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CD (D 0 � -- m m � . v O ] % w 7 $ k 00 2 0)� / �� cr G) < / 0 m E 0 c R E72CD o■ m k E� :3 ] k � CD § cc ƒ\ K § F CD ten 2 cD 0. 08 j / 2Q % 22 / 0 FDRi — m2 @ CD m m 0 � CL m F. 2 o 0 § 0 N 3 2 . aC ƒ / F B co 0 CD 0 n 0) 00 c k « 3 % CD CDƒ � � CD 0 \ % k 7 % CA ¢ 7 _ ® q =r 0 cn / � 2 2 - g\ ] ' k - 0 5t � 0 �o f 0 2 + 0 -n # 5CL 7a & f � � ■ R2 0 a MECHANIC" MOBILE HOME .setback dab Gas P%ft I watt ° date by date UP Z INSULAMON L-2 7— a L.� e0MM insulation byFloors date by date by FIRE DEPT. FRAMING walla date by dab by date by PLUMBING Attic OTHER GmwAvork by date by WALLBOARD NAILING D.w v. date by by Water Line FINAL INSPECTION date date by date by C�VJ^tT rn e- el,t 4o a -. 3-Z?- ZOO 6 AZ L iytt hk5 /8 JC3a �i rs�/L CD�pu� �.eoT�T-�✓ �:�<� ��av>L �eAOE No 47- lffis TiM� 49 5 Z.3-&- Pl.FASC-RF P r'l -- -/7� C- L PERMIT NO.: BLD ((M/ /r MASON COUNTY 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 « 7 APPLIC NT INFORMATIqPJ CONTRACTOR INFORMATION Owner Contractoi Name 676,tz V 4X I Mailing ddress Mailing Address City State J1,#Zip Code q&n4v City State Zip Code Phgne J �'1 5=/3.T�Other Ph.D(.�b)"?3/-�Ta 3 Ph.( ) Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration 'SEPTIC/WATER SYSTEM INFORMATION-Connect to New,x,Peptic E)%sting Septic Connect to Sewer j System .Name of Sewer System Wf4jI Water System Name of Water System i I PARCEL INFORMATION-k digit Tax Parcel No. OL*&' Fire District Legal Description ©a+t-1 ---- Site Address(Please include street name, street number and city) Directions to site Piro ,� c'n O , Will timber be cut and Id in parcel preparation? (Yes/No)A I F -� Is your property within 200' of the following: Body of Water(Name) L�o Saltwaterj )n Lake River/CreekA.20 Pond�S Wetland&&2 Seasonal Runoff J20 Streams Slopes or Bluffs PERMANENT RESIDENCEW SEASONAL RESIDENCE❑ TYPE OF JOB NewA Add Alt Repair Other ,U/s�e of Building Describe Work ,q // l,l 4,,� /►1,,-00 .�„--e d $&L , ,e-- No. of Bedrooms No. of Bathrooms_y_SQUARE FOOTAGE-1st Floor !yam 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached i MOBILE HOME INFORMATION-MakeX6n/d w wz-�Model)( Q/• Sda Model Year Gj Length -059, Width :72 Serial No. No. of Bedrooms�3 _No. of Bathrooms_ 1 Type of Heat Purchase Price $ 4:Z Replacement Unit ?(Yes/No) Installer Nam Certification No. Lt1fI1',ti3 �''LL..C.O//� yy q 1 i 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: I 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 approval. X //1-lze- O/ X Date •Date � i FOR OFFICIAL USE BEYOND THIS POINT Accepteckby r Date/ - St��(nittal Amount Due `~—. Receipt No Building Dep....... APPRO UD; pB;NIBD BDIVDI.Tl+ IV COaS Occ GroupW e onstr. Planning Department I Environmental Health Department Public Works Department I Fire Marshal Valuation $ ?ff& (0on i �fE i Building Permit Fee Site Inspection i Plan Review Fee EH Review Fee j Plumbing&Base Fee Planning Review Fee i Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee LA 465 Violation Fee Pre-Paid at Submittal ( "� TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFO-WATIO Case No. Name/�/�N�i�L1. .� ��G�7yf/' �AF CEL NUMBER SHOW THE FOLLOWING ON SITE PLAN Show Direction by indledtionng N, S, I-, W In rielation to the plan [Lot Dimensions Fences 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 ad aunt.pr0firty line; adjacent property line- , I F-adjacent property line I I I I ' I i I ' I I I I I � I I � I I I 1 n I I V I I I I I I I I � I I 1 I I I 1 I I I I I i I I I I r I I I I I I I I ' Fad scent property line adjacent property line- SAMPLE SITE PLAN I I' I I E- djac[He.aon,st/..lspucr o_ perty lJin e adja�t property line-� r3, pit %JAL. 7 T AMtrtuLru.RAL Soy-- � eL LCsARAG6 PePmc0 r I I I I � I ' -----/OD' I 1 I l ' � I ad'acenfi pro �. E-adjacent ro ert'line, ert line4 - 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,TOPOGRAPHYPROFILE dts►a.;es. to turf La.r't d:ata.�cc: ro 3�op� tom dia+anca_ to � Date Signature MASON COUNTY PROJECT SITE INFORMATIONIP Case No. x y. r ' Name 6 CEL NUMBER /.2 Z "40Udj�te ZAl SHOW TH ,FOL NG ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions' Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainege Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent prop2rtiesif on shoreline prnrith'trr itl .'f t'of adjacent property line. adjacent property line4 ., I E-adjacent property line I . 1 1 ._ 4 1 I I I I I I � I I � 1 I I I � I I 1 1 1 I 1 I I I I 1 1 1 I I I I ` I I I I I 1 1 I I I adjacent property line-> I ' (-adjacent property line SAMPLE SITE PLAN adjar�nt property line-� 3Lo� _ _ (-adjacent property line I p 36. FIR RVE gp:.,;,1 CREEK ;' \\ _ :&Ll3.6N \�I I WousG. jP0.oPoseD smp+.C- �I 1 , 6 0 1 R I VAGIuT 1 � C ARAv6 \ 1 .. I(� P0.cPosCfl 50 \ T /16R SltLLTu,ILAL I 1 1 /00. -) I 1 \ I I I I r I adjacent property lined (—adjacent ro ert y 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 dl3tar�GQ, fio ' ruL?"Y,a.YL cl;s t'a r.G,L to S►opAZ �-o¢ dis+anc� 4o a i o Signature Date j83` � r. LL � 3.74.E c es f, � r PoMLf J - ��iOP WA - i i Q k i N 512.90' ' tt+cb;1 560.00' /�d( \1wnE "Ps� ;+� nk VI Z k i w I:_ , •,t 4�MP LZJ w/a%�L ao� \t1 fJ /ovzyn� 307 46 q N pt 8�d g ppg 3 3 Y 1� -t.M ift E 6 1 (� i klk • - �� — — •ram. 1w / Ys:, �a�i• tpMttp___. N � � - m � tf tLy� o N ....... ......... ...•..... .n.... n+n t*� t �rv.t +t�!tt triifr!i111 PARCEL"a1 The South 326 foot of the North .359 feat, as measured along the East lieu tbareof, of all that portion of the Northeast quarter (NE Northeast quarter_=-(NE-IT6)-:of-=g +,n_-thii-tyone (31) , Township tventytva (22) North, Range one (1) west, W.H., lying Easterly of the Easterly right-of-way lino of State Route 3; exgenting therefrom road rights-of-gray. Portion or parcel Nos. 12231 11 00000-and 12231 11 00001. I (iiii: rtion of the Northeast quarter (NE 2/4) of the Northeast quarter (NE 1/4) of Section thirtyona (31) , Township tventytvo (22) North, Range one (1) west, w.K., particularly described as follows: f BEGINNING at the.Northeast corner of said Section thirtyone (31) ; thence west, along the North line thereof, 660 fast; thence South 630 foot; thence East, 660 fast, to the East line of said Section thirtyons (31) ; thence North, along said East line, 650 feet, to a the POINT OF BEGINNING. EXCEPTING therefrom, all that portion thereof which lies westerly of the Easterly right-of-way line of State Route 3; EXCEPTING therefrom, all that portion tharsot which lies within the North 359 feet, as aeasured along the East line thereof, of said Northeast quarter (NE 1/4) of tha Northeast quarter (NE 1/4) ; EXCEPTING therafrom, road rights-of-way. Portion of Parcel Nos. 12231 11 00000 and 12231 11 00001. TOGETHER WITH and SUBJECT TO an easement for ingress, egress and utilities, 20 feet in width, as described in instrument recorded Kay 5, 1987,. Auditor's File No. 466650. 1783373 Page: 4 of 6 12/13/1999 02:17P P S JOGEN NISC 13.00 Mason Co, UA '{1{ i t f .j COMMITMENT FOR TITLE INSURANCE Office File NO" Q-115048 SCHEDULE B-I SPECIAL EXCEPTIONS: 1• Easement affecting a portion of said Purposes hereinafter stated, asPremises and for the granted December 18, 1976, in the Office ofthe r cordingment Officeroofed Mason County, Washington under Auditor's File No. 320453; In favor of: Public Utility District No. 3 and Pacific For: Northwest Bell Telephone Company Underground and/or overhead transmission and electric lines and appurtenances thereto; 2• Easement agreement executed named upon conditions therein providand ed,Veincluding the ritssterms, covenants and provisions; Recorded: May 5, 1987 Recording No. : 466650 Said agreement includes, but is not limited to, sharing the costs Of maintenance and improvements. 3• Agreement, including its terms,restrictions and equal share of covenants, provisions,the cost of the construction, maintenance or repair of the roadway described herein; Recorded: March 30, 1993 Auditor's File No. : 562132 4• General taxes for 2001, which have been paid; Amount: Tax Account No. : 12231$494- 7 223T 11 00000 Affects: Said premises Land AV: $20,900.00 Improvement AV: $21,970.00 5• Liens of real estate excise sales tax upon any sale of said premises, if unpaid. Excise tax rate for Mason County is 1.53*. kj b nIIILDING Pwam= �;jL??am DATE _JLI � Planner Area psL Parcel CHECKLIST FOR PROPOSED CONSTRUCTION Comp .Plan Designation UGA RAC RCC _)OIA •—For IH Yes No Within 200 FT of SMP designated shorbline, wetlands, etc. Where? [ ] ] Located near possible Critical Area, What Kind? (Wetlands, Streams, Lakes, Slopes) [ ] [ RLC already done? Proposed construction within floodplain Eagle nest [ ] [ Six year moratorium [ ] [ Multi-Setbacks [ I [u] State road access needed Commercial Development (parking standards, sign '11 ordinance, public works review, other applicable agencies) [ ] [� Mobile Home or RV Park 30 Musr MEET A CURRENT _ 6- :?PUT 9- - - po M 81 HAN3ES. slre- PR OR TO PER G WORK E P AN THE MUST B ,v Q P INSP CTION. �o w 512.90' tr�;l 560.00' /3A aanE c+s -v AV G- n:k r z M h `, 6 O LJ 7� LJ �,��• APF RC Vt .) t 4�MPIVII SON BU - '�' CHANGES Sl BJECT TO APF ROVAL aq• aa% DATE 0 � wivi O't'L l!1 .s— S�