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Home My WebLink AboutBLD2021-00694 Final MFG Home ADV2021-00102 - BLD Permit / Conditions - 6/16/2021 Mason County Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton,WA 98584 360-427-9670 ext 352 www.co.mason.wa.us BLD2021-00694 MANUFACTURED HOME PROJECT DESCRIPTION: NEW MFG ISSUED: 06/16/2021 SITE ADDRESS: 7400 NE TAHUYA BLACKSMITH RD BELFAIR EXPIRES: 12/13/2021 PARCEL: 223047790150 APPLICANT: LYONS DANA MARIE OWNER: LYONS DANA MARIE 1802 NEVADA AVE SE 1802 NEVADA AVE SE PORT ORCHARD,WA98366 PORT ORCHARD,WA98366 360-649-4456 LEGACY-UNKNOWN: WASHINGTON HOME CENTER License: UNKNOWN PO BOX 176CHEHALIS,WA98532 Expires: (360)748-6649 FEES: Paid Due Technology Surcharge $11.00 $0.00 Modular/Manufactured Home $275.00 $0.00 Fee-2nd half collected at ready to issue State Fee-Residential $6.50 $0.00 Building Plan Review/Change of $120.00 $0.00 Use-Onsite Sewage Modular/Manufactured Home $275.00 $0.00 Fee- 1st half collected at submittal Planning Review Fee $240.00 $0.00 Totals : $927.50 $0.00 REQUIRED INSPECTIONS Setback Inspection Set-Up Inspection Footing Inspection BLD-Final Inspection Printed by:Genie Mcfarland on:06/16/2021 03:18 PM Page 1 of 5 Mason County Mason County - Division of Community Development x 615 W.Alder St. Bldg.8 Shelton,WA 98584 360-427-9670 ext 352 www.co.mason.wa.us MANUFACTURED HOME BLD2021-00694 CONDITIONS Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28 and 14.17. * The stamped approved site plan is required to be on-site for inspection purposes. If an inspection is requested and the approved site plan is not on site, approval will not be granted. In addition, a re-inspection fee(refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted. * The foundation/footing must be placed on undisturbed,firm-native soil. " 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 contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)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 OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified installer responsible for each major part of the installation. RCW43-63B.090 An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily located in plain site within three feet of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each installer performed or installed. Certification number and signature of the certified installer responsible for each major part of the installation. WAC365-210 * This permit is for the placement and installation of the manufactured home only and does not imply approval or review for any other items indicated on the plot plan. * All construction must meet or exceed all local and state ordinances in addition to the International Codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocation. * All property lines shall be clearly identified at the time of foundation inspection. * Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. Printed by:Genie Mcfarland on:06/16/2021 03:18 PM Page 2 of 5 Mason County Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton,WA 98584 360-427-9670 ext 352 www.co.mason.wa.us MANUFACTURED HOME BLD2021-00694 * A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater Management Application/Worksheet the document entitled"Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan"constitutes an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be located within 25'of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your project. * All RED stamped approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department prior to any further inspections being performed or approvals granted. * Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. * Concrete used for basement walls,foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). * If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American National Standards Institute (NCSBCS/ANSI A225.1). * Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. * REQUIRED INSPECTIONS (Footing Inspection-prior to pour(set-up manual must be on-site), Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. Until resolution of any/all problems no occupancy(Final Inspection)will be granted for the residence. OWNER/CONTRACTOR(indicate which) * The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including installation instructions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be clearly marked in the installation instructions. * All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction. Printed by:Genie Mcfarland on:06/16/2021 03:18 PM Page 3 of 5 Mason County Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton,WA 98584 360-427-9670 ext 352 www.co.mason.wa.us MANUFACTURED HOME BLD2021-00694 " CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting additional inspections. * All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may grant a one time extention of 180 days, upon the receipt of a written extension request prior to permit expiration. Letter must indicating that circumstances beyond the control of the permit holder preventing action from being taken. No more than one extension may be granted. * All building permits shall have a final inspection performed and approved by Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordinances and building regulations. * When parcel development requires direct access to county road(s), a Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at(360)427-9670, ext.450 or 100 W Public Works Dr. Shelton. The building permit will not be finaled until the permit holder can show proof that the access permit from Public Works has been finaled and approved. * The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility of the applicant, owner or contractor to make the required corrections indicated on the plans. Once the plans are marked "APPROVED",they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. * All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor increase the velocity flow entering or abutting to any state or county culverti ng/d itch i ng system or road way. * Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. * By definition, propane tanks and heatpumps are structures,which must meet setback conditions. Please check your "Approved Site Plan"to ensure these structures meet the setback conditions listed. * No clearing permitted on the waterward (west)side of the road by the lake * On-site Septic System final installation approval required prior to temporary/final occupancy of the residence. * Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained * Applicant/Owner assumes all responsibility if On-site Sewage Components are encumbered. A.) Drainfield/Reserve requires a 1 Oft setback from all footing/foundations. B.)Septic tank(s)requires 5ft setback from all footing/foundations. C.) No foundation/Perimeter Drains within 30ft, down gradient of Drainfield/Reserve area. D.) No Cut Bank(s)(greater than 5ft and over 45 degrees)within 50ft, down gradient of Drainfield/Reserve area. Printed by:Genie Mcfarland on:06/16/2021 03:18 PM Page 4 of 5 Mason County Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton,WA 98584 360-427-9670 ext 352 www.co.mason.wa.us MANUFACTURED HOME BLD2021-00694 I hereby certify that I have read and examined this application 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/local law regulating construction or the performance of construction. Issued By: ` Contractor or Authorize A ent: Date: 69 IG/ Printed by:Genie Mcfarland on:06/16/2021 03:18 PM Page 5 of 5 CA a �Fi ,v. Lm 't�7I'Lt �Ctl 1"' L,\1ov'S , I �15 W. Alder street -7460 9t-T-ky, --Wc.cks y 4*R4, Fl v anal 0blba, �5 Ito go ,r1i 1. J ZCO � <t w w ) / = rr W CC Q L . ' � W LL- M-�on Q O II .� m 0 �- W. J p \ 5l I f r i i 3 30 t o i�' `', ,`; j.. ryjC�o Q S' 0 L, w i d'ki rL co lot r� r� i► LLY aa' CL E� o a v✓�F�rP h�,c n i,� �� 37 v,/aker Sp O)mk`�� . Z 2 23 �> �_: LYE Ro�I On&q y o w Nd V o2D RIt l Oa, J W b Name nVIS Parcel# 3a►! ,'J—CO15 BLD# Ift V()0 Mason County Department of Community Development Q� 6P �` Small Parcel Stormwater Management Application/'Workshee p 01 q "" Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity. Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requ'�n t for Stormwater Management in this jurisdiction.A complete copy of the ordinance can be found on tAx VEi t�JFe: b=//www.co.mason.wa—us/code/commissioners/index.htm Please follow the links to "Title 14,Chapter 14.48 Stormwater Management". MAY 10 7n71 Regulated activities shall be conducted only after Mason County Public Works approt45 W,rrAJgtn (Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan". This document will assist you in preparing the necessary information and plans for Public Works to review and approve. Per Department of Public Works this document will constitute an approved plan if all of the relevant details*are to be installed in their entirety AND no part of the stormwater system adversely affects any septic system(see Environmental Health information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval. A design by a registered professional may be required for more complex sites. *These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan on the pages that begin with"Handout" PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A)OThe relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works Department can provide additional instructions, guidance and examples. (Section 14.48.130)contact Public works at: Phone: (360)-427-9670 EXT.450 Mail:P 0 Box 1850,Shelton WA 98584 Physical:415 N 6th St, Shelton WA 98584 If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or any other,parcel.You may also wish to consult with the septic design professional involved with the project.Mason County Division of Environmental Health can be reached at: Phone: (360)-427-9670 EXT.352 Mail:P 0 Box 1666, Shelton WA 98584 Physical:426 W Cedar St, Shelton WA 98584 A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met prior to a request for final inspection of the building permit. Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor.I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- describ property for view and inspection as may be required. X Owner/Agent/Contractor(circle one)Date: `-�—7— 24 Page 2 of 2 Narnetana Parcel# �9 p 30q--77—qpi 5D BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 1 of 2) Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is made for residential development,or redevelopment',with more than 2,000 square feet of impervious surface 2. 'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment. 2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas, concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces. To Calculate Impervious Surfaces Please Complete This Table Surface Type Length X Width = Area *All dimensions in feet Buildings ` ^ I X 3 VU X _ JrS Measurements for buildings are taken at the perimeter of the farthest projections(example: S 'l ' X eaves/gutters) X = Driveways j " L� ` X X = Length of drive begins at the right of way X = Parking Areas X = X = Any paved, gravel or packed area per definition above table X = Patios/Walks X = X = Any paved, gravel or packed area per definition above table X = Others X = X = If the total impervious area of the proposed site X = development is greater than 2000 square feet a Small Parcel Stormwater Site Plan is Required Total Impervious Surface Area (sum of all areas) qD If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below. Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity. Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor.I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- descri property fo eview and mspecti as may be required.X Owne Agent/Contractor(circle one)Date:,<< If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign the information provided on page 2 of 2. Page I of 2 L,Vaoal - oob9z� BUILDING Mason County RECEIVED Community Services-Building Division MAY 10 202, MANUFACTURED HOME PLAN REVIEW SPECIFICATIO S 1 5 W. Alder Street t UNIT INFORMATION: Snow Load ^ o Make ,�-� Model pin QkL6 t Year 309 c� c Square feet �L1��_ Width (U O Length Single ouble riple-wide(indicate) NEW r Replacement(indicate) All footings must be min. 12" below grade within 24"of the skirting when perimeter blocking is required. When manufacture specification is not available use ANSI A225.1 or HUD 24 CFR 3285. Must provide pier plan with reference sections. Allowable Pressure(Pound Per Square Foot)No Allowances made for overburden pressure,embedment depth,water table height,or settlement problems Soil bearing is assumed at 1500 psi If set-up is using a greater soil bearing capacity a soil report from a design professional is required Fill(compact or uncompacted) Compaction Report required through Special analysis Peat or organic clays Compaction Report required through Special analysis SET UP SPECIFICATIONS: Manufacturer's Pier Plan O ANSI A225.1/HUD24 CFR part 3285 FOUNDATION: Check the type of foundation and attach detail plans from manufacturer's or the ANSI A225.1/HUD24 CFR part 3285 O Pads JA Continuous concrete footing(runners) O Slab ANCHORING: O Ground O Magnum '4 Concrete-2500 PSI ,4 J-bolt O Expansion bolt For new units,this information can be obtained from the home retailer or contractor. Previously owned units,which manufacture's instruction are not available must utilize the ANSI A 225.1/HUD24 CFR part 3285 code for installation.Washington State law requires that a certified installer install manufactured homes. The undersigned I hereby acknowledge he/she does understand that the Mason County submittal and review processes will be based on the information provided herein and will be verified at time of inspection. X tsla Applicant/Dealer/Installer(indicate) Date RECEIVED Pinehurst- a 1C�W Alder Street 5440 -r31/2" l'-5 I/4" arched 4648 PAP DW BD _ -- PLANNIN G- _7 00 lrr opt. G .. . I •• I I ---- - ---- ---- MBathr tL � I � i .. - ------------------ _ OpL Fireplace _ b _-- OpL Snack bar 13'-2 1/4" 12'-I0" 9'-8" 5'-6 9440 tl 4658 arched 4658 P T-_G prU - 60•0 Utility- _ Room_- Bedroom 03 Master . Bath _ -b P I 36, Enlerca immeni cer,�er �0 !v 36• 36• Master Bedroom 02 - uesti Living Room Bedroom a th ` Srolller EES 4656 46W 46 06 46W 4658 Trap Dbi Trap Trap �� lo.-g" 5'-3 1/211 24'-8 3/411 15'-2 3/411 Model: 3 Bedroom, 2 Bath i' 1494 Square Feet Floor 56'-0" x 2ro 26' -8" ' K445W'1/I5/14 �� lPt�G12C�G6GGG{KJL¢ (�(/� 1124 Garber St.,P.O.Box 250 Caldwell,10 83606-0250 • 208-454-5000 800-859-0347 Fax 208-455-3274 www.kitwest.com 21086 KPG Kit 2504 1500 Pinehursl E i i i h'lodel: 2504 Pinehurst Square feet: 1494 F I I , r rD—I 1 I St i pp r o0 Ar I 0 D ra t d x 7 �o } Prellminary 01-26-21 K Johnson, 1-a i '� i Prellminary 03-29-21 I k Johnson, H F Qom? CUSTOM ` w HOMEQUILDERSI I 'x 6� S sNg(nn93woH Em wolsnD A — H 'UOGUL40r IL-6L-£O FJ B4,W(,F3Jd , S H IL-9L-10 fi�eu(w(,aad 0 0 si i; i{ ®❑❑ Y i i 2I2Ih� 1 s , Is rn ua uid toG z F I MASON COUNTY COMMUNITY SERVICES Permit No: N1 PERMIT ASSISTANCE CENTER: •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 Phone Shelton:(360)427-9670 ext.352•Fax.,(360)427-7798 Phone RECEIVED 900Belfair.(360)275-4467•Phone Elma:(360)482-5269 BUILDING PERMIT APPLICATION r PROPERTY OWNER INFORMATION: CONTRACTOR INFORMAiiO"/N: NAME: dd\Q U CVNS NAME:WoAiL 10.+DYl XY11C'� C 'eel MAIL ADDRESS:p0(�(Ch(`_ MAILING ADDRE CITY STATE: ZIP:q,% 58 CTTY:&h A*N STATEW ZIP:9d59 PHONE#I: PHONE'.8C0- D-' 2t/ CELL:3(eo-2 o-R'A7co PHONE#2: - I - 414rolLe EMAIL-: Kt�k\(1• \t K�ndoll P WaSti hocrl�.ilJfr EMAIL: ', . L&I REG# EXP. PRIMARY CONTACT: OWNER CONTRACTOR OTHER �t NAME On5 EMAILJ e-r irP13 7e amati. aM MAILING ADDRESS qC1 92OX 5.05 CITY STATE ZIP PHONE .4too -4 q 9—g387 CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) — 1 90 ZONING LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICTS L SITE ADDRESS S' CIT a DIRECTIONS TO SITE ADDRESS r Cf C¢K v7C1� IS THE PROJECT WITHI OF SLOPE(S)GREATER T N 14%: YES❑ NOX SNOW LOAD:_psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKEg RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW"Z ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc.) en �.e-nC2 IS USE: PRIMARY X SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS HEATED STRUCTURE? YES(WholeBld V YES(Fart[s]ofBldg)❑ NO❑ DESCRIBE WORK SQUARE FOOTAGE:(propased) 1 ST FLOOR t iM sq.ft. 2ND FLOOR tA sq.ft. 3RD FLOOR �l k sq.ft BASEMENT sq.ft. DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* / MAKE 1 J+ MODEL� YEAR,070a 1 LENGTH 57(9 WIDTH BEDROOMS; BATHS 2 SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTICV SEWER❑ / NEW R' EXISTING❑ PLUMBING IN STRUCTURE? YES D� NO❑ If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION D S PROPOSED? YES❑ Nt$ EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS� TOTAL BEDROOMS OWNER acknowledges that 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 and I further declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This pernittapplication becomes null li.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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) X 5- 1-- ZI Signature of OWNER lust be signed by the OWNER Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT •/d•2 PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH MASON COUNTY Mason County Permit Center Use: �) COMMUNITY SERVICES Aw a l= ( Y / Building,Planning,Environmental Health,Community Health 615 W.Alder St.—Bldg.8,Shelton,Wa 98584 bate RCvd a Phone:(360)427-9670 ext.352♦Fax:(360)427-7798 Fee: $130.00 Request for Administrative Variance for Reduction in the Required Setbacks 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 furtheruction requires a standard variance. Setbacks are measured from the fizrthest projection of ��-X/ED including roof eaves and gutters. MAY 10 2n2l Applicant/Owners: der Street Mailing Address: 0 brA 5(�) rp I_ NNING City: S 42 0 U,eC k- State: � � Zip: �3 g Telephone: ?)�0 0-62 qCt —o).J P)7 Email: )e(- t r L 13, 77 @ ` � , COM If this reduction is tied to a building permit,please give permit case number. BLD 00 (D 9�✓ ParcelNumber(s): 9 oa?)0H jTrb5 Zoning @?Ea Site Address: Requested setback variance: ft. ❑ Front ❑ Rear Side ft ❑ Front ❑ Rear ❑ Side ft. ❑ Front ❑ Rear ❑ Side ft ❑ Front ❑ Rear ❑ Side Front Setbacks—From access easements and road right of ways. Minimum 10 feet. Rear Setbacks—From the rear property line. Minimum 10 feet. Side Setbacks—From the side property line. Minimum 5 feet except for certain shoreline designations. An illustrated site plan is required. Your site plan must show the following: north arrow, abutting street or easements, and set backs to all property lines and existing buildings, slopes, surface water, wetlands, critical areas, septic, well and driveway. Show all proposed new development. FRONT AND OR REAR YARD REDUCTION REQUESTS: For existing lots of record as of March 5, 2002; You must meet one of the following: 1) One of the following exists on the lot (check all that apply): ❑ 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. SIDE YARD REDUCTION REQUESTS: For existing lots of record as of March 5, 2002; You must meet one of the following: 2) One of the following exists on the lot(check all that apply): ❑ 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-half acre; fA 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. Owner/Agent (please indicate) A( M A-1) SignatUe Date Official Use Only Approved by: Date 0 5-a g a Q a I Denied by: Date Reason for denial: