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CONCRETE MECHANICAL MANUFACTURED HOME
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Date By INSULATION Date -cc- BY
BG I Sla 4 InsuW1on Floors FINAL I NSPECTION
Date By Date By Date Z:,;C C By 7-%�
FRAMING Walls FIRE DEPARTMENT
Date By Date By Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLBOARD NAILING
D.WN Date By
77
Date B ilk 1 11
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GE1�E� MASON COUNTY PERMIT NO.
RE 2�05 BUILDING PERMIT APPLICATION
426 W. Cedar- P.O. 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
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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
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License
https://fortress.wa.gov/lnl/bbip/Detail.aspx?License=MODERLL972DO 9/2/2005
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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 -