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Fall Dale Data Donee By Co ments 4 A4, 27 Z,X2,07- FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. C-On PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 9�Shelton (360)427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR I FORMATI N Owner �1 Company Name Maili Address 3 Mailing Address O fl City tate Zip Code City�2, 1. 1 State Zip Code PhoneOther Ph. Phone%_ -%?J1&-0ther Ph. Li I er 2contractor Reg. Exp. 6 avail address tk5ht Mail Address Drivers Lic.# DOB Drivers Lic.# IV DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic IV Existing Septic Connect to Water System KJ Name of Water System Wel Sewer Syste Name of Sewer Syste PARCEL INFO ATION - 12 Digit Parcel No. r- — Fire District Legal Descriptio Site Address(Pie se include street name, street number and city) .6-- L Directions to site o N0,A `-k-0 C T !►� Fa -rT Will timber be cut and sold in parcel pr ration?Yes Is property within 200'of Saltwater �Lake VIM River/Creek KI Pond M— Wetland_ l f I, Seasonal Runoff�_Stream Slopes or Bluffs > 15% MV 0 Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE cZ - 5 - SEASONAL ❑ Use Describe Work S No. of Bedr oms No. of Bathrooms&quarelFootage- 1stEll o 2nd Floor 3rd Floor Basement Deck vered Deck Other Sq. ftGarage Attached DetachedCarport K Attached Detached KJL�� MANUFACTURED HOME INFORMATION - Make �Il 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. WNER/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 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 commence w'thi 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY M F S INSP TION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: Owner/Own s Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection 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 MASON COUNTY PERMIT NO. ' BUILDING PERMIT APPLICATION 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 INFORMATION CONTRACTOR I FORMATI N Company Name H�� �. - _ 6+ Owner r .r Mailing Address I = Mailing Address 4 - I cat<. `Diz, City t ' State`l' Zip Code ` -� City ( rZ V R r State Zip Code Phone Other Ph. Phone Other Ph. Lien/ itle FTolder ` ` j Contractor Reg. #_f r_ 33_ i7 I - E-mail address r E Mail Address Drivers Lic.# DOB Drivers Lic.# QT.'r� DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic LZA Existing Septic I Connect to Water System' 1 Name of Water System Well ' Sewer SysterL�`, Name of Sewer System \I PARCEL INFO ATION - 12 Digit Parcel No. 7 " 7 ': Fire District Legal Descriptio �, . ,�, � Site Address(Please include street name, street number and city,) r - E �-,, .r `7 r-- Aj _... Directions to site VIaZ�.1 fit- L-r r ,a,� t-, , .t_o`/ ` 'te F r r 'f~..1~? lj ' f rl\ 1 k'.-i `+.�i � �. �..'. � '1�`� �1.�.� _.'.'3.' 1 l �-3��• ."y.� _. I` l,.tFr °" {' Will timber be cut and sold in parcel preparation?Yes No Is property within 200'of Saltwater i.� Lake \ River/Creek Pond '�r Wetland 1 t:., Seasonal Runoff 'Ss 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 - New—Add—Alt—Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of:l5il�i trag Describe Work S ' , :"t k t,/ No. of Bedrooms r No. of Bathrooms '�.;_�`• Square Footage- 1st Floor J. 2nd Floor 3rd Floor Basement Deck Covered Deck z Other ZA Sq ft. k A Garage -�A Attached ' ' Detached ` Carport Attached -� `' Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ if 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 F 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 commenced withi d 180 days of if construction workis suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANq,7F S INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. .- X rr, a Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building 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 Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. C BUILDING PERMIT APPLICATION < �._ 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 l Shelton (360) 427-9670 • Belfair(360) 275-4467 a Elma (360)482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR I FORMATI N Owner� N t_) \kJ �A u t��\`/ "'f 2 V CT Company Name Mail'n Address "'� Mailing Address -T- City State V) A Zip Code City _ State CA Zip Code Phone Other Ph. Phone Other Ph. 6ern? t I e ki�T'E�t f' / - t k C r-P ontractor Reg. #61�2_ � Exp. li:mail address 117, ' ) ^vic_� Q F, 2g� LLkf I4i:_tk J Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM NFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System ki '/ Well Sewer Syste Name of Sewer Syste PARCEL INFO ATION - 12 Digit Parcel No Fire District Legal Descri.ptio Site Address (Ple se include street name, street number and city) ~� Directions to site -' r` I 'T "�'"r` Will timber be cut and sold in parcel pre ration?Yes o I Is property within 200'of Saltwater �Lake River/Creek KN n Pond t- Wetland-- j b Seasonal Runoff _tjC�,. Stream Slopes or Bluffs 15% "0 Is this permit submittal the result of a Stop Work.Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use 1• w Describe Work:hLMT I xI�t ,?` r rs^aS E No. of B�ed�r�oms No. of Bathroom Square Footage- 1st Floor _2nd Floor K 3rd Floor Basement, Deck Covered Deck 'Other x ) Sq. ft. Garage Attached Detached Carport±/ Attached Detached MANUFACTURED HOME INFORMATION - Make Z Z 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 fro7,,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.r mmenced within 180 days or if,construction worlds suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY M F S INSP TION.INACTIVITY OIL THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: �s7—n f� Owner/Own s Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department o0 Planning Department Environmental Health Department Fire Marshal FEES Building Permit.Fee Site inspection Plan Reviewtee t •/ EH Review Fee Plumbing &'Base Fee Plannin Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee f Violation Fee Pre-Paid at Submittal �S j. Valuation $ 30 0 Op TOTAL FEES MASON COUNTY PERMIT NO. A BUILDING PERMIT APPLICATION 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 iAPPLICANT INFORMATION CONTRACTOR I FORMATI N Owner - ,.�t-1-,. V j !(O 4�t?ti. / '"T g ,j t Company Name >G-r IRt�, Mailing Address ( ' (%I '7 Mailing Address City r State\J Zip Code �� '3 City State Zip Code . Phone Other Ph. Phone 4. , 405 1 =q Other Ph. _ �ii--k s �t<-<'� t -contractor Reg.# 7 Ex Lieny' i F�Ider � E>Il�. P• E-mail address at 7 C? ' r\y� Q V� , /L u Imo. u—. • ./Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM)NFORMATION - Connect to New Septic Existing Septic LIZA Connect to Water System Name of Water System KI ZA Well Sewer Systern_N/A&Name of Sewer System— PARCEL INFORMATION - 12 Digit Parcel No: Fire District Legal Descnptiq Site Address(Please include street name, street number and city) Directions to site ( f t-L-`�' o f' *'"'C-01 r I.1 W 4 "i t e '-c f►>i J ST, ram. �►.�" Will timber be cut and sold in parcel pre aration?Yes N Is property within 200'of Saltwater 11D Lake River/Creek .Pond_ Wetland-L-U b 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 - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use ofdhilAiag �Q Describe Work�� ra. J ?,AT) nt 1` r L�-T cz �•1 S No. of Bedr oms��No. of Bathroom Square Footage- 1st Floor--( �r�l� 2nd Floor . 3rd Floor /'�Basement Sje A Deck Covered Deck A Other )h Sq. ft. Garage d Attache —Detached Carport Attached �� Detached �— J MANUFACTURED HOME INFORMATION - Make Model Model Year 1 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 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,commence w thi, 180 days or.if construction worldas suspended fora period of 180 days.PROOF OF CONTINUATION OF WORK IS BY M F S INSP ION.INACTIVITY"OF THIS PERMITAPPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION: X ,.77 Date: . G L Owner/Own rs Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department 0 Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review'Fee EH Review Fee Plumbing &'Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES Cl) D 1. 0 V A n m b� cDi, w ,Dv z,om mA > o a r z ; I1 V: VI Z N - G F n p o v I^ y A o > -G>i - z m o w m D a z r X L y N ZO O A i o 0 o 7 A s rn o c L Z ; G T D S I G 7 T rT G 1'1 OI DD ZA w G 4ln �T U) CD m if n n O ZO � G n Z > Z s O D O DTO SO g X-ev�r 90<JO m SO��Cs- ygy20moDr 8 T)OIAi fln> rs+�10T O SV� O O N Z z xZy z m ~ Z?ZOn r OZZOO x020wr) O OZOWc) T�r 1 -U D A !J O N :. 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EXCEPT THAT PORTION DEEDED TO THE STATE OF WASHINGTON RECORDED MAY 13, 1993 UNDER AUDITOR'S FILE NO. 564736 (ALSO KNOWN AS LOT B OF SURVEY RECORDED UNDER AUDITOR'S FILE NO. 409449, RECORDS OF MASON COUNTY, WASHINGTON. ) PARCEL 2: TOGETHER WITH A 30 FOOT NON-EXCLUSIVE EASEMENT FOR INGRESS, EGRESS AND UTILITIES OVER, UNDER AND ACROSS THE SOUTH 30 FEET OF LOT A OF SURVEY RECORDED UNDER AUDITOR'S FILE NO. 409449, AND OVER, UNDER AND ACROSS THE EAST 30 FEET OF THE SOUTH 150 FEET OF SAID LOT A. TAX PARCEL NO: 12217-22-00032 i I I l i © Alcoa Wireless Services ALCOA 18330 Union Hill Rd Suite 250 Redmond,WA 98052 Phone:426 882-9769 Fax:425 882-1860 September 14, 2006 Debbera Coker Mason County Building Department PO Box 186 Shelton, WA 98584 Re: WA0168 Allyn Murphy, Building Permit Number COM 2006-00097 Dear Ms. Coker; We estimate the cost of the installation of additional antennas to this tower will be $30,000. Thank you. Greg Hutton Supervisor of Construction & Technical Services for the NW Region Alcoa Wireless M)503-309-0267 O)503-303-3033 F)206-350-1422 E-mail) gregory.hutton@alcoa.com Alcoa Wireless Network Services,Inc.is a subsidiary of Alcoa Inc. I FIELD REPORT NO: 73086 -=�rKraZa1 & Associates , Inc . GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING CONSTRUCTION TESTING AND INSPECTION DATE: 7 9—O '7 CONTRACTOR: PROJECT#: JURISDICTION:_ PROJECT: C'l'< < tni_irrc_ [/a/0A)4,,-j.l PERMIT#:-014 7—roo=l1M 7 LOCATION: ,Au;ZAJ INSPECTOR: ,TA A46-5 �� KRAZAN PROJECT MANAGER: J 41 WEATHER: OVC�C 5 f TEMP: 4� _ r t r * ? < f rr t4 4 1 1-1 414 44', r pT Equipment/Asset Number(s): To the best of my knowledge,the abov?"w,S)WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements. 1 Superintendent/Representative: Technician: Serving the Western United States ISO/Field Rep—rdm Revision I