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Box 186, Shelton,WA 98584 427-9670/1-800-562-5628 (Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269) PLEASE PRINT )'") /tEa 4-Al #1 er Phone 0j;eAddress /UD/�'Tl/_ �'f A Lp - Fire District# I City St 1/1/l Zip 9P528, Directions to Job Site NCB . ,r v �P/� ,� ,G!/�ti � p/2422!2c Owner Mailing AddreE ,�-3 20� City 6i,� ,�2 St1�'. Zip 33s LienfTitle Holder Address City St Zip #2 Contractor Name 7 Contractor Reg# 44 rowl Y PY9W4 Address P4�� 7d-5 Expiration Date _/ City 62/{% "I/1/'yt;tloo St__1&4__Zip Phone# 83/2- #3 If septic is located on project site, include records. Connect to Septic?tV Public Water Supply Well X�19 Connect to Sewer System? Name of System (If residential, proof of potable water is requir 1146cel No. 2 ZZOZ - 3 egal Description 7 k Af 4,A y'-1 . y 3 4 A., ���y S Of I?�Yv an!f z D-c- 13ceL-le-Ae8 #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 s7 1p Describe work .�h4n�"EQ sc'hpA. \)�w� n #7 Type of Job: New Add Alt Repair Other A&42 Z ANPi1/� #8 MOBILE/MANUFACTURED HOME INF RMATION Model Year Make 0odel ��`� L �` po� � h� G'4103Q4 ^60X)F-P n� Length t�Width / Serial No. S )039 --4& #Bedrooms _#Bathrooms _Type of Heat FL&C D TH Purchase Price$ IgMo EM #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: AUG 1 5 1%7 River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other W LTH SERVICES Show following on the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Drainage Plan Wells Septic Systems Easements Proposed Improvements Name of Side Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3.35 each) Egg Mechanical Fixtures ($6.75 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other Bath Tubs No.. ULILi g Fees _Showers _ Furn BTU _Hot Water Htr _ Heatpumps _Laundry Washer _ Vent Systems _Sinks _ Spot Vent Fans _Floor Drains big,. Boilers/Compressors Laundry Basins _ HP _Dishwasher No. Air Handling Units _Disposal _ cfm# _Urinals No. Fire Protection Systems _Other — Auto. Fire Alarm Sys 50.00 _ Fixed Fire Supp. Sys 50.00 Permit Basic Fee 16.75 _ Auto Fire Sprink Sys 35•0 i TOTAL PLUMBING $ NIQ, Other Gas Outlets Wood, Gas, Pellet Stove i NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75 f WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27,AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT 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 WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING ARTMENT. DEPARTMENT. X W R X BY DATE DATE i a:'• i t DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: 11 W5 8/Zs Environmental Health: Q `# Building Plan Review e r o wle - C1 1",Cv ystce e- /ss -e Z. S C ham- err Co-nfr,4 4v C4 W. t rose Occupancy Gr up: TA of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Violation Fee Site Inspection Building State Fee Other Other- Other Building Valuation: rOTALFEE . 5 .I MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health Dater Quality Personal Health PO BOX 1666 SHELTON,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 <:;::>::><:. late:wwwF >1:: ir1eEca�znatton:yam:b :u�ad :un�brl:lact::l::za: :cam r:>:::<:>::>::::»::::::>::»>:...........<>:>;<:»»::::::::>:::<:::: ... ::.:::::: . :::::.::::::::::::::::::::.:::::::::::::::::::::::::::::::::::::::::::::::::::.:::.:::::::::::::.::::::::::.:::.may—lam.. ....::::::::::::::::::::::: ::::::: :: ::.:::::.:::::: . on. fI'arE. .. . 1.: #u: he:::: . ::alwater ::ti ::tYi....................................... .... ..... ............ .......::::::::::::..:::::::::::::::......:.:::::::::::::.....:::::.::::::......:..::.::......:....:.... .:...:.....:............ .. hula .a a lma�e�ats: o:>the:h al t:d.. .�ea�t:t'¢r; exa:::::::>::::::::>:::«:::>::>:::<:::>::::::>:<:>::::<::<:::>:::...... .... . ........... .................................................................... ......................................................... PART 1: Applicant/Parcel Identification Name of Applicant 4444�/ TIC. �uAll Date 9Z, 14 7 Mailing Address ®D ��l c2 3 2�, Telephone�2,f a6�-�l�3 Assessor's Parcel Number 22 Z0 2-- 3/—a�®d-' v!� 7 Type of Water System Check One): Reason or Application Check One): Public/Community water System(2 or mom Building permit oonnoetio-) ❑ Land use application, K so.. ❑ Individual water source(one connection),if so.. ❑ Division of land Well #of Parcels? ❑ Spring/surface water SPH9 - ❑ Other(explain) ❑ 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 A'✓40 ,0I e C'ff 00�� Water Facility Inventory (WFI)Number: ❑ The water purveyor has filed a letter granting blanket hookups to this water system, ❑ I am the manager of this water system. The water system has been approved for services. There are presently connections inuse. This will be the connection. 7 system is able and willing to prov-W water to this(these)connections without excee E s water g the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date W_7 H.WDATAURCHIMWATERAD3.WP Update:October 20,1995 Individual Water Well ❑ Water well report(attach to application) Depth ft. ❑ Well capacity test(attach to application) gpm gpd Well ca acity tests are often performed by the well driller at the time the well is constructed. Test results from these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test,a well capacity test,which provides stabilization of draw-down and recovery data,must be performed by a licensed contractor. ❑ Satisfactory bacteriological test(attach to application) Individual S rin /Sur ace Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ I have reason to believe that this water source can provide at least 800 gallons per day and/or provides water at a rate of 2 gallons per minute based on the following observations. AUTHOR OF STATEMENT DATE RELATIONSHIP TO APPLICANT In addition to providing the above statement, the applicant will need to arrange an on-site inspection by the health department prior to determination of adequacy. Departmental use only. Do not write below this line. ............. ffi .:::::::::::::::::::::::::::.::::........::.: .::::: .:..::...::.....................:.::::::::.::.:::::::::::. ::.:::::::::::::::.. ` :>: ; TDY>T .ERr[ NATIOT> A l�cant:s water:su 1;:>: ar ;> d .: a :t .: .... PF::::.. :: F : :::: P..::...::................:.::.:::::.::.:::. meet.tli8 >ofxta.. d.: s..... ... ..._._ ..:..... ;:::>:::::::::::::: ,/ .:.CJLr :: :<Q.>'fl't T.... IT' J11 Tt�li::: .47 1.!.......':i' >::::Tii :; lermrrir�rt :cdl' ade ::.a.: :::.. . ................::..:...:..:.:.::..:: .:::.::.:::::::::::::::::::........:::::. . .::. .. ...:::::::::..:.:..::.::..:...... .............. .uufi :;:ampZ:;4.::.wuf..r... ; to ;:>tn :....... . ........:..:.:::.:. .::.::.:::::::::::::::::::::.::::: :::::::::::::::::::::....:.::: :::::::: '.:::::::.:.::::::::(��.::::.:.......:.:.... ..............::.::,::: :::::::::::::::::.:::......... . Zeabc:>WIerrea: :r .. .......................:....................................... ..............::.:::::::............... .... .... :.:.: ::.::. :;:. . :`: ::: >.. >:.,.,. <IFT? T�4TION>:>:: ::::< 'licaut. :: afi r:�u ':: ;:::...a .............. . .............:.::. .:::::::::::.:::::.::............................................... P.......:::::::::::::.:::.:::.::::::.PP.: .::::.::....::.........................:::::::::: .... ieffi <:>::>;: +d <uats:>ta::meet:ale::needy< rfiitridedsafax.:.............................. ...........................::::::::::::::::::..:................::.::::::::::::::::::::::::::::::::::::::::::::::.::::::.:: ::.:::::::.:::.::::::.:.:,.................................................:::::::::: :.:::::::::::.::::..... ............... H.•IWDATAURCHIMWAMRAWAP Update:October20,1995 ����C` � , �� �� �� ��� � � � ����D \� .-� �.. • ■■■■■I■■■I■■■■■■m■m■■■■■oo■■■■ ■■■■■i■■■N■■_■_■_■_■_■_■_■_■_■_■___■■■__■■_ ■■ ■■■■■■■■ommamm■■■■■mma■■■■■w ■■■■■am■■l-F400mm■■■■■■■■■■■■■■■ ■■■■■E■■■■■■f/■■■■■■■■■■■■■■■ ■■■■■■amii■■m■■■■■■■iawg ia■■■ ■■■■o■r■■■■■■■■■■■■■■■■Iill■■■■ ■■■■■I■■■■■■■■■■■■■■■■■■IIIIi■■■■ ■■■■■I■■■■■■r:ii■mmmm■ii■iiRHOM■■ ■■■■■'■■■I■■`s1■■■■■■■■m':l mmm■mm ■■■■■■■■I■■■■■■■■■■■■■■bl■■■■■ ■■■■■■■■I■■■■■■■■■■■■■C3 N HME■ ■■■■■■■mmmmmmmilammmmmmosaffiffiffimmommm I■■■■QT2 ■' ■■■■■■■■■■■ ■■■■■I■■■11■■■■■■■■■■■■■■■■■■■ ■■■■■m■■11■■■■■■■■■■■■■■■■■■■ 08/08/1997 08:34 2063731313 HUNT & WHITE, P.S. PAGE 02 SUN BEACH MOBILE HOME PARK 4255 Northshore Road, Belfau Washington 98528 (360)275-8618 August 4, 1997 Larry Hhrm Re:Moving ytwr mobile home into Sunbeach Mobile Home Park. Dm Larry ?his later is to serve as approval for you to move your 1974 Fteet vood Mobile into our park site. site d 7 Address:4253 North Shore Rd *7 Helfair.Wa_ 98529 We look forward to having you as part of our community. i very Truly Yours I I�t Park Manager 1 I ii i I i i E I f MASON COUNTY DEPARTMENT OF HEALTH SERVICES �n�lronmental h'ealtl� IYater Quality Personal h'ealtl� PO BOX 1666 SHELTON, WA 98584 August 19, 1997 LOCAL (360) 427-9670 BELFAIR (360) 275-4467 & 4468 TOLL FREE 1-800-562-5628 FAX (360) 427-7798 Larry Blum P.O. Box 2326 Gig Harbor, WA 98335 RE: BLD97-0970 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