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C> zr -- 3 ae 0 ra rA o _ a N c O n CA -� a zI 00 a a - 0 0 W lm ov —o c c'9 00 46 -0 fl'f ce 00 rums Building Peru#_q7 "-"77 2 MASON COUNTY a BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 , 1-k>c—^l Job Location z4zj-1 �_ Shc>42F- ffO. jP 2- This structure has been inspeected by Mason County Building Department and the llowing VIOLATION of County Laws and Ordinances has been found- Items listed below must be corrected to compliance gain code 9 442Cv d� �.S !CS' Dv v You are hereby noMW that the above cor actions shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK O Call for re-inspection when corrections are made before continuing Make corrections, items will be checked on next inspection ❑OKto Department SCe2 Date Z -2'7 41 r Inspector VVEMV µ+; MASC' 1 CQ,IJ�TY BUILDING PER, MITI ►PPL14 ' 42611i/:CdiTar)PO. Box IN,Shel*,WA "584 427.- -5628 q 4Caliing From:Seattle 464-OW, Beftir 275-4467 i", 2-5269) PLEASE PRINT 1 Phone# C Sfte Rim # _.-_.__ - z lx - Adz Owner Mailing Address ;I City .r.�,�.� /S'csvQ StZi / -42 LienlTitle Holder Amr*P Address City St Tap #2 Contractor Name V- L lid Contractor Reg#C�[ W4AJA L CCJnm2s�cT � Address ,!IT117005 Expiration Date?' J L__Jffe_ City Ah&z 0/*n14A --D St WA Zip9dVe Phone# Soto -2 79-g3 2- j #3 If septic is looted on project site,include records. Connect to Septic? Y^ Public Water Supply­) L Well Connect to Sewer S�stem? �Name of System TT (If residential,proof of potable water is required) #4 .:Parcet.No. . 1,2 O2. Legal Description-rR rt or Gr y't I S .,c t 3 * s' AA f #5 Building Square Footage: 1st FI 2nd FI 3rd FI Loft Basement ! #Bedrooms #bathrooms Deck Other Garage Carport (Circle:Attached or Detached?) #6 Use of building /"1 �S'�G�hv?7� Describe work #7 Type of Job: New Add Aft Repair Model Year 1 uD makeig&4 Model x j Length S0 Wklth�Serial No. 1 � Q TQ 3 X (f #Bedrooms_, #Bathrooms Z Type of Heat 64eC AM is pal Purchase Price$ I2, 500 pV1 Q WmS ram+ #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh SaKwator Seasonal Runoff Other S11ow RailbU the aft plan k • Lot Dimensionses '�, • SUuckire Sebacks Water Lanes n wak SoprhYY, Systems n� t I asements Proposed improves tridicaMe Oppa8; Name of Side.PRopl-h �a� � 1M � . � Name#, ny Street;. APPLICANT TobRAW SIIEPLAR BELOW, ._ 1, APPUCA�IT T;O DRWTOPOPqAPHY PROFILE e�L:c�W t , * 7 k� NnMg Fixtures(S3.35 each) En MgdMeW Fixtures(0.75 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, th Basins eatpump,Other Ba Tubs NHZeaVumps Sho rs BTU Hot er Htr ry asher SystemsSinks Vent Fans Floor Drains NlZ. _Laundry Basi _ HP Dishwashe N _Disposal - afm# Urinal big. Fire P _Oth _ _ Auto. Fire s 50.00 Fixed Rr Supp. S 50.00 P it Basic Fee _ Auto F' a Sprink Sys 35.00 TOTAL PLUMBING G Outlets ood, Gas, Pellet Stance NOTim 1HIS i.MUL A. _V0,0_IF WORK 01 t14110N AU'THORR ED IS NOT COW MENCEDI WMN 00 it Basic Fee 16. YYORit��� ii��` �PlIIEOD _ OF AT TOTAL MECHANICAL_ $ III86CEP.PROOF E> CaElt' ON vF 11 lRK iS dlf �iIEAWOF A RA0©R iN8>R=C'fi10N. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE RECUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WAgRINWON AND I RCW 1&27,AND AM-AWARE OF THE MASON COUNTY AMAWAREOFTHEORD,NANCEREQUI�'3REGU- ORDINANCE REQUIREMENTS FOR WHICH'TNIS PER. LATINGiTHEWORK-FORVIICH-THEPfERMIT4SLSSUED j MIT IS ISSLIED-AND114AT ALL WORK DONE WILL BE IN AND ALL.-WORK ,DONE WILL..BE _IN..CONFORMANCE CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT MADE WM40UT FIRST OBTAINING APPROVAL FROM RRST'OBTAINING APPROVAL FROM 'THt BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER k DATE _., DEPARTMENTAL REVIEW .FOR&OFFICE USE ONLY m"4, cow. HM AppDvW Planning: ►"�"'C Environmental Health: Building Plan Review Occupancy Group: Type of Const: Fire Marshal: Other: F1rE S Special Conditions: Building Permit Plan Itheck Plumbing.Fee Mechanical Fee Wood/G&%(Peitst Move Violation,Fee Site hsspection Building State Fee Other' M0, Other T... Other Building Valuation: TOTAL FEE 08/08/1997 08:34 2063731313 HUNT & WHITE, P.S. PAGE 03 SUN BEACH MO-RME HCJME PARK 4255 Norfth+ore Road, Belfatr Washington 98528 .(3 )275-8618 AMM t 1"7 no.Hdaties 1W Mo+mg ym mabdo home JM Sunbagh bGdlde Rome Paris. Dent Doa Tab jow is to gem as appmvai for you to Drove your 19M Oalrbra*b4owk U=our park site. sha s 2 Add 4233 Nora Shom Ltd #1 Delft,Wo. Mn Wt kook forvassd to blvinS you n part of out omoawnitp. V Tj*Yams Sig res AM Padt�er ' MASON COUNTY DEPARTMENT OF HEALTH SERVICES fnvironmsntd HA Water Quality0000001 Hsa PO BOX 1666 SH N,WA 98584 LOCAL(360)427-9670 BELFAIR(360)275-4467&4468 Application for Determination of Adequacy TOLL FREE 1-800-562-5628 FAX(360)427-7798 Instructions ?;;?:,a .,�::,:+. :.r. f.. .y,�a<an..•�•, •,"v,.•: :..�;<:.:??:: r�. ,,3:d•. •'< :..t.o.t+: s,,a.;. n:•?•-.'•-t:a3::;3:::::::.;?:•.:r:;:.:: '.k:^;: ::if••{':','.'•,:+•'''•�."',v,.,F:. +� ..c:' 7.'a:;;t:. ;r. '-'',�,L,,e .:a a .,,a .tac .,.s:... •r. �• i t+•'iv?:{3:ir�i-ij4:•?::i::i3i:•?l}:::?::.:.?3}::;??:ii'•i ii i::iYtrv:': •. r PART 1: Applicant/Parcel Identification Name of Applicant boNIA40 hk1,#&rs Date 4`�z�7 Tele hon min) S)Z,"3 77 Mailing Address p .40 ME S/ Assessor's Parcel Number .22S6y 3/-,9,n 0 Type of Water&skyn Check One): Reason or lication Check One Public/Community water System(2 at mam Budding permit —) o Land use application,if so.. o Individual water source(one amna ion),if so.. p Division of land Pr Well #of Parcels? a Spring/surface water SPH9 o Other(expo) 0 Boundary line adjnstmrnt Other(explain) J 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 N Water Facility Inventory(WFn Number: 0 The water purveyor has Sled a letter granting blanket hookups to this water system. o Ip dymanager of this water system The water system has been approved for services. There ace dooms m use. This will be the connection 'Ili water system is able and w71mg to pm�e water to#us(%ew)oomacions wit>bout the limits of the water system or any limits set by state and local regulation, Signature of Water System Manager Date W_7 H:IWDATAWRCWMWAn2UD1WP Update:Odober20,1995 MASON COUNTY # F DEPARTMENT OF HEALTH SERVICES j EnvironmentalAealtl A'ater Quality PersonalAealtl August 19, 1997 PO BOX 1666 SHELTON, WA 98584 LOCAL (360) 427-9670 BELFAIR (360) 275-4467 & 4468 TOLL FREE 1-800-562-5628 FAX (360) 427-7798 Donald Holmes 7997 NE High School Road Bainbridge Island, WA 98110 RE: BLD97-0972 Parcel No. 22202-31-00080 There are no septic records on file for the either the Sun Beach Mobile Home Park or for the space that your manufacture home will occupy. Records will need to be created and the septic system determined to be functioning adequately. Your building permit cannot be issued by Mason County Environmental Health until the following items are completed and turned in: • An as-built drawing must be provided by a professional engineer or a certified designer; the as-built must show system layout in detail, depth of drainpipe form original grade, and designate an area suitable for drainfield repair; homeowner as-builts will be accepted if key system components exposed and verified by a site inspection through submittance of an Environmental Health Review form; • either a,pumper's report or a report done by an O & M specialist to verify inspection during the past 3 years. Note: to speed the processing of your building permit, please include your building permit number and parcel number on the information you provide. If you have any questions, please call me at extension 358 or Pam Denton at extension 554. Carolyn Jensen Environmental Health Specialist cc: Steven Hunt, Sun Beach Mobile Home Park