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ot1i * « CONCRETE MECHANICAL MANUFACTURED HOME
o Footings!Setbacks Date g Y3/"`36 j By / , Ribb Gas Pipinons
C) Ir►teriorDate By Interior-Date By XX DOW By CO)
Exterior Date .S'—/�e�6 BY Exterior-Date By
OD O
Point Load r Isolated Footings INSULATION DOW By
BED T SLAB INSULATION
Date By Data By FIRE DEPARTMENT
Foundation Walls Floors Date By
Date Cr, tS B By �/� Data-7 By/7— DECKS
FRAMING Vftft Data By
Date Q-,�/--G BYZK% Data By PROPANE TANKS
PLUMBING vault Data By
Date By OTHER
Groundwork Attic
Date By Data By Type-
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Date By
Int.Brace Fay Date By
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Pastor Request Inspect. b
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MASON COUNTY PERMIT NO.d``Q660 —CIO 3 �--�
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
On the web wwwco.mason.wa.us
APPLIC NT INFORMATION CONTRACTOR lt4FORMATION
Owner it-'G Company Name VitS Ir15�t't.l inn
Mailing Add ess Mail" Address I/ S
City' I State-WA Zip Code City ' r State W_ Zip Code
Phone 4Sq"14q Oth r Ph. oCa- O-i-lq 15 Phone 3PaC-Tl(4-r) Other Phd)-98(a-3
Lien/Title Holder Contractor Reg. #i°�►VtEG 1�31C 1 Exp. S-3 t - Olo
E mail address V E Mail Address
Drivers Lic.# L DO - Drivers Lic.#DAV 1 E 0 DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System 1. Name of Water System Pa#,a G1 i'S e �1
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. 1 Fire District
Legal Description Lut 9 SSA 'G`3'
Site Address(Pleas include street name, street number and city)5S 1 i A1r
Directions to site JA &Afb'lr
1 r Pavv(
Will timber be cut and sold in parcel preparation?Yes AW
Is property within 200'of Saltwater 13 Lake River/Creek Pond nQ
Wetland Seasonal Runoff Stream r 1U Slopes or Bluffs 15% M
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New-, Add Alt Repair Other PRIMARY RESIDENCE [4 SEASONAL ❑
Use of Building earl � escribe Work N9L�% ��� r uCf Ion
j No. of Bedroom No. of Bathrooms Square Footage- 1st Floor 2_ t 2nd Floor
I 3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage--I Attachedi Detached Carport Attached- Detached
MANUFACTURED HOME INFORMATION - Make 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.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order orpermit 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 CoL"y-a -tp the above
described property and structure for review and inspection. This permit/application becomes null &void if work or awth r4;ed Construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY
MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDAf,4, E�k? ATION.
X Date:
Owner/Owners Representative/Contractor (indicate which one) ;
I
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED t= TES
Building Department a�vc� Yo
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee - Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee \ O Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ ITOTALFEES
FORM MUST BE COMPLETED IN INK PERMIT NO.eI
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
On the web www.co.mason.wa.us
APPLICkNT INF MATION CONTRACTOR I FO MATI N
Owne oaA OP a V l LS Company Name n ,Ups
Maili A dres C C10 Mail* g Add I �/ 6ut 54"•
City U ►� �tatAe /A Zip C99de $5 City Y r t t Zip Code
Phone ✓ Other Ph.lo0 }D�441� Phone 1y' 3 Other Ph. O Lien/Title HolderDrt Contractor Reg.ff�AyIE 3K-1 Exp. -Olo
E mail address I ad VW5(e 2 ULA E Mail Address
Drivers Lic.#DAV IE bL9120 D DOB -S9 Drivers Lic.# bAV IF
Qa1Sbf� DOB �-1 -13
SEPTIC INFORMATION - Connect to New Septic X Existing Septic. Connect to Sewer System
Name of Sewer System
PARCEL INFORRAATION- 12 Digit Parcel No. '�50t,I 7q 006 9L Fire District
Legal Description a SSA 011S IgS Pfin O V Site Address (Plebe include street name, street nu ber and city 38l 1 r aiY AR5
erections toge I A k e 00 PadPal r kV(A 1-6 DgLn& Ks, ja4L idftipri
ow cReTE
1 , a Ik i ki!4pytie-H.
Is property within 200'of Saltwater YID Lake River/Creek r16 Pond
Wetland r b Seasonal Runoff _e Stream ► O Slopes or Bluffs 1 15% Ylb
TYPE OF JOB - Newer_Add Alt Repair Other Use of Building Sinale fb 114 re-Sr
Location of Fixtures/Units- 1st Floor 2nd Floor Basement Gara e____9__Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric,-Y— LPG— Natural Gas_ Heat Pump X
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace I
Bath Tubs a Heatpumps I
Showers I Spot Vent Fan 4
Water Heater I Propane Tank 1
Clothes Washer t Gas Outlets S
Kithen Sinks I Wood/Gas/PelletStove 1
Dishwasher I Kitchen Exhaust Hood 1
Hosebibs S Dryer Vent I
Other I 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 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 OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X ". Date: -13
caner Owners Representative/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 Grou T e 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 Addres i ' { "� ! i + F Mailing Address
(.I( i i i r State i t ,City ' '� Zip Code `-�`�' City ( I ` + �� State t rl Zip Code I '�
( t. )�,1 t` . -' il�? ,(it fit:. +6`"s�7 cy `)i1- t ( (r
Phone Other Ph.( '
'� Phone Other Ph.'
Lien/Title Holder Contractor Reg.#a LA I `t ( i..r k ( Exp. + C r<
E mail address t:�i + ( y�' t+ �`+ '�t E Mail Address
Drivers Lic.# ' r to ! i. l 'i t`. . I DOB Drivers Lic.# �/ ( , 1�1 +.1. �4 DOB
SEPTIC INFORMATION - Connect to New Septic__X_ Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. t r ":z. �" r i <- ' Fire District ,LI
Legal Description Li i t ..f t 1 ..:., 4° 4_' - t.:
Site Address (Please include street name, street number and city) a'1
Directions to site �-t c t I t�:t i1r"�++ flt�iI G (_c.6 + 1 V_ I t itV. I)EI. f,`iizr:. tt
t<<++,-
Is property within 200'of Saltwater i t Lake `� -River/Creek }�= Pond w
Wetland i �C Seasonal Runoff Stream ; ai Slopes or Bluffs J 15% +/
TYPE OF JOB - New x. Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1 st Floors— 2nd Floor Basement Garage X Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_Y__ LPCz_ Natural Gar,_ Heat Pump X
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Heat um s I
Showers s �— Spot VentFan LI
+
Water Heater Propane Tank
Clothes Washer t Gas Outlets
Kithen Sinks t Wood/Gas/PelletStove t
Dishwasher + Kitchen Exhaust Hood I
Hosebibs Dryer Vent I
Other I Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
QNNER/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 receW 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 s
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X ,—. Date: -
wnej)/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd -Receipt.Nc
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group—Tyve 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
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TOPOGRAPHY PROFI ; OF VRTH SURFO
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Direction: Scale: %�pptaval tor.office use
Building Permit number: ►�__ .4 ' Building:
Owner/Applicant: o 0-0 i Date of
Planning:
n D application: Env. Health:
Parcel Number: 30 h 12 9 OOoz
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MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
March 23, 2006 PO BOX 1666 Shelton WA 98584
Shelton (360)427-9670
Fax (360)427-8442
DOUG DAVIES Elma (360)482-5269
P.O. BOX 1904
BELFAIR WA 98528 Belfair (360)275-4467
Case No.: BLD2006-00328 Parcel No.: 123061290002
Dear Applicant:
Your building permit cannot be approved by Mason County Environmental Health until the
following are completed and turned in:
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: Paradise #1 Water System is behind in there bacteria and nitrate
sampling. Can not approve the building permit without current sampling
with satifactory results.
3/23/2006 1 of 1 BLD2006-00328
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
L
March 23, 2006 PO BOX 1666 Shelton WA 98584
Shelton (360)427-9670
Fax (360)427-8442
DOUG DAVIES Elma (360)482-5269
P.O. BOX 1904
BELFAIR WA 98528 Belfair (360)275-4467
I
Case No.: BLD2006-00328 Parcel No.: 123061290002
Dear Applicant:
Your building permit cannot be approved by Mason County Environmental Health until the
following are completed and turned in:
ma-
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: Paradise #1 Water System is behind in there bacteria and nitrate
sampling. Can not approve the building permit without current sampling
with satifactory results.
3/23/2006 1 of 1 BLD2006-00328
Mason County Permit Assistance Center
,� 1 `Punning Intake Checklist
Owners Name: "v Date:
Project: I - Reviewed By:
Commercial Developme YES (No Comments:
Planner: GBM TSC K& SNG PBC
Site Plan:
North Arrow �� X 2 C
Property Dimensions: �_ G, BW
��Y�°Q.
9/Streets and Driveways Shown. Road name: ���
❑ -AA-Ex sting Structures shown with setbacks
Well Location, Septic and Drain-field Shown with setbacks
u-"'Identify all surface water(streams,ponds, shoreline,wetlands, etc.)
p,Topography(slopes)
4_11'r,oposed Structur Ss (Direction/Setback):
F: j L /etbackR: <,', /1 S 1: S2:
W-Utility and Drainage Easements: (ge No (if yes enter condition#5022)
p—Accessory Appurtenances 10n�r (_-/0
❑�ounty Access Permit Needed(add condition#0010)
Stat cess P eede�(a ditiondard ons to o al ing 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: A)-PT- Slope: rV
Shoreline Designation: Comprehensive Plan: Rural Zoning:
No Not Applicable ❑ Agricultural `y-RR 2.5 5 10 20
❑ Urban ❑ In-holding ❑ RMF
❑ Rural ❑ LTCFL ❑ RC 1 2 3
❑ Conservancy %�L. Rural ❑ RI
❑ Natural ❑ RAC - ❑ RNR
❑ Unknown ❑ RCC-Hamlet ❑ RT
❑ Urban Growth Area ❑ MPR
❑ Unknown ❑ Unknown
Water Body(type of water if unnamed): ►� -yQ_�
SEPA: Yes(1'�O Unknown
Flood Plain: YES NO Unknown 1p#
Aquifer Recharge: YES NO nknown Map#
Tags/Cases:
RLC/SPI Case: 6-Year Dev.Moratorium:O ) YE&NO
Eagle Nest Tag: YES N Other YE
Addressing: Check box if needed ❑ Reviewed by:
Revised:11-01-2005 1APLANNINGTACPLANNING INTAKE
MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST
Owner's Name: ) , IS', Date:
Reviewed By:
Docuinents:
✓Building Permit Application Completed
�/Pl ng Intake Checklist Completed,
es:Allowable building area,roof overhangs,decks,etc.
I
Lnergy Code Application Form-O Electric wall heater O Electric central furnace O LAGFurnace
O Heat pump with electric furnace `Heat pump with LPG furnace O Boiler(heat type
O Other: Specify:
_ZMechamcal/Plumbing Application-WATER HEATER FUEL E
Engineering? YeIGZD Snow load used: e Seismic Zone(circle one): D 1 or D2
T Geotechnical report or assessment?
Construction Plans:_Y 3 COMPLETE SETS
�/ Plans Legible Re gnized Scale �levation Views �s Section
undation Plan oof Framing Plan �oor Plan-Use of Rooms Noted
Floor Framing Plan-all floor levels represented? Loft,crawlspace,etc.
—Do-1-Tuaang Plan,including covered.porch framing
Plan Details: �,/
Roof framing details,truss lay-out may be needed _ I l L .
_Nall Framing-Does bearing-wall height exceed 10'?(Engineering may be r q ired) w
Floor framing: Floor joists: M it 0 t S + Floor beams: 1 .
ir�Window headers: Typical header:
foundation:footing size,reinforcement
v-C; a Walls-Does Concrete Wall Height Excee '?(Engineering may be required)
_V!J,andings at all exits? Less than 30"above grade? Y ! N
Heated By Furnace-Location of Furnace
✓Fireplace/Stove Information Shown-Fuel e?
Window Sizes Marked on Plans
_.. -Story-arage? (Engineering maybe required) R602.10.1, 1 t story of a two-story D 1-45%,D2—55%
t/$raced wall panels(shear walls)marked on plans or lateral engineering? (Plans may not be approved if not provided.)
COMMENT :.
i
IRREGULAR BUILDINGS(Irregular 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 my ( pchimneys,
p ) y grade is includes maso or concrete construction exc:fire laces and veneer).
When this applies the entire story shall be designed.In accordance with accepted engineering practice.
t,
2003 IRC Plans submittal checklist simplified/WORD
t
J
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES _
Environmental Health Personal Health
PO BOX 1666 SHELTON,WA 98584
LOCAL(360)427-9670
BELFAIR(360)275-4467 35 Z
Application for Determination of Adequacy FAX(360)427-7798
Instructions
`., Complete lPart 1. No determination can be made until Part'l is.fully c6hipleted.
2. Complete only the portion of Part 2 applying to the type of watersystem utilized.
3. Submit completed application,with attachments to the health department for review.
PART 1: Applicant/Parcel Identification
Name of Applicant_N (i(� `F l � d 12. LJ Its Date
Mailing Address LI _ _Telephone
r cl 52
Assessor's Parcel Number 1%3 b(o( 01�q000 9k
Type of Water System (Check One): Reason for Application (Check One):
Public/community water system(2 or
more connections) 10 Building permit
❑ Individual well(one connection) ❑ Land use application,if so...
❑ Well ❑ Division of land
❑ Spring/surface water #of parcels?
❑ Other(explain) SPH2_-
❑ 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_ CLI:CIC(l Se --4-1
Water Facility Inventory(WFI)Number: A A CC)4
❑ The water purveyor has filed a letter granting blanket hookups to this water system.
❑ I am the mana er of this water system. The water system has been approved for services. There are
presently connections in use. This will be the 3 connection. s water system is able and
willing to prove a 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 - Si--�� �--T ^ Date 3'i"
Update:March 22,1999