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Date By Z BG f SLAB INSULATION — Date :r_ By Date By FIRE DEPARTMENT m Foundation Walls Floats Date By Date By Data By DECKS F OWM I N S Walla Date By ByrnData By PR_00i ENE TAPIRS PLUMBING Vault Crate By Date By OTHER Groundvwark Attic Date By Date By Type- Date By D.W.*r DRYWALL Type- Dale. By Int.Bracts Wall ..6Y .�.�..��.. t7ate Bye � r Date FINAL INSPECTION 0 v Water Line Fire Separation y C Date B}. Date By Dates 3 � � B2/ Q Rake or Request Inspect. c Type of Insp. Fail Date _ Date DoneBy _ Comments to o a _ y 3 CD Fc 0 MASON COUNTY PERMIT NO. " �t 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. Jt A L.v o Company Name "/hVm eo4);-4-T9t` }ta<t DIV! -;7, Mailing Address °Q° Q 19 41-1 Mailing Address I &:_'S -I H '1_0 NI 01 q City �FLF' I State � Zip Code 2 City IN,AI tad€� State ' Zip Code 3 Phone� "` f t Other Ph. �"" Phone ;0 . -!jS X Other Ph.44 45--7143-I � Lien/Title Holder "A Contractor Reg. #`#°omst Et 'f Exp. 6 1 30 10 Email address ASLOT=200 S ILVtA MfstK , INI ' E Mail Address REAMASIVT. e �)Vk Drivers Lic.# ti € A DOB i4 r � Drivers Lic.# N �A DOB N r SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic K10 Existing Septic fQ .� Connect to Water System t Q Name of Water System f A Well .,t o Water System-di 0 Name of Water System m f PARCEL INFORMATION - 12 Digit Parcel No. : 9 6 0 7.3 Fire District Legal Description Site Address (Please include street name, street number and city) N? wD 4 p c�, 1 L, P �P, `� ��2 Directions to site O �. � S 0 t I ,t nj ° I "r) , .��: t c)v , r. q;< 16 4 F Z t .Asa 5{, P,9In f- ,'d 4 --m v w a..c 6 f., .d F'ai 4_A}r2 w✓ Will timber be cut and sold in parcel preparation?Yes N" Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?YesAR TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building Describe Work 6d7h FoLE 0 1'T14 trr P L V V , 'N No.of Bedrooms No. of Bathrooms Square Footage - 1 st Floor 2nd Floor. 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garaged Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make P4 Model Year Length Width-Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price $ Replacement Unit? Yes/ No 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 permis- sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion or thew k pro used irte�ap ication, I have obtained permission from them to apply for this permit and conduct the work proposed. X �¢ .-. Date: 3 Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by `' Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department AA l t " 7ke l') S't V Planning Department t Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee 6 5 Site Inspection Plan Review Fee L( EH Review Fee Plumbing & Base Fee PlanningReview Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee �'/ � `A Pre-Paid at Submittal Valuation $ TOTAL FEES r LET JALV r I011 Cotmtrv- Suits C•16521 Highway 99-Lynnwood,WA 98037-3161 Pletase Check After Doing Site Plan: WSeptic and drainfield 3/Lot size Ikaw North Anow.an Circla ® POSME BU TFRA ILDINGS Everett(425)968-4171 Puyallup:(253)840.9552 aproperty dimensions ❑l Sewer lines L�Elevation of property DIV".OF Administrative Headquerters:'(425).743-1555 0 Existing buildings L�f etbacks of.proposed&existing.buildings ❑Bode$of water �I ��•� FAX:'(425)742e4378 Toll Free: 1-800.824.9552 Lv pra osad building �faln road with name ❑ loorplan PERMA$ILT p jt contractors uc:a:TowrlcPFo99LT ❑Easements LAccess to proposed building lopes&Contours,(5'increments) ` Quality:Our Future Depends On lt.TIA Job Name: Ir=AM SLoI-rty Job Site Address: T- _ Legal Description: Tax Account#: ( �3�• '� C3 MAP L-C v T> r i U I"a..`t t) �-l 5•tp ` fAL �� FY.tSTtty ' GAFA6 E 11 Y i `�rSt llvc4 ItO, �' ... Rrz`>1-t' V.'N� jf 4. -, ! S.�4 r r �V ZIP, f i i xta � APPROVED MASON CC JNTY DCD PLAN^!,;,"\.! SITE PLAN REQUIRED TO BE oi`I CHAN ES U JECT TO APPROVAL f BY Da Le 2 t+ i i j i D NOT SIGN INCOMPLETE SITE PLANI ustomer has verified and oved the location of a building,orientation of the building to the North,and verifies that all White-Customer Copy White-Office Copy ilities are shown on this ra in the corriect loc io . USTOMER SIGNATURE ` �'-Q � LEAD# _ r 01995 Perma-Biit Industries FR-34 6/07 I IIiII'I I�'II"II I�'I Request To Revise An'Approved Plan Permit Number: BLD200 - Name ,t \aeh-1 Alm_ _ Parcel Number lA 2-9 - `'� _ Phone Number daytime Project Address Mailing Address Please provide a complete, detailed description of the proposed revisions to the approved plans: Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No Are the approved site plans included? ❑ Yes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? ❑ Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No If Yes, Has the engineer or architect approved this revision? ❑ Yes ❑ No Is a stamped and signed approval included with this request? ❑ Yes ❑ No (Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record Does the proposed revision modify the footprint or location of the structure? ❑ Yes ❑ No If Yes, Is a revised site plan, with all new setback dimensions included with this request? ❑ Yes ❑ No Additional Information: Applicant's signature Date: Office Use Only Received by: Date Sent Assigned To Approved By Date ❑ B. Original Valuation: $ Additional Valuation: $ ❑ P. t/, (►Z. Sq.Ft. x$ $ Sq. Ft. x$ $ Total New Valuation $ p P.W. Additional Fees: Additional Planning Dept. $ Additional Conditions/Comments: Additional Plan Review $Additional Building Permit $ .Additional Plumbing $ Additional Mechanical $ Additional E. H. Dept. $ Other $ Total Amount Due: $ Amount To Be Paid Up-Front$ r � MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 411 N. Fifth Street/ P.O. Box 186, Shelton WA 98584 360.427.9670 ext. 352 DDR Rec'd by Request for Administrative Variance for Reduction in the Required Setbacks ($115.00) For administrative review, the minimum variance on a setback request is 5 feet from the side yard lot lines and 10 feet for front and rear lot lines or any access easement. Request for further reduction requires a standard variance. Setbacks are measured from the furthest projection of the structure, including roof eaves. Applicant/Owners: Jcbo L-o i rb Mailing Address: O LSgX Telephone : Yoe Z-75 0`18 5 City: n LJZ"hP— State: Wk Zip: 'FRSzS If this reduction is tied to a building permit, please give permit case number. BLD o0 1'�o Parcel Number(s): --Zoning Site Address: 9 O rjE M/kPL.E 3Ec-�5az2 Requested varianc Front Rear 4iYird (please circle all that apply) Requested setback variance: 130 r.T Fes E An illustrated site plan is required. Your site plan must show the following: north arrow, abutting street or easements, set backs to all property lines and existing buildings, slopes, surface water, wetlands, critical areas, septic, well and driveway. Show all proposed new development. The following circumstances must apply: FRONT AND OR REAR YARD REQUIREMENTS: 1) Existing lots of record as of March 5, 2002; You must meet one of the following: (Please circle all that apply) 2) One of the following exists on the lot: a) steep slopes, wetlands, or streams present; b) soils that restrict building or septic development; c) lot width at the front yard line of no more than 50 feet; d) lot size of no more than one-fourth acre; e) existing improvements of buildings, septic systems, and well areas. IACommunity DevelopmentTACWARIANCES\2009 Adminstrative.vandoc Updated: 12-15-2008 � . . ti SIDE YARD REQUIREMENTS: 1) Existing lots of record as of March 5, 2002; You must meet one of the following. (Please circle all that apply) One of the following exists on the lot: steep slopes, wetlands, or streams present; b) soils that restrict building or septic development; c) lot width at the front yard line of no more than 50 feet; d) lot size of no more than one-half acre; e) existing improvements of buildings, septic systems, and well areas. Explain how these circumstances preclude a reasonable development proposal from meeting the setback standard for Rural Residential 2.5, 5, 10, or 20 zones. COS c7��A L('0 X B t t~L 31 C 51,E )ZEC.fl y�n�cG��D LD � �V 11--3 L7 B V I L_ j t_b k o ,e. 12-—t$ IZ-t,C.V A'1 io�1 ,4-r�C) cop A4cp>c I/_ckTEX..�l t0' T'o cot^V C)4-- , tS i i�1j:� Owner/Agent (please indicate) Signature and date Official Use Only ' Appr oved Date Denied Date Reason for denial: I:\Community Development\PAC\VARIANCES\2009 Adminstrative.var.doe Updated: 12-15-2008 4/20/2009 Conditions Associated With 2:55:28PM Case #: DDR2009-00036 lip,$ Permit Condition Status Updated item# Code Title Status Changed By Tag Date By 1) 10 TREES IN REDUCED BUFFER NOT MET 4/20/2009 AHB In order to relocate the proposed pole building location and reduce the proper vegetation buffer,the applicant/ owner shall plant at least five(5)western red cedar trees in the wetland vegetation buffer between 50 and 70 feet so th and southeast from ffie new structure footprint;these trees are to be maintained for three years to assure lant survival. X Page I of 1 CaseConditions..rpt �T JkLQ r ia,I lOWII Count!'V` suite C•16521 Highway 99•Lynnwood,WA 98037.3161 PlAasa Check After Doi Site Plan: Septic and dralnfleld gLot size Draw North Arrow POST FRAME BUILDINGS Everett:(425)258.4171 Puyallup:(253)840.9552 ,Property dimensions I ❑Sewer lines = M Elevation of property g ISM OF Administrative Headquarters:(425)743.1555 Ex Wing buildings Of etbacks of proposed&existing buildings [I Bodies of water 'PERMABILT FAX:(425)742-4378 Toll Free: 1.800.824.9552 Y4, P posed building' p U`{PM;'ain road with name ❑��.loorplan It Contractors Llc.p:TOWNCPF099LT ❑Erasemenls Access i-proposed building 6sliopes&Contours(5'Increments) Quality:Our Future Depends On It." Job Name: EAMl LF—N4 S Ld T T n Job Site Address: f Legal Description: Tax Account: I_ 2� 32A7:S`! Ot)73 N P LOT ReSI PLAI PAP,P I.e k) o c i U R.`•T DATE Is o 2S1 ASS � I PLANNI G ALL SETBACK ARE ME URE I I I FROM TI1 FURTH T PROJECTION F T1-f E3 ° L�DiNG r I GA RP.6f= (N 5 i c,i•Rv�:a ar>:N �N6Tjr�r T t MASON APPROVED COUNT CID PLANNING 47 D % SITE PLAN REQ''l ,V-D 10 BE ON SITE I CHAN S S B, CT µ I tZl U — Dated BY - r I Gl - YD p SITE PLAN REQUI- t E ON SITEN f CHA. GES Sl r U APPROVAL i By Da t CoN1'9A r0t2 PJIL-L BIk51-E•� �Mt'1EhIDEp nnoV10 IZ -)e, tr �►2t4rrJ A- LAN EX 15Trtit�, I ! I i I I . I I i )0 NOT SIGN INCOMPLETE SITE PLANT ;ustomer has verified and l(oved the location of I e building,orientation of the building to the North,and verifies that all White-Customer Copy White-Office Copy tilitles are shown on this ra ing in the corrpct loc t io . :USTOMER SIGNATURE LEAD