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HomeMy WebLinkAboutBLD2007-00350 Cancelled ATF Deck - BLD Permit / Conditions - 2/17/2007 o CONCRETE MECHANICAL MANUFACTURED HOME p Date o0 Footings ISetbacks Gas Piping By Ribbons m 6 IntenorDate By Interior-Dane By Date By W Z cri o Exterior Date By Exterior-Date B Sat-up � Point Load I Isolated Footings INSULATION Date By TI Date By BG I SLAB INSULATION Data By FIRE DEPARTMENT Foundation Wails Floors Date By Date By Data By DECKS FRAMING Walls Date By Date By Date By PROPANE TANKS PLUMBING vault Dale. By Date By OTHER ? Groundwork Atdc Gate By bete By Type: Date By D.W.V DRYWALL Type: Date Int.Brace Wall Date By 0 By Date By FINAL INSPECTION 0 Water Line Fire Separation N Date By Date By Date By CD m �1 `D Pass or Request Inspect, c Type of Insp. Fail Date Date Done By Comments CD m Q- o - 0 n� m N 6 O 8 Z3 n. 0 0 (D 0 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, WA 98584 P10 ' RESIDENTIAL BUILDING PERMIT BLD2007-00350 OWNER: TIM POMERINKE RECEIVED: 3/2/2007 CONTRACTOR: LICENSE: EXP: ISSUED: 6/19/2008 SITE ADDRESS: 22 NE BONANZA RD BELFAIR EXPIRES: 12/19/2008 PARCEL NUMBER: 123312390093 LEGAL DESCRIPTION: TR 16-C OF GOVT LOT 2 LOT: 3 OF SP#2241 PROJECT DESCRIPTION: DIRECTIONS TO SITE: ATF DECK ON MH (3) 3 MILES WEST FROM BELFAIR ON HWY 300, TURN WEST ONTO LARSON LAKE ROAD, FOR 1/2 MILES, TURN EAST ONTO BONANZA ROAD FOR 300' General Information Construction &Occupancy Informa ' n Square Footage Information No. of Bedrooms: Type of Constr.: Type of Use: MH Insp. Area: No. of Bathrooms: Occ. Gr p: Lot Size: Deck: 512 Type of Work: DECK Fire Dist.: 2 No. of Stories: Occ. L a Building: Valuation: Building Height: Occ. St to Basement: deck 64 Manufactured Home Informati9fi Setback Information Shoreline& Planning Information Make: Length: Ft. Fro . N 50 Ft. S eli Ft. Water Body: none g SEPA?: Unkn R ar: S 5 Ft. lop Ft. Shoreline Desi pp Model: Width: Ft. Si 1: E .0 t. 9•� DMitIA livable Year: Serial No.: Si 2: 0 I Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type ty. ��ype Qty. Type By Date Amount Receipt Plan Check Fee KS 3/2/2007 $99.61 S12007000 Planning Review Fee KS 3/2/2007 $170.00 S12007000 Building State Fee RTB 3/8/2007 $4.50 612008000 Building Permit Fee RTB 3/8/2007 $153.25 612008000 EH Plan Review TW 11/9/2007 $35.00 612008000 Total $462.36 BLD2007-00350 Please refer to the following pages for conditions of this permit. 1 of 4 pr v rn cnv w v 0 N CD (7 v C) -I X� -� X (p 00 X5' cr � w Xp � D O D X (n w -I o = m � 3 0 („ '< w � -0v mo = o = W m 3 (n O F CD O N fD �. 0 � cr 0) (n 0 � (D O o T r: < wc� a mo (n 0 m -0 - = 0 �' v — v (n (D O C (D O Cl) 0 C O O C C-) O w p 3 (Q O 0 w p CD c 0 m - o ° -I o w < 3 .. -* (/� (n w C O cn w z - � CD cn C C CD (D w C - O w 0 7 Q p m 0- 0 (D O 0 0 D CD fD � � Q �. �,� 0- a a-0 3 n O o -� cn � � � OW � m � C: (n Gov � w 0 w 3, m o w C= m e to c� a o t3 0 z — O ^• Q m Q- C (n w Q CD -0 (n 0 n cn a a 00 O T Q(Q N lD C O m 0 CD � O (D 00 Q. 0 to � p s = � ' CD � 3 m (D a C CD � ► lD m CD - w C 3' CDw �« w - -a Ccn Q w m m 7 m w CD a -' ° C. 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CD (D CD -�, CD 0 CD Q_ o Q C) � � a1 O' `D o (D 0 Q C' � O � = O_ -, 0 n � 3 CD CL w co m _ 0 ° v3 � cn v' S�. m CD 0 CD CD 0 CQ- 000 0 �' 0 = on a) 0 � 0 O C Q a0) = 00 = n N a o N O Q N Q t3' O Q ~ 3 Q v = n CD 3' (D O CD (D m y CD s C) CD CD O (D (n N Q a) O 0 X ol< 2 -+ (DD CD 'O CD O Q ° o o U) Q �' cn O Q C: ° v v :3 (D A — 0 :3 (D CD (gyp ((DD (D 0 v — to -6 3. : <' CD ° ° ° m T. 3 0 77 Q o' - 6 FORM M COMPLETED IN INK MASON COUNTY PERMIT NO��� -- PLE RESS ARD BUILDING PERMIT APPLICATION IF 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us AP CANT,INFO ATION CONTRACTOR INFORMATION Owner -r I ' F_ "'' I /\)kr Company Name Maiiin Address Mailing Address City �+ "' State Zip Code � � City State Zip Code Phone ^7��_C 1`7 S"17r6nther Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# PC 0 E OB - `" C Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System - PARCEL INFORP4ATI9N - 12 Digit Parcel No. Z-7, Fire District 1-Legal Description - 01 14 aE M 9, C,n t2 C n 0 N � Site Address (Please include street name, street number and city Direction to site ' E ' �>r'I I Will timber be cut and sold in parcel preparation?Yes 0o Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs-**' 5% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y /No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE R SEASONAL ❑ Use of Building Describe Work No. of Bedrooms___ __—No. of Bathrooms `Z Square Footage- 1 st Floor 12 77 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANU,F�AQTURED HOME INFORMATION - Make L- I b e#?t ` Model �c�r#ccv'Draf� � Year Length Z9$ Serial No. ��-7�7�4 U N . of Bedrooms--3 --No. of Bathrooms �— g IiC)G> Re Type of Heat F�0�c� •�i� Purchase Price $ � � Placement Unit? Yes/ No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocat, Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the cc E d'b �.^�, that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permissir rri a the necessary parties. If permission is required from any easement holder or any other party in interest regarding this appli Qr,the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. oJ6�hhz2 c; 0 j agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the a described property and structure for review and inspection. This permit/application becomes null &void if work or aut &CO ction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF 1l��r MEANS OFAPRGRESS INSPECTION.INAC VITY OF IS PERMIT {PPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X , r— �., I �� Date: 17 — 0 L_m4__�O_W_dga Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: ` ��'� Date 7f DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department O f ' Planning Department Environmental Health Department '61 Fire Marshal FEES Buildinq Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Plannin Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT _._ BUILDING PERMIT APPLICATION ° 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us AP TCCANTe INFO ATION CONTRACTOR INFORMATION Owner F, kz I K)k r Company Name Mailin Addresg i Mailing Address « State Zip Code - City State Zip Code City Phone Phone Other Ph. �>�_� '���`"`��� ther Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# l>1`� To, t i f)2, OB q - f ( Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFOR ATIQN - 12 Digit Parcel No. '-'�' Z Fire District Legal Description o``��' L- " ' r 0 0 N f a r,� a � �C3 Site Address (Please include street name, street nnber and city �-L : : C�)�,u z '�i � Direction to site Abe C', � ' I ` �' tCA t" H C I I 0 pe, " C � -T Will timber be cut and sold in parcel preparation?Yes No Is property within 200'of Saltwater Lake River/Creek Pond i Wetland Seasonal Runoff Stream Slopes or Bluff—s j 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y s/No TYPE OF JOB - New Add V Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms -'2. Square Footage- 1st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached �.- i e I�'�eG Atjgo roc) 1. Year Tf MANUFACTURED HOME INFORMATION - Make �' Model Length gftLMidths Serial No. � �r�`� � N . of Bedrooms \�No. of Bathrooms — Type of,.Heat Er RLE� A'k Purchase Price $ t-1 0 a C 00 Replacement Unit? Ye / No i Installer Name Certification No. IOWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. -, Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare I that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them,to apply for this permit and;conduct the work proposed. The owner or agent on owners behalf, represents that the information provided_is accurate and grants,em[Ayees of Mason County access to the above i described property and structure for review and inspection.,Thit permit/application becgi6es null &void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period off,1`0daysr-PROOF OF CONTINUATION OF WORK IS BY" ME,o,NSOFAPROGRESSINSPEC ON.INAC I�/ITYOF ISPERMIT4 PLICATIO` OF 180,DAYS WILL INVALIDATE THE APPLICATION. .- - 7 IX -- - a. Date: w Owners Representative/Contractor (indicate which one) k FOR OF USE BEYOND THIS POINT Accepted by: ' �. Date V DEPARTMENTAL REVIEW APPROVED DENIED NOTES t Buildinq Department V Planning Department °- Environmental Health Department ' Fire Marshal FEES i Buildinq Permit Fee Site Inspection I i Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other i Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal I Valuation $. TOTAL FEES MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner # ' Company Name Mailing Address Mailing Address Cityr �::� State Zip Code ' `rv' City State Zip Code ��a'` ` Other Ph. Phone Other Ph. Phone Contractor Reg. itExp. Lien/Title Holder E Mail Address E mail address DOB Drivers Lic.# `COB Drivers Lic.# SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer Syste PARCEL INFORMATION 12 Digit Parcel No. r" Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site , r � _ Will timber be cut andsold in parcel preparation?Yes Is property within 200 of Saltwater Lake River I Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs->7159% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No , TYPE OF JOB - New Adds Alt Repair Other PRIMARY RESIDENCE Ej SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms �Square Footage- 1st FlooL. t �`` $" 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached INFORMATION - Make Model r L.—Year f MANUFACTURED HOME 6 ; No. of Bedrooms No. of Bathrooms Length Width Serial No r Replacement Unit? Yes/ No Type of Heat ;° Purchase Price $ p Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.'PROOF OF CONTINUATION OF WORK IS BY MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. w. p Contractor (indicate .ye t.a Date: X Owr✓Owners Re resen�tative/ $ ti which one) ne Accepted b t ,. Date FOR OFFICIAL USE BEYOND THIS POINT p y NOTES DEPARTMENTAL REVIEW APPROVED DENIED Building Department Plannincl Department Environmental Health Department Fire Marshal FEES Buildina Permit Fee _ Site Inspection Plan Review Fee 9. �i / EH Review Fee Plumbing & Base Fee Plannin Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee r'------- State Fee Violation Fee 3— Pre-Paid at Submittal TOTAL FEES Valuation $ S ' t • ALL � ETBA 1 ARE M K u --' ' EASUAE.[ R�M�fHE_,.F € I�RTHEST RCJEGTIO 100 THE UIL DINS_T 1' f � , { i i I x € v M i i x -4 € e = c, — I t x € C, [.� >.. i ^Y�a <..m...:g - °t .« .w.a. •! .......z.r:�. .�6�.,,. ..„ .....w -........ `�'^ �y1/ <dR._.:<...€ _...1 { t € d . _ TOP RAPHY PROFILE. rt i` ,r t Direction,` S I Approval: for office use Buildin Permit number: Building: Owner/Applicant: Da Uf---_ Planning: i{ application: Env. Health: Parcel Number: SHORT PLAT No. 7 _ APPROVED: i N 89 50'09" W DIRECTOR OF GENERAL SERVICES 678.45 NW COR GOV LOT 2, SEC 31, T23N, R1W, W.M. FD I" IP " W o „3 n1�cV ' p � o(co CP OUTlL !VATC ESTATE OF S/4M B. TN ELER N 144'42"W 7 849.20 0 110.00 4. NE COR SW 1/4 GOV LOT 2, SEC ic�6 5 (Ti rb 31, T23N, R1 W, -b FD IRON PIPE (0 PRIVA7 20—► -ROAD 4- tic 't o m UTILITIES �—�-- -----ril % 145.00 62.76 i0 N 89 39'14" E I z /S. 'E3USH-f DAVIn h h 00 W y' f1� E SCALE 1" = 100• 0 50 100 200 Legal Description FD MONUMENTS 0 FO IRON PIPE Lot 4 of Mason County Short Plat No. 1700, Auditor's File No. 469858. SET 1/2" RE6AR w/cAP WARNING: Mason County has no responsibility OWNER: to build, improve, maintain, or JOHN 6YERLY otherwise service the private roads P,p. Box 133 contained within or providing service to � _r•___� . 9 R.-Ifni, t,ve ORS-?a i 4" 34"Vertlany from nose of tread Vertical Pickets k z3 F�tyt. joist 16"Center TI T � '2'Center �4x4 PT Pier blocks , 2-112"Gal Through bolts 112"Gal.Through Bohs 4x4x15 Masonry !block 14x14 pier blk 4x4 PT Post l a U A I c a a N LIHE w W N yy M u � U U tq g b V x d' l x to �S per, n m s rly PLI b 9G R x ar ca 34 'cS " .. � D4 ti V N v c� X N r 91 TF ti y A A b M Mason County Dept. of Community Development Mason County Bldg. 3 426 W. Cedar NP14 P.O. Box 186 (360)427-9670 Local (360)482-5269 Elma Shelton,WA 98584 (360)275-4467 Belfair Notification of Permit Cancellation Permit approved, not Issued May 30, 2008 JIM POMERINKE P.O. BOX 532 BELFAIR WA 98528-0532 Case No.: BLD2007-00350 Parcel No.: 123312390093 Proiect Description: ATF DECK ON MH (3) Dear Applicant: Upon review of our records, the Mason County Permit Assistance Center has identified that your building permit application has been approved and ready to issue since 11/13/2007. Once approved, permit applications are valid for 6 months. If you intend to obtain this permit, you must make arrangements to do so within ten (10) working days from the date of this letter. If we do not hear from you within the that time, your permit will be cancelled and a building inspector will make a site visit. In the event that your project has been completed and a permit was never issued, you will be assessed penalties as allowed under Mason County Title 14 and Mason County Title 15. If your project has been cancelled or if you wish to withdraw the permit, please notify me as soon as possible at (360)427-9670, ext. 356. If you feel that you have recieved this notice in error please contact me. Thank you for your cooperation. Sincerely, J"IMA'j Mindi Brock Mason County Department of Community Development May 30, 2008 BLD2007-00350 Mason County Dept. of Community Development Mason County Bldg. 3 426 W. Cedar I Pro P.O. Box 186 (360) 427-9670 Local (360)482-5269 Elma Shelton, WA 98584 (360)275-4467 Belfair Notification of Permit Cancellation Permit approved, not Issued May 20, 2008 guq JIM POMERINKE �P"WAAJI- P.O. BOX WV-'& IV „ BELFAIR WA8528 1I V 9,6tw Case No.: BLD2007-00350 Parcel No.: 123312390093 Proiect Description: ATF DECK ON MH (3) cu 5� Dear Applicant: r � Upon review of our records, the Mason County Permit Assistance Center has l3 identified that your building permit application has been approved and ready to issue since 11/13/2007. Once approved, permit applications are valid for 6 months. If you intend to obtain this permit, you must make arrangements to do so within ten (10) working days from the date of this letter. If we do not hear from you within the that time, your permit will be cancelled and a building inspector will make a site visit. In the event that your project has been completed and a permit was never issued, you will be assessed penalties as allowed under Mason County Title 14 and Mason County Title 15. If your project has been cancelled or if you wish to withdraw the permit, please notify me as soon as possible at (360) 427-9670, ext. 356. If you feel that you have recieved this notice in error please contact me. Thank you for your cooperation. Sincerely, \J�" -f �(L/ Mindi Brock Mason County Department of Community Development May 20, 2008 BLD2007-00350 MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST ttArame: I Date: I ' 1 7 Reviewed By: ocuments' i/Building Permit Application Completed 1,c� ing Intake Checklist Completed, _mite plan includes:Allowable building area,roof q*orhangs,decks,etc. Fire Apparatus Access Road info required? Y�s/No l_Lergy Code Application Form-O Electric wa1 el�at-er O Electric central furnace O LPG Furna ce O Heat pump with electric furnace O Heat pump with LPG furnace O Boiler(heat type Oi" Other:Specify: ecnical/Plumbing Application-WATER HEATER FUEL TYPE Engineering? Yes (Need 2 sets of calculations)No iO _ Geoteehnical report or assessment? Yes No t°' Snow load: Seismic Zone(circle one): D1 or D2 Construction PI _e� COMPLETE SETS Legible Recognized Scale _ — g Elevation Views _Cross Section _Foundation Plan _Roof Framing Plan _Floor Plan—Use of rooms noted(all floor levels) _ teck orFraming Plan-all floor levels represented? Loft,crawlspace,etc. Framing Plan,including covered.porch framing Plan Details.- -Roof framing details,truss lay-out may be needed,truss or stick framed? ____Wall Framing-Does bearing-wall height exceed 10'?(Engineering may be required) —Floor framing: Floor joists: Floor beams: _Window headers marked on plans: Typical header. —Foundation:footing size,reinforcement —Concrete Walls-Does Concrete Wall Height Exceed 9'?(Engineering may be required) Landings at all exits? Less than 30"above grade? Y / N _.__Heated By Furnace-Location ofFurnace -___Fireplace/Stove Information Shown-Fuel e? � Location(s): Window Sizes Marked on Plans _ Braced wall panels(shear walls)marked on plans or lateral engineering? (Plans may not be approved ifnotprovided) ____ 2-Story Garage? (Engineering may be required) R602.10.1, 1 a story of a two-story D 145%,D2—55% C NTS: AA ENGINEERING REQUIRED: Braced wall panels/braced wall lines are not marked on plans(R602.10) Amount and location of bracing does not meet minimum required in Table R602.10.1 IRREGULAR BUILDINGS(Irregular Shape)R301.2.2.2.2 Irregular portions of structures shall be designed in accordance with accepted engineering practice. A portion of a building shall be considered to be irregular when one or more of the following conditions occur. - 1)Exterior braced wall line or B WP cantilevered or offset by more than 4' 2)Roof or floor is not laterally supported on all edges 2A)Portion of roof or floor extend more than 6 ft.beyond the braced wall line. 3)End of BWP extends more than 1 ft.over an opening more than 8 ft in width belo . 4)Opening in a floor or roof exceed the lesser of 12 ft.or 50%of the least floor or roof dimension. 5)Portions of floor level are offset vertically 6)Shear wall lines do not occur in two perpendicular directions. 7)When a story above grade is includes masonry or concrete construction(exe:fireplaces,chimneys,and veneer). When this applies the entire story shall be designed.In accordance with accepted engineering practice. DESIGN CRITERIA:Wind 85 mph exp B(unless proven otherwise), Seismic Zone: Snow: psf Mason County Planning Intake Checklist Owners Name: ITkk Date: J � Project: Reviewed By: Commercial Development: YES 0 Comments: PLANNER: GBM TSC CMM KJ PBC RDH Site Plan: o - forth Arrow roperty Dimensions: -u-Streets and Driveways Shown. Road name: !, - L' - 4 - I Existing Structures shown with setbacks --b�e+l-L-scatted, Septic and Drain-field Shown with setbacks . . tify all surface water (streams, ponds, shoreline, wetlands, natural or historic drainage, defined drainage ditches) p_-T'6pography (slopes) ❑ Proposed Struct re Setbacks (Dir ion/Setback): F: R: � 1: Aerconclition S2: �r-Jtility and Drainage Easements: Yes No if yes e #5022 ®-'Other Easements 1"D �J��Ccessory Appurtenances: Propane / Heatpump 1 10/Xariance applied for: Yes / No - parking spaces allotted? Yes / No lw)launty Access Permit Needed (add condition #0010) 0i/fltate Access Permit Needed (add condition #0020) Standard Conditions to be added to all Building permits that planning reviews: #5019 and #070Q Site Access: Are there any impediments (dogs/gates) that my restrict access to your site? Is the site clearly marked? How? Address ❑ Name Critical Areas: ❑ Other: Setbacks: Shoreline:Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: .!1—N6f Applicable ❑ Agricultural 2.5 10 20 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LT �FL ❑ RC 1 2 3 ❑ Conservancy Viral ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR ❑ Unknow ❑ Unknown Water Body (type of er if unnamed): sr)- SEPA: Yes/ No Un ow Flood Plain: YES/NO,, wn Map# Aquifer Recharge: %jN0 U now Map# Tags/Cases: RLC/SPI Case: r � L 6-Year Dev. Moratorium: YEnIN Eagle Nest Tag: YES OtherYE Revised: 09-29-2006