HomeMy WebLinkAboutBLD2008-01358 Final MFG Home DDR2008-00204 - BLD Permit / Conditions - 6/23/2010 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
Irflo Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2008-01358
OWNER: MICHAEL MARTIN
CONTRACTOR: D B & R LICENSE: DBRIN**044JQ EXP: 4/10/2010 RECEIVED: 11/6/2008
SITE ADDRESS: 1521 NE HAVEN WY TAHUYA ISSUED: 1/22/2009EXPIRES: 7/22/2009
PARCEL NUMBER: 223305000350
LEGAL DESCRIPTION: HAVEN LAKE TR. 350
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
Manufactured Home N SHORE RD FROM BELFAIR, R ONTO BELFAIR TAHUYA RD, R ONTO
HAVEN LAKE L ONTO NE HAVEN WAY. PROPERTY ON R, BEHIND WOOD
FENCE
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 2 Type of Constr.: VB
Type of Use: MH Insp.Area: No. of Bathrooms: 2 Occ. Group: R3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:
Valuation: Building Height: Occ. Status: Primary Basement
Manufactured Home Information Setback Information Shoreline&Planning Information
Make:Oakwood Length: 44 Ft. Front: E 10.0 Ft. Shoreline: Ft. Water Body: na
Model:BVC443F Width: 27 Ft. Rear: W 4 .0 Ft. Slope: Ft.
SEPA?: No
9
Side 1: S .0 Ft. Shoreline Desig.: Not Applicable
Year:2008 Serial No.: Side 2: N 30.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Mobile Home Submittal Fee KKK 11/6/2008 $247.00 S22008000
Mobile Home Submittal Fee KKK 11/6/2008 $247.00 S22009000
EH Plan Review KKK 11/6/2008 $40.00 S22008000
Water Adequacy Plan Review KKK 11/6/2008 $40.00 S22008000
Address Fee KKK 11/6/2008 $162.00 S22008000
Planning Review Fee KKK 11/6/2008 $190.00 S22008000
Mobile Home Issuance Fee MAL 11/7/2008 $247.00 S22009000
EH Plan Review ADR 11/17/200 $60.00 S22009000
Total $1,233.00
BLD2008-01358 Please referto the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2008-01358
CONDITIONS FOR
BLD2008-01358
1) Approved di ensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X 71,
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 800-64� §J 4e person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
3) 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 caRo-�Jt with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X
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-p<o{tany further inspections being performed or approvals granted.
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5) Owner/Ag t is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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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 o p[pv d documents will result in failure of required building inspections.
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7) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
8) 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.
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BLD2008-01358 Please refer to the following pages for conditions of this permit. 2 of 5
9) Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State
Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present
to,supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified
installer responsible for each major part of the installation. RCW43-63B.090
An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily
located in plain site within three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each
installer performed or k stalled. certification number and signature of the certified installer responsible for each major part of the installation.
WAC365-210 X c
10) If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American
National Standards Institute (ANSI). To order the ANSI instructions you may either get an order form from the Mason County Building Department or you
can contact ice of Manufacturing Housing (360) 725-2800.
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11) 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 PEED (3-SECOND GUST)the wind speed for Mason County is 85 MPH.
X
12) Per IRC -SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
accordanc applicable provisions of this section and the manufacturer's installation instructions.
X
13) 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 i c ledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
14) 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 r o ti
X
15) Lake Cushman La is designated with a 551b snow load rating. The owner/agent of this permit acknowledges that if the unit permitted under this permit
does Ktoq the recommended snow load rating, there is a potential for failure due to weight accumulation beyond that of the design criteria.
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BLD2008-01358 Please refer to the following pages for conditions of this permit. 3 of 5
16) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all
responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the
inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason
County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been
discovered. I further understand that this investigation will be schedule a allows. Until resolution of any/all problems no occupancy(Final
Inspection)will be granted for the residence.
OWN ER/CONTRACTOR(indicate which) Signature X
17) This permit is f e lacement and installation of the manufactured home only and does not imply approval or review for any other items indidcated on
the plot plan. X
18) 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 S WIr
19) Placemen of structure must comply with standards set forth per the international codes regarding descending and/or ascending slopes.
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20) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
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21) 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 sy, e made prior to requesting additional inspections.
X
22) The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including
installation instructions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be
clearly n1r
in the installation instructions.
X
23) All property lines shall be clearly identified at the time of foundation inspection. X aiz
24) 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 A
ordinances and building regulations.
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BLD2008-01358 Please refer to the following pages for conditions of this permit. 4 of 5
25) 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 evented action from being taken. No more than one extension may be granted.
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26) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connect nd flashing. Install metal connectors approved for contact with the new types of pressure treated material.
X
27) Retaining walls needed to support a surchfw such as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
28) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/ Reserve requires a 1 Oft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. No fou n drains within 30ft, down gradient of drainfield/reserve area.
X
29) Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X l�► �
30) Xpplic�l�gq acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Residential 5.
31) Owner m st ow proof of satisfactory water sample and well log prior to temporary/ permanent occupancy of the residence.
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32) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approv ,P�an"to ensure these structures are shown and meet the setback conditions listed.
X
33) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan" to ensure
these structures meet the setback conditions listed.
X
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 i tion.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 up L 5nd struc ore an inspection.
O
OWNERORAGENT: DATE: L 3"
BLD2008-01358 Please refer to the following pages for conditions of this permit. 5 of 5
C0
o CONCRETE MECHANICAL MANUFACTURED HOME
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0 Date By
CP Footings I Setbacks Gas Piping Ribbons
CD Intenor Date By Interior-Date By Date Ely
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Cn Exterior Date By Exterior-Date By Set-up
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Point Load/Isolated Footings INSULATION Date By
BG I SLAB INSULATION
Date By Data By FIRED EPARTMENT >
M
Foundation Walls Floors Date By
Date BY Data ay DECKS
FRAMING Walls Date By
Date By Data 13Y PROPANE TANKS
PLUMBING Vault Data By
Data By OTHER
Groundwork Attic
Date By Date By Type
Data By
D.W.1v DRYWALL Type-
Date By Int Brace Well Date By
Date By
FINAL INSPECTION
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Water Line Film Separation
Date By Date By Date Z- --Z3 CD
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0 Type of Insp. Fail Date Date Done By Comments
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(4) Singulair UV disinfection unit.
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PLO( k_ L A. tdAPPROVED3.• �
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0 W M E JZ-' M iGN AC tIARTiWASO �
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BE ON SI DESIGNER
PAGE OF PAGES CHANGES SUi3,,LCT TO APPROVAL • i
✓� XPOtRES
---_ Date N Za
Name NIB 1-4 Parcel# o?, :W--�0— 00 30 BLD#
Mason County TO B KEpr r
Department of Community Developments N TN
Small Parcel Stormwater Management Application/Worksheef ( 1-nf j 'r C
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 surfaces,structural development
including construction, installation or expansion of a building or other structure, and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'Common 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 r,
Buildings All X
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections (example:
eaves/gutters)
X =
Driveways Q X
X = Length of drive begins at the right of way .
X =
Parking Areas X =
X = Any paved, gravel or packed area per definition
X _ above table
Patios=alks X =
X = Any paved, gravel or packed area per definition
X _ above table
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Smaii Parcel Stormwater Site Plan is Required
Total Impervious Surface Area (sum of all areas) ®'D
If the Total Impervious Surface Area is LESS 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 1 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-
describe operty for review and bispection as may be required. 7
XA 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
Name - YL Parcel# 43 -WJV� 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
P
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
http//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) 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 sign re below. 1 declare that I am the owner,owner's legal representative,or the contractor. 1
further acknowledge the'a€e atio provided is accurate and employees of Mason County are granted access to the above-
des a pe for revs an spe ion may be required.
X Owner/Agen eol?tract
circle one)Date:
Page 2 of 2
FROM (WED)MAR 12 2008 13:55/ST, 13:54/No, 6820026609 P 2
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ALL OF THESE INCREDIBLE FEATURES ARE INCLUDED
• Upgrade Exterior Design including 16' Gable
w/accent Columns
• 16" Eave over Front Door Sidewall
• Picture Frame style Oak Cabinets through out
• Ceramic Tile accent Edge and Splash in Kitchen
• General Electric Dishwasher
• Glamour Style Master Bathroom
• Rounded Drywall Corners
• Fiberglass Tub/Shower Guest Bath
• Washer/Dryer Overhead Cabinet Utility Room
FROM (FR O SEP 19 2008 16:00/ST. 16:00/No. 6820026476 P 2
SALES ACREEMENT`. CMH Ilomes,Inc.
CUSTOMER NO. 110 Box 9790
DA`rl:: MaryvilleyTN 376VZ
DUYLN(J): t r y C Q_I iJ� �t ✓1 SSN:
ADDRESS: r .
nr.uVFnv Annac.cr. r�SY S ,b e Yl W ak-1 e,P
1 ELEPHON°: V —I �' SALES PERSON:
BASE PRICE: S 57 1* 5 7 y Make:_ AA UA00 b Model:—92
Dealer Prep S Year_afl—L.cngth Width p7__9,y___Stock#
Sua-TorAL S / Senal No. ❑New 0 Used
Sales Tax S 4_�U y'Ll TRAne: Makc: Model:
S Year _ Length Width _ Title#
S Serial No.
S Amount owed will be paid by. ❑ Boyer ❑ Seller
1. CASIt Patce $ �7p11 Owed to:
Trade Allowance S
Less Amount Owed S OlmoNs: L P vt t�a r 51 U e 0-
Trade Equity $ S �! `` ^
Cash Down Payment S L:1 L, LLIf Lt U t PA `� C
Other Payments S _..
2. LPss ALL CRrawri S SELLER RESPONSIBILITIES:
3. REmAININC BALANCE $
EST/MArltD MoxrrACE.Buyer is voluntarily purchas-
ing any insurance products listed below.All numbers
are estimated.
A. OtherChargcs BIuv RESPO
NSIBILITIES; sue O o�
Property Insurance S
Credit Life lnsuranec S
H13PP S
Title Nees $ May not meet local codes and starudardr. New homes meet Federal
License Fees S Manufactured Home Standards.
S Buyer(s)agree:(1)that the terms and conditions on.page two arepart of:
this agreement;(2)to purchase the above homeducluding the`optibns;.-
S (3) they received and acknowledge receiving a completedxopy tittliis'
agreement;(4)that all promises and representations oradcsietsted;:on`i
S this agreement;and(S)there are no other agreements,written w venrtial..
'1MAI, $ unless evidenced in writing and signed.by the parties.
B. Unpaid Bel./Amt. finunced(3 A)$ _ eLlgr: ,�= Buyer:
C. Interest Rate % _ X
�._ IM[YW 1
D. Finance Charge S
X
E. Total of Payments(B+D)
F. Total Sales Price(ItA*n) $ X
G. Number of Payments#
X
H. Payment Annount S__ . ., t°�'•^>
Thu is not a loan commitment.
Mute State Sales Agreement•Pad 100'e Page 1 CMH1179
UMMm- HARD COMPLETED IN INK MASON COUNTY PERMIT NO. I Jv
r, BUILDING PERMIT APPLICATION C, I 1 �
ND 0,5 426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton 360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
4 t -5 Wd O3(0-5 On the web www.co.mason.wa.us
APPLICANT IN ORMATIO CONTRACTOR INFORMATION
Owner I mc" t vn � Company Name Qk5'-
Mailin d�d�e�s 'fS QUC Mailirlg,Acfdrrss l/Lf ,Sh A
City 7 'f State Zip o e City( c �, State Zip Code
Phone o471 Other Ph. Phone C�' T17 Other Ph.
Lien/Title Holder Contractor Reg. #M Oy440 Exp.
E mail address E Mail Address
Drivers Lic. # DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION Connect to New Septic Existing Septic
Connect to ter System Name of Water System
Well Sewer System Name of Sewer System U o-3 5 C)
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Ple elude treeq name, stre nu �r and city) �'y We4 if 4r►''
Directi ns site {-o �,�G► !fie CLX r`r r m eS
CAA
Will timber be cut and sold in parcel preparation?Yes
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?Yes/No
TYPE OF JO - New dd Alt Repair Qjher PRIMARY ESIDENCE P SEASONAL ❑
Use of Building +' ( K escribe ork- � «thy Neu) �� `r'�` 1'-e
No. of Bedroom No. of BathroomsaLSquare Footage- 1st Floor_lo'OhD 2nd Floor
3rd Floor Basement Deck- Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED H'OOME INFORMATION - Make Vq6 Model X yg33r Year gL'
Length yq ,�Vidt�Serial No. �30 No. of Bedrooms No. Bathrooms ._
Type of Heat u chase Price $ 0 � ' Replacement Unit? Ye
Installer Namer 11 Certification No. d
OWNER/BUILDER ckn wledges 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 and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is
not corn enced within 180ays or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
M OF S ICTIO VITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X Date:
Owner/Owners Repre 4
ntative/Contractor (indicate which one)
FOR OFFICIAL USE BE OND THIS POINT Accepted by: Date _ �Q
DEPARTMENTAL REVIEW APPRO D DENIED NOTES
Building Department It p
Planning Department
Environmental Health Department J
Fire Marshal
cR- FEES
Building Permit F 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
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
• r
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
411 N. Fifth Street/ P.O. Box 186, Shelton WA 98584
360.427.9670 ext. 352 \ C c7 4 D D R dam.
Rec'd by
Request for
Administrative Variance for Reduction in the Required Setbacks ($105.00)
For administrative review, the minimum variance on a setback request 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.
Applicant/Owners:
Mailing Address:
Telephonecity.. State:_ Q,'- i State: T� Zip:
If this reduction is tied to a building p-er,mit, please. i _e permit
case number. BLD r -C- G I �� •
Parcel Number(s): � D 3 j 0 -- 5 U- oa 3 50 Zoning
Site Address: 15,�,l&F
Requested varianc : Front Rear/ Side Yard (please circle all that apply)
Requested setback variance: 10
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 following circumstances must apply:
FRONT AND OR REAR 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:
a) steep slopes, wetlands, or streams present;
b) soils that restrict building or septic development;
c) lot width at the front yard line of no more than 50 feet,
lot size of no more than one-fourth acre;
e) xisting improvements of buildings, septic systems, 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 Iot-
a) steep slopes, wetlands, or streams present;
b) soils 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;
e) 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.
AD 1 C11PIC01
c Lt (a� S I Z z iLJ C ( f Q ,� ✓ 0 2-
S--e (OGC'C 4d— �^
Owner/Agent (please)ndicate)
Signature and date
Official Use Only
Approved ate
Denied Date
Reason for denial:
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