HomeMy WebLinkAboutBLD2001-01028 - BLD Application - 3/2/2009 SEVA-01 TUE 02:58 PM MOTOR VEHI HWY PAT FAX:7756882772 PAGE 18
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KKASE PReSS NARo YEMNT NO.: OL0
MASON coUNyy
BUILDING PEMIAP. � Pl1CATION
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INFORMATION CONTRACTOR INFORMATION
'I Adarass Centraatar Name
Malang Aoor+ss
J��� L�� Pho' -�311r '� Ph.(
—J Coo* t 1 Ph,City ° Zip code
--
sHotoer—ggh+,� Ca t•----J� A Omer Pat.(_
1 ali0rl
$F-PTICIWATER SYSTEM INFORMATION-Connect to New Sept
K ;ng Saptie Connect to Sarver��h + SM0. me Na of Sewer System Al A. ��yyeN ys yyatw Syatem Name of
PARCEL INFORMATION-12 digit Tax Parcel No.
al oesonptian 12.3s2�__r�f_r—tom tQ� Fin Oistritl—
leg TI�aBc A -d At;Z yy�� r f�.�..l L
Site Addrasa(Plea{ tnCktda stroet name,street7Wrbel and city)
11 t>MaC0M 10 sae C r
i t
WiN"Moor at ctd ano sold In pared preparalion?(Yes1No)
is your ompeny within 200.of the low".
Saltwater
Now+ng:Body of Water(Name), �'16tJ;12 L.4 W
Lake ✓ RiveaCreek Pang Welland Seasonaf Runoff Stream Slopts or
Bluds
TYPE OF J08 New Add Alt Repair V, Olher Use of 8wft
Desclibt Work�g�L��W?f►fL� rj,( � R�r�.run
No.i Bedrooms No.of Bathrooms SgUARE FOOTAGE-1sj floor�T2nd fhoor
bd Floor Loh`_Basament Deck _Omtr
Garage attached Ootached Caroon +uuehea Detached �.fl.
t
1 MOBILE HOME INFORMATION-Make Yodel
Length -Vlfidlh Serial No. Model Year
Type ad Heat Purchase Price i No•of sedrooms�„�,-,No.of 8solrooms�^
klstMler Hams Repbatment unit T(Yesfm)
'i Ca1iticatI0n No.
1 PIOTICLf ms RtReKT!!Comes MILL a VOID IF TWOnK OR CONST1tucrwm IiNOwza Nd NOT COMMlaClo w"m Ne GAYS OR 9
I Co"Alffi CT"WORK M 3uspt,4 EO OR ANANOONEO FOIL A►WW OF Nit OATS AT ANY TIME AFTU"W WORK Is OOMmN em
'I - /ROOF op CONTm"Tim OF WORK Is IT MtA1es OF A FItocasts 04KCT10N. burner W pat twwN/t eeAeN-rNeoee'nle NAM tAt
iMMliutMm Imovteae is accurate sate W""4"*r ms of Meson Cou"y abbess to ate above seserited pnlentr ant
OW'""It" Frv)aet.ACLtbeweetlmenl of teen It by sis"Wre below: sauewees W revww ant
OWYNER AFF10AV1T.+c mV Met I am mcno hem VW reeui,ements r t" CONTRACTORS AFFNDAVIT•1 coMry etr I rat Cteterry reetitrea es a
Catbaspr Re9'preeen Law fICW T1.71 aM am eerq et Me e,aMnte carareew n W&SIaA M- NpweeteMa for wince Hid lank a leaded bate fm aN wall tat be:Nero m .eglMenitlty �Ntt Slott t aw Legit N Ste Wen,"rylaemwnee'nor"" rd croneas snaN be meat.woRrt fist sltet a tleM�9eMPe was l r rtttleA aw armt al rsred snit b1 wet
a "� am ,ppovskMKe 01kewIH.Ne pwyor MIM a lneel.iOloW.
I
FOR QF�IC�USE BEYOND THIS POINT (�
Accepted by Amwm DIN T
--- Rseapt
,.,E
Oct; nstr p�JC .aq
Planning Department
Environmental Hulth Depanmont
. . .Public Works Departmem '
t Fire Marstlal •--�--_i—.—
! Valuation s
i
BuW ft PWMO Fee e l
Sde Inspection
Plan Review Fe! t1FC Plan Rev ew Fes
Pkirming d Base Fee —' Put>fie Worts Rawew Fee
McChantgl a ease Fee Olhw
WoodlGas/POOM Stove Fee '�—Olker
VtolaliomFee pre.Paid at Subtrio"I
TOTAL,FEES "—�^—
SEP-18-01 TUE 02:58 PM MOTOR VEHI HWY PAT FAX:7756882772 PAGE 18
1 FORM MUST be COMPLETED W erK I I O�
PLEA=PREss MAnD PERMIT MO.: tltO l J
MASON COUNTY —
BU1L.hING PERMIT APPLICATION �
�\� f M w.cadeQt.O.as tIIM►Nfa•
< v aRehon • ve"7o Setif IMPT
rj �• �AJPTIMFdRMAT10N
\Vn ■�'1, CONrRACTQR INFORMATION
Adwass M MConlropor Nam
Q� �� CdY: -^� Slaht Zip Code 1 i Cils
` PhMq'C�?_.I�¢9L rs 01Mr Pn.( _1 Phy • Zip Code
LivwfT`itie Holder :A#f L--) Dlher PI►.cont
�)
3"'I'WANATER SYSTEM INFORMATION-Connect to New Septit wExWinp Sptie Connect to Sower 511 ..._Namt of Sewer System_[f — YVater SYstlm Nerve of
wtMer System
PARCEL INFORMATION-12 di"Tax Parcel �d�No.12, I ! r—
LeO+d Oeseription L � fire Oistric{r
Site Addntss(Pie irKltrdt weet name,street umber arc City) ,
Dirycharts t0 sit Vito ihwri► ^`t TI nttS� P -
I
Wis timber oe cut will sow In Pots,preparation?(Yes/No)
J Is your progeny within 200'of the fOMowln9i Body of Water(Name), TI(.m LA Y.t __Saflwatof
Lake Reny,RivertCreek Pond WetlWO Seasonal Rune(/ Stream Slopes or
Biuffs
TYPF OF JOB New Add All Repair Other use of Btttidlnp
Ooscribe Work
No.-of Bedmoms No.of Bathtoofoll SQUARE FOOTAGE-1st Flow
loo 2rd Fr Lolk _easement DeckL Otntr y,w Floor
;.
Gara9t Altadled Delached_,Catoon Anathed t)euCneO s4•ft.
1
I MOBILE HOME 1HFORMATION-sMaks anodes
length ,Wkkh,_`Ssfial No. Model Yeer
II Type of Heat Purchase Price S No.of Begroont: No.of ammoms
last eikr Name—'—'- RePMOement unit?(YeVNO)
CefNfiapon No.
IIOTICj 71tie PERW eI W1S FRILL a vm M WORK OR CONSTRUCTION AUTtlOW 07 Mi T OOMTeOAM eTRTeN TM EMv an R
Cottl"WJ Y"WORK IS SU=►EI M OR A0yrOOMFA FOR A PERM OF Wo oST?AT ANT'TIME AMR WW WORR q i PROOF OF-M"WATWtI OF WORK It 0T MEAN&OF A PROGREts N SKCTM TM aww of avant On oswnu a bobjK nPteeetta that Me
1 infortitad"Novieed is accurate ohd trams ettyittyees of Mason Coatry avows to the above aaatroled MNetty 44e sMeetwes rot hvwr swe
YMPat"a al"ie aoleet.AewtewredemeM of seen to by signatu.e oNOw:
OWMER AFFIDAVIT-4Moncc"Sal I am t�I been ua raatwwwts a tree CONTRACTOR'S AFROAVIT lc a"ew I am Cw#w y ftV M d n a
Cadrastw R S.2T aid am o.m or Me a,,,.a contmaw Mt lot stall of*ltteNt$—ill ttW 1 ant atam of Ill waunce
n wteow"fw wMro etas Patna a isaw0 ate ew as wars VA of done m 'steAltneMs tegttll•rle eN WNe ter stllttt Seib etertneln t ees malt ea tnaes vMhtrA fuse o0tamatg sha•M date N catkMrrrce ettxee�l , MU M R .�wieot�
Na oo
r rest a aootnet.
)(
' FOR OFFICIAL USI:BEYOND THIS POINT
Accepted-by �_Dne Suotndtat Amount Due Recapt Me.
J4tlPROVED '13ENIE0
Oce Grottonstr.
Plartngtp epanmMt
Environmental HeaiM Depan;ant
Publie Works Oepattmem --'�"�'
I
t
Fire Marshal —`-
' Valuetlon S
i
Suit"Permit Fee Sds InspeCGert
Plan Review Fee -^ uFC laA 0—view—Fee
PlumbbW 3 8ase Pee Public Works Review Fee -
Mechanical 3 Base Fee Other
Wood/Gasrveget Stove FOther
ee —�—
lftolatian Fet �' Pre-P!d aT Somilal
( )
TOTAL FEES
SEP-1,8-01 TVE 02:59 PM MOTOR VEHI HWY PAT FAX:7756882772 PAGE 19
s i I FORM MUaTW CONPUTW O M
MASON COUNTY PROJECT SITE INFORMATION
Case No.
Name& &4C&VdQ PARCEL NUMBER,1.43,1; S/ 00900__ Date, c/31v/
SHOW THE FOLLOW NG ON SITE PLAN Show Direction by indiwtlono N,S.E,W In relallon to lM
site plan
Lot Oirtxnsions Fences
Existipp Sutictures Ddveweys
Structure Setbacks Stwellnes
Water Wnas TopoorsohY
We 1inGudk*adjacent) Dralw t Plan
rSj •►
Names Of Ffentho StMeb Septic qys"m
IDRAW$ItE PLAN BELOW Inelude ad'aeent PrOoettlea if on shoreline of w;thhIn 100 het dfigtM emm Itne.
adjacent property line4 , , 40ertt gropeny Pane
1 1
1 t -
104
' � FLOhTIrJtb '
t 1
Docr4
1 ,
1 1
� 1
' cos,.r,ssb ct..te �
' OLlc�ty '
t
IPROPmT
adjacent operty,fined u EE amid Pf0WV line
SAMP(,E SITE PLAN
i404T progeny fined sto' EidjueM iroperty fate
� ' t
1
,
1
I 1 1
I 1 ,
1 4�
i t
ed' eent property aRe-) Fad cant line
TOPOGRAPHY PROfILE(Sbow a side view of property. Show slopes,cuts and lilts. if possible WIMAe height and the
degree of slopes. See sample topography profile.)
SAMPLE TOPOGRAPHY PROFILE _
�Yd'6
Jlalt'Uwtt ••
Sr�pa is
Ilr_ 1{i_ t0
1' w4va T
sA
Date
---c": Cienetura .
MASON-COUNTY
" DEPAIRTMENT dIt Cd*MUN1TY DEVELOPMENT
Plana ,, �DIVI on
P O Box 279y�loon,WA 98584
(360)427.8670 .
f�64
NOTIFICATION OF#NCONIPLETE APPLICATION
November 09, 2001
K.R. BACKLUND
6114 MESA RD
RENO NV 89511
Parcel No.: 123055100900 �' T
Project Description DOCK
Dear Applicant:
You have submitted a permit application (case no. BLD2001-01.028),for proposed
construction or development in the county. Upon review of your application, I have
deterrruned that the contents of the application are incomplete or do not provide enough
detail for review.
Therefore, review of your application will not proceed until the necessary information is
provided (see the comment section of this letter for details.) Once the information is
submitted and the.application is complete, I will continue to process your application
accordingly.
Please contact me at (360) 427-9670, ext. 577 if you have questions.
Si y,
Ri Mraz
Land Use Planner
Mason County Planning Department
11/9/01 1 of 2 BLD2001-01028
' NOTIFICATION OF INCOMPLETE APPLICATION
1116101 Case No.: BLD2001-01028
Comments A site inspection,of the subject property was conducted on
1117/01 with the following results.
Under the assumption that the applicant wishes to place the dock
IN the lake upon completion of the repair, the following explains
what is needed to proceed with processing the permit for a dock.
Per the enclosed document"Construction of Piers, Docks, &
Floats" and the Mason County Shoreline Master Program, the
project requires a Shoreline Substantial Development Permit
(SDP), and review under the State Environmental Policy Act
(SEPA), in addition to the Mason County Building Permit. There
is an exemption from the Substantial Development Permit if the
dock or pier is being built on a parcel with an established
residence. However, since the lot is vacant, an SDP is required.
The enclosed information explains the process involved with this
permit, including public notice and comment periods, and a public
hearing before the Mason.County Board of Commissioners. This
process can take from 3 to 5 months. As explained in the
enclosed information the Substantial Development Permit also
requires a fee of$450.00, plus advertising costs. The SEPA
procedure includes completing the enclosed Environmental
Checklist. The SEPA fee is $200.00. The County will distribute
the SEPA notice. You may also be required to submit an
application to Washington Department of Fish and Wildlife
(WDFW)for a Hydraulic Project Approval (HPA). Please contact
Jeff Davis at (360) 895-3965 for details.
Once I receive your completed Substantial Development Permit
Application, SEPA checklist and fees, I will be able.to continue
processing your development application. Thank you, and please
call if you have any questions about the application process.
11/9/01 2 of 2 BLD2001-01028
TWOS P�k�tCEL
IN� LIj�S
BLU JEP� #S
0��M ovIlc I&AL;
IMAGES
LARGE FORMAT
IMAGESL HAVEBEEN. STORED IN
FILE CABINETS) UNDER
PARCEL NUMBER
PARCEL # 193a5
CASE # Ll a001 - oioas
� r
DATE
P
laaser Area
_ems
Parcel # 66900-
• t
CHECKLIST FOR PROPOSED CONSTRUCTION
Comp Plan
Designation UGA RAC RCC X_RA . For Ili
Yes No
KWithin 200 FT of SMP designated shoreline, wetlands,
etc.
Where? 1 i, l�lL
Located near possible Critical Area,
]]What Kind? (Wetlands, Streams, Slopes)
RLC already done?
[ ] [ ] Proposed construction within floodplain 7�
Eagle nest �#
[ ) [ Six year moratorium
[ ) ] Multi-Setbacks
State road access needed
[ ] ] Commercial Development (parking . standards, sign
ordinance, public works review, other applicable
agencies)
[ ] Mobile Home or RV Park r-,
Q
SEP-26;-01 WED 07:30 AM MOTOR VEHI HWY PAT FAX:7756882772 PAGE 2
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