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HomeMy WebLinkAboutBLD2014-00378 Final Garage - BLD Permit / Conditions - 12/19/2014 ft+ inspection Line tanu)4zi-tzaz MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352 Mason County Bldg. III 426 W. Cedar P.O. Box 279 Shelton, WA 98584 i� RESIDENTIAL BUILDING PERMIT BLD2014-00378 OWNER: KENNETH KROHN RECEIVED: 4/25/2014 CONTRACTOR: LICENSE: EXP: ISSUED: 6/12/2014 SITE ADDRESS: 550 NE LAKE RIDGE DR BELFAIR EXPIRES: 12/12/2014 PARCEL NUMBER: 223047600020 LEGAL DESCRIPTION: TR 1-13 OF SURV 12/68 TR B OF SP#1629 PROJECT DESCRIPTION: DIRECTIONS TO SITE: GARAGE (24x32) OLD BELFAIR HWY TO BEAR CREEK DEWATTO TO TAHUYA BLACKSMITH RD WHICH WRAPS AROUND ERICKSON LAKE LAKE RIDGE DR IS ALONG THE WEST EDGE OF THE LAKE AND IS ACCESSED FROM THE SOUTH FNn I nST I nT AT FNn nF Rn General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: Type of Constr.: 2n 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: 1 Occ. Load: Building: Garage-Detached 768 Valuation: $ 32,302.08 Building Height: Occ. Status: Primary Basement: Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: W 100.0 Ft. Shoreline: 300.0 Ft. Water Body: Rear: E 390.0 Ft. Slope: Ft. SEPA?: Model: Width: Ft. Side 1: N 20.0 Ft. Shoreline Desig.: Year: Serial No.: Side 2: S 30.0 Ft. Comp. Plan Desig.: Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Plan Check Fee TW 4/25/2014 $306.83 S2201400000001 Planning Review Fee TW 4/25/2014 $205.00 S2 2 0 1 4 00 00 0001 Building State Fee DLC 5/30/2014 $4.50 S1201400000001 Building Permit Fee DLC 5/30/2014 $472.05 S1201400000001 Total $ 988.38 BLD2014-00378 Please refer to the following pages for conditions of this permit. Page 1 of 5 ' CASE NOTES FOR • BLD2014-00378 CONDITIONS FOR BLD2014-00378 1) Cont actor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. The a are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1 -647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) Ow er/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 3) All ap roved 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 noybA 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 D r#ment prior to any further inspections being performed or approvals granted. 4) Ow /Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X i� 5) 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 correcti ns indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Offi . 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 vel Jof approved documents will result in failure of required building inspections. X 6) 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 heating system exceeds 1 watt 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 t e ime of permit application. X 7) TH F UNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL. X BLD2014-00378 Please refer to the following pages for conditions of this permit. Page 2 of 5 .8) —The "a roved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the "approved" site plan is not on site, then app o al will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the BuiliVng Department prior to any further inspections being performed or approvals granted. X 9) A minimum of 75 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance with IECC/WSEC Section R40[L' 1 X 10) 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 t consult with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contracto i knowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. X �— 11) The use, handling and storage of haz r s materials or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fire Marshal. X 12) This s u ure is limited to U-occupancy use only(private garages, carports, sheds, and agricultural buildings.) Any other use will be in violation of the intern I codes and Mason County Regulations unless a "Change of Use" permit is applied for, reviewed and approved. X 13) 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 theret . I documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charg d r shall be collected by the Building Department prior to any further inspections being performed or approvals granted. X --� 14) All cons ruction 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 per i vocation. X BLD2014-00378 Please refer to the following pages for conditions of this permit. Page 3 of 5 5) Hrovisions Tor surface/subsurtace drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the ' stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be 1p g6ted within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your projec X 16) All chang s "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinanc r gulation, must be reviewed and approved by Mason County prior to construction. X 17) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The con truction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with t international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building In p, t r sh be made prior to requesting additional inspections. X 18) All property lines shall be clearly identified at the time of foundation inspection. X 19) All buildinp permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to re e 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 Maso ounty ordinances and building regulations. X 20) All permits xpire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action f period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder revented action from being taken. No more than one extension may be granted. X 21) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT PROP RT ES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM OR R WAY. X 22) App ed per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 23) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure these s r tures meet the setback conditions listed. X BLD2014-00378 Please refer to the following pages for conditions of this permit. Page 4 of 5 24) Landi g and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Appf D ed Site Plan"to ensure these structures are shown and meet the setback conditions listed. X 25) Retaining walls needed to support a sur urge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. X 26) Temporary erosion control measures must be implemented to prevent water quality degradation of adj t waters or properties. Silt fencing, straw, or surface matting must be installed and maintained until upland vegetation has become established. X _ 27) All construction and demolition debris must be removed from the site after project completion. P r disposal of construction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X 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 uthorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and $tru ure(s) for review and inspec ion. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if conftry6tion work is suspendqq fora period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PE IT APP nICATI N O - 8 D S L INVALIDATE THE APPLICATION. Si;na ur4 Date t' \--\.-, A k)�,k REPRESENTATIVE - CONTRACTOR WNER Print Name (Circle one to indicate) BLD2014-00378 Please refer to the following pages for conditions of this permit. Page 5 of 5 ao o CONCRETE MECHANICAL MANUFACTURED HOME A Gas Piping Footings !Setbacks Date By Ribbons = o Intenor Date By Interior-Date By Oate By Z 4 Exterior Date q (� /(� By � Exterior-Date B Set-up nI Point Load!Isolated Footings INSULATION BG!SLAB INSULATION Date By Z Z Date By Data By FIRE DEPARTMENT M Foundation Walla Floors Date By = Date BY Data By DECKS FRAMING Walls Date By Date Z 4 ILI By 0c, Data By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Date By date By Type DateBy D.W.v DRYWALL Tyke Date By Int Brace Wall Date By Date By FINAL INSPECTION p Water Line Fire Separation N CDG O p Date By Oafs By Date I I ` /� By m A s Pass or Request Inspect. c 5 Type of Insp. Fail Date Date Done By Comments w o 00 y o � US6 1`1 � � � I��( C i to�t i u�`� M�.��ar- 6+"t i� �t� '7 ? Tv r.l ti yfn n 3 G a� v f. `° a ' a lz 5 N N O S N .D fD 3 v cn cu 1 0 PLANNING, - - --_ i I -11 I i North Fence SITE P LAN for shed NMI ;Home. I Kenneth Krohn tic �_I ;. 550 NE Lake Ridge Dr Drainti-Ild +� ` Belfair,WA 98528-8720 i -- - -- I EMevation ._ aw constkoftipn; - ___ Scale: 1 box is 20 ft Lot is 220 ft x 660 ft from ` road to lake. I believe Erickson Lake is now a _�-_. _ __ �_. _. _ _ _._. _ _-_ wetland and all space on G. water side of fence (-250 I- R S . g KPEI_ E - .0 D. ft) is left natural. . . I �*1E _ - 540 ff Ca W iII IIiI ! I DIN Vertical scale for elevation a j is 5 ft/box.�. 520 ft 1 New building is 24' E-W 0 and 32 ft S-N. End of she _ Road , , is at least 20 ft from S Slope is 11 ft down 500 ft over�110 ft APPROVED �fr " MASON COUNTY-DCD PLANNING. i. . t_ I. _ ;. L. I E ON 5iC SITE PLAN REQUIRED TO B I i- 1 --I I TOPOGRAPHY PROFILE: ZCH7ANES SUBJECT TO APPJjQV 1 By Do. N o U) w w rY Direction: Scale: Approval:for obits uee CV C__) Q Q Building Permit number. Building: r I C V 0 Owner/Applicant: Krohn Date of Planning: uJ ng� C:... � 11": � U Parcel Number: 22304-76-90010 &90020 application: Env.Health: .;._�I `J' '� CV w W Q �/ CV w �' Name Kenneth Krohn Parcel# 22304-76-9001A&9-a020 BLD# 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 surface 2. 'Redevelopment means,on an already developed site,the creation or addition of impervious d #11 tincludin construction,installation or ex ansion of a buildin or other structure,and/or re la eiat is not part of a routine maintenance activity,and land disturbing activities associated with structural or impervious re eee 2Common 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. To Calculate Impervious Surfaces Please Complete This Table Surface Type Length X Width = Area *All dimensions in feet Buildings 24 X 36 = 864 40 X 52 = 2080 Measurements for buildings are taken at the new bldg 2 4 X 32 = 768 perimeter of the farthest projections (example: eaves/gutters) X = Driveways 10 X 200 = 2000 X = Length of drive begins at the right of way X = Parking Areas X = X = Any paved, gravel or packed area per definition above table X = Patios/Walks 8 X 8 = 64 [''�,_ �T T 2 X 4 0 = g 0 �rL &Lked area per definition X — APR 2 above table Others X = Vv X = f Aal Ai&9%Tea of the proposed site X = development is greater than 2000 square feet a Small Parcel Stormwater Site Plan is Required Total Impervious Surface Area (sum of all areas) 5856 If the Total Impervious Surface Area is LESS THAN 2000LESS THAN 2000 Square Feet,please read,acknowledge and sign below. Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity. 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 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 r Name Kenneth Krohn Parcel# 22304-76-90010 & 90020 BLD# 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: h2R/www.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) xx 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 County's Public Works Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at: Phone:(360)427-9670 EXT.450 Mail:P 0 Box 1850,Shelton WA 98584 Physical:415 N 6th St, Shelton WA 98584 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 furthe a nowledge that the information provided is accurate and employees of Mason County are granted access to the above- desc property for review and ins ectio T y be required. X (!��,Contractor(circle one)Date: , zs 2 Page 2 of 2 Google Maps 3/9/14 10:16 AM 44 dA r • go jw 4w. 4 i ! •• 4& rr * 4t ' w dV tv- It •. i 4 44 sld �.J:• +' -'� `+zk�j��"6!i Sri ��y •� �`rr`-`�%`- ��Cv 'fir- _ _�F` •al1_ ,.J. ''.�'. �i.� -..fi SU • .` -' - Ima}7e y 0. _alGlobe,U S.Geological Survey.Map data`2814 Google 100 ft 1 I n Find a Map > States > Washington > Mason + 59— 1 — USGS Place Name: Erickson L 491 t , „ Q Erickson Lake is classified as a Lai County, Washington. Feature Name: Erickson Lake fi Feature Type: Lake County: Mason T Kr �1 Primary State: Washington f 3 Yr✓'' + i, o h Latitude: 47.5133598 Nt01 y 't V Longitude: -122.9427101 y t I Lr 1 -iJ L 472 Feet abov, Elevation: ; (144 Meters) USGS Quad Map: Holly ,�� 411 L Like G f MyTopo Detailed topographic map of Erickson Lake. r soN cop"��; 1-04 "rr MASON COUNTY PERMIT NO. -- _ DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING•PLANNING•FIRE MARSHAL �Z57C8 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 rasa PO Box 279,Shelton,WA 98584 (360)482-5269 Elma ext.352 BUILDING PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: Kenneth A Krohn NAME: N/A MAILING ADDRESS: 550 NE Lake Ridge Dr MAILING ADDRESS: CITY:_Belfair STATE: WA ZIP:_98528_ CITY: STATE: ZIP: PHONE:_360-372-2894 CELL:_206-790-4333_ PHONE: CELL: EMAIL:_kkrohn@u.washington.edu EMAIL : L&I REG# EXP. PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER)_22304-76-96"and 90020 FIRE DISTRICT_2 LEGAL DESCRIPTION(ABBREVIATED):Lots IA and I of sulYdi `ib2'9 NE qtr of SW qtr sect 4 twnshp 23N range 2W SITE ADDRESS 550 NE Lake Ridge Dr CITYBelfair DIRECTIONS TO SITE ADDRESS_Old Belfair Hwy to Bear Creek-Dewatto to Tahuya-Blacksmith Rd which wraps around _Erickson Lake. Lake Ridge Dr is alogg the west edge of lake and is accessed from the south end. Last lot at end of road. IS PROPERTY WITHIN 200 FT: 14') 0 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 X TYPE OF JOB: NEW x ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(RESIDENCE,GARAGE ETC.)_storage shed--steel sheetmetal from VersaTube kit 24'by 32'on pad IS USE: PRIMARY❑ SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BRM —fvE DESCRIBE WORK strictly unheated storage--perimeter walls and roof but no internal partitions SQUARE FOOTAGE: 9q x&"-7 Y&-Y'CZTL) ' ram- Yoh 1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT �cj�- A R.S T. DECK sq.ft. COVERED DECK sq.ft.STORAGE_768 sq.ft. OTHER sq.ft. GARAnE �.ft. ATTACHED❑ DETACHED x CARPORT sq.ft. ATTACHED❑ DETACHED ❑ e MANUF URED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN MAKE N/A MODEL YEAR LENGTH WIDTH 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 p vided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and' spection.This permiUapplicati n becomes null&void if work or authorized construction is not commenced within 180 days r if onstruc on wpoTk is-Ape Jed r a nod of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSP IN C�TI TY I P IT PLICATION OF 180 DAYS WI INVAL ATE THE APPLICATION. X �� L 2- Sig ture of Applicant �FR o X_Kenneth A Krohn 7/OWNREPRESENTATIVE/CONTRACTOR Print Name (CIRCLE TO INDICATE) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT O- t—I- PLANNING DEPARTMENT FIRE MARSHAL 0 NO elt