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Home My WebLink AboutGRD2023-00009 LRG2023-00005 - GRD Application - 9/11/2023 (i00U MASON COUNTY PERMIT NO. DEPARTMENT OF COMMUNITY DEVELOPMENT R E CAE D BUILDING•PLANNING.FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 Mason County Bldg.8, (360)275-4467 Belfair ext.3orp 11 2023 T=_ 1854 � 615 W.Alder Street,Shelton,WA 98584 (360)482-5269 Elma ext.336 LAND MODIFICATION PERMIT (Grading Permit) 615 W. Alder Street 1(� OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: �AhI `QYT0yR'�fi-eS , LLC NAME: ICI W [�`ce�h COnSfiCu C�o►-• l►1(. MAILING ADDRESS:2Q N. R4►MIIt0k-) 12A MAILING ADDRESS: 112j,1 N AA1N16tbl ad CITY: C hp-i)AIl S STATE:��/ b, ZIP:9� CITY:C kp-IJA I15 STATE: \N4n,, ZIP: a l c,� Qt PHONE: '3bo•74o• 034S CELL: PHONE: :�66- 14& 0345CELL: U CO EMAIL: YR1oe((A @ 1/NWoyjz t \l)omec,• Viz'r EMAIL : yg)&ZCCA @ 1�WgY tQh l�o w►eS. b (I L&I REG# NW GP-ECsC-o122 GLS EXP. lam/g 2,{ O PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) 422117- 411, - O O C)b Q FIRE DISTRICT_ 5. LEGAL DESCRIPTION(ABBREVIATED): SE SE LNINU NUY C}- 11-0 h-/VV Q J SITEADDRESS (No N LADE CUSIiMAN P-0 CITY R000SVOP-T �Lvv DIRECTIONS TO SITE ADDRESS �U W �Pry Ovto US-101 N +ovjo.1wk V' V I IS PROPERTY WITHIN 200 FT: `� I LIJ SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND C, SEASONAL RUNOFF❑ STREAM❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES EA NO❑ WILL TIMBER BE CUT AND SOLD IN PARCEL PREPARATION? YES 0 NO TYPE OF JOB: EXCAVATION ❑ FILLING ❑ GRADING 14 CUTTING ❑ OTHER ❑ TOTAL SIZE OF PARCEL -;14 .Zq RE /SQ FT SIZE OF AREA TO BE EFFECTED \5•o� ACRE Q F ESTIMATED AMOUNTY OF CUBIC YARDS 9 b D DOES THE SITE HAVE SLOPES 14%OR GREATER YES NO❑ DESCRIBE SCOPE OF WORK 12-OOA vA ACU SS WILL FILL BE BROUGHT ON SITE? IF YES,SITE ADDRESS: No 1�,�p.��-w LI �O�n ha �). !!wave I WILL EXCAVATED MATERIAL BE TAKEN OFF SITE?IF YES,SITE ADDRESS: N U DOES FILL CONTAIN POTENTIAL HAZARDOUS MATERIALS? YES❑ NO HAS A SOILS REPORT BEEN COMPLETED ON SITE?IF YES,INCLUDE A COPY. YES❑ NOS WILL PROPSAL RESULT IN REDIRECTION OF ANY SURFACE WWATER RUNOFF? YES❑ NO a WILL WORK ALTER WHERE STORMWATER OF GROUND WATER ENTERS OR EXISTS THE SITE? YES❑ NO B WILL QUALITY,QUANTITY OR VELOCITY OF STORM/GROUND WATER BE ALTERED? YES❑ NOO WILL THE RUNOFF BE COLLETED/CONTROLLED BY INTERCEPTORS,CURTAIN DRAINS OR OTHER DEVICES? YES 1Z NO❑ WILL THE LAND BE REPLANTED UPON COMPLETION? YES❑ NO Ig WILL THE PROPOSAL RESULT IN SLOPES STEEPER THAN THOSE CURRENTLY ON SITE? YES❑ NO g IS THE SITE WITHIN 200 FT OF A DESIGNATED SHORELINE OR A WETLAND? YES 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 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 permittapplication 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. CTIVITY OF T RMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. x HIS 00-zoo- 2..02.E ("n6tuior I pli nt Date X AN 1 h ki OWNER/REPRESENTATIVE/CONTRACTOR Print Name (CIRCLE TO INDICATE) T MASON COUNTY PERMIT NO. DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING CONMASON.WA.SARSHAL (360)427-9670 SheltRdbct.0 E I V E D Mason County Bldg.8, (360)275-4467 Belfair ext.352 �85 615 W.Alder Street,Shelton,WA 98584 (360)482-5269 Elma e - ;xr 1 1 2023 LAND MODIFICATION PERMIT (Grading Permit)615 W. Alder Street 1� OWNER INFORMATION: CONTRACTOR INFORMATION: oQ NAME: \O ah1 `QTo y-e'f1-eS , LLC NAME: N W [sYQ-eh C0r1StCU (-fi0• �►LC. (� 8 MAILING ADDRESS:2l,I N. R4mi 1f-o►n IZd MAILING ADDRESS:_I I al N �] CITY: (-'h6 nh STATE: V k ZIP:. 11061c�;2. CITY:CI1dWic, STATE: W-K ZIP:gq)C') + PHONE: 31oo•-14o• 034c; CELL: PHONE: 960•140. 0345CELL: CO EMAIL: Y21000(A 0)V1WD+Y'kR1'\InoNM.eS. Vlg-f EMAIL : reb2CCA Y�Wq,c-t2r.lnow►eS- L&I REG#NW CaP-EC�C9 22 QS EXP. /� PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) 4221 b- 414- - O 0 O b O FIRE DISTRICT_ LEGAL DESCRIPTION(ABBREVIATED): SE SF LYINU NuY C�- 11-D Iv-/W .J SITEADDRESS (No AVVfLI 5*) N CUSHIMAN p-D CITY i}toOOSVOP-T DIRECTIONS TO SITE ADDRESS M-101 N +owaVek IS PROPERTY WITHIN 200 FT: �+ I SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND C& SEASONAL RUNOFF❑ STREAM❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES 64 NO❑ WILL TMMER BE CUT AND SOLD IN PARCEL PREPARATION? YES 0 NO❑ TYPE OF JOB: EXCAVATION ❑ FILLING ❑ GRADING 14 CUTTING ❑ �O�TH/�E/�Rq❑ TOTAL SIZE OF PARCEL 31.1 .29 RE /SQ FT SIZE OF AREA TO BE EFFECTED /.CJL/(J ACRE Q F ESTIMATED AMOUNTY OF CUBIC YARDS oI b p �T-"— DOES THE SITE HAVE SLOPES 14%OR GREATER YES M NO❑ DESCRIBE SCOPE OF WORK V-oadwu -1�0"c ACU SS WILL FILL BE BROUGHT ON SITE? IF YES,SITE ADDRESS: WILL EXCAVATED MATERIAL BETAKEN OFF SITE?IF YES,SITE ADDRESS: (J U DOES FILL CONTAIN POTENTIAL HAZARDOUS MATERIALS? YES❑ NO HAS A SOILS REPORT BEEN COMPLETED ON SITE?IF YES,INCLUDE A COPY. YES❑ NO WILL PROPSAL RESULT IN REDIRECTION OF ANY SURFACE WWATER RUNOFF? YES❑ NO WILL WORK ALTER WHERE STORMWATER OF GROUND WATER ENTERS OR EXISTS THE SITE? YES❑ NO WILL QUALITY,QUANTITY OR VELOCITY OF STORM/GROUND WATER BE ALTERED? YES❑ N014 WILL THE RUNOFF BE COLLETED/CONTROLLED BY INTERCEPTORS,CURTAIN DRAINS OR OTHER DEVICES? YES IZ NO❑ WILL THE LAND BE REPLANTED UPON COMPLETION? YES❑ NO WILL THE PROPOSAL RESULT IN SLOPES STEEPER THAN THOSE CURRENTLY ON SITE? YES❑ NO IS THE SITE WITHIN 200 FT OF A DESIGNATED SHORELINE OR A WETLAND? YES 14 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 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. CTIVITY OF THIS RMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. x �)•2$- 2-02� tur pii nt Date X AN 1 h UAInj OWNER/REPRESENTATIVE/CONTRACTOR Print Name Wa IRCLE TO INDICATE)