HomeMy WebLinkAboutBLD2008-00169 Final Detached Garage DDR2008-00084 - BLD Permit / Conditions - 9/4/2008 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2008-00169
OWNER: WILLIAM PETERSON RECEIVED: 2/14/2008
CONTRACTOR: HILINE HOMES LICENSE: HILINH`981BT EXP: 2/10/2010 ISSUED: 4/4/2008
SITE ADDRESS: 1611 NE TAHUYA BLACKSMITH RD TAHUYA EXPIRES: 10/4/2008
PARCEL NUMBER: 223305000239
LEGAL DESCRIPTION: HAVEN LAKE TR. 239
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
Detached Garage. Collins Lake entrance at fire station. Main road to Lake View
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: 1 Occ. Load: Building: Garage-Detached 720
Valuation: Building Height: Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: E 10.0 Ft. Shoreline: Ft. Water Body: None
Rear: W 211.0 Ft. Slop Ft. SEPA?: No
Model: Width: Ft. Side 1: S 21.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: N 35.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Q Y. Type By Date Amount Receipt
Plan Check Fee KKK 2/14/2008 $208.81 S22008000
Building State Fee MAL 2/15/2008 $4.50 S22008000
Building Permit Fee MAL 2/15/2008 $321.25 S22008000
EH Plan Review TW 2/26/2008 $40.00 S22008000
Total $574.56
BLD2008-00169 Please refer to the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2008-00169
CONDITIONS FOR
BLD2008-00169
1) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150' from an approved
access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such roads nnect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X t.f f
2) 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
1-800-647-Q . The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X (�
3) Approved p�err�mensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
4) 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
Department prig to any further inspections being performed or approvals granted.
5) Owner/Agen t jS responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
6) 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
removal of approved documents will result in failure of required building inspections.
X �(1 `
7) This structure is approved as un-heated space. If at any time this building is to be used for anything other than what it is approved for, a change of use
permit shall bed applied for, reviewed and approved prior to the change.
X
8) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
BLD2008-00169 Please referto the following pages for conditions of this permit. 2 of 5
9) The "approved" 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
approval 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
Building Department prior to any further inspections being performed or approvals granted.
X G_, i
10) Per 2003 IRC - SECTION 1609 -WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BASIC WI 'NVPEED (3-SECOND GUST) the wind speed for Mason County is 85 MPH.
11) Per 2003 IRC - SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
X cordanCce.yvith the applicable provisions of this section and the manufacturer's installation instructions.
12) 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/contractor is acknowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X jJ
13) The use, handling and storage of hazardous ma gals or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of
the Mason County Fire Marshal. X Q IT
14) 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
international codes and Mason County Regulations unless a "Change of Use" permit is applied for, reviewed and approved.
X
15) 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
charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
X
16) 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 �eyocatigr).
X U -
BLD2008-00169 Please referto the following pages for conditions of this permit. 3 of 5
17) Provisions for surface/subsurface 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 located 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 project.
X (
18) Placement of structure must comply with standards set forth per the international codes regarding descending and/or ascending slopes.
X "i
19) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
X
rdinance r reguP
on, must be reviewed and approved by Mason County prior to construction.
20) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
X Inspector ally made prior to requesting additional inspections.
21) All property lines shall be clearly identified at the time of foundation inspection. X <
22) 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
Mason County ordinances and building regulations.
X
23) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have prQvented action from being taken. No more than one extension may be granted.
X C& {
24) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material.
X uJ f
25) Retaining walls needed to support a surcharge 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) 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 Site Ian" to ensure these structures are shown and meet the setback conditions listed.
X ` .
BLD2008-00169 Please referto the following pages for conditions of this permit. 4 of 5
27) `Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X
28) Water quality is not to be degraded to the detriment of the aquatic environment as a result of this project.
X
29) Prior to final approval, all upland areas disturbed or newly crept,e,d construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X C
30) All construction and demolition debris must be removed from the beach after project completion. Proper di Sal of construction debris must be on land
in such a manner that debris cannot enter or cause water quality degredation of State waters. X ?/
31) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are requiry5for this proposed development and
construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X L-4 f—
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at anytime after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described property
/and structure/for rev`lqw and inspection.
OWNER OR AGENT DATE:
BLD2008-00169 Please referto the following pages for conditions of this permit. 5 of 5
0 % CONCRETE MECHANICAL MANUFACTURED HOME m
Date
N �
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C) Footings /Setbacks Gas Piping By Ribbons M
90 o Interior Date By Interior-Date By Date By N
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0) Exterior Date =/�j-4� By TA Exterior-Date By
Set-gyp Z
INSULATION
Point Load!Isolated Footings Date By
BG 1 SLAB INSULATION _..__......_..._..___...
Date By Data By FIRE DEPARTMENT r
Foundation Walls Floors Date By D
Date By T/Z Data By DECKS
FRAMING walls Date By
Date . ® B Data By PROPANE TANKS
PLUMBING Vault Data By
Date By OTHER
Groundwork attic
Type:
Data By Date By Date By
D.w.v DRYWALL Type-
Date
Brace Wall Date By a)
Date By Date By FINAL INSPECTION 0
fD Water Line Fire Seperation C
d
Date By Date By Date
m 90
Pass or Request Inspect. c
0 Type of Insp. Fail Date Date Done By Comments
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Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
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Mason County Bldg. III 426 W. Cedar P.O. Box 186
Ir Shelton,WA 98584
flo
RESIDENTIAL BUILDING PERMIT BLD2008-00169
OWNER: WILLIAM PETERSON RECEIVED: 2/14/2008
CONTRACTOR: HILINE HOMES LICENSE: HILINH"981BT EXP: 2/10/2010 ISSUED: 4/4/2008
SITE ADDRESS: 1611 NE TAHUYA BLACKSMITH RD TAHUYA EXPIRES: 10/4/2008
PARCEL NUMBER: 223305000239
LEGAL DESCRIPTION: HAVEN LAKE TR. 239
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
Detached Garage. Collins Lake entrance at fire station. Main road to Lake View
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: 1 Occ. Load: Building: Garage-Detached 720
Valuation: Building Height: Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: E 27.0 Ft. Shoreline: Ft. Water Body: None
Rear: W 211.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: S 2 1.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: N 35.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Plan Check Fee KKK 2/14/2008 $208.81 S22008000
Building State Fee MAL 2/15/2008 $4.50 S22008000
Building Permit Fee MAL 2/15/2008 $321.25 S22008000
EH Plan Review TW 2/26/2008 $40.00 S22008000
Total $574.56
BLD2008-00169 Please referto the following pages for conditions of this permit. 1 of 5
17) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
a 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 located 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 Xproject.
18) Placement of sructure must comply with standards set forth per the international codes regarding descending and/or ascending slopes.
19) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
Xrdinance 6 reguj�ion, must be reviewed and approved by Mason County prior to construction.
20) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shallb@ made prior to requesting additional inspections.
X ram%
21) All property lines shall be clearly identified at the time of foundation inspection. X LL//6
22) 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
Mason County �iinances and building regulations.
23) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
(older�e prevented action from being taken. No more than one extension may be granted.
24) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors a flashing. Install metal connectors approved for contact with the new es of pressure treated material.
�1 9 PP types
X C,_j 1/
25) Retaining walls needed to support a surchargg such�S structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X � f�
26) 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 Sie n"to ensure these structures are shown and meet the setback conditions listed.
X
BLD2008-00169 Please referto the following pages for conditions of this permit. 4 of 5
9) The"approved" 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
approval 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
Building De�ftr nt prior to any further inspections being performed or approvals granted.
10) Per 2003 IRC - SECTION 1609-WIND LOADS- 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BASIC WIN PEED (3-SECOND GUST)the wind speed for Mason County is 85 MPH.
X
11) Per 2003 IRC -SECTION R905- REQUIREMENTS FOR ROOF COVERINGS- R905.1 Roof covering application. Roof coverings shall be applied in
accordance,yvith the applicable provisions of this section and the manufacturer's installation instructions.
12) 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/contractor is ac olaWedging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X jjJJ
13) The use, handling and storage of hazardous ma�{ials or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of
the Mason County Fire Marshal. X Q., 5
14) 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
international codes arA Mason County Regulations unless a"Change of Use" permit is applied for, reviewed and approved.
X 47
15) 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
charged and shall bespllected by the Building Department prior to any further inspections being performed or approvals granted.
X if t/
16) 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 �evocatiqq.
X �
BLD2008-00169 Please referto the following pages for conditions of this permit. 3 of 5
CASE NOTES FOR
BLD2008-00169
CONDITIONS FOR
BLD2008-00169
1) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved
access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such roads c�nnect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X (.
2) 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
X 800-647-TY. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
3) Approved perrnensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X ti.)
4) 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
Department prigr,to any further inspections being performed or approvals granted.
5) Owner/Agent' responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X lc )
6) 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
removal of apNoved documents will result in failure of required building inspections.
X�,,i V
7) This structure is approved as un-heated space. If at any time this building is to be used for anything other than what it is approved for, a change of use
permit shall b�applied for, reviewed and approved prior to the change.
X
8) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
BLD2008-00169 Please referto the following pages for conditions of this permit. 2 of 5
27) • Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X t �
28) Water quality is n
x L} to be degraded to the detriment of the aquatic environment as a result of this project.
29) Prior to final approval, all upland areas disturbed or newly crepte�d gyconstruction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X C- -ti
30) All construction and demolition debris must be removed from the beach after project completion. Proper di al of construction debris must be on land
in such a manner that debris cannot enter or cause water quality degredation of State waters. X LC/
31) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are,teq'irod,for this proposed development and
construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X c-c 1 -�
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described property and tructure for Nva inspection.
OWNER OR AGENT: "1/ DATE: Q
BLD2008-00169 Please referto the following pages for conditions of this permit. 5 of 5
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MASON COUNTY PERMIT NO. w
BUILDING
U DING PERMIT APPLICATION aC�
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467• Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATIO CONTRACTOR INFORMATION
Owner 0 ,1 A, e. t- d'1/1 Company Name J4• 1-'r'h'P_ 1-4 o-wm eS
Mailing Address t l Maili g Address O 'I
City Stat SeA Zip Code City Q ' rr State SN I ca. Zip Code CARS
Phone ��-215- other Ph. Phone 3 Go- 7 -! . Ot r Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic.# PETE I442S KS DOB 15- 0 Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic )�,. Existing Septic
Connect o Water System Name of Water System
Well Water System Name of Water S to
PARCEL INFORMATION - 12 Digit Parcel No. '- Fire District
Legal Description
Site Address(Plea,w include street name,fret num r and i ) /
Directlo s to site uo-1) �'T e -n -1 0 f'
`7`h-� e 0 306, ,-A;5rE'
lWilKimber be cut and sold in parcel preparation. Yes/ I�
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff _Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - w d Alt Repair Other P AR R ID C t4 SEASONAL ❑
Use of Building - Describe Work
No. of Bedroom . of Bathrooms Square Footage- 1 st Floor 2 n d or
3rd Floora�ement Deck Covered Deck Other Sq. ft.
Garage X ached Detached _X_Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/No
Installer Name Certification 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 the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties. If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate land grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF ONTI A K IS BY MEANS OF A PROGRESS INSPECTION.
X Date:
Owner/Owners Representative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPRO D DENIED NOTES
Building Department L
Planning Department
1 7-
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Buildinq Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee Sao
Violation Fee Pre-Paid at Submittal Zola
Valuation $ 100( TOTAL FEES
t
TO BE KEPT IN THE
MASON COUNTY
PARCEL FILE
DEPARTMENT OF COMMUNITY DEVELOPMEWI
411 N. Fifth Street/P.O. Box 186, Shelton WA 98584
360.427.9670 ext. 352
Rec'd by
Request for
Administrative Variance for Reduction in the Required etb�cks ($105.00)
For administrative review, the minimum variance on a setback nest is 5 feet
from the side yard lot lines and 10 feet for front and rear lot lines or any access
easement. Request for further reduction requires a standard variance.
Setbacks are measured from the furthest projection of the structure including
roof eaves. t
Applicant/Owners: ..Lill
Mailing Address: 2C, i t C'J
Telephone : ,3 C, l - `4 6 Cam` 4
City: State: Zip:
If this reduction is tied to a building permit, please iv permit
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Parcel Numbers ._ y "
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nested variance:`Fr / Side Yard,. (please circle all that apply)
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Requested setba k var Cance: Is- ft.
An illustrated site plan is required.
Your site plan must show the following: north arrow, abutting street or
easements, set backs to all property lines and existing buildings, slopes, surface
water, wetlands, critical areas, septic, well and driveway. Show all proposed new
development.
The follows circumstances must apply:
FRONT AND REAR YARD REQUIREMENTS:
1) Existing lots (record as of March 5
You must meet one ot`tbe followin �{Please circle all that apply)
2) One of the following�x slstts.ofi the lot:
steep slopes, wetlands,jor'st?e s present;
oils that restrict byilding or septic- development;
c) lot width at thp:front yard line of no more-than 50 feet;
lot size of n'o'more than one-fourth acre; '>..,
e) xisting improvements of buildings, septic syst r�ti 'and well areas.
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SIDE YARD REQUIREMENTS:
1) Existing lots of record as of March 5, 2002;
You must meet one of the following. (Please circle all that apply)
2) One of the following exists on the lot:
teep slopes, wetlands, or streams present;
b oils that restrict building or septic development;
c) lot width at the front yard line of no more than 50 feet;
d_) lot size of no more than one-half acre;
,4);i)existing improvements of buildings, septic systems, and well areas.
Explain how these circumstances preclude a reasonable development proposal
from meeting the setback standard for Rural Residential 2.5, 5, 10, or 20 zones.
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Owner/Agent(please indicate)
Signature and date
Official Use On
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Approved �` Date
Denied Date
Reason for denial:
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