HomeMy WebLinkAboutWaiver of Liability - RLC Inspections - 2/12/2025 GARY YANDO,DIRECTOR
P�oN.srgTFo
M o DEPARTMENT OF COMMUNITY DEVELOPMENT
o N = PLANNING - SOLID WASTE - UTILITIES
7 N Y y BLDG. I • 411 N. 5'ST. * P.O. BOX 578
of 1864 �o SHELTON,WA 98584 • (360) 427-9670
DISCLAIMER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD,
LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS:
The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created
by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's
willingness to proceed with processing of applications which might be affected by that Order, the undersigned property
owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of
Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"permitting
actions'),which damages are attributable to the County's decision to take permitting actions despite the risk that changes
to the County's development regulations might later make the County's permitting actions invalid.
Date (Parcel No. or Legal Description)
Property owner's signature(Notarized)
(or the County may accept the signature of the owner's authorized agent upon proper proof of authorization)
ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL)
STATE OF
COUNTY OF
On this day of , in the year , before me Notary Public,
personally appeared personally known to me to be the person whose name is
subscribed to this instrument, and acknowledged that he/she executed it.
WITNESS my hand and official seal. -For County use only-
Reviewed by applicant on
`D--j rc
(Date)
Notary's signature Staff Initi
My Commission Expires.
RESOURCE LANDS & CRITICAL AREAS CHECKLIST
Permit Number
Owner DI+V//D /�/2 So�f Parcel # �_Z I 610�) 70
❑ 1. Saltwater/Lake 20z Acres
S� C V/ram SMP Designation
Name of Water body
❑ 2. Rivers, streams, or creeks
Type of Water
❑ 3. Lakes or ponds less than 20 acres in size? (Check if yes.) t
❑ 4. Wetlands: Areas that are inundated or saturated by surface water that under normal
circumstances support vegetation adapted for life in such conditions as the following:
Marshes, bogs, and swamps. (Check if yes.)
5. Slopes greater than 15% or 8.50? If yes, degree of slope °
❑ 6. Floodplain? (Check if yes.)
❑ 7. Seismic Hazard Area? (Check if yes.)-
❑ & Aquifer Recharge Area? (Check if yes.)
om rehensive Plan Desi
❑ 9. C nation p g
❑ 10. Other
Wr
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Authorized Signature Date
DRAWINGS & ADDITIONAL FINDINGS
L-
/ -BIIILDING PERMIT # `�� LJ I �J
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Ae
DATE -�> / ~
Planner Area 01�
g00070
CHECKLIST FOR PROPOSED CONSTRUCTION
Yes No
] t l Within 200 FT of designated shoreline, wetland, or
associated wetland
Where?
f ] [ ) Proposed construction on/over/in wetland
Proposed construction within floodplain
�7 Eagle nest
State road access needed
f ) f ] Commercial Development (parking standards, sign
ordinance, public works review, other applicable
agencies)
[ ) [ ] Mobile Home or RV Park
[ 7 [ 7 Exempt from building permit application
I 7 [ ] Exempt from SEPA process (WAC 197-11-305, WAC 197-11-800)
[ l [ ] Meets all requirements (which section(s) of SMP does
proposed construction pertain to?)
[ ] [ I Variance or Conditional Use Permit required
[ ) I ) Exempt from Shoreline Substantial Development Permit
process (Wac 173-14-040)
Exempt from Substantial Development, but within Army
Corp_ jurisdiction (WAC 173 -14-115)
I 1 ( ] Address needed
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BUILDINGG PERMIT #
DATE l
Planner Area
Parcel # _ —Z- Z 13 — 3: 901 V 0
CHECKLIST FOR PROPOSED CONSTRUCTION
Comp Plan
Designation UGA RAC RCC SRA For IH
es No
] [ ] Within 200 FT of SMP designated shoreline, wetlands,
etc. / - './ ,,
Where? /t C (� L�-�J `�
[ ] [ ] Located near possible Critical Area,
What Kind? (Wetlands, Streams, Lakes, Slopes)
[ ] [ ] RLC already done?
[ ] [ ] Proposed construction within floodplain
[ ] [ ] Eagle nest
[ ] [ ] Six year moratorium
[ ] [ ] Multi-Setbacks
[ ] [ l State road access needed
[ ] [ l Commercial Development (parking standards, sign
ordinance, public works review, other applicable
agencies)
[ ] [ ] Mobile Home or RV Park
U7/2b/UU WED 11:50 FAX 3604277798 MASON COUNTY BLD 3 lm001
TX REPORT
TRANSMISSION OK
TX/RX NO 3220
CONNECTION TEL 360 427 0327
CONNECTION ID
ST. TIME 07/26 11:47
USAGE T 02'39
PGS. SENT 5
RESULT OK