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Home My WebLink AboutBLD2015-00668 Pole Bldg - BLD Permit / Conditions - 10/8/2015 Inspection Line (360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352. Mason County Bldg. III 426 W. Cedar Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2015-00668 OWNER: JACOB AARO RECEIVED: 8/4/2015 CONTRACTOR: LICENSE: EXP. ISSUED: 10/8/2015 SITE ADDRESS: 31 E SAPHIRE CT BELFAIR EXPIRES: 4/8/2016 PARCEL NUMBER: 122187800050 LEGAL DESCRIPTION: PCL 5 OF BLA#04-48 PTN SE SW S 21/72 S 30/6 PROJECT DESCRIPTION: DIRECTIONS TO SITE: POLE BLDG WITH STORAGE LOFT ST RT 3, L ON MASON BENSON RD, R ON TRAILS RD, R ON TRAILS END DR, L ON RASOR RD WEST, R ON RICHARDSON RD, FOLLOW TO SAPHIRE CT General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: Type of Constr.: vb Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: u Lot Size: Deck.- Type of Work: ACC Fire Dist.: 2 No. of Stories: Occ. Load: 0 Building:3,360 Garage-Detached 3,360 Valuation: $ 144,144.00 Building Height: Occ. Status: Primary Basement: Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft. Front: W 200.0 Ft. Shoreline: Ft. Water Body: Rear: E 30.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: IN 220.0 Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: S 40.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Plan Check Fee GMM 8/4/2015 $809.74 S1201500000001 EH Minor Plan Review GMM 8/4/2015 $ 100.00 S1201500000001 Planning Review Fee GMM 8/4/2015 $205.00 S1201500000001 Building Permit Fee CRE 9/23/2015 $ 1,245.75 S2201500000001 Building State Fee CRE 9/23/2015 $4.50 S2201500000001 Total $ 2,364.99 BLD2015-00668 Please refer to the following pages for conditions of this permit. Page 1 of 5 CASE NOTES FOR BLD2015-00668 CONDITIONS FOR BLD2015-00668 1) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X ,�/ 2) This structure has NOT been reviewed or approved as an Accessory Dwelling Unit(ADU): A second dwelling unit detached from an existing single-family dwelling for use as a completely independent or semi-independent unit with provisions for �g, eating, sanitation and sleeping. ADUs are required to meet the requirements under Mason County Development Regulations 17.03.029. X 3) All construction and demolition debris must be removed from the site after project completion. Proper d'sposal of construction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X 4) Concr to leachate and wash water must be contained during construction pouring, such that water quality degradation of adjacent waters does not occur. X �jj 5) All property lines shall be clearly identified at the time of foundation inspection. X :�5A 6) Retaining walls needed to support a surchargch as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. X '� /-� 7) 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. X,!A 8) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Approved ate Plan"to ensure these structures are shown and meet the setback conditions listed. X f �-� 9) 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 1-800-64779982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. x - -:> /� BLD2015-00668 Please refer to the following pages for conditions of this permit. Page 2 of 5 10) All 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 Depar�mpt prior to any further inspections being performed or approvals granted. X �� 11) Ownerr//Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. 12) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the 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 rem oval9f approved documents will result in failure of required building inspections. X � 13) This structure is approved as unheated space. To be considered unheated space the area may be provided with a heating system that does not exceed energy usage of 1 watt per sq. ft., or 3.4 Btu/h per sq. ft. A permit and approval shall be required prior to installation of any heating system. When a heating system exceeds 1 waft per sq. ft(or 3.4 btu/h per sq. ft)the heated space shall be insulated in accordance with the energy code in effect at the time of permit application. X 14) THE FO NDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL. X LQ - 15) WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85 MPH. X '�S 16) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the manufacturer's installation instructions. A drip edge shall be provided at eaves and gables of shingle roofs. (IRC 2012 R905.2.8.5) BLD2015-00668 Please refer to the following pages for conditions of this permit. Page 3 of 5 17) 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/contracr is cknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. X , . 18) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. A. Drainfield/ Reserve requires a 10ft setback from all footing/foundations. B. Septic tank(s) requires 5ft setback from all footing/foundations. X. YoUndation drains within 30ft, down gradient of drainfield/reserve area. 19) This structure is limited to U-occupancy use only (private garages, carports, sheds, and agricultural buildings.) Any other use will be in violation of the intern oraaI codes and Mason County Regulations unless a "Change of Use" permit is applied for, reviewed and approved. 20) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charge anti shall be collected by the Building Department prior to any further inspections being performed or approvals granted. X !— 21) All construction must meet or exceed all local ordinances and 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 re,�ocation. X 22) All property lines shall be clearly identified at the time of foundation inspection. X 23) All building permits shall have a final inspection performed and approved by the 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 MasoryCcy my ordinances and building regulations. X 24) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connec rsy�and flashing. Install metal connectors approved for contact with the new types of pressure treated material. X ,�1 25) Retaining walls needed to support a surg4ar e such as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. X BLD2015-00668 Please refer to the following pages for conditions of this permit. Page 4 of 5 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. u re Date i OWNER - REPRESENTATIVE - CONTRACTOR Print Name (Circle one to indicate) BLD2015-00668 Please refer to the following pages for conditions of this permit. Page 5 of 5 1 Name-f),QV6'�Q AO(ro Parcel# i2ZfO--79-ooq-o BLD#Z - Optabpj BUILDING Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 2 of 2) 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 requirements for Stormwater Management in this jurisdiction. A complete copy of the ordinance can be found on the Mason County website: httpHwww.co.mason.wa—us/code/commissioners/index.htm Please follow the links to "Title 14,Chapter 14.48 Stormwater Management". Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan (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) The 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 C oouunty's Public Works Department can provide additional instructions,guidance and examples. (Section 14.48.1RtrE oi��^"s at: Phone: (360)-427-9670 EXT. 450 1 fib/ �rjj�� Mail P 0 Box 1850, Shelton WA 98584 AUG 0 4 2015 Physical: 415 N 6th St, Shelton WA 98584 1 26 W. CEQAR ST 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- described property for review and inspection as may be required. X wne/Agent/Contractor(circle one)Date: age 2 of 2 Small parcel stormwater site plan Written description Jacob Aaro Mason county tax parcel No.12218-78-00050 The site is located west of Belfair on a 5 acre lot.Approximately 2.25 acres of the lot is"usable"as there are road easements running through the property and powerlines running from north to south on the west end of property. The lot is forested and runs a grade of 2%-5%to the East. The land clearing has already been done in center of lot and would be estimated at 3/4 acre. Trees and native vegetation will remain all along north, east,west and south perimeters. There are 2 entrances to property. The"top"driveway enters East from Saphire Ct. and will come into a small parking area. The"bottom"drive enters West from Blackhawk Ct and will open into a parking area as well. Both entrances and parking areas will be graveled. The total estimated area of impervious drive surfaces is 2,300 square feet.The garage will be about 2,400 impervious feet and the house will be 2,500 feet. The total proposed impervious surface is 7,200 square feet,which fall within the limits for small parcel drainage review. The top driveway will flow into property and runoff will be dispersed through vegetation. The bottom drive is fairly flat but will slope slightly to north where runoff will be dispersed through vegetation. Grass will be planted along south side of property, all other exposed areas not getting grass will be planted with wildflowers. To avoid saturating the soils near the foundation of the house and shop ,roof runoff will be directed towards vegetated flow paths via downspout extensions. An onsite septic system has been approved to be installed in center of lot on the north side, and is above or out of the way of all these stormwater runoffs. In order to prevent erosion and trap sediments within the project site,the following Best Management Practices(BMPs)will be used approximately as shown on the Erosion and Sediment Control (ESC)plan: • The driveway will be graveled immediately. Areas accepting sheet flow from driveways and parking areas (that are not being left in native vegetation)will be seeded and mulched. • All exposed soil not getting grass will be planted with wild flower seed immediately. • A rocked construction entrance will be placed at the beginning of lower drive. 00 V, 1 er- fEmma soon yv',ae�A j PLANNING: ALL SETB 'CKS ARE MEASURED FROVTHE FURTHEST I �PROJ CT ON OF THE BU LDING !� r \A t W i - PPROVED r SON COUNTY DCD PLANNING lie i PLAN .' `,-ISITE PLA REQUIRED TO BE ON SITE r CHAN E6 SUBJECT TO APPROVAL By Date Fu4iml - I a` RECtIVED AUG 42015 �Y- 426 W. EDAR ST P TOPOGRAPHY PROFILE: Direction: Scale: Approval: for office use Building Permit number: 1�� Building: Owner/Applicant: O'':, ° r J Date of Planning: Parcel Number: �j application: Env. Health: �j(.0 C UI H-;z U 5 3o �a ; a e a1f. i 54d VV fir` r r t �- I o WaL yv`f�661 ✓� � � � . Gray'" . I �f \A 1 o � i TOPOGRAPHY PROFILE: 1 1 Direction: Scale: Approval: for office use Building Permit number: 1 Building: Owner/Applicant: -�c�C ;f J Date of Planning: Parcel Number: �j t� application: Env. Health: F(o5ion' 0k P 1 Copt Noy4 q Peox. Cl -r- `,,,rPa cr� VT, c7 cn �C7t �- o 6 -A- /S A s U +n S - we � � o • �.r 01- CotAr+- ti i i 0� 0 6 U TOPOGRAPHY PROFILE: Pqe(+ +�e dos+ 12_- y Direction: Scale: Approval: for ofrice use Building Permit number: 1/-Z D Building: ApP QAC v� Ao"- Planning: Owner/ licant: Date of Parcel Number: V 1 yy �1( Q`'1 g-0(DID 5 D application: Env. Health: P it i PI �--- Ve { e. o ro P 4UVC � 4. F v f l T J o� c a V 00 J TOPOGRAPHY PROFILE: prc�e' : ► -�� -t ire a5 ' - j °�' t Building Permit number: Direction: Scale: Approval: foroffke use � �2 U Building: Owner/Applicant: -0,kC c)Y-j c�J t�� Date of Planning: Parcel Number: ,� J U -w0 6 application: Env. Health: I HANDOUT "L" ALTERNATE INFILTRATION ELEMENTS GrassNegetation Flow 24"Min. Driveway ly Overflow --�- 5'Min. — 6"Min. Filter Strip 36"Min. DRIVEWAY INFILTRATION TRENCH (Not To Scale) Sides& Bottom of Trench Lined with Filter Fabric House GrassNegetation 24"Min. ��e°� COU"�A MASON COUNTY PERMIT NO. I 15 DEPARTMENT OF COMMUNITY DEVELOPMENT DD LoLog BUILDING•PLANNING•FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352 ixsa PO Box 279,Shelton,WA 98584 (360)482-5269 Elma ext. 352 BUILDING PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: 0 cc) b A C✓C) NAME: d w h e! MAILING ADD SS: Z ' d'lza� �n SE MAILING ADDRESS: CITY: r)irf 0rc a/c STATE: (A>c ZIP:X 56 CITY: STATE: ZIP: PHONE: 5�300- 66 CELL: PHONE: CELL: EMAIL:�sf�i��.Fq/rt,'(1,c3 rn C/��i�.C o/+'I EMAIL : L&I REG# EXP.T/ / PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) co 5_0 FIRE DISTRICT / LEGAL DESCRIPTION(ABBREVIATED) : G R� SITE ADDRESS 3/ S-t r,%ram CITY H -ii r- DIRECTIONS TO SITE ADDRESS f A K e- os 15 �o L-41 U IS PROPERTY WITHIN 200 FT: SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO,/ TYPE OF JOB: NEW JX ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(PprDENCE,GARAGE ETC.) ep IS USE: 'PRIMARY Pr SEASONAL n NUMBER O EDROOMS -0' NUMBER OF BATHROOMS DESCRIBE WORK J SQUARE FOOTAGE: U I ST FLOOR_ sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. ft. BASEMENT sq.ft. DECK sq. ft. COVERED DECK sq.ft. STORAGErf W) sq. ft. OTHER sq.ft. GARAGEZaQ sq.ft. ATTACHED ❑ DETACHED ❑ CARPORT sq.ft. ATTACHED ❑ DETACHED ❑ 7DTH F VIE INFORMATION: *4 COPIES OF THE FLOOR PLAN MODEL YEAR BEDROOMS BATHS SERIAL NUMBER 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. 1 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 permitiapplication 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 INSPECT INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. x - - llzn ignature of Ap,pplicant e xCf� �4a�G OWN /R ATIV /CONTRACTOR Print Name (CIRCLE TO IN19(C TE) DEPARTMENTAL REVIEW APPROVED DA E DENIED DATE TA2 �pTJ§ICONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL �.rg°N LN�'�- MASON COUNTY PERMIT NO. 15 - DEPARTMENT OF COMMUNITY DEVELOPMENT 1. D L91ob BUILDING•PLANNING•FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 Mason County Bldg. 111,426 West Cedar Street (360)275-4467 Belfair ext.352 18S4 PO Box 279,Shelton,WA 98584 (360)482-5269 Elma ext. 352 PLAI BUILDING PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME Q�c A C>'✓C) NAME: MAIL G ADDIySS: I r3E`lZcdY� Ln S MAILING ADDRESS: CITY: ?fJ 0 arc STATE: l.�)��, ZIP: 9 CITY: STATE: ZIP: PHONE: --J o?�"E6 CELL: PHONE: CELL: EMAIL : EMAIL:1Sf 0/,0,,4ct M,^U -'0 ill�C.)"ylwi�. C�r✓1 L&I REG# EXP. PARCEL INFORMATION: s PARCEL NUMBER(12 DIGIT NUMBER) I _ FIRE DISTRICT LEGAL DESCRIPTION(ABBREVIATED): G R� SITEADDRESS 3 E �q A,re CITY c �r^ DIRECTIONS TO SITE ADDRESS -f AK IS PROPERTY WITHIN 200 FT: SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NOZ/ TYPE OF JOB: NEW X ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE( SIDENCE,GARAGE ETC.) IS USE: PRIMARYO SEASONAL F] NUMBER O EDROOMS -A' NUMBER OF BATHROOMS DESCRIBE WORK SQUARE FOOTAGE: W R U 1 ST FLOOR�sq.ft. 2ND FLOOR sq. ft. 3RD FLOG —sq. ft. BASEMENT sq. ft. DECK I sq. ft. COVERED DECK sq.ft. STORAGE -QQD sq. ft. OTHER sq. ft. GARAGE sq.ft. ATTACHED❑ DETACHED ❑ CARPORT sq.ft. ATTACHED ❑ DETACHED El 7DTH F VIE YFORMATION: *4 COPIES OF THE FLOOR�PLAN� MODEL YEAR BEDROOMS BATHS SERIAL NUMBER 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 permitlapplication 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 INSPECTI INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. x - erg�S % Signature of Applicant e x �cok Aoa-G OWN /REP& ffttJW F,6TRACTOR Print Name ( deb CATS) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE ;,,,T"/N(WJt8/CONDITIONS BUILDING DEPARTMENT Q PLANNING DEPARTMENT FIRE MARSHAL