HomeMy WebLinkAboutBLD2013-00667 GARAGE - BLD Permit / Conditions - 8/27/2013 W Z -0
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FORM MUST BE COMIPLETED IN INK MASON COUNTY PERMIT NO.
PLEASE PRESS KA.RD 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,Lis
APPLIG�T INFORMATION GONTRACTO INFORMATION
Owner <`OXi Is QksvEll Company Na
Mailing Address 9-0 W Mailing Address
City —State Q_Zip Code MRS City State Zip C e
Phone �(,O 421—3$53 Other Ph. Phone ther P .
Contractor Reg. xp.
E mail address E Mail Address
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 INFORMATION - 12 Digit Parcel No. y10-01- 7-1- 10011- Fire District I
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Blu $ >5%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? es/No
TYPE OF JOB - New Add Alt Repair Oti��� I PiR1 •ARY RESID}kNCE Z SEASONAL ❑
Use of Building Describe Work h� ' htJJ� G/LLt P�
No. of Bedrooms—No. of Bathrooms Square Footage- 1st Floor 2nd Floor
3r loot Basement Deck Covered Deck Other Sq. ft.
Garage Attached Detache 141'M- Carport Attached Detached
MANUFACT D H9ME INFORMATION - Make Year
Length V%/idth erial No. �epB,12
rooms of Bathrooms
Typ of Heat hase Price ment Unit? Yes/
In taller Name Certi i ation 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. 1 further declare
that I am entitled to receive this permit and to do the work as proposed in the application. eclare 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 ployees 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 commenged within 180 days or if c struction work is suspended for a period of 180 da ys. PROOF OF CONTINUATION OF WORK IS BY
APR GRES INSPECT INACTIVITY OF THIS PERMIT APPLICATION OFI 6 YS ILL INVALIDATE THE APPLICATION.
Date:
Owner/Owners Repres /Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accept by: Date
DEPARTMENTAL RENEW iAPPROVED DENIED NOTES
Building Department
Planning Department _
Environmental Health Department l�
Fire Marshal
FEES
Building Permit Fee Site Inspect n
Plan Review Fee EH Review ee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood /Gas / Pellet Stove Fee State Fee 311 1 : 31 P C V D
Violation Fee Pre-Paid at ubmittal
Valuation $ TOTAL FE
/A
PLANNNI-N
� (jLANNIN
ALL SETBACKS ARE MEA 5'URED
FROM THE FURTHEST
PROJECTION OF THE BUI DING
XA
lk N
7i s
APPROVED
ON COU- If BCD PLANNING
N '
STE PLAN REQlUFllED TO BE ON SITE %
CHANGES SUB"IL-C'T 10 APPROVAL
B, Date
'A
7
Name K r•ay),�q ?�Y'� Parcel#-,4 a) ' ^C�(J(�r�� BLD# t
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 surfacez.
'`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
'Common 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.
afcula€e:Impety. 4?us Su aces;�lease Corr`�plete_Th s Tab7�;
Surface Type Length X Width = Area *All dimensions in feet
Bufl ins X =
X = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
X = eaves/gutters)
X = I
Driveways G 'X —
X Length of drive begins at the right of way
X =
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 = `tf.the total.impervious area-of the proposed site
X = "ems greatei than.20DD square feet a
Stormwater'Site.Plan,is Required
Total lmpervious.Surface area;(sum af'
If the Total Impervious Surface ArQais LESS THAN 2000 Square Feet,jpleased,acknowledge and sign below.
Based Upon the information you hav d `Stormwater Site Plan IS ed for this development activity.
OwnerBuilder/Agent Acknowledges that submission of inaccurate informa on 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-
descnbedBrgperty for review and inspection as may be required.
X �[��O' Owner/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 1 of 2