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Box 186, Shelton, WA 98584 AR 53- Shelton (360) 427-On the web w(ww.Dco.mason.wa.usma (360) 482-5269 Apz C_- _ rnc CANT INFO MATION CONTRACTORIN MINION er Company Name d Address Mailing Address State Zip Code city� State dip ode Y Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.#AN40Qgaz-072 P. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTE ,.INFORMATION -Connect to New ptic_ _ Existing Septic Connect to Water System Name of Water System '� �°' /J 1' Well Water System Name of Water Syste ' PARCEL INFORMATION- 12 Digit Parcel No Fire District Legal Description 1 2 ZZ g - 7$ _ 9D� '73 �. Site Address(Please include street name, street number d city) Directio s to site r'� 7` L ' �1 Will timber be cut and sold in parcel preparation?Yes/ o Is property within 200'of Saltwater Lake River I Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/ jfp- TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE Use of Building Describe Work ❑ SEASONAL [ No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -)vlake Model: Year- Length �, Wiclth �,=Serial No. 7` �' No.of Bedrooms _. No. of Bathrooms Type of Heat Purchase Price$ /e39F6 tv, Replacement Unit? Yes/ o Installer Name _.�f?/V/ �'�I 17 /, Foy S Certification No. g�dA/NS rDS-/3 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 OF C NUATIO OF W IS BY MEANS OF A PROGRESS INSPECTION. X Date Owner Owners Re resentative/ ontractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date [Fire PARTMENTAL REVIEW APPROVED DENIED NOTES lding Department T nning Department e �, ironmental Health Department lic Works Department Marshal FEES Building Permit Fee 5-d Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Plannin Review Fee Mechanical & Base fee Other Wood/Gas (Pellet Stove Fee State Fee S� Violation Fee �f 0 E� Pre-Paid at Submittal Valuation$ TOTAL FEES PyoN•STATFo� MASON COUNTY c DEPARTMENT OF COMMUNITY DEVELOPMENT A N �N Planning Division s� N Y n P O Box 279,Shelton,WA 98584 (360)427-9670 1864 REQUEST FOR ADDITIONAL INFORMATION August 01, 2005 Parcel No.: 122297890073 Project Description: Manufatured Home Dear Applicant: You have submitted a permit application (case no. BLD2005-01178) for proposed construction or development in the county. Upon review of your application, I require additional information to complete the permit review process. Therefore, review of your application will not proceed until the necessary information is provided (see the comment section of this letter for details.) Once the information is submitted and the application is complete, I will continue to process your application accordingly. If the additional information is not provided to the County within 180 days of this request, the application shall expire and no further action on the proposed development shall take place. Please contact me at (360) 427-9670, ext. 363 if you have questions. Sincerely, Kell McAboy Land Use Planner Mason County Planning Department 8/1/2005 1 of 2 BLD2005-01178 REQUEST FOR ADDITIONAL INFORMATION 8/1/2005 Case No.: BLD2005-01178 Comments: A site inspection was conducted on 7/29/05 to assess critical areas relevant to future residential construction. It appears that the property is adjacent to a wetland and possibly within a wetland setback/buffer area, depending on the wetland category. A wetland delineation and categorization will be needed to determine the applicable buffer requirements for the site. A list of wetland consultants is enclosed for your information, although you may also choose other qualified professionals not on this list. Also enclosed is the Wetlands chapter from the Mason County Resource Ordinance. If you have any questions, please don't hesitate to contact me. 8/1/2005 2 of 2 BLD2005-01178 MASON COUNTY DEPARTMENT OF HEALTH SERVICES July 19, 2005 PO BOX 1666 Shelton WA 98584 Shelton (360) 427-9670 V)qoLl'v �/�U Fax (360)427-8442 Elma (360)482-5269 Belfai r (360) 275-4467 Case No.: BLD2005-01178 Parcel No.: 122297890073 Dear Applicant: Your ilding permit cannot be approved by Mason County Environmental Health until the folio ing are completed and turned in: Water bacteriological analysis. T Please see comments at the end of this letter. Please call me at (360)427-9670, ext. 554 if you have any questions. Sincerely, Trish Woolett Environmental Health Mason County Health Services Comments: According to our records this water system was required to take a bacti sample on or before 05/11/05, Our records do not indicate this has been completed. Please send us a copy of the satifactory results or contact the water system manager about getting the sample turned in. 7/19/2005 1 of 1 BLD2005-01178 Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 3 Topic Index I Contact info Search It Nome Safety Claims& Insurance Workplace Rights Trades ft Licensing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber General/Specialty Contractor A business registered as a construction contractor with L&I 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 MODERLL972DO Licensee Name MODERN LIVING LIMITED Licensee Type CONSTRUCTION CONTRACTOR UBI 601957031 Verify Workers Comp Premium Status Ind. Ins. Account Id 0 Business Type CORPORATION Address 1 6119 PACIFIC HIGHWAY EAST Address 2 City FIFE County PIERCE State WA Zip 98424 Phone 2539260455 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 3/20/2003 Expiration Date 4/14/2007 Suspend Date Separation Date Parent Company Previous License Next License Associated License https://fortress.wa.gov/lnl/bbip/Detail.aspx?License=MODERLL972DO 9/2/2005 BEDRTHIRD OOM �loraos _LLLLL I IL 119a11Q fMRMJ y MASTER LLL WN_LL A BEDROOM _LLLI"xl:r-LL G"RM. Issas LLLLLLL Ieral4e LLLLLL L LL LL -LL — LL i l „ L L FlW CHENE7IE. mao■v-r V44G Mo*TER —�- 60 ROOM BEDROOM .i. BEDROOM ITJa1T-r I2-4x17a LLL- Ir-tart OFnOW GAM ROOM K' w.i L;L LLL LLL m FORK=7a r "x""iL L 1980 SQ.FT. 48R,38&DOUBLE MASTER SUfTE g327" AVER ASON BUILDING INSPECTOR LLL 'WANGES SUBJECT TO APPROVAL LLLL LLLLL n O r OFFlCE LLLL tdATE Z r-Ioxe-Io� LLLL LLL L«. anaeMl nor.E afFICE OF ROW SASE MEW 94M ... )001- FOR EM7006 ton a wwa 3 I t) ZooS- oil -is RECEIVE® SIB ' ES PR OfR TO CHANGESFOR ARM NGPWORK L 12229 =1 �- � od� 1 ?005 426 CEDAR S-r, �s"/cro� Alt r(Jl fT v f STD!jF cfl/ \`j PtA � p 7'11FS CAN OR INS S/TFe47 - `0Al.� cTI�N c� N -= )LL J i Y I r 1 �y� r� 0 /}zt h + 1 ,7 EN Alt CL F" •X� Y+ `r � d ' �v a. •r. 00 Tw ' -l� + L �� + : ✓ O I � /I / s•.-- i w+ aUir—UG"CUUJ WL' UJ�b4 1'r� LIbBT�y ttomrc lna�aalmo YNR IVI1. ❑ll] OtIJ IJUy li UL �• W ED m of Jr- = � 1 ---------� rFF :T- r U rl r�i 1 iq L-:L" ITo I0 SN 1 W..y . N.....b.. 7 k by .............. _, ) y J r Aoo e- 0 - dIto ��✓� — r AGES' ) iRED , BE ON SIT`. �ITt ��riV 1•. U AC1 B E-CT 10 A?PROVt1L, �G- G�I Mason County Permit Assistance Center Planning Intake Checklist Owners Name: (A o®e Q rj u+vp Date: Project: 1A-9� 'J IZA Reviewed By: A (t Commercial Development: YES Comments: Planner: GBM TSC CMM 'l-KJM SNG BJR Site Plan: td North Arrow qb Property Dimensions: X `a Streets and Driveways Shown. Road name: A ❑ All Existing Structures shown with setbacks ❑ Well Location, Septic and Drain-field Shown with setbacks rya C ,: Identify all surface water(streams, ponds, shoreline, wetlands, etc.) Topography(slopes) z a ❑ Proposed Structure Setbacks (Direction/Setback): F: E / dLle�R: / �o5 S1: N / 4,�1S2: / �J ❑ Utility and Drainage Easements: Yes �Nd`(if yes enter condition#5022) ❑ Other Easements No f-� ❑ Accessory Appurtenances ❑ 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: N oN e Slope: F r,-T- Shoreline Designation: Comprehensive Plan: Rural Zonin ElNot Applicable ❑ Agricultural )2:,,RR 2.5 0 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy a Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR ❑ Unknown ❑ Unknown Water Body(type of water if unnamed): a�cs�J L SEPA: Yes JIV Unknown Flood Plain: YES NO Un owh Map# Aquifer Recharge: YES NO Unkno(i Map# Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: YES �,NQ Eagle Nest Tag: YES O Other YES "�00_) Addressing: Check box if needed ❑ Reviewed by: Revised:07-12-2005 1:\PLANNING\CHARELL&RENEE\PLANNING INTAKE MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST Owner's Name: e,,v-R1 c V-ti� Date: Reviewed By: Documents: Building Permit Application Completed Planning Intake Checklist Completed, Site plan includes:Allowable building area,roof overhangs,decks,etc. _Fire Apparatus Access Road info required? Yes/ Energy Code Application Form-O Electric wall heater O Electric central furnace O LPG Furnace O Heat pump with electric furnace O Heat pump with LPG furnace O Boiler(heat type ) O Other: Specify: —Mechanical/Plumbing Application-WATER HEATER FUEL TYPE _Engineering? Yes No Snow load used: Seismic Design Category: D 1 or D2 —Geotechnical report or assessment? Yes No Construction Plans: 3 COMPLETE SETS Plans Legible —Recognized Scale _Elevation Views —Cross Section _Foundation Plan _Roof Framing Plan Floor Plan-Use of Rooms Noted —Floor Framing Plan-all floor levels represented? Loft,crawlspace,etc. _Deck Framing Plan,including covered porch roof framing plan Plan Details: Roof framing details,truss lay-out may be needed Wall Framing-Does bearing-wall height exceed 10'?(Engineering may be required) Floor framing: Floor joists: ,Floor beams: _Window headers. Typical header: Foundation: footing size,reinforcement —Concrete Walls-Does Concrete Wall Height Exceed 9'?(Engineering may be required) Landings at all exit levels? <30"above grade? Y / N _Heated By Furnace-Location of Furnace —Fireplace/Stove Information Shown-Fuel Type? —Window Sizes Marked on Plans _2-Story Garage? (Engineering may be required)R602.10.1, I'story of a two story: D 1—45%,D2—55% —Braced wall panels(shear walls)marked on plans or lateral engineering?(Plans may not be approved if not provided) COMMENTS: IRREGULAR BUILDINGS(Unusual Shape)R301.2.2.2.2 Irregular portions of structures shall be designed in accordance with accepted engineering practice. A portion of a building shall be considered to be irregular when one or more of the following conditions occur: 1)Exterior braced wall line or BWP cantilevered or offset by more than 4' 2)Roof or floor is not laterally supported on all edges 2A)Portion of roof or floor extend more than 6 ft.beyond the braced wall line. 3)End of BWP extends more than 1 ft.over an opening more than 8 ft in width below. 4)Opening in a floor or roof exceed the lesser of 12 ft.or 50%of the least floor or roof dimension. 5)Portions of floor level are offset vertically 6)Shear wall lines do not occur in two perpendicular directions. 7)When a story above grade includes masonry or concrete construction(exc: fireplaces,chimneys,and.veneer). When this condition applies the entire story shall be designed in accordance with accepted engineering practice. 2003 IRE Plans submittal checklist simplified(WORD 07/15/2005 06:43 2538512764 BLACKHAWK RE PAGE 02/03 MA5UN CUUN I Y DEPARTMENT OF HEALTH SERVICES Environmental Health Personal Health 1666 SHELTON,WA 98584 V E D PO BOX LOCAL(360)427-9670 BELFAIR(360)275-4467 a 4463 470 CED&R STA Application for Determination of Adequacy Instructions PART I.- Applicant/Parcel Identification NameofApplicant JIII In 71IXi425 Mailing Address "!E: Telephone 6 -7 �646-3 Assessor's Parcel Number 2 9, �7 -CS,ly 7—' Type of Waters stem Clzeck One): ,Reason Lor4MUcaflon (Check qLtgL,__ Public/Community Water System(2 or more Building permit connections) ri Land use application,If so.. tr Individual water source(one connection),if so.. 0 Division of land 0 well 4 of Parcels? F] sprinoudace water SPH9 - t] Other(explain) 0 Boundary line adjustment 0 Other(axplain)_ PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated for adequacy: Public lVater_S stem Nanic of Water System 'ejlell-o4 ze,�2 ),-- Y* Water Facility Inventory(WI)Number: nfeO-) 1;/7-!5-- 0 The watcr purveyor has filed a letter granting bl&aket book-ups to this water system. I am the M er of water-system. The water systctnhash approved for ep services. 7-liere arc pre r Sys scritly corinectionS in use. This will be the S connection, MIS were stem is able and willing (these)connections liout ex Ming the limits of the water system or any to purovi e water to this limits set by state and local regltian. Signature of Water System Manager.. Date f lip Update,March 22,1999 V -