HomeMy WebLinkAboutFDPO - GRD Application - 4/2/2018 Permit No. FLD
Date reed:
Mason County Fee:
Department nf Community Development
(vE 5 w A1de.(s , 81.1 S, ; Shelton, WA 98584
Mason County Flood Damage Prevention Ordinance #87-08
FDPO Development Permit Application
The undersigned hereby makes application for a permit to develop in a designated floodplain area. The work to
be performed is described below and in attachments hereto. The undersigned agrees that all such work shall
be done in accordance with the requirements of the County Floodplain Ordinance and with all other applicable
Local, State and Federal Regulations. This application does not create liability on the part of the County or any
officer or employee thereof for any flood damage that results from reliance on this application or any
administrative decision made lawfully thereunder.
Applicant: Contractor:
Mailing Address: Mailing Address:
City, State, Zip City, State, Zip
Phone: ( ) Phone: ( )
Email: Email:
Parcel Number: Property Address:
A. Description of Work(complete for all work):
1. Proposed Development Description:
❑ New building ❑ Improvement to existing building ❑ Manufactured home
❑ Filling Other
2. Size and location of proposed development (attach site plan):
3. Is the proposed development in a Special Flood Hazard Area(zone A AE,Al-A30,AH,or AO)?
❑ Yes ❑ No
4. Per the floodplain map, what is the zone and panel number of the area of the proposed development?
Flood Zone Designation A Community Panel Number :PO-0 Fcw nAgfgi
5. Are other Federal, State or local permits obtained?
❑ Yes ❑ No
6. Is the proposed development in an identified floodway?
❑Yes XNo
7. If yes to#6, is a "No Rise Certification" with supporting data attached?
❑ Yes ❑ No
B. Complete for New Structures and Building Sites: NA
1. Base Flood Elevation at the site: feet NGVD
2. Required lowest floor elevation (including basement): feet NGVD
Permit No. FLD
Date rec'd:
3. Elevation to which all attendant utilities, including all heating and electrical equipment, will be protected
from flood damage: feet NGVD
C. Complete for Alterations, Additions, or Improvements to Existing Structures: ,!V,�
1. What is the estimated market value of the existing structure? $
2. What is the cost of the proposed construction? $
3. If the cost of the proposed construction equals or exceeds 50 percent of the market value of the
structure, then the substantial improvement provisions shall apply.
D. Complete for Non-Residential Floodproofed Construction:
1. Type of floodproofing method:
2. The required floodproofing elevation is: feet NGVD
3. F000dproofing certification by a registered engineer is attached:
❑ Yes ❑ No
E. Complete for Subdivisions and Planned Unit Developments: A41
1. Will the subdivision or other development contain 50 lots or 5 acres?
❑ Yes ❑ No
2. If yes, does the plat or proposal clearly identify base flood elevations?
❑ Yes ❑ No
3. Are the 100 Year Floodplain and Floodway de►ineated on the site plan?
❑ Yes ❑ No
Applicants Signature: Date:
Administrative
1. Permit APPROVED: DENIED statement attached
2. Elevation Certificate attached: ❑ Yes ❑ No
3. As-built lowest floor elevation: feet NGVD
4. Work inspected by:
5. Local Administrator Signature: Date:
CONDITIONS:
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