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Building Permit # MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location 130 9 0 c)F
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliance
1 IM. -eo ter l llHk- 1- 5' i � �Kil[.. Ci�'1�
4 -!o". !'W-tiSd% ter+
r viroyl¢14 Ncc. For GIoy a 5 -to TaNKs.
X K-
gofA tIK& K -tl 6 r- 1'
u c-as+ 1
-P A Gin, r
�40, 1 1
11
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
`a Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OK to
`This is not a complete inspection Department SW
Date —�lU 6 Inspector
DO NOT REMOVE THIS TAG
3
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD MASON COUNTY PERMIT NO BLD
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584 c
Shelton(360!427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 4 1i�68'
APPLICANT INFORMATION CONTRACTOR INFO
Owner-/V(A/ T/2 VoAy RMA 14 . r -
I'Aailing Address J Z2 3 A G Contractor Name N Mrs
s J^ Mailinn Aridrp! S Z cam-
Clty� C/ �l State(--A Zip Ccde�98sp 3_ City l=\W��
Phene(3(.Q )g7o _ - Zither Ph.(_J Ph S le Zip Code
Lien/Title HolderO iAi P-fZ Ll tV t� -- therPh.(
Address S d Contractor Reg. # N
�_.Q /00 rN s T S� Lff/�c?fi✓o a!J Expiration_ 11 / 07 lam_
k/ 8y99
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existin Septic
Systelll_____Name of Sewer System gConnect to Sewer
Water System Well Water System Name of
PARCEL INFORMATI@ 12 di III Tax Parcel No.
Legal Description 111 / / '�' Fire District_
Site Address(Please include street name, street number and city) p rq A 103
Directions to site IF L £ry, FILY �2
Will limber be cut and sold in parcel preparation? (Yes/�1o) %Is your properly within 200'of the following: Body cf Water (Name)
Lake____ River/Creek Pond Wetland Seasonal Runoff Saltwater
Bluffs Stream Slopes or
PERMANENT RESIDENCE Q SEASONAL RESIDENCE❑
TYPE OF JOB Ne%v_Add Alt Repair Describe Work Other Use of Building
ST.tiC v N -
No. of Eedrooms__3 _No. of Bathrooms:_ SQUARE FOOTAGE-1st Floor
31d Floor-Lott- Deck Other Basement y 2nd Floor
ft
GaraU stI
e Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make Model
Length Width Serial No. Model Year
Type of Heat No, of Bedrooms No. of Bathrooms
Purchase Price $Installer Name Replacement Unit ?(Yes/No)
Certification No.
NOTICE: THIS PERMIT BECOMES NULL 6 VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 190 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
intomtation provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify,that I am exempt from the requirements of the 'CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in confor nce there h. No changes shall be made without
Er.proval
first oL•laini r
X /
Dale .— 0
ate_____
FOR OFFICIAL USE BEYOND THIS POINT
At:cel:!ed by Date Subn lilt a{Amount Due
Receipt No.
DEPARTMENTAL REVIEW APPROVED I DENIED
Building Department CONDITION CODES
Occ Group Type Constr
Planning Department
Environmental Health Department
'43Public Works Department i
IFire Marshal �---- I
i l �
Valuation $
FEES
Building Permit Fee ? Site Inspection
Plait Review Fee i EH Review Fee '
Plumbing& Base Fee
i Planning Review Fee
i
Mechanical 8 Base Fee Cther azu fcris ' 00
►1-Ib.
Wood/Gas/Pellet Stove Fee l State Fee
Violation Fee Pre-Paid at Submittal
t )
TOTAL FEES
FORM MUST BE COMPLETED IN INK PERMIT NO: 81.
PLEASE PRESS HARD i' , c MASON COUNTY �••�
? Y =irrEE D
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584 MAR Gt� 4 2UO
Shelton(360)427 9670 Bellair 360 275.446T Elma(360)482.5269 Seattle 206 4F>t-646B Llf
APPLICANT'INFORMATION CONTRACTOR INFgOW- 1.
OwnerQ� T� vo Contractor Name [ C f -I
Mailing AddlessJ:k2 3 AG/� J J"-- Mailinn Address_Cily L/4G/- k Stalet✓A ZipCede`79403 City Zip Code 15E5&_
Pho11e(3fd 8. d -MI6'rAther Ph.(_J Ph. 4her Ph.( "
Lien/Tille Holder GO[//V)-/Z+l I,,LjX D l Contractor Reg.# /E
Address5ZcQ /007-H ST SL LfiKA=6✓0 1 Expiration_ � _
I-if 9 Fy9 _
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
Syslem__Nanie of Sewer System Well Water System Name of
Water System
O
PARCEL INFORMATIttJI�12 di 1 Tax Parcel No. ,� / r
() �_/ t'sL' Fire District----'
Legal Description III �
Site
Address(Please include street name,street number and city) A D L t -
Directions to site L.4Mj_ I—ZI-A 'Elzr [-C
Will timber be Cut and sold in parcel preparation?(YeslKo) 1 s_
Is your property within 200'of the following:Body of Water(Name) Saltwater
Lake___River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE(] SEASONAL RESIDENCE❑
TYPE OF JOB Neta_X_Add Alt Repair Other Use of Building
Describe Work ST'.rrT uZ -13 N
No.of Bedrooms 3 No.of Bathiooins Z SQUARE FOOTAGE-1st Floor q2nd Floor
3id Floor Lotl Basement Deck 01her sq ft.
Garaqe Attached_Delached_Carport Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length Width Serial Na. No,of Bedrooms No.of Bathrooms
Type of Heat Purchase Price$ Replacement Unit?(Yes/No)
Installer Name Certification No.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROrPRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT•I certify that I ain exempt from the requirements of the 'CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a
Contractor Registration Law RCW 18.27.and am aware of the ordinance contractor In the State or Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all pork will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conf nce they h. No changes shall be made without
aFproval Iirst obtain r
X_ Cale —zz_0 X ate
FOR OFFICIAL U$E BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
DEPARTMENTAL<REVIEW APPROVED DENIED CONDITION CODES:
Building Department
Occ Group Type Constr.
Planning Department ,--
Environmental Health Department �
I
Public Works Department
Fire Marshal •---'
f�
i
I: Valuation$
s —
FEES
Building Permit Fee I ' Site Inspection
Plan Review Fee i EH Review Fee
Plumbing&Base Fee I Planning Review Fee
i
i fAchanical&Base Fee Other 'yb ip0
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
TOTAL FEES
FORM MUST BE COMPLETED IN INK PERMIT NO BLD
PLEASE PRESS HARD MASON COUNTY
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 96584
_ Shelton(360142i 9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464.6968
APPLICANT INFORMATION CONTRACTOR INFORtAATIO
Owner 0-0 (A/ 7 R V0
actor Name
Contr j,
( � r ,
Mailing Addl ess 2 3 A G ,f Jam______ Mailinn ArldrP.CS:�"' s
City Ll+cl=Cf State6✓)q Zip Ccde,47F ,-o 3 City t= �W\j�l fe ft Zip Code
Pholle(21 � d - G bher Ph.
�_J Ph. ,
ther Ph.
Lien/Title Holdet O u ( �r2 �/ Contractor Reg. # /� /E
Addresses U p 7-N .S T S Lfi/Ci=f�✓a U O Expiration___jL_/�/ _
95vg9
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
SystelllName of Sewer System Well Water System Name of
Water System
s
N
i
j PARCEL INFORMATION-12 digit Tax Parcel No.Z7� / .27 / S~
Legal Description ---�— � bDAQ S Fire District
Site Address(Please include street name, street number and city) 3 0 A D
Directions to site L.i4lT i_ L�rH 12,ram /T
Will limber be cut and sold in parcel preparation? (Yes/No)�-`,�-
Is your property within 200' of the following: Body cf Water(Name) Saltwater
Lake_--- River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs_
PERMANENT RESIDENCE t] SEASONAL RESIDENCE❑
TYPE OF JOB Ne\v-.)C_Add Alt Repair Other Use of Building
Describe Work S' V7- N —
No. of Eedrooins_ No. of Bathrooms__ SQUARE FOOTAGE-1st Floor 2nd Floor
31d Fluor Lott Basement Deck Other
Garage Attached Detached Car ort Sq. ft.
p Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length_ Width Serial No.
No. of Bedrooms No, of Bathrooms
Type of Heat Purchase Price 5 Replacement Unit ?(Yes/No)
Inslaller Name Certification No.
NOTICE: THIS PERMIT BECOMES NULL 6 VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
' CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structu►es for review and
inspection of this project. Acknowledgment of such is by signalure below:
j OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the 'CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a
j Contractor Registration Law RCW 1a.27 and am aware of the ordinance contractor In the Stale of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in confo!rrp4nce therew h. No changes shall be made without
approval first obtaini r
X—� Cale XJ-11
al e
FOR OFFICIAL USE BEYOND THIS POINT
At-.cP14e d by Date Submittal Amount Due Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES
Building Department ,
Occ GroupType Constr.
Planning Department
Environmental Health Department i
I i
Public Works Department
S
FORM MUST BE COMPLETED IN INK PERMIT NO BLD
PLEASE PRESS HARD MASON COUNTY
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 13601427 9670 Bellair 360 275.4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR lNFqRJAATIOJqi
owner D6 A w 'T1? VO/\) Contractor Name_
Mailing Addt ess 2 A G/� S Jam— Mailinn ArlrirPs.q S Z 1
City L/+C/;-l-r Slate WA Zip Cede,%cJ FS O 3 City Stafe Zip Code
Phone(3(U ).$)'C) -?6TAther Ph.(_J Ph. ether Ph.( "
Lien/Title Holdet_L O u/V 7"R ''I- (,v'.Z 1.) L Contractor Reg. #_ 14I1ANH,*19I -ply
Address_5_L.Q /U 0 7-H J r S/= LiI I-C,t=fi✓o U Expi rat ion_/
914 99
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name DI Sewer System Well Water System Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No.,�L a/ 2`Z O Fire District
Legal Description /0 :
Site Address(Please include street name, street number and city) DR 0 A 0 e&-
Directions to site L i4/-C/= L Z n. /r/zI'C i-�
Will timber be cut and sold in parcel preparation? (Yes/N.o) Vt s-
Is your property within 200' of the following: Body of Water (Name) Saltwater
Lake ^_— River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE l7 SEASONAL RESIDENCE❑
TYPE OF JOB New_Y Add Alt Repair Other Use of Building
Describe Work
No. of Eedrooins 3 No. of Bathrooms2_ SQUARE FOOTAGE-1st Floor 2nd Floor
31d Floor Lott Basement Deck Other sy. It.
Garage Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make Model 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.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf.represents that the
intonnation provided is accurate and grants employees of Mason County access to the above describer)property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the 'CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor In the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all wor k will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conforpqnce therew h. No changes shall be made without
approval first obtaini r
X_ Cale�••�,�. '� �( ale
FOR OFFICIAL USE BEYOND THIS POINT
Accep!ed by Late Submittal Amount Cue Receipt No.
DEPARTMENTAL REVIEW APPROVEb DENIED ; CONDITION CODES
Building Department
Occ GroupType Constr. 'r
----I
Planning nnin
9 Department
crime nt
r j
Environmental Health Department —��
6!ZLJ C Z-j G L -7. 1'9
Public Works Department I j
FORM MUST BE COMPLETED IN INK PERMIT NO: BLD .2_
PLEASE PRESS HARD MASON COUNTY
BUILDING PERMIT APPLICATION C`a-S
426 W.Cedar/P.O.Box 186,Shelton.WA 98584
Shelton 13601427 9670 Belfair 360 275.4467 Elma 360 482-5269 Seattle 206 464.9968
APPLICANT INFORMATION CONTRACTOR INFORj1AATl0
Owner��/l1_ 7"fl V0// Contractor Name 11JAIHa
Mailing Addi ess :Z 2 3 —
T' Mailinn ArtdrPc�; tc S Z [ 1
City_L/+C t--11 State 6/,4 Zip Code'g8.S0_3 Cily ! ----% S • e Zip Code _
Phene(3(.0 ).87y -XGT.21 Ph.(—� Ph, etherPh.( "
LieniTille Holdei L 0 uni )F'R °f W.2 p,Ir Contractor Reg.
Address esQ___ UO T H S7" Si= 1-A1-<1 fW0vQ Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System__Name of Sewer System Well Water System Name of
Water System
O
PARCEL INFORMATION-12 digit Tax Parcel No.c-1 a/ ,�7 / S—r /6�} Fire District
Legal Descriptioti /W
Site Address(Please include street name, street number and citY)--L3 D 220,1D 0 ALL/-
Directions to site_�A/-C/^
Will timber be cut and sold in parcel preparation? (Yes/No) V= `
Is your properly within 200' of the following: Body cf Water (Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE C) SEASONAL RESIDENCE❑
TYPE OF JOB Newt Add Alt Repair Other Use of Building
Describe Woik S'T'xR 1.3.v r (.o N No. of Bedrooms 3 No. of Bathrooms_- SQUARE FOOTAGE-1st Floor 2nd Floor
31d Fluor Lott Basement Deck Other sct It
Garage Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make
Model 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.
NOTICE: THIS PERMIT BECOMES NULL b VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
inforrttatian provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the 'CONTRACTOR'S AFFIDAVIT4 certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the Stale of Washington and that I am aware of the ordinance
requirements for which this permit is issued and That all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in confor nce there h. No changes shall be made without
approval first oblainl r
X_�_r� Dale ' )( ate
FOR OFFICIAL U$E BEY ND THIS POINT
1 Accep!cd by Date Submittal Amount Cue Receipt No.
DEPARTMENTAL REVIEW APPROVED ''DENIED ' CONDITION CODES:
Building Department
Occ Group Type Constr. �S� p� ,
Planning Department
l I
Environmental Health Department
I �
Public Works Department I i
FORM MUST BE COMPLETED IN INK PERMIT N0.j '15L0
PLEASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATIORv,
426 W.Cedar•P.O.Box 186, Shelton,WA 98584
Shelton (360)427-g6n the web w(360)?75-4 wa.usma(360) 482-5269
APPLICANT INFORMATION O CONTRACTOR INFORMATION
Owner Q 0/4 W T/L Vd/-/ Company Name Hr L SMd= H dr►t,�S
Mailing Address �=N T"EZ P/2 I S IF L n
�2 2 3 R �y G Mailing Address�- S>" / � �s y 1
City r /= `f State Gar f} Zip Code fo 3 City_"! A,A State�- Zip Code
Phone 3
Phone '1 lD o Fr70 - 8 6 k 2 Other Ph o ' y fl2 -7 S O Other Ph.
Lien/Title Holder Cd c.w r/1 Y to z D/F - Contractor Reg.#J41, A d 9.9 j arFxp•
E mail address n V 7"11 4-0M 63 m S/-i - " — E Mail Address
Drivers Lic.#r1Z yvNPW 3 9 OB 11- G ` f!o 2 Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic — Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Qigit Par I No. a Fire District
Legal Description ' !0
Site Address (Please include street name, street number and city)-Wk lzollp U h r R - t, L o T
Directions to site 1- K�' -rm IF R 2' Lf
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New )L Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
ype of Fixture No. of Fixtures Fees Fuel Type:Electric.,X. LPG Natural Gas_ Heat Pump—
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers "�" Spot Vent Fan
—
Water Heater Propane Tank
Clothes Washer 1— Gas Outlets
Kithen Sinks Wood/Gas/PelletStove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other (,,IA C G
Base Fee Na T i1 r- Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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 parses.If permission is
required from any easement holder or any other parry 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.
PROOF CONTINUATION OF WO K I Y MEANS OF A PROGRESS INSPECTION.
Date: 3-' 2 Z -O G
X Owner/Owners Represen tive/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group—Type Constr—
Planning Department
Environmental Health Department
FEES
Plumbing &Base Fee Site Inspection
Mechanical &Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee
Other
Violation Fee TOTAL FEES
PERMIT NO.
MASON COUNTY
PLUMBING/MECHANICAL 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 INFORMATION
Owner D C '' 62 :Tf2 4 u/2 Company Name h' - L ' l'•: h' r -�-
Mailing Address j 2, 7
Mailing Address �-
City "'{ State t., 4 Zip Code-S LZJ 2 City L r State ` Zip Code
Phone r _ S Other Ph. Phone `� ` 2 2 ` 0 Other Ph.
Lien/Title Holder Cc v ?'/2 " i,/. 9r. Contractor Reg.# ="' '-� ' Exp.
E mail address L) L- `''i `" e`� `'' /'`` " - c ` E Mail Address
Drivers Lic.# /7 f /7 3 f r OB 1 i - G - fa 2. Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic— Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. 32/e2 7 rl 00/0 g Fire District
Legal Description /
Site Address (Please include street name, street number and city)__11 C 22.4 J c /"_ L o T
Directions to site L A j t /` L +r,,if A ="C /4
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:ElectricX- LPC�_ Natural Gas_ Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs
Heatpumps
Showers �'�" Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks 1 Wood/Gas/PelletStove
Dishwasher � Kitchen
Dryer cev Exhaust
aust Hood �
Hosebibs
Other Other' G4A c L
Base Fee ` Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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.
PROOF CONTINUATION OF WORK I Y MEANS OF A PROGRESS INSPECTION.
X Date: � —
IOwner/Owners Represen alive/Contractor (indicate which one)
i
FOR OFFICIAL USE BEYONDTHIS POINT
1 Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
f Occ Group—Tyge Constr.
j Plannin Department -/7-0
Environmental Health Department
FEES
Plumbing &Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
MASON COUNTY PERMIT NO.
PLUMBING/MECHANICAL 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 INFORMATIO�J
Owner D 0/`/ W TJZ It'd A4 Company Name H Z L 1-/,/
Mailing Address 12 7 1 P i 06 iZ S/- Mailing Address I L n/
City L -State W P Zip Code 2f --so 2 City /-L n,A State-4 Zip Code q I L4 /
Phone 11, U fi`7 o - r<. 2 Other Ph. Phone 16 v - y S 2 - 1-7 S 0 Other Ph.
Lien/Title Holder C 0 1? Y L✓i d IF Contractor Reg. # /4,r G r A/14 cr r 13?Exp.
E mail address n U' 7-/Z Lro,"t C) Al S /-I - c v Ph E Mail Address
Drivers Lic.# /1 Y o,,i A 03$ /SOB I J— G - f!c 2 Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic— Existing Septic Connect to Sewer System
j Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. --'32.12-9•S 1- Dn I h:;� Fire District
Legal Description /0 3
Site Address (Please include street name, street number and city) 110v i_ L o r
Directions to site L I- M f= C rt"/f A 2"C IT j
i
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
I TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1st Floor 2nd Floor Basement Garage Closet
! !
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS j
Tvge of Fixture No. of Fixtures Fees Fuel Type:ElectricX- LPC Natural Gas` Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank j
Clothes Washer J Gas Outlets
Kithen Sinks Wood/Gas/PelletStove
Dishwasher d Kitchen Exhaust Hood -4—
Hosebibs Dryer Vent
Other Other WA L
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
j 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.
PROOF CONTINUATION OF WORK I Y MEANS OF A PROGRESS INSPECTION.
X Date: -3 z z '0 C
Owner/Owners Represen tive/Contractor (indicate which one)
I
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES j
Building Department
Occ Groug-Type Constr.-
Planning Constr.—
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical& Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
MASON COUNTY PERMIT NO.
PLUMBING/MECHANICAL 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 INFORMATION
Owner -
�- � Company Name
Mailing Address Mailing Address "-
City State Zip Code City Mate Zip Code r
Phone .. Other Ph. Phone Other Ph.
Lien/Title Holder 7 Contractor Reg.# w - -Exp.
Email address E Mail Address
Drivers Lic.# :'` " '"/,. ' r'TJOB 6 - Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic_ Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city) I'' - -
Directions to site ' r
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1st Floor 2nd Floor. Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS '
Type of Fixture No. of Fixtures Fees Fuel Type:ElectricL LPQ— Natural Gases- Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers '' Spot Vent Fan
Water Heater / Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks f` Wood/Gas/PelletStove
Dishwasher — — Kitchen Exhaust Hood
Hosebibs h» Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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.
PROOF DF CONTINUATION OF WORK 113Y MEANS OF A PROGRESS INSPECTION.
Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Type Constr.-
Planning Constr.-
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical &Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 3
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Find a Law or Rule Get a Form or Publication
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Prin r Friendly Version
General/Specialty Contractor
A business registered as a construction contractor with LEH to perform construction work within the scope
of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment
of account and carry general liability insurance.
License Information
License HILINH*981 BT
Licensee Name HI-LINE HOMES
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602167453 VerifY �Workers Cam
ld2t
- _
Status I,
Ind. Ins. Account !'
Id 0
Business Type CORPORATION
Address 1 11306 62ND AVE E
Address 2
i�
City PUYALLUP !
i
County PIERCE f
State WA
Zip 98373
k Phone 2538401849
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 1/30/2002
Expiration Date 2/10/2008
I Suspend Date
Separation Date
Parent Company NW CENTRAL CONSTRUCTION INC
Previous License
Next License HILINW*9606L
Associated
License
https:Hfortress.wa.gov/lni/bbip/Detail.aspx?License=HILINH*981 BT 6/28/2006
I . - Building Permit Information Form - 1664 Plan
E4
This form contains the information you'll need to complete your building permit packet. We've included information for all counties,
some of it may not apply to yours. If you have any questions,please give us a call at 360-807-1849
Applicant/Owner/Contact Information: Your name,address phone number tt
Contractor Information: Name: HiLine Homes of Elma E
Address: 50 Enteronse Ln Ste 215
Elma WA 98541 MAR <
Phone: 0 __ 7
License# HILINH'981BT � a�•�iuE,:,
Expiration: 01/30/06
Tax Parcel#/Assessor's Acct.#: This will be with your property information.
Job Site Address: Your new home address(example:xxx Filmore St.)
Legal Description: This will be with your property information. (example:Lot xx Large Lot Sub Division xxx in Lewis County etc.)
This will be a New Single Family Residence
Describe work/Type of Job: New Home construction
Home Information: Floor Area: (sq.footage)
Main/1st: 1664 #of stories: 1 Carports: 0
Second: 0 Bedrooms: 3 Decks: 0
Basement: 0 Bathrooms: _ 2 Porches: 0
Total: 1664
Garage: _ 484 (Attached)
Construction Method: Wood frame
Heating System:
Be sure to choose the information below that correlates with the heat system you have ordered.
HVAC/Mechanical Contractor is the company installing your heat system.
Cadet/Wall Mount/Zone Heaters: Standard heats stem
Installer: North Pacific Electric Contact: Bernie/Kim
License#: NORTHPE994JB Phone: 360-943-6020
Expiration: 06/27/04 Location: Qlvmoia
Manuf: Marley Brand:
Module#: WH1031, 1531 &2031 KW: 7
WHF: AMPS: 20
On permits,for the#of wall heaters,put 1,or you'll be charged extra for every one.
Heat Pump w/furnace w/HWH:
Installer: Chehalis Sheet Metal Contact: Dave Pvles
License#: CHEHASM252MH Phone: 360-748-9221
Expiration: 07/02/04 Location: Chehalis
Manuf: Trane Module: 2TWB0024A1000A KW:
Tonnage: 2 10
HSPF: 7.75 Seer: 10
LRA: 60 Efficiency: 100%
Natural Gas or Pro ane furnace w/HWH:
Installer: Chehalis Sheet Metal Contact: Dave Pvles
License#: CHEHASM252MH Phone: 360-748-9221
Expiration: 07/02/04 Location: Chehalis
Manuf: Trane Module: TDE060A93 WattsJ77 BTU: 60,000 Efficiency: 80%
Spot Vent Fan: 1 Kitchen Exhaust Fan:_1_ Dryer Vent: 1 Wood/Gas/Pellet Stoves:_ Gas Outlets:_
Plumbing System: Installer: Allied Plumbing
Contact: Darren
License#: ALLIEP'986KC Phone: 360-289-4114Roo .r
Expiration: 05/31/06 Location: Rochester
Toilets:_2_ Bathroom Sinks:_2_ Bath Tubs:_0 Showers: 9_ Kitchen Sinks:__ Water Heater:_I
Clothes Washer:_]_ Dishwasher:_ Hose Bibs:_I (first 4 enter quantity of 1,every home has 2)
Energy Compliance Information:
Compliance Method/Path:Always#3 (Per Washington State Energy Code)
Total sq.ft of glazing(glass): Standard home_ 214. w/sliding glass door option: 231 divided by
a
q 9
total sq.ft.of heated area: 1664 equals lazin o 0
g percentage,of 13//o standard or 14/o w/sliding glass door option.
Swinging doors and skylights are not counted in this configuration because they meet all requirement minimums.
Window Schedule: See attached form.
Ventilation System:
IntermMently o rating Whole House Ventilation System using ehauat fans 8 Wk dDW fr h^ir Vanta.(VIAQ 303.4.1)
House Fan Specifications: Whole house fan:Qty: 1 Manuf:Solitaire Ultra Silent Module#:S110U CFM: 110
Bathroom One-Bulb Heater/Fans:Qty 2 Manuf: Solitaire Ultra Silent Model#: 162 CFM: 70
Copyright 2003 HiLine Homes
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VICINITY MAP NORTH
NAME:
SITE ADDRESS: o `G'aIep- ENVIR®NMEN `.:,
CITY: svielAzo
ZIP: 919sv HEALTH
MAILING ADDRESS: Z-z-s t
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ZIP: C ;0
PARCEL NUMBER: 3Z�2�S 10G10`�
PHONE NUMBERS H: Z 061
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Mason County Permit Assistance Center
Planning Intake Checklist
Owners Name: Date: j - a mil- v
Project: Reviewed By:
Commercial Development: YES UPBC
Comments:
Planner: GBM TSC CMM RDH
Site Plan: ���
North Arrow N N
Property Dimensions:s: X N�/,
��� , Zez
Streets and Driveways Shown. Road name:
,zf All Existing Structures shown with setbacks
.i Weld-Location, Septic and Drain-field Shown with setbacks
z.,W Identify all surface water(streams,ponds, shoreline,wetlands, etc)
Topography(slopes)
_Proposed Structure Setbacks (Direction/Setback):
F: /F / J 5—R: l.,/-59 1: JV S S2: /
,gf -_Utility and Drainage Easements: Yes No ' yes enter condition#5022)
,vd- Other Easements
Accessory Appurtenances i,�_9 e
❑ County Access Permit Needed(add condition#0010)
❑ State Access Permit Needed(add condition#0020)
Standard Conditions to be added to all Building permits that planning reviews:#5019 and#0700
Are there any impediments that may restrict access to your site? (dogs/gates)
Shoreline and Planning Info
Setbacks: Shoreline: Slope:
Shoreline Designation: Comprehensive Plan: Rural Zonin
,4V—Not Applicable ❑ Agricultural &4-RR 2.5&�10 20
❑ Urban ❑ In-holding ❑ RMF
❑ Rural ❑ LTCFL ❑ RC 1 2 3
❑ Conservancy Rz4ural ❑ RI
❑ Natural ❑ RAC ❑ RNR
❑ Unknown ❑ RCC-Hamlet ❑ RT
❑ Urban,Growth Area ❑ MPR
❑ Unknown ❑ Unknown
Water Body(type of water if unnamed):
SEPA: Yes Na__ nknown
Flood Plain: YES NO (i. iow� #
Aquifer Recharge: YES NO nknown Map#
Tags/Cases: aN
RLC/SPI Case: 6-Year Dev. Moratorium: SEagle Nest Tag: YES NO Other
Addressing: Check box if needed ❑ Reviewed by:
Revised:11-01-2005 MPLANNINGPAOPLANNING INTAKE
Window Schedule
HiL NE for 1664 plan R`
D� Hiline Homes of ElmaMA,R �
Manufacturer: Milgard Windows Inc. Model: Style Line Series
Type: Vinyl U-Value = .35
Windows
Quantity Size/Handin Glazin area Total S . Ft. Location
width x hei ht
1 8'0 x 510 40 40 Living Room
1 4'0 x 5'0 20 20 Living Room
1 6'0 x 60 30 30 Dininq Room
1 4'0 x 3'6 14 14 Kitchen
1 3'0 x 3'0 9 9 Mast. Bath
*1 6'0 x 4'0 24 24 Mast. Bed
1 4'0 x 4'0 16 16 Bedroom 3
1 4'0 x 510 20 20 Bedroom 2
Slid. Glass Doors
1 6'0 x 6'10"s d 41 41 Dining Rm.
Total glazing area 214 sq.ft.
214 - 1664 = 128 X 100 13%
Glazing Area + Conditioned floor Area Glazing Percentage
If a sliding glass door option was chosen, switch the appropriate window w/the sliding glass door
and use the calculation below.
1 6'0 x 6'10"s d 41 41 Appropriate Room
231 - 1664 = .138 X 100 = 14%
Glazing Area + Conditioned floor Area Glazing Percentage
All other doors, windows&skylights do not need to be calculated do to the fact they meet all minimum requirements.
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELTON (360) 427-9670 BELFAIR (360)275-4467 SEATTLE (206)464-6968
ELMA (360)482-5269 FAx: (360) 427-7798 WEB SITE: WWW.co.mason.Wa.us
P.O. Box 186, SHELTON 98584
2001 Washington State Energy Code (WSE
effective July 1, 2002 i
2000 Ventilation and Indoor Air Quality Code (VR9),-.
BUMDIN
Code Compliance Application Form
The following information will be required for the WSEC and VIAQ plan review:
1. Complete the Washington State Energy Code/Ventilation and Indoor Air Quality Code
(WSEC/VIAQ)application located on the reverse side.
2. Complete the window and door schedule on the reverse side. Include all windows, skylights,
sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening
dimensions of the windows and doors. Information about the U-factor of the window will also help
to expedite the energy code review. If you are complying with the WSEC by prescriptive path and
are using the area weighted average method you must include your calculations.
3. On your building plans note the location and fuel type of water heater, location of exhaust fans
(bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and
slabs,
4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 284. Additional
WSEC and VIAQ compliance information is available on the internet at:
www.energy.wsu.edu/buildings/
Prescriptive Requirements °'for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor
Area%of Door Wall Wall Wall
Option Floor U_ Ceiling vaulted Above interior" exterior Slab4
10 Vertical Overhead" Factor9 Ceiling3 Grade below "Below Floors on
12 grade Grade Grade
I 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10
II* 15%' .40 .58 .20 R-38 R-30 R-21 R-21 R-10
R-30 R-10
III Unlimited
Single
Family Res •40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
(R-3)Only
'Reference Case/Call(360)427-9670 ext.284 for footnote information. Log &solid timber wall with a min.avg.thickness of 3.5"are
exempt from the above grade wall insulation requirements.
I G02,0() C� 0)1q5(O
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES -
Environmental Health Personal Health
PO BOX 1666 SHELTON, WA 98584
LOCAL(360)427-9670
BELFAIR(360)275-4467 8 4468
Application for Determination of Adequacy
Instructions
1. Complete PazC L.No determination can be made until Part I is fully completed.
1 Complete only.the.portion of Part 2 applying to the type of water system utilized.
3. Submit'completed application,with attachments to the health department forreview.
PART 1: Applicant/Pareel Identification
Name of Applicant D 0 ti TR Vo Cv Date S. Z O 0 �c
Mailing Address 12 2 3 1?X o G i t'r I-I CF_ q- Telephone 3 o - Y 31 3 , 2 o q
Assessor's Parcel Number 3,9 I d -15 l 0 01 y 3
Type of Water System Check One): Reason for Application (Check One):
Public/Community Water System (2 or more ❑ Building permit
connections) ❑ Land use application, if so..
❑ Individual water source(one connection), if so.. ❑ Division of land
❑ Well #of Parcels?
❑ Spring/surface water SPH9 -
❑ Other(explain) ❑ Boundary line adjustment
❑ Other(explain)
PART 2: Water System Information
Complete the section appropriate for the type of water system being evaluated for adequacy:
Public Water System
Name of Water System Z_11q1-e4 ,,in4ae,ciG
Water Facility Inventory(WFI)Number: --;�/V/507—
❑ The water purveyor has filed a letter granting blanket hookups to this water system.
I am the manager of this water system. The water system has been approved for /a5 D services. There are
presently//2 9 connections in use. This will be the /QZ9connection. i�i s water system is able and
willing to provide water to this(these)connections without exceeding the limits of the water system or any
limits set by state and local regulation.
Signature of Water System Manager Date 5(2_Z(*,
H:IWDATAURCHIVDWATERAD3.WP Update:March 22, 1999
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