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FORM MUST BE OMPLETED IN INK MASON COUNTY PERMIT NO
PLEASE PRESS I IARD 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
IAPPLICANT INF RMATION CONTRACTOR INFORMATION
Owner , e*` i - + Company Name
mailinpAddress i ' ` ' {- Mailing Address
City � �4' St teWAZip C de City State Zip Code
Phone `'' Other Ph 3/^-4 - I= E Phone Other Ph.
Lien/Title Holde Contractor Reg. # Exp.
E mail address A' t :� j E Mail Address
Drivers Lic.# .� _ A I ..: DOB ' _ 7i Drivers Lic.# DOB
SEPTIC /WAT SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Wate ystem Name of Water System
Well S ar System Name of Sewer System
PARCEL INFO MATION - 12 Digit Parcel No. 1 f - � �' Fire Distri t
Legal Description 1r
Site Address(Pie,se include street name, street number and city)
Directions to site
Will timber be cu nd sold in parcel preparation?Yes/fid
Is property within 00'of Saltwater Lake River/Creek Pond
Wetland-__ Seasonal Runoff ,ter Stream Slopes or Bluffs �/o
Is this permit bmittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yesl(
TYPE OF JO - New—Add—Alt Repair_ Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building- Describe Work
No. of Bedroom No. of Bathrooms Square Footage- 1st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTU D HOME INFORMAT ON Make } { `t= Model =-" t' Year
Length dt 2, ' '�'�Serial No. f ` I rA No. of Bedrooms � No. of Bathrooms _
Type of Heats 2 �C Purchase Price$ Replacement Unit? Yes/ No ,
Installer Name 'ar`. r''"` Certification No. Q''-7
OWNER/BUILDE Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement 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 t ceive this permit and to do the work as proposed in the application. I declare that l have obtained the permission from all
the necessary parti . If permission is required from any easement holder or any other party in interest regarding this application or the work t
proposed in the ap cation, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners b alf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property d structure for review and inspection.This permit/application becomes null&void if work or authorized construction is
not commenced wi in 180 days or if construction work is suspended fora period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
MEANS OFA PRO ESS INSPECTION.INACTIVITY OF THIS PERMITAPPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. �5
__�. .._.._ Date: :
X Owner/ tners Representative/Contractor (indicate which one)
FOR OFFICIA USE BEYOND THIS POINT Accepted by: Date ' <� 1
DEPARTMENI 4L REVIEW AFOROVED DENIED NOTES
Building Depart 4nt
Planning De art nt -, —a &
Environmental HE Ith Department
Fire Marshal
FEES
Building Permit IlEle Site Inspection
Plan Review Fed I EH Review Fee
Plumbing & Base ee Planning Review Fee
Mechanical & Bas6 fee Other
Wood/Gas/Pe I t Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
a
Name wl' Parcel# Oekl, �— t1fr� BLD#
i
Mason County
Department of Community Development
S' all Parcel Stormwater Management Application/Worksheet (page 1 of 2)
i
Per Mason q6unty Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for res,iilential development,or redevelopment', with more than 2,000 square feet of impervious surface'.
'Redevelo m at means,on an already developed site,the creation or addition of impervious surfaces,structural development
including conkl ruction,installation or expansion of a building or other structure,and/or replacement of,impervious surface that is not
part of a routi maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'Common im rvious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or as ialt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltr t n of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
F X4 t t z
Surface Type Length X Width = Area *All dimensions in feet
Buildings X
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
! X =
Driveway's X =
InU = Length of drive begins at the right of way
X =
Parking Ar s X =
X = Any paved, gravel or packed area per definition
above table
X =
PatiosNValtS X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X
X = I r
X _
. t
all a
If the Total 10 pervious Surface Area is LESS THAN 2000 Square Feet, please read,acknowledge and sign below.
Based Upon t4t information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/ gent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgem t of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowl ge that the information provided is accurate and employees of Mason County are granted access to the above-
described propel for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Dater v7�d
i
If the Total I ervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign
the informati" provided on page 2 of 2.
Page 1 of 2
i
i
l ,
Name Parcel# BLD#
Mason County
Department of Community Development
Spiall Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon;t ie information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14,ChO ter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management n this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
htt Hwww.c' mason.wa—us/code/commissioners/index.htm
Please follow the links to"Title 14, Chapter 14.48 Stormwater Management".
Regulated aot vities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason Coupi y Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document
entitled "Mali aging Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan".This document will assist
you in prepaii ig the necessary information and plans for Public Works to review and approve. Per Department of
Public Wor4i 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 It low). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by egistered professional may be required for more complex sites.
*The details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on th$ ages that begin with"Handout"
PLEASE INI AL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) N The rt levant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entireo kND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alt rnative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be b cated as not to adversely affect any septic systems on this,or any other,parcel.
If you have fib her questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department c�l i 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 develop nent has,or will have,a septic/drainfield system you may need to contact Mason County Division of
Environments I Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other, pad el. You may also wish to consult with the septic design professional involved with the project. Mason
County Divisip i 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 wil be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a requ t for final inspection of the building permit.
OwnerBuilder/A yent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgemoi t of such is by signature below. I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowle ge that the information provided is accurate and employees of Mason County are granted access to the above-
described prope:tY for review and inspection as may be required.
X -- Owne Agent/Contractor(circle one)Date:
i
Page 2 of 2
srgr MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
s N = Planning Division
z� N y y P O Box 279, Shelton, WA 98584
(360)427-9670
1864
NOTIFICATION OF INCOMPLETE APPLICATION
May 28, 204
JESSE MCA NAHAN
2520 W DE AN RD WEST
SHELTON A 98584
i
Pal el No.: 420352000000
i
Proiect Deb rbtion: New MFG Home
Dear Applico t:
You have SUbmitted a permit application (case no. BLD2009-00395) for proposed construction or
developme t in the county. Upon review of your application, I have determined that the contents
of the applidE tion are incomplete or do not provide enough detail for review.
i
Therefore, r iew 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. If the additional
information s not provided to the County within 180 days of this request, the application shall
expire and no further action on the proposed development shall take place.
Please contoct me at (360) 427-9670, ext. 295 if you have questions.
Sincerely,
Tammi Wrig I ht
Land Use Plah er
Mason Counter Planning Department
i
I
5/28/2009 Page 1 of 2 BLD2009-00395
NOTIFICATION OF INCOMPLETE APPLICATION
5/28/2009 j Case No.: BLD2009-00395
Comments:
A site inspe ion was done on 5/27/09. There is a wetland system within 250 feet of your proposed
development. Under current regulations wetland buffers can range from 25 feet to 250 feet.
The Mason Gounty Resource Ordinance Wetland Chapter 17.01.070 is enclosed for your
information.; In order for the Planning Department to further review your proposed development, a
Wetland Delineation and Categorization Report that meets the requirement of the Mason County
Resource QrJinance Wetland Chapter will need to be submitted to the Planning Department with
an accurate ite plan. However, if the proposed structure can be sited as to be 250 feet from the
wetland edge, then a Wetland Delineation and Categorization Report would not be required.
The report \0 II need to address all of the criteria listed in the Wetland Chapter. It is necessary for
you to hire qualified wetland consultant to prepare the report. A list of wetland consultants is
enclosed foi your information, although you may also choose other qualified professionals not on
this list.
Depending u on the wetland category, rating, and buffer requirements a Mason Environmental
Permit (MEP i may be required to allow the proposed development. See section D and E of the
enclosed W tlands chapter of the Mason County Resource Ordinance regarding permits and
buffer requi ments. If the proposed structure is within the standard wetland buffer, it may still be
possible to nstruct in the buffer with adequate mitigation (Section F), which may include buffer
restoration, etc. Permits can be issued when the applicant can demonstrate that the activity is both
unavoidable 3nd necessary. A MEP application is enclosed for your convenience. The application
fee is $380.!If the proposed development will occur within the wetland buffer please submit the
MEP along ith a mitigation plan. If development is outside of the wetland buffer/setback then the
MEP will no a required but you will still need to submit the report for staff review. There is a
Wetland Deli ieation review fee of$140.
Upon review f the parcel documents there is currently an open enforcement case
(ENF2003- 503) relating to wetland issues. At that time a wetland report was submitted to the
County by F E cific Rim Soil & Water, Inc. This report does provide some information regarding the
wetland system however it does not meet the current requirements that were adopted in December
2006. 1 am pi oviding you a copy of this report and a letter outlining the requirements in order to
bring the pad el into compliance. Please contact Christine Clark, Code Enforcement Planner,
regarding th' outstanding enforcement case. She can be reached at (360) 427-9670 ext. 577.
Either you ojr your consultant may contact me if you have any questions.
5/28/2009 Page 2 of 2 BLD2009-00395
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