HomeMy WebLinkAboutBLD99-0215 Final Mobile Home - BLD Permit / Conditions - 6/23/2000 M a
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date/"_ by T� date by
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PERMIT NO.: BLD g9�oa�5
•' 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 4825269 Seattle 206 464-6968
APPLICANT INFORMATION ICONTRACTOR INFORMATION
�'
Owne OHN /� osEM.a2x t/ArY jyyKE Contractor Name
Mailin Address /yb2 ...%t^ RvE S. Mailing Address
.�
City A State 5 , Zip Code 1�6Ot City State Zip Code
Phone(2s-3)�(0/-/27�ther Ph (. Ph.(_) Other
Lien/Title Holder Contractor Reg. #
Address Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic�_Existing Septic Connect to Sewer
f System Name of Sewer System Well-X Water System Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. O / /
Legal Description -r S Q TT7 900�j13 Fire District Z
Site Address(Please include street name, street number and city) Jy F- 1yIJJrS1,9r4 &MOD DIZ SCIPAIffg Directions to site-_StgA N/zL 1?i—_ PA.S. r• Mis !oN /?Ff,c YaVr1+ eAe+�P <'�r �� M,fs�•n/
t,.20 o 0 D 1t
Will timber be cut and sold in parcel preparation? (Yes/No) [�
Is your property within 200' of the following: Body of Water(Name) A71 S/D/V C crc(c Saltwater
Lake River/Creek
Bluffs _ Pond Wetland Seasonal Runoff Stream. Slopes or
TYPE OF JOB New_Add Alt Repair Other Use of Building
Describe Work
No. of Bedrooms Z No. of Bathrooms / SQUARE FOOTAGE-1st Floor-�_2nd Flgor
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make IBLE[TY Model g1L)&E4w00 f? Model Year 932.i
Length 60 _Width /y, Serial No. C!>2L.. 18 Z21 No. of Bedroomsl_No. of Bathrooms_
Type of Heat Fre � P, � - 1 Purchase Price $_ L,, oab.00 Replacement Unit ?(Yes/No) tqo
Installer Name —� 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-I certify that I am exempt from the requirementsG 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 rh• oe- Date '2 9- 99 X
Date
FOR OFFICIAL USE
'�`` BEYOND THIS POINT
Accepted by Date ��S�ubmittal Amount Due
eceipt No._.
i PAR M NTAI..;I�1 V f»Il1f ROV D NIi»D DiDltiDlTl l C?4 .
Building Department -
Occ Group_ Type Constr.
A-90 zo/zi.s�7
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
Valuation $ �.
.: ,.. . . .
Building Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing & Base Fee Public Works Review Fee
Mechanical & Base Fee Other
Wood/Gas/Pellet Stove Fee Other f
Violation Fee Pre-Paid at Submittal
•>�::.,,:s::.w•�.`>�:.'k' ':>iik:^3• '�•, '•�•�� :�:�<v<��..'� y.;� :<�.::,>•�:: TOTAL FEES
'•sk: •ireekx,•::<t:r.`::•tc+r'...ra,?sx2�.Sk•%at?a�. ^me:r,':btSfi:r: J:'tS+:a%L.'«•+t:K:`'t^•:•S'.'•`:W.•S:%:5:'.�S::s•::;:r;;
�#a'.c <#ie•:'tx'•xte:3x•S:::xs?eauve..:<.r•:�
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD
MASON COUNTY PROJECT SITE INFORMATION
ss��'' Case No.
Name,.�OE{O oSEMA2y V&a Dy= PARCEL NUMBER_ 1Z307-3Y-900Jf3 Date
SHOW THE FOLLOWING 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 C� Z
Well Location (including adjacent) Drainage Plan
Names of Streets Easements
Names of Fronting Streets Septic System (T�
DRAW SITE PLAN BELOW include adjacent properties if on shoreline or within 100 feet of adjacent property line.
adjacent property line- , 14£'ZOO) , Fadjacent property line
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PAS
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ISIS t
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adjacent property line-) *0%kh ' Fadjacent property line
SAMPLE SITE PLAN
adjar�nt property lined E-adproperty line
ff�:22L(a'
soKA-360%J AL 1
CREEtC \ 1 A fi MOM t< I ,G[idE�J
]I I F �G I HOus�
1 j PrLoPastD snpttc -�,
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VAGiuT C ARAM I /
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194.
P0.oPasCD /
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BO'
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1
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1
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adjacent property line-) ; �. \; Fadjacent properfy 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
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go/
fi MtSStOM apd to¢
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CREEK
Signat Date
GHC ASU PACU 2535963603 07/26/99 09:35 5 :03/06 NO:016
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
En.ironm*ftial Health Mat.,Quality R►soit i!b
�a—
' YV rSVA lOoo isnEl.avN, w yov"
LOCAL(Z60)a -9670
BELFAIR(360)27t'-4467 4468
Application plication for Determination of Adequacy TOLL FREE 1-800- .5628
FAX (360)4 7-7798
Instructions
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ermm anti. tt'.t At�l�iimtil:rat.
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: :;:.Na..d�t...... adea... ... +. ,::..
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a olituvnia:Io. �ltie vain : +';:
PART l: Applicant/Parcel Identification
Name of Applicant �N d RQt�rrlAay U 1r- Date q
Mailing Address Z - yo t" /9 vr- 5 aJ Telephone Z V 3- 6(o I— 1-2.7 l
F" Mn L-►-a A r G-)A_ q 4�v 2
Assessor's Parcel Number /2 ',:��-7 �Y 90013
_Ape o Water System (Check One , ReasoR or ADDlicatron Check Onc.):
I
o public/Community W suer System(2 or man f Builftr'pit
amnoodme) o Land use application,if so..
Pr Individual water source(oeo omnoo0on),if so.. K] Division of land
1K Well #of Paraob?
o Spriuglsnttfaoe water SPH9 -
o Other(explain) to Boundary live adjusopaeat
o Other(explain)
PART Z: Water System Information
Complete the section appropriate for the type of water system being evaluated for adequacy:
Public Water System
Name of Water System !"
Water Facility Inventory (WFI) Number:
0 the water purveyor has filed a letter granting blanket hookups to this water system.
a lam the manager of"water system. The water system hac been approved for services. Thineprom ar
eonnecdiw>s to use. 11tis will be the connection. 'T s water systetn is able an
willing to provt�e wets to this(these)conn=tions without ezcee mg the limits of the water system or emy lwtp
sot by state and local regulation.
Signature of Water System Manager Date
W-7 HA DAMARCHNF.IWA1'PRAMI&F Update:Oclobo, 20,199
GHC ASU PACU 2535963603 07/26/99 09:35 5 :01/06 No:016
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GHC ASU PACU 2535963e:iO3 07/26/99 09:35 :02/06 140:016
nrAO 4WN MY
DEPARTMENT OF HEALTH SERVICES
Datc ��J j q 9 PO BOX 1666 SHELTON.W 98584
SHELTON (360)4 7-9670
PAX (360)4 7-7798
ELMA (360)4 2-5269
_ BELPAIR (360)2 5-4467
r1 u N Vu iv a SEATTLE (206)4 4-6966
3/yu Z
BLD q 4- U 2_l r Parcel Number l 3 -3 - u
Your building permit cannot be issued by Mason County Environmental Health until
the following are completed and turned in:
Application of Water Adequacy.
❑ Approved septic system records or approved septic design for bedrooms
❑ Complete and accurate scaled plot plan which shows all building(actual &
proposed), driveways, location of septic system, location of reserve drainfleld
and wells.
❑ Report within the last three years from either a septic tank pumper or an
Operation and Maintenance Specialist.
Well Log. [ :Water bacteriological analysis.
Copy of a recorded Certificate of Residential Use for bedrooms.(sign
❑ and notarize the enclosed form. Either return the form to this office with a check
for$8.00 payable to the Mason County Auditor or record it yourself at the
Mason County Auditor's office and bring us a copy.)
Other;
If you have any questions, please call me at 360-427-9670 Ext 353.
Cindy Bingham
Environmental Health Technician
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