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CL 0 p- CD 083 / a : E R 0 / ' @qq ] ® J $ \ k CD 0 � � m o � U • 0 o CONCRETE MECHANIC` �' MANUFACTURED HOMEDate 2 3 C) Footings I Setbacks Gas Piping By ��— Ribbons _ Interior flue By Interior-Date By Date By m r Exterior Date fjl� By Exterior-Date B Set-up00 r Point toad I Isolated Footings INSULATION Date By D BG I SLAB INSULATION n Date By Date By FIRE DEPARTMENT 0 Foundation Walls Floors { Date By Qo Date L By Data By DECKS m FRAMING Dw 2-If By _ Date By mm Date 2 -r-ri' By PROPANE TANKS Z PLUMBING Vault Date By O Date I a`t 13y uvf OTHER X Groundwork Attic Data W B Type" Date By y Date By O.1N.V DRYWALL Type. Int Brace Wall pate By Date 2_S, By Date By FINAL INSPECTION p m Water Line Firer Separation N Date By (� Date By Dates`1fL"' / fay Pass or Request Inspect. b Type of Insp. Fail Date Gate Done By Comments S) L-Z 2-- 8 >•'h'�'y!� Pco�o ,e 15�T" Cn /0 WC A-t-( .,z 0 h 74/T _ _� ! - i �M M 8 N U "Y : .�3 N ING.. V L [tT i I 10 tt- < S 12 VT Now Uj I it _du r j i _ W i .r � n . � y i _-...... ....... ......!_____, f +.._...... ...._..,. __ �_.yam.... __..... �_ �.....�__._._._ ' i i S S f 1 /i} 1 /71 17-1 I ' -- ' - �- TOPOGRAPHY PROFILE: Direction: Scale: Approval: foroffice use Building Permit number: Building: � /� � ^ Owner/Applicant: --°X�L/� �%/ �T � %/ Date of Planning: application: Env. Health: Parcel Number: �����' �5 Lr}C7�J�l� CL LEGAL DESCRIPTION a 1TNT PORTION OF 7H9 43RTT3 H0"OF7TMWORTtTRBSTODARTTD.OF TTR3 NORTH- �.�: PlST QVAATLt OFSPC7t(tN36 TpI1T13HQ 71[g4TTl PANBBY WYSY,WN,Of MASON yl WU�T Y,9rWf4YCRClM De" noR AS7DLAXk Ili l H EDAT(WO ArnM(h''iLfBtIC7TC NOyM%?TOl7Yl1�00 8AlD fYClKIX 3S TIliFI TF1B "- CFl(T4R1d1!OF n•.,...1 .Y37CTHEYCITXFAST Y.gMop.4TALOtiOCt'DtYIgVA.U A DC4f.U'C2OY'1TY9TPT8TN77BI DIORTT?ASf CGR701tOPS.tD RT,R171PY.STOIJA1TTy 114 CORN=L OP TIBiT'CIRTRFlST OItA/,TTR;T8ETC29CtfIHQ73101'ARSTAI.0�077SE EhST LtNR POLUDCOOCRM tK MSWrr OF 8AI0 NLY!'71fWBSTQU,tk7F3.OF7HE t10RTYlS.LTT QIAAIEIt.T DL47.4T1'SOF3M-.Y1 PYH SLQVET8 OF BJECORMCD BF.C.T1tX/CC�i11ER: `FYET;TTf$(CE tOri7.ti`+CEOf 7S7.1�3 iB8T70TF6C1'Y7D1[.DIB BBlACAEII:THEHCL SE.TBARAC"YBAST TOLM 11,4.O;ON PIPE t160.7.7iTeLT ALCNO S�.ID CIDtfEBLD,3 TOTT$A�2Y70Y BEUD,N[Iq. 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EQUIPMENT/PROCEDURES I.TM9 St K M WAS AODOhpC157(EbHY T1'A%DAHD P=D 7BA%l0XB U9INOA TTTKON OIT. t -'�" �1 ` Tdb a z LT1ua 8lAVET Ni$71Y01t 6O7FLn7HC)AYQ,fLM3DYCJLY'SI,LVRSkDSRIPSCAY88i7 � n + .G._r,.^,. - �• BY A'.LG7}L1kl+Al. ` 173.�9 1x.aP IO1,77 1Z3 t8' TAR :SSO' 10.0� Aneatiuev>;cmr>sYua,E—��\` �'� - -------------------- 1 tu�R7�T *al�tei .. tF1T7tRTYFD THLa81,12\'BY. \\\ �.• /y�•nf1// 60'B �I.TTBllYbms wta cAs (&WD.LOABWLTAtQ., DARA C.AP 11 .----_------------ ------------------------ ----------------------------------------� 1 I h BCAtB V•l07 Ncnm- &ID BR.ID I OE wAsa�>as 1av(Y Yeuu I AGO AND THEEASMDa SHOWN ON IO7 80 n cm UMVEY,VOL L PG.0isN07 BBDYOl F0KAa'*MAQtO5S CRF1fX. I 1 1 1 I LEGE =RA Lka SUBVEY WCAPIOx suRVBroR s C 7C+iTS &�IDxtr Lad �r eyiag L SVWW 1N TSB NY.[ 4 OF fa a lfi OF S&uow S8, ?04 Mp El • MASTIC CAP,RPTS'43333 x1i NtT6TH R1NG8 9 189T W.V,1N YAMY MAW,, TAMI;GTgN. O SIM [10T1i ATUODDTAN4.3, F Xf o!7r4 t .v'� $abal LAiTnVR'S CBR?7 WA78 M ORO OF StlBW FIM: .vl se �3a—asoe—aSn..3eaps/r` Issg Bleaaot 31Gtc6t11 r . P.a bo:t38Ben.w 4 Qt/ - �736 TOR, a Rv r*owt ce RMt L B"wm,PLS -.� o% +Yzmt a. 971$S. Thampsoa Avenue �wSwIlkS at O tf9P l4 q[�6e2t E-,�M 3A7ST Bf1CVRTL57lBfiSON,P1.9 �'��'�i' IJ ,S�i++f l4md Ad CE CBiOTFTC'A70Tb.33113 D!7/ilye ft.: 06-186d set 1 of 1 0 LL o N w i Name L l Parcel# BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page I of 2) Per Mason County Code, Title 14, Chapter 14.48 a stormwater site plan is required whenever a building application is made for residential development, or redevelopment', with more than 2,000 square feet of impervious surfaceZ. 'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development including construction, installation or expansion of a building or other structure,and/or replacement of impervious surface that is not part of a routine maintenance activity, and land disturbing activities associated with structural or impervious redevelopment. 2Common impervious surfaces include,but are not limited to,rooftops, walkways,patios,driveways,parking lots or storage areas, concrete or asphalt paving,gravel roads,packed earthen materials, and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater. Open,uncovered retention/detention facilities shall not be considered as impervious surfaces. To Calculate Impervious Surfaces Please Complete This Table Surface Type Length X Width Area * All dimensions in feet Buildings (i Z, X X = Measurements for buildings are taken at the X _ perimeter of the farthest projections (example: eaves/gutters) X = Driveways X = X = Length of drive begins at the right of way X = Parking Areas X = X = Any paved, gravel or packed area per definition above table X = Patios/Walks X = X = Any paved, gravel or packed area per definition above table X = Others X = X = if the total impervious area of the proposed site X = de�relgprnbrit-is greater than 2000,square feet,a Small Parcel Stormwafer;Sito Flan is Required Total Impervious Surface Area(sum of all areas) p� If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read,acknowledge and sign below. Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity. Owner/Builder/Agent Acknowledges that 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, owner's legal representative,or the contractor. I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- described property for review and inspection as may be required. X Owner/Agent/Contractor(circle one) Date: If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign the information provided on page 2 of 2. Page 1 of 2 i Name y Z Parcel# 3,,2 134,7-3 000,E 0 BLD# y _ Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 2 of 2) Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity. Title 14, Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater Management in this jurisdiction. A complete copy of the ordinance can be found on the Mason County website: httpHwww.co.mason.wa—us/code/commissioners/index.htm Please follow the links to "Title 14, Chapter 14.48 Stormwater Management". Regulated activities shall be conducted only after Mason County Public Works approves a Stormwater site plan (Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document entitled "Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan". This document will assist you in preparing the necessary information and plans for Public Works to review and approve. Per Department of Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval. A design by a registered professional may be required for more complex sites. *These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan on the pages that begin with"Handout" PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A)-)�—The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the system will be located as not to adversely affect any septic systems on this, or any other,parcel. If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works Department can provide additional instructions, guidance and examples. (Section 14.48.130)contact Public works at: Phone: (360)-427-9670 EXT. 450 Mail: P 0 Box 1850, Shelton WA 98584 Physical: 415 N 6th St, Shelton WA 98584 If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or any other, parcel. You may also wish to consult with the septic design professional involved with the project. Mason County Division of Environmental Health can be reached at: Phone: (360)-427-9670 EXT. 352 Mail: P 0 Box 1666, Shelton WA 98584 Physical: 426 W Cedar St, Shelton WA 98584 A condition will be added to the building permit that states, in part,that all conditions the Stormwater site plan will be met prior to a request for final inspection of the building permit. Owner/Builder/Agent Acknowledges that 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, owner's legal representative,or the contractor. I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- described property for review and inspection as may be required. C424h� Owner/Agent/Contractor(circle one)Date: Page 2 of 2 ' n 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 INF RMATI N / CONTRACTOR INFORMATION s �Owner G, VAA;,&f ,f,,Jj e14 Company Name Mailing Addres' -S 0 evi Mailing Address L��l11 City 'z-A('erxA._ �" State !.d)1 Zip Code 7 city-�'�F� State- . Zip Code 4 -2'L Phones �.5-�1_ ��'� Other Pho?5.3 3 7-7 0 Phone/,4s4 l 5,26-6,y-2 2 Other Ph. Lien/Title Holder Contractor Reg. #�Fs��ifLCgyc.y' Exp. E mail address 1/P S� 1lYLr ./ E Mail Address Drivers Lic.# DOB / S / Drivers Lic.# DOB ,v .9 SEPTIC INFORMATION - Connect to New Septic— ExW' ting Septic. Connect to Sewer System Name of Sewer System ST-4 f/`d -e4l V- f1"O�� PARCEL INFORMATION - 12 Digit Parcel No. *� /-Z�"r1 �- %� Fire District Legal Description Site Address (Please include street name, street nu ber and city) Dire tions t site Is pr rty within 200'of Saltwater Lake River/Creek x Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - Newer Add Alt Repair Other Use of Building Location of Fixtures/Units - 1st Floor L 2nd Floor Basement Garage "^ Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG— Natural Gas_ Heat Pump_ Toilets 167— Type of Unit No. of Units Fees Bathroom Sink 14 Furnace i Bath Tubs / Heatpumps _ Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks I Wood/Gas/Pellet Stove Dishwasher �— Kitchen Exhaust Hood / Hosebibs o1 Dryer Vent / Other 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 CONTINUATIO OF WORK I BY ANS OF A PROGRESS INSPECTION. X �t-sir^ JfJ ��� �' C��.✓S u-'-�. Date: , Owner/Own#r"s Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group—Type 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 I MASON COUNTY PERMIT NO. 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 www.co.mason.wa.us APPLICANT INFORMA-99N CONTRACTOR INFORMATION Owner F► .s �b �� Company Name Mailing Address `f Mailing Address 3G `i�`%vur> •�i�� S� �5 City tate 4�21 Zip Code City State wv A' Zip Code 9P-5�4 Phone.:2 S T 3 A'ArV Other Ph. Phone -7S,? - ` ,:P 6 -lr< :> Other Ph. Lien/Title Holder Contractor Reg. Exp. c E mail address �' f S E Mail Address Drivers Lic.# DOB 712 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System <'ue Well Sewer System Name of Sewer Syste PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) D cd dh44 Directions to site -rrj f W"41,;r...) Will timber be cut and sold in parcel preparation?Yes/ffO Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% 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 ❑ SEASONAL ❑ Use of Building Describe Work &� 2 e,I' ',,/A No. of Bedrooms No. of Bathrooms_ , Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck— Covered Deck Other Sq. ft. Garage-- Attached 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 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 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 County access to the above described property and structure for review and inspection. This permit/application becomes null & void if work or authorized 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 INVALIDATE THE APPLICATION. Owner/Owners,Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: 9WDate DEPARTMENTAL REVIEW APPROVED DENIED NOTES r . Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee O _ S—S— Site inspection Plan Review Fee ll �6 EH Review Fee Plumbing & Base Fee 7 G _ D Planninq Review Fee Mechanical & Base fee 60 Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee a 7 -orPre-Paid at Submittal Valuation $ TOTAL FEES I r 144 r _