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Gn & J = 0 7 D 3 / D ) m _% _ _£ C . f f � 0 3 � � _ _ a _. / o q / fa \ % � -0 f0 / k0 / j O = c 2 - 7 � � /2 Ef < E _ 0 (n 0 £ = 3 7 \ \ a ] g7 32 »$ ) $ � & # kk 0 - 7 \ k \ 0 5 E a ° 3 & 2 < 0 _ = 2 < = o \ a S' < 0M 0 = / (07 \D CD t \ CD j COr NCRF E MECHANICAL MOBILE HOME ' Ftiti Se ck date 2-�� b f /�� Ribbons date b-c- by Gas Piping date by Foundation Walls date 3 —/ Set UP date :' /,9 � by L INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date - - by date < -Z - 2 by date by PLUMBING Attic OTHER Groundwork date by date by WALLBOARD NAILING D.W.V. date 2 �f L by . date �j-Z Z �D Z by Water Line FINAL INSPECTION date by +� date by date by 0 2- ZL Bu iding l3ermit # cz r`/ys MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location �-%=-19r'l 1 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 % You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection W OK to �_,� / �'',� 6,7:l m ' ❑ This is not a complete in ection Department Date �'/ c 1 Inspector l If DO NOT REMOVE THIS TAG PERMIT NO.: BLD 2, " MASON COUNT`r �I 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 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner _ rf, ) a , ! ,, Contractor Name, r Mailing Address + •..Ao": ' _ a..,;_. t..' ' Mailing Address > ,� State • 2L Zip Code '.--,f City State l.,V,,4 Zip Code ra,_ Phone( % Other Ph.( j A Ph. Other Ph. Lien/Title Holder < t~., .t-' Contractor Reg. # A,✓-"r 11 •ty , .. r�., , 'e'R� Address Expiration .: Is PTICIWATER SYSTEM INFORMATION-Connect to New Septic�_Existing Septic Connect to Sewer stem Name of Sewer System Well �;' Water System Name of ater System PARCEL INFORMATION-12 digit Tax Parcel No. r = .� / > �' / :"� `+ 'i" } `,� > ,� .. � -,_ Fire District Legal Description 6,*�0 2C�1• ' IZ46 - Site Address(Please include street name, street number and city)_ Directions to s a itt,e .. _ � " A,.) "j � ` ;.,:'::,,• a �" ?..;,f! Will timber be cut and s-d in parcel preparation? (Yes/6) A,lj Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB e �c Add Alt Repair Other Use of Building a7'i L1 Describe Work CLtA ..T2f✓C7� A.; a No. of Bedrooms , No. of Bathrooms SQUARE FOOTAGE-1st Floor I - '"' 2nd Floor 3rd Floor,_.......— Loft-- Basement , Deck Other fj�0 -a.O:, sq. ft.' r� � 2 Garage ; (ttached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length W h Serial No. No. of Bedrooms No. of Bathrooms Type of He Purchase Price $ Replacement Unit ?(Yes/No) Installer Na el 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 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-1 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 conformance therewith. No changes shall be made without approval. first gbtaining 4pr�, val. a X Date X Date �A FOR OFFICIAL USE B€*SND THIS POINT Accepted by _..,� }_.. Date ,+ 66bmittal Amount Due >' V Receipt No. -- t 17PARTMENTAI» REVIEW APPROVED _DENIED CONDITION CODES Building Department M Occ Group 3 Type Constr. 5N v Planning Department Environmental Health Department Public Works Department I Fire Marshal -T Valuation $ 150, 1 3., 31 F>w>ES Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee S 1 . �l0 Mechanical & Base Fee H L •©C) Other < Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal <.�• •�::.:>. .>...::�:•� ' `.<'> » '':> <` ':< TOTAL FEES ct: FORM MUST BE COMPLETED IN INK PERMIT NO.: PLEASE PRESS HARD 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 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION _ OwnercW-/ f C4rN-I &4(_Jt_1_t,�� Contractor NameAg_ef IrIC. 6<26 44L Ct7i9tiZi4C7 Mailing Address 7-.On LoAg—P CA"E_ PL, A,7 Mai lin Address ,0,—D 3U City State c-v Zip Code gt334Z City i51/ State W4 Zip Code - �2 " Phoneme 1617 Z3 Other Ph.( Ph.(_ S^ O420ther Ph. 73/-Zb OZ Lien/Title Holder Contractor Reg. # lrV&—C/3 v� Address_ cte,, e . Expiration O / Of_/,e6LAt> f SEPTIC INFORMATION-Connect to New Septic__.' S.Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. 276 330 / o / 66/.3! Fire District Legal Description Site Address(Please include street name, street number and city)!-5D Ale A✓ Directions to site AV I-Ah - . rLJ 1 ur property within 200' of the following: Body of Water(Name) /1i4(/e,�,) 4,414.41 Saltwater Cakl X River/Creek Pond Wetland Seasonal Runoff Stream Slopes or uffs TYPE OF JOB Add Alt Repair Other Use of Building _ a?/-Ce Location of Fixtures/Units 1st Floor 10' 2nd Floor-_' Basement U Garage i Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel T ricer_ Type of Fixture No. of Fixtures Fees LPG Natural Gas eatpump) Toilets 3 T Unit No. of n1 Fees Bath Basins ur Bath Tubs _ um p I_ Showers 7— e ans �5" _ Water Heater / Propane Tank I Laundry Wsher Gas Outl s I Sinks �? _ Wood(gas)Pellet Stove k Dishwasher _� Direct Vent?I Other Other Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 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 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 conformance therewith. No changes shall be made without approval. first obtaining - val. X Date Date�� 1 00 FOR OFFICIAL USE ND THIS POINT Accepted by Date Submittal Amount Due Receipt No. £3AfiTMEI!1T RI�1(#E W;>; APB RC7t!£D.:: ::.DENIE#3.> :..:.: ..:<<;>:: C{�NDt#13?itil CARES Building Department Occ Group Type Constr. Planning Department Other Other ::>:::: >:.;;>::>:>::>:::>:«;: DES..:: . :. Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name6VY-0CAWY MCILWA49 PARCEL NUMBER;??, Date% D SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Q Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line- I ►) t—u. I E-adjacent property line I I 1 I I I I ( I I I I I I 0 I I I I � I 1 I I I I SE -!514E ; PlA 0 { I 1 adjacent property line- ' EA 0-4 DCAe—E I <-adjacent property line SAMPLE SITE PLAN adjar�nt property lined aio' _ _ Fadjacent property line D 30- rRESCRve �c-3o�l .13 . N AL I c � HOM t I Gnaaw I House. I j PrLoPaun s¢prtc. 1 , I I+— 6 I I VACAr,jT I aArtwc a I % o' I 3 j C0.oPosCD I \ T A&R=u-LTWLAL So I 1 I I I \ 80, I I � I \ I /00 I I L—aLL I I I L.arGL.f_ I adjacent propert line-> ; Ate. \; E-adjacent pro pert'line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE distance- to ruti-L�Yt di3't'ar�LL +o Slops tc¢ L/ � dis+ar.cm A 4e L.—f=VC—L' LU t 16 on Sig ture Date r MASON COUNTY DEPARTMENT OF HEALTH SERVICES - , Personal Health Environmental Health PO BOX 1666 SHELTON,WA 98584 LOCAL(360)427-9670 BELFAIR(360)2754467&4468 Application for Determination of Adequacy Instructions rlplete Part Y No clef matron care be made untli Part I is 11 com feted X. :. ..: ate:alle::: : . of ��:�y�tcam..::::::.:::::::::::.::::.:::.:-.::: ::.;:: Iced: wkhttachnnents;tothe:health;dent: oxnevi....... PART 1: Applicant/Parcel Identification Name of Applicant aL�-'I +�C C �U-Uq�- Date Mailing Address E I c.�Velephone Assessor's Parcel Number T e o Water S stem Check One : Reason orA lication 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 S stem Name of Water System Water Facility Inventory(WFI)Number: ❑ 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 services. There are presently connections in use. This will be the connection. 1s water system is able and willing to prov'T water to this(these)connections wr out exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date H.jWDATAL4RCHIVEIWATER,4D3.WP Update:March 22,1999 W - 7