HomeMy WebLinkAboutExpidite Permit - BLD Letters / Memos - 8/22/2005 MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT ;
Permit Processing/Inspections/Addressing
Mason County Bldg. III 426 W.Cedar MASON C," -,ATY
P.O.Box 186 Shelton,WA 98584
(360) 427-9670 Belfair (360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968
REQUEST FOR BUILDING PERMIT EXPEDITION
NAME: �' L�r� rzl51S ,Sf4 /� L`��
MAILING ADDRESS f� ''� Na STAy
CITYTE�zIP_
PARCEL: 12 7 % 2 - D L 2 /U
LEGAL DESCRIPTION:
SITE ADDRESS:
REQUEST DUE TO: MEDICAL CONDITION FIRE OTHER-
EXPL6NATION OF HARDSHIP: C
< S
STD
MUST INCLUDE SUPPORTING DOCUMENTS. THIS MAY BE A LETTER FROM A
DOCTOR INSURANCE CLAIM REPORT OR REPORT OF FIRE DAMAGE FROM
APPROPRIATE FIRE REPRESENTATIVE.
I (WE) UNDERSTAND THE INTENTION OF THIS FORM IS TO DETERMINE AND
DOCUMENT JUSTIFICATION FOR EXPEDITION OF A BUILDING PERMIT TO ALTER
OR RECONSTRUCT A RESIDENCE ON THE ABOVE NAMED PROPERTY.
SIGNATURE OWNER/AGENT:
OFFICIAL USE ONLY
ENVIRONMENTAL HEALTH
BUILDING DEPARTMENT PLANNING DEPARTMENT DEPARTMENT
APPROVED ❑ APPROVED ❑ APPROVED ❑
DENIED ❑ DENIED ❑ DENIED ❑
SIGNATURE SIGNATURE SIGNATURE
PERMIT NO.: --_
DATE RECEIVED:
MASON COUNTY
n DEPARTMENT OF COMMUNITY[� DEVELOPMENTREC�2 G RESOURCE ORDINANCE (Chapter 17.01 MCC) -
y b 411 N. 5TH Street/P.O. Box 279, Shelton, WA 98584
�L AUG 2 , �
I MASON
/4 ENVIRONMENTAL PERMIT APPLICATION
MASO ENVIRONMENTAL PERMIT L�' CONDITIONAL USE U VARIANCE u
The purpose of the Resource Ordinance is to protect Mason County's natural resource lands and critical
areas and is under the authority of Chapters 36.32, 36.70A, 39.34, 58.17, 76.09, 84.33, 84.34 and 90.58
RCW.
PLEASE PRINT
1. �
Owner: /1' A (�5 C Own
�h n er Mailing Address:
Site Address: _
'ZR Old D r! Q &Z/�.4 • /-1 ti City: K 1 i:6 i ?Y. State: Zip: Z
City: !;'t/- ,/L State Y24 Zip:aE2ALien/Title Holder
Phone: Daytime(�4,0 ) �7
Address: ig )14 f/C
Fire District#: .3
City: State:�Zip:
Signature:
t,
2• Parcel Number:IPj / 7 - - 0 Legal description: 9 .ill '/z N tA)A/Parcel Size:
3. Directions to site:
<;12
'-State what sections require a permit: In-Holding Lands,Chapter 17.01.062 U
4. Long-Term Commercial Forest,Chapter 17.10.060 U Wetlands,Chapter 17.01.070
Mineral Resource Lands,Chapter 17.01.066 LI Frequently Flooded Areas,Chapter 17.01.090 U
Aquifer Recharge Areas,Chapter 17.01.080 U Landslide Hazard Areas,Chapter 17.01.100 U
Erosion Hazard Areas,Chapter 17.01.104 U Seismic Hazard Areas,Chapter 17.01.102 U
Fish and Wildlife Habitat Conservation Areas,Chapter 17.01.110 U
5.
Identify current use of property with existing improve ents:
o
6.
Identify and describe the proposed project,including the type of materials to be used,construction methods,principle
dimensions and other pertinent information(Attach additional sheets if
needed):
1
V t o t y <" /oa SAG /V- Al
7. Will there be an alteration of a wetland and/or wetland vegetation area? Yes U N01�6�
8. Any water on or adjacent to property:
Saltwater LJ Lake U River LJ 1 Wetland X Seasonal Runoff U
Other 9 10 1 eO
9. If septic is located on project site,include records.
Connect to septic? u Community Septic? U Public Water Supply? LJ Well? U X)o/UE
1 E}c
Type of Job: New LJ Add U Alt LJ Repair
/P�Demolition LJ Other
This permit is granted pursuant to the Resource Ordinance (Chapter 17.01 MCC)and nothing in this permit
shall excuse the applicant from compliance with any other federal, state, or local statutes, ordinances, or
regulations applicable to this project, but not inconsistent with the Resource Ordinance. The permit may be
rescinded pursuant to the event the permittee fails to comply with the conditions of this ordinance.
MASON ENVIRONMENTAL PERMIT: $510.00/$305.00(with another permit)
MASON CONDITIONAL USE ENVIR.PERMIT: $1,225.00
MASON RESOURCE ORDINANCE VARIANCE: $1,225,00
HEARINGS EXAMINER: $490.00
I:\PLANNING\R&GPAC\ENVIRONMENTAL REVISED 01-04-05
Show the following on the site plan `7,, /V
Lot Dimensions Flood Zones
Existing Structures Fences
Water Lines Driveways
Drainage Plans Shorelines
Septic System Topography Indicate Directional by (N,S,E,W,etc.)
Proposed Improvements Easements In relation to plot plan
Name if Flanking Street
APPLICANT TO DRAW SITE PLAN BELOW: N®,
amFAO C>Ae 4 7/1 g
11
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APPLICANT TO DRAW TOPOGRAPHY BELOW: lY��
1
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DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
COMMENTS
Planning:------------------------------ -------- ------ - ---
Environmental
Health:------ ------------------------------------------ -- --
Building Plan
Review: --- ----- ---- ----- ----- ---- ---
Occupancy
Group:---
Fire Marshal:
Other:
Conditions: FEES
Accepted by: ----—-------- — ------------------Date: -------—-----------
4ASON COUNTY RESOURCE ORDINANCE July 2003
LIST OF ADJACENT PROPERTY OWNERS
WITHIN 300 FEET OF YOUR PROPERTY BOUNDARIES
FOR CONDITIONAL USE AND VARIANCE
Addresses are to be obtained from the Mason County Assessor's Office, Bldg. 1, Second Floor.
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KASON COUNTY RESOURCE ORDINANCE July 2003
Publication cost is the responsibility of the applicant. Final permit processing will not occur until
advertising fees have been paid to the newspaper by the applicant. The Shelton-Mason County Journal
will bill the applicant directly.
/WE understand that I /WE must sign and date the attached acknowledgment indicating and that I /
WE understand that is MY / OUR responsibility. I / WE must submit the signed page as part of
application in order for it to be considered as complete.
? 2. O
DATE
O ER 47
APPLICANT
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