we just received. In addition to staff on the ground, they plan to use a helicopter for filming. Tom and Cheryl -yours was faxed. Ellen and Kris --- yours is in interoffice mail. Please give me a call if you don't see it by the end of the day. Thanks. RA- I DID RECEIVE THE APPLICATION- I HAVE APPROVED "CONTRACT OVERTIME" FOR ONE DEPUTY FOR THE SAT. SHOOT UP CASTLE CRK- CSP IS COVERING THE FRI. SHOOT UP THE PASS. THE HELICOPTER IS A WORRY BUT NOT ENOUGH TO MAKE THEM JUMP THROUGH A "$$ BOND" @ THIS LATE DATE. W/ LAW ENFORCEMENT ON SCENE, IF THEY HAVE A PROBLEM WE'LL HAVE IMMEDIATE NOTIFICATION FOR RESCUE RESOURCES, SO I'M OK W/THE APPLICATION - OF COURSE IN A PERFECT WORLD WE SHOULD HAVE MORE LEAD TIME---- THANKS T. GRADY Rose Ann Sullivan Planning Department Pitkin County Community Development x5482 OUOU~. file://C:IDOCUME~ 11ROSEAN~ 1.ASPILOCALS~ 11Temp\eud 14.htm 11 / 1 /2004 boboxenberg@aol.com, toklat@sopris.net, Nissan Commercial -Temp Comm'I Use/Special Eveni To: boboxenberg@aol.com, toklat@sopris.net From: Rose Ann Sullivan <roseanns@co.pitkin.co.us> Subject: Nissan Commercial - Temp Comm'I Use/Special Event Permit - 11/5 & 11/6 Cc: Bcc: Attached: I wanted to let you know that we have received a "last minute" application from @Radical Media, .lt1c. to film. a ,~is.~.a commercial this Friday and Saturday, east of Aspen and up Castle Creek. Filming will only occur during daylight hours and there will be no road/area closures associated (/the shoot. CO State Patrol will be with the crew for shooting along ~ g2 and a Pi#1sin. County Sheriff Deputy will be /the crew up Castle Creek. Exact locations are still being pinned down. The applicant is working with the USFS on all White River .~ locations. If you would like additional information on this application, or would like to receive. a faxed copy, please ,give me a call at 920-5482. 0~~1(~1 Printed for Rose Ann Sullivan <roseanns@co.pitkin.co.us> ..: 11/10/2004 10:29 M 3037331670 COLOFILMLOC ~""'°"" PAGE 01 . '. ~a radica~.n~edia ..~~ Nora Xork I Loa Aagele® ~ ~C+hdo~ 1 Pspis ~ syduey • ~,~ Date: !! ~~ b~D~ _ ..~ ' "ro: ~~~" /E-T~N ~vG-c.~ ~~A1 ~J~ Co3x,,paz~y; ~~ k~ K ~u~~ ~on~-rtc,unt-I~,~ 1.~ue.~ ~ ~ ~~~'~ ., l~xoimt: '~c~rescsr. •ra~e,~ca~ ~~.~ / Pages: (inc~_ mover ~f ~ , ~~r /~~~ .. ~~ .~. ~ ~~-~ ~,~. ~`/l ~~'~ '"fit ~.. ~~"'9 ~~ ~ac.,~.. -~Zi Yip ~~r~ ~~... ~~ J y1'~~GQ~ . `~m~s /~ .. r ~ ~ ~ ~ ~~ @~adicaL~nedia 1fi3012tt,. Street Santa. Monica CA 9Q4~.4 .. '~ :3 i.0 6b4 X500 Fair 320 b64 X600 zaf°•~radicalnzedia.com . UUUU.I __ 11/10/2004 10:28 3037331870 COLOFILMLOC PAGE 02 Z Fern, ^!f'"4r ~~ ~e~~ fQ~ 1~ (R~v, Nvvernbm' 1$ss) ~ X~IB~'eir ) Give forth to ttte '~~ 7)L?I,evlr+tQ,~t Of l~n 'IiaBRUry IdentEflicat~on l~ur1'tber and Ce~rtificati~n r~nr~str:t: no Igor c'~t~,rral rte~enuc Service sen7:f to the 1RS. ~'~•~ i ~Eemr (tf tr joint accourn or you cnanyad your name, see Spsctpc Inatructiots on a e 2J o f4uarnass Warne. if difF7:ren, teem 7above. (S7:A S } pe7:lfi~ tgAtruaeions on t,ogd 2,) ~ia, c:hac;7a opprvrrnate rypx: [] IndividuuErgeie proprietor Cor ration j-j~~.~ - Po Partnership [~ Otha~ r ,,,__ 7~n Aadrets (number, street. and ape dr sulfa noJ ~ ----'^-•---,",-.-----°.,...---- v Regc+esfar's name en4 s7979ress (opdenai) -... a G7ty, sro,e, anq zE!' evUo Tax a er ldentificatian Aturnber 1N) Ctifr.7 your TIN in the apprppriate box. Far use rcc4unc 7:umb73r(s} nrxo (opuonag individuals, ti'7)S is your social security number (s5N), )-towever, Er ypu are a resident align OR a 3o7;i7st neewd,y number Sole proprlr?tar, S22 the ingtrUCtiOnS on page 2. -~ f nr other entities, rf i5 o.Ur employer itlenr)fiC.r3+i°n number (lylN), If you do not niave a OFt ~ For Payees ~xernpt Ft^oaa Backup nu7rit,;gr; see ri,YW t0 9LS a F1N pit Page Z• Note: !f the accauntls in rrJnre t/>an ~ Withholding (See the instructions one ,tame, employer identlficatron r,um6er SF;e the ch~rf on edge ? j°r c~tf/delings on wh0.se on Page 2.) numb ,• __ _ _ - s to a,,;ter. i Ceftr,~ation _ _ + Under I)ene~ltie5 of perjury, 1 certify that: f _ 1 • rt,e nun,a,t,r snows on this farm is n,y tercet taxpayer ldeat(ficatlnn number (ar (am ,,"aging far a number tv be issued to rne), ano 2• ) rem not subjeca to lic7ckup withholding because: (a} ! arrt exempt from backup withhotding, ar fib) ( Ve not been notified b the lntt4mai hevrnue Service (lr:53 that I am subject to backup withholding aS a rosult of a failure to report all'ln~rest or divi7,tr3nds, or (c~the tR~ hes ngtHisd me that t ,m no longer subjtscc to backup witf7ho(ding. Certification knstrutainns. you must cross ouz imam ~ above if yUu I,av® been notrfrgd by thQ IRS that yr;~u tree currently subject to backup wiU,horJ7n9 because you r7nve lalled tt> report all interest and dividends ore your tax return, FAr real e9tatt trartsactlons, item 2 does not apply. Fc,r n,nrtc~z,ge interest paid r~cqutsiti7,in Ur aband°nntent of SeGUreA (~ropeRy, cant;7.!letio7T of debt, <tvntrf4~utions to an In7Yividual retirement <+rranye~nc:^7t (RSA), ant) gyngrelly, payments othc;r than ini~rest and dividends, you are not required to st~h the Certification, but yvu must prwiila yQUr COn'~Ct Trly. (Su:e t e inSVUCtionS On page 2.) . Sl~n f ._ 1 Here ! sipnraturq - Pur oar, .. _.. ,..- bate -• p of form. A Person who is What is backup wiihholttin ~ reiauirecl to Flle an information ieturn with 5~ Persons 5. 1(ou do not certify to the requester xiie; IrS n7uyt get your correct tax a er making certain payments to you must yp iclentiriratl0n tuimber (TIN) to report, for withhold and.pay to the IRS 31 °l0 of Such withholding under 3 above (f7srCreportabie payments under certain conditiortS, 7hi5 IS Enter@8t and q(v(dLr1d aCCOunts opened rxeimhle, irtCame paid to you, real estate called "paCkup withholding," Payments after i1g83 ontyJ. transtictiS,rtS, ntUrtgage interest you paid, that may be subject tv backup wlthhai(lin9 ac:quisicivn Tar ab8ndonrnent of secufed include interest, dividends, broker and PrUUerty, cancellation of debt, Crr Cer in payers and payments are conttiUut,Ons you made to en 1RA, barter exchartye transactions, rents, exem t from hxrckup wlthholGing, See the royalties, nonemployee pay, and certain Fart J instructions and the Separate U~,H Farm w.c~, if you are a u.5. pefson payrnentS from fishing boat operators, Real lnstr coons for the Requester of Forst (inc(ue(r'ng 4, rFS)dent rlie7z), to give. your estate transactions are not subject to W"9' c:urie~;! TIN to chg p4;r5on requesting it (the bat;kup withholding. r~:c)ueStar) 7tnd, whCn appricabte, to: P~f]~~t1~S ~. <;ertify tt18 71N you art•: giving is T1N,~nake ttte ~: `Pquest®r your correct Correct (ar you are waiting for a t7umhv_r tv reportt all your texahie nteresttfa0 ~, and FaElu to furriish.I'liV. If you fail t0 furnish be issuad),~ your erect T!N to a requester, ynu are dividends pp your tax return, paynTeniS subje t La a penalty of a50 for each such 2. Certify you are not subject to backup you receive will np( be subject tq baCKti~i fallur' unless your failure is due tp wi#hh~~lding, or withholdiryg, payments you receive wit! be r@asot able Cause 7~nd not to willful neglect. a. Cl:,irn exemption from backup subject to backup withholding it: Clvii enalty far fals@ informatlan 1Nith w)thholding it ypu are an exempt piayea. 7• You do not furnish your TIN to the reSP to uvi-.bholding, tf you make a If yot•i are a forei_ n requester, ar false tatement w(th no reasonable basis you u;;e r•r Form W 8 (certificate r.,f foreign 9 person, IRS prefers ~, You do not Ceilify your T+N when that r 5i,lts in no backup withholding, you stra{us}. Af[er December 37, 2000, foreign required (se7S the part !)1 instruCtiOnS on are st~,ject to a 5500 penalty. w goes must use an t+pNrupriaie Fdtm page 2 for rJetails), or Crirri171ta1 penalty for falsifying 3: The 1R5 tells the r•pque,ter that ou information, 1NlUfully falsiFying N°ta: it~~ r~ryu73srer Bruce you a form other furni'shea an incorrect TtN, or Y Cer<1rr~ations or affErmations may subject th`rr1 fv"" ~"' ro rcyuPSC your 1'/N, y,FU 4. The !RS tells you iaicriminal penalties )nciuding ,'thee nrusr use tl,e requester's' form ir'it is t0 backup withholding because ou did not rlitistar,tiv!/y similar rp tills Form Uy_ ~p You that sole are Subj@Ct an~pr~ imprlsonnient, ' 9• Port al! your inb:re~t ana dividends pn Misu. of Tl>nls. if the reque$t7~r dl5CloseS your tax return (far r®portapia interest and d Q s TtNs in violation Of Eeder~r) law, (he ~- _ dividends only), Ur rW tie t®r may be subj~c;t tp civil and _~"" y crimin t penalties. ' Cdt. No. 1023XX "'- ~. Form ~(/-9 (Rev. 71.9rJ) OIJOUIS Kris Jewkes, Ol :57 PM 11/5/2004 -0700, after the fact Page 1 of 1 X-Sender: kris]@finance X-Mailer: QUALCOMM Windows Eudora Pro Version 4.2.0.58 Date: Fri, OS Nov 2004 13:57:27 -0700 To: roseanns@ci.aspen.co.us From: Kris Jewkes <krisj@ci.aspen.co.us> Subject: after the fact X-MailScanner-Information: Please contact the ISP for more information X-MailScanner: Found to be clean Hey Rose Ann, Sorry about not getting back to you by the 3rd on the Nissan commercial application. At this late date I am signing off on the insurance even though the General Liability aggregate should have been $2 million, rather than $1 million. Also, now that the crux of the special event permit season is over, I'd like to set-up some time to talk to you about some changes I'd like see about making - it is the last thing i have to do for the HR/Risk restructure. Let me know how your schedule looks over the next 4 or 5 weeks. Thanks. Kris Jewkes Pitkin County Risk Mgmt. 970-920-6017 0000?Cl Printed for Rose Ann Sullivan <roseanns@co.pitkin.co.us> 11/9/2004 _ _ 10/3112004 23:39 3037331870 COLOFILMLOC PAGE 01 FAX FAX ~ TO: Rose Anne S~ll~van, ~'itkin County Community De~weY©pment L (970) 9205452 office (970) 920-5439 fi~.~c .FROIVt: BROOxI~ c..roxNSON o~ cozor~ro ~r ~.oc~~roNS.co~n LoCA'x'.CON MGR. for :@Xaclical.media- Nissan commercial Off: 303-733-S722 Fax: 303,733-kg70 Mobile 303-94I-3'7'4 e,zaaail: brookeQCaloradoFilmLocations.conk ji) PAGL{S) WICO~R. D.A,TL-": 1Ot31/44 x~: Hello again Rose ,A,nne, Here's the completed application you sent to me along with ar: insurance cexta~cate i sent to the Sheza~'s i~epartment already. ,I have also attached the cover letter I sent to Jim Stark that has our information as given to him,. The one thing not on his application is the private N. Hayden aroad. e Angela is helping me contact the HC7A to get pern~zssion for that once. Z do have some areas listed on the Forest Service permit fox sta in ~'~ areas that may be under county control but have listed them again in you application. They include the ,~shcroft parking lot c~ the turnout on Castle Creek 12oad across fxonx T.~ittle Anne Road, -` I have also been checking in with Bu Eylex about all the roads & he had no i~mxnediate concerns. i will be available Monday afternoon to ring a check to you fox the application fee. lvleanwhile please call me if yo have any questions ox avncerns on youz end. "hank agaizt, ~'~~ ~ ~ Bxooke Joh s Location Manager @radical.media /Nissan OQ~~2~. _. '', ~~~~~ e~"'QMMLTNITY DEVELOPMENT DEP ENT' 130 South Galena Street Aspen, Colorado 81611 (970) 920-5526 ~~ Pitkin County Land'Use: 172. Board of Adjustment 159 County Land Use Code 173 Deposit 1?4 Flat Fee ~"` .` 162 Zoning and Sign 169 Public Notice 160 Planning.Enforcement 175 Hearing Officer Referral Fees: 210 .Airport LUCO1 County Clerk 211 ~ County Engineer ~ 194 Environmental Health. ,, 208 Historic ~ 198 Housing 190 :Land Management 209 Redstone HPC 206 Wildlife Officer Building. Fees: 170 Board of Appeals 135 Building Code Sales 105- Building Permit 100 Contractor License 120 Electrical Permit 195 Energy Code Review 1 i5 Mechanical Permit 150. ~ Plan Check , ' 110 €~ Plumbing Permit 130 Reinspection 151 Aspen Sanitation . .152 AVFD Fire Marshal 158 BFD Fire Marshal Other Fees: 155 Use Tax 165 Copy PZ005 Master Plan Copy Performance Deposit 185 Park Dedication 186 Parking Cash-in Lieu. 1S GIS Requirements B1202 B12 3 Road Impact Fee S 0 chool Impact F'ee ~ ' r TOTAL ~ NAME• , ~ ..; ~.„~ . ADDRESS/PROJECT: ,,.. ~; ,. PHONE: .;. .: .' .. ,f n CASE/PERMIT#. # OF COPIES: DATE: ; ; a INITIAL:. x"