HomeMy WebLinkAboutBLD2004-01215 Final Pole Garage/Storage BLD2000-01346 MFG Home - BLD Permit / Conditions - 12/15/2004 W +
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o CONCRETE MECHANICAL MANUFACTURED HOME t
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,- Suite B+16521 Highway 99•Lynnwood,WA 98037-3161 P see Check After Doing Site Plan: Septic and drainfield �aiza Draw North Arrow is C*k,
— Everett:(425)258-4171 Puyallup:(253)840-9552 I
liroperty dimensions O ewer lines eI Elevation of property
Administrative Headquarters: (425)743.1555 xisting buildings etbacks of proposed a szisling buildings ❑80diee of wafer
.FAX: (426)742-4378 Toll Free: 1.800.824-9552 ���777
Contractor's Lic.0:TOWNCPF099LT ed building Ram road with name - 0� �
IiaAxess to proposed building idSidpae i Contours($'Increments)
Q.Ii y:Oar FutWa 0.It.-
Job Name::A K:VV RAN& Job Site Address:
q
Tax Accounw ;n_!9 V 0 0 q Legal Description:0-01
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PLANNING
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E
M APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
CHANGES SUBJECT TO APPROVAL
I �
DO NOT SIGN INCOMPLETE SITE PLANI
Customer has verified and approved the location of the building,orientation of the building to the North,and verifies that all White-Customer Copy White-Office Copy Yellow-Accounting
utilities are shown on this drv!!V the correct I tion.
CUSTOMER SIGNATURE LEAD N T 166
01995 Perma-130lndustfles FR-34 08=
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT 1\10 &4 - l21 S
PLEASE PRESS HARD BUILDING PERMIT APPLICATION RECEIVED '
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5jW.'2 9 2004
On the web www.co.mason.wa.us
APPLICANT I FORMATION CONTRACTOR IN�F RMA 1 N / n+wc.
Owner j A .0 De6omk V'0Ly%S0Vy) Company Name--/Own vr�7�ry/- 1 I�r1i
Mailin Addres I - Blvd Mailing Address v' C I 7- qww act
City State tolA _Zip Code 9595 OV CityL v woo State W At Zip C de '79037
Phone 3b0-YV Zg37 Other Ph. Phone_ 2-5-7 3-/355 Other Ph.
Lien/Title Holder Alo k%oa- Contractor Reg.#I-OwnCvf-og9/f Exp. Ofo 3a aS
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well---)�—Water System Name of Water System 'a '
PARCEL INFORMATION - 12 Digit Parcel Fire District
Legal Description
Site Address (Please include stre t name, street number and city)
Directions to site ( + kd- o n I.e o
Wi timber be cut and sold in parcel preparatio . Yes�
Is property within 200'of Saltwater Lake River/Creek Pond e
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% /T
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE JR SEASONAL ❑
Use of Building V- Describe Work r-O
No.of Bedrooms o.of Bathrooms Square Footage- 1 st Floor 2n Floor
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Garage i2� _ 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 permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica-
tion or or t k propoLW101w,
the app cation,I have obtained permission from them to apply r thi permit and conduct the work proposed.
L Date:
Owner/Owners 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
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Plannin Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION M.
426 W. Cedar• P.O. Box 186, Shelton, WA 98584 ( f
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 i t Company Name
Mailing Address -
t
Mailing Address a f
City ! State r,t Zip Code j` City. State Zip Code i
Phone >4 !" ' 7 Other Ph. Phone
Other Ph.
Lien/Title Holder f `. * Contractor Reg.# Exp. y
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic—'
eptic Existing Septic
Connect to Water System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION - 12 Digit Parcel No. ;" + > Z,.. Fire District
Legal Description
Site Address (Please include street name, street number and city) ' . s,.4
Directions to site
Will timber be cut and sold in parcel preparation?Yes
Is property within 200'of Saltwater Lake River/Creek Pond ,
Wetland Seasonal Runoff Stream Slopes or Bluffs 1 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE 0 SEASONAL ❑
Use of Building Describe Work
-
No.of Bedrooms No.of Bathrooms Square Footage- 1st 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
i
Type of Heat Purchase Price $ Replacement Unit? Yes/No
Installer Name Certification No.
O VNER/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 hav tt� s-
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest
tion or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work pro sed.
. , 9 2004
. JUL 2
X„ :3 `" Date: ; ii.
Owner/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
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee 7
Plumbing& Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
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 INFORMATION CONTRACTOR INF RMA I N
Owner Ran do E Dk 60r ' �r$0 VNI Company Name awn Courl Cl7dr?+
MaiIin Add res 1 r I ,e, E 1vd5j Mailing Address ail+ C 1b 2 wmllci
a
City State tq Zip Code CityLIVIVIwood State Uj A Zip C de 9E303,7
Phone abO— �Z7"'Zq31 Other Ph. Phone c 15-7113-1555 Other Ph. _
Lien/Title Holder N® `.,A.- Contractor Reg. Exp. O+o 20 a5
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well_ 'k Water System Name of Water System %v
PARCEL INFORMATION - 12 Digit Parcel No.--S-Z-13 513,1000 Fire District
Legal Description
Site Address (Please include street name, street number and city) r i ,!- S
Directions to site 14-'u + 1�r +,r n I-e F n f Q
Wi aratio timber be cut and sold in parcel prep . Yes,ZD
Is property within 200'of Saltwater Lake River/Creek Pond d'
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% r V 11T
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye
TYPE OF JOB - New X Add Alt Repair Other PRIMARY RESIDENCE JQ SEASONAL ❑
Use of Building ±I Describe Work r ✓ ct
No.of Bedrooms P o.of Bathrooms Square Footage - 1 st Floor 2n 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 $ fit, Replacement Unit? Yes/No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccutate information may re ult 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 permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest rggprdipg.thipAViVA
tion or the work proposed in the app ication, I have obtained permission frornthem to apply or thi permit and conduct the work pr
Xc9 A✓v� �... 'Date: / 9 2U�4
Owner/Owners Representative/Contractor (indicate'which one) JUL 2
FOR OFFICIAL,USE BEYOND THIS POINT BELFAIR OFFICE
Accepted by: Planning I'd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
r q Building DepartmentU-1 2_V S S 012 5
e Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planninq Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee 10111e-Paid at Submittal
Valuation$ TOTAL FEES
r ,
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 INFORMATION CONTRACTOR INFORM
ATI N r
Owner Company Name_ L�-vil
Mailing Address-° <%t x ii",(A2. ! " J r."j Mailing Address'<�vi 4 C IE.-5-z I
City - State tt,,A Zip Codey 213 6 {s't CityL }eto,%j o , State �Q /a Zip Code °I t"6`57
Phone 4k0-1ZZ—ZI-1 3? Other Ph. Phone ` 2 - 1 td�-1555 Other Ph.
Lien/Title Holder Al., +�*-+�- Contractor Reg.# ,. .t _ =� /` Exp, t € c_s
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
i
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well,` _Water System Name of Water System <+ R 1 r
PARCEL INFORMATION - 12 Digit Parcel No." "► Fire District
Legal Description
Site Address (Please include street name, street number and city) ( v- eea+✓',t7au rt n,
Directions to site q �, �.,t 1 t 4�.1,.
Will timber be cut and sold in parcel preparatio . Yes<0
Is property within 200'of Saltwater Lake River/Creek Pond
i Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% rvz
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ® SEASONAL ❑
Use of Building ;:. Describe Work - `+ ►
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 �ffrr
declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have ob� V�
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest rega i g is applica-
tion or the work proposed in the app cation, I have obtained permission from them to apply or this permit and conduct the rk propoca&
x . Date: f2Z
Owner/Owners Representative/Contractor (indicate which one) AFLFAIR OFFIC
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
i
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
# Building Department
Planning Department # L, g G
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planninq Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee L Pb-Paid at Submittal
Valuation $
TOTAL FEES
i
ST,,r�° MASON COUNTY
o A E DEPARTMENT OF COMMUNITY DEVELOPMENT
s N Planning Division
N y c= P O Box 279,Shelton,WA 98584
(360)427-9670
1864
NOTIFICATION OF INCOMPLETE APPLICATION
August 04, 2004
RANDY RANSOM
301 E WALLACE KNEELAND BLVD
SUITE 224
SHELTON, WA 98584
Parcel No.: 321352390004
Project Description: POLE GARAGE/STORAGE
Dear Applicant:
You have submitted a permit application (case no. BLD2004-01215)for proposed
construction or development in the county. Upon review of your application, I have
determined that the contents of the application are incomplete or do not provide
enough detail for review.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360)427-9670, ext. 294 if you have questions.
Sincerely,
—GU
Joanne Long-Woods
Land Use Planner
Mason County Planning Department
Comments:
8/4/2004 1 of 1 BLD2004-01215
I
I
M
NOTIFICATION OF INCOMPLETE APPLICATION
8/4/2004 Case NO.: BLD2004-01215
Comments: The parcel is adjacent to a steep slope. A steep slope trends
downward away from the building site at an angle between 8.5 and
21.8 degrees. This area may meet the criteria for a Landslide Hazard
Area per the provisions of the Mason County Resource Ordinance No.
77-93. Applications for development within 300 feet of a potential
Landslide Hazard Area require a geological assessment to evaluate
slope stability and address specific efforts to remediate the hazard.
Based upon the results of the assessment, a more detailed
geotechnical report may be required.
Enclosed is a copy of the Landslide Hazard Areas chapter of the
Resource Ordinance. Please note the distinction between a geologic
assessment and a geotechnical report. This project will require a
geological assessment.
The report must state that the hazards of the landslide area can be
overcome in such a manner as to prevent harm to property and public
health and safety, and must also assure the project will cause no
significant environmental impact. See Mason County Code
17.01.100E7.
8/4/2004 2 of 2 BLD2004-01215
/ Prepared by:
MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST
Owner's Name: � I Date: 7 —2-q-N Reviewed By:
Documents:
_✓Building Permit Application Completed
1�Planning Intake Checklist Completed,
1/Site plan includes:Allowable building area,roof overhangs,decks,etc.
_EneW"e Application Form-HEAT FUEL TYPE
al/Plumbing Application-WATER HEATER FUEL TYPE
Engineering Included&' (erred onto building plans:Design criteria:Code reference[ ow load
_
Seismic Zone(circle one):(91
or D2 ; Calculation incl(circle): Vertical Yes / No ,Latera es No
Construction Plans:_✓3 COMPLETE SETS
_✓Plans Legible L/ftecognized Scale _--'Elevation Views moss Section �_ oundation Plan
_t,L'koof Framing Plan _Floor Plan-Use of Rooms Noted _Deck Framing Plan,incl cov.porch framing
_Floor Framing Plan-all floor levels including loft,crawlspace,etc.
Plan Details:
_Roof framing details,truss lay-out may be needed
Wall Framing-Does bearing-wall height exceed 10'?(Engineering may be required)
or framing: Floor joists: ,Floor beams:
Headers. Typical header:
_Foundation:footing size,reinforcement
_Concrete Walls-Does Concrete Wall Height Exceed 8'?(Engineering is required)
Non-Conventional Framing-Foam Core,Logs,etc.?(Engineering is required) �t�^
Point loads trace to footings below? ✓� l• //,
Slab insulation shown
7 _Landings at all exits?
_Heated By Furnace-Location of Furnace °44
_Fireplace/Stove Information Shown-Fuel Type?
_Window Sizes Marked on Plans O�Fi�
Braced Wall Panels(BWP)[also referred to as shear walls]Reference 2003 IRC Section 602.10:
Braced Wall Panels(BWP)Marked on Plans? YES(continue below) NO(lateral analysis included?)
_4'Exterior BWP's located at comer,OR check option below:
4'panel within 8'of comer with 1800#holdown ,or
2'comer panel and 4'BWP located within 8' or corner R602.10.5(see detail),or
2'8"Alternate BWP(ABP)
_4'Interior Braced Wall Panel(IBWP),not to exceed 25'o.c.EXCEPTION:spacing may be 35'o.c.in order to
Accommodate one single room not exceeding 900 SF,length of wall shall be required length multiplied adj.Factor from
Table R602.10.11 (25'—30'use factor of 1.2,30+'to 35'use factor of 1.4)
Continuous footing required under 2-story structures in D2 or see exception in 602.10.9.
IRREGULAR BUILDINGS 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 floorextend more than 6 ft.beyaond 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 grade is includes masonry or concrete construction(exc:fireplaces,chimneys,and veneer).
When this applies the entire story shall be designed.In accordance with accepted engineering practice.
COMMENTS:
i
i
Mason County Permit Assistance Center R E C E t V.. s
Planning Intake Checklist fAJL 2 9 ?m
/�,.,
Owners Name: �R6 '�So m Date: -7 --0 BELFAIR
Project: Reviewed By:
Commerci Develo ent: YE O Comments:
Planner: GBM RAM TSC JL
Sit Plan:
North Arrow
a-'Property Dimensions: _249�) _X�S
qi Streets and Driveways Shown. Road name: GY-7--a r)(I 1,P LA
e'All Existing Structures shown with setbacks
ar"Well Location, Septic and Drain-field Shown with setbacks
0'Identify all surface water(streams,ponds, shoreline,wetlands, etc.)
aTopography(slopes)
of Proposed Structury Setbacks (Direction/Setback): ,
F: 'V /000 R:� a
_/ S 1:�/A 292: / 0- 0
V Utility and Drainage Easements: Yes N (if yes enter condition#5022
❑_ ArrPecnry AnWenances ❑ 6 YR TIP
❑ o e present for site inspection? YES/ NO
Shoreline and Planning Info
Setbacks: Shoreline:�Slope:
Shoreline Designation: Comprehensive Plan: Rural Zonmi �''�
❑ Not Applicable 13 Agricultural RR 2.5U 10 20
❑ Urban ❑ In-holding ❑ RMF
❑ Rural ❑ LTCFL 0 RC 1 2 3
❑ Conservancy CR ural ❑ RI
❑ Natural ❑ RAC 0 RNR
0 Unknown ❑ RCC-Hamlet 0 RT
❑ Urban Growth Area ❑ NTR
❑ Unknown ❑ Unknown
Water Body(type of water if unnamed): no
SEPA: Yes T9 Unknown
Flood Plain: YES NO nkno #
Aquifer Recharge: YES NOi�nknownMap#
Tags/Cases:
RLC/SPI Case: ncxns 6-Year Dev. Moratorium: YES
Eagle Nest Tag: YES N Other YES tNO
Addressing: Check box if needed Reviewed by:
❑ County Access Permit Needed(add condition#0010)
❑ State Access Permit Needed(add condition#0020)
Standard Conditions to be added to all Building permits that planning reviews: #5019 and#0700
Raised:6-22-04
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I CONCRETE MECHANICAL MOBILE HOME
f Footings-Setback date by Ribbons
date by Gas Pips^ date by
Foundation Walls date "141"Z001 Set Up
date by INSULATION date
BG/SLAB Insulation Final
date by date by date `11—(o—D by L
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
rOrr
AZIC G
ZOO 1 A N c t►s
/ E �; � I�f2R►w By 'F
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Building Permit # ' MASON COUNTY
L`=1•5q ' BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location la'qst.,vt
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliance
4 cIS-r Ml'r 0 LS 0vt (O
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OK to❑ This is not a complete inspection Department ��C4 I l/
,//N �1
Date Inspector us X'7 Z?T�-'
11044 NnT MOOV THIV--- T A ,� '
10/25/00 Activities for Case #: BLD2000-01346
3:46:09 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BLDA010 Application Received 10/11/00 10/17/00 KLW DONE No Hold KLW 10/17/00
BLDB110 Building Plan Review 10/17/00 PEND No Hold MEC 10/25/00 pending slope inspection
BLDB130 Planning Review 10/23/00 SLO SLO No Hold MMS 10/23/00
BLDB135 Addressing 10/17/00 10/20/00 GMM DONE No Hold GMM 10/20/00
BLDB138 Planning Pre-Review 10/20/00 10/23/00 MMS DONE No Hold MMS 10/23/00
BLDB200 Environmental Health Review 10/17/00 10/24/00 CEW HOLD No Hold CEW 10/24/00 need paper work
BLDB210 Water Adequacy 10/17/00 10/24/00 CEW HOLD No Hold CEW 10/24/00 need signed water app,well log,
and satis bacti
BLDB201 EH More Info Letter 10/24/00 CEW DONE No Hold CEW 10/24/00
BLDB200 Environmental Health Review 10/25/00 10/25/00 CEW DONE No Hold CEW 10/25/00 bedrooms and plot map match
BLDC050 Pre-Site Inpection 10/30/00 LW PEND No Hold MEC 10/25/00
U
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VX /
76
Page 1 of 1
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PERMIT NO.: BLD -lot 3
MASON COUNTY
BUILDING PERMIT APPLICATION a
426 W.Cedar1P.O.Box 186,Shelton,WA 98584 /
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICA T INF RMATION CONTRACTOR INFORMATION V
Owner Ot Contractor Name 0-0-44-r
Mailin ddress ar Maili Address
City State(,ti� Zip Code City State(,_ Zip Code S
Phone(N.4Q 1100ther Ph.( D ) !, Ph.( Other Ph.(300
Lien/Title Holder Contractor Re . 4-
Address Expiration (} /
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Well Water System Name of
Water System
PARCEL INFORMA ION-12 digit Tax Parcel No. ° /�/ ` UL�r:JL Fire District
Legal Description
Site Address(Please i clude street name, street numb r an city) of
Directions to site e
t Hp 5 Ati. c
Will timber be cut and sold n parcel preparation? (Yes/No)
Is your property within 200' of the following: Body of Water (Name) A A- Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE SEASONAL RESIDENCE❑
TYPE OF JOB Ne Add Alt Repair Other Use of Building
Describe Work
No. of Bedrooms _No. of Bathroom ZSQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
MOBILE OME INFORMATION-Make Model Model Year 2.000
Length / Width_ Serial No. No. of Bedrooms No. of Bathroo s 2
Type of Heat Purchase Price $ Replacement Unit ?(Yes/No)
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 1 am exempt from the requirements 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
approv first obtaining approval.
Date / X Date
FOR OFFICI L USE BEYOND THIS POINT
� ---)c" t�
Accepted uY. Dat 1 ) ubmittal Amount Du / -f Receipt N
DEPARTMENT REVIE APPROVED DENIED CONOITlt N p S
...
Building Departme
Occ Group e Constr.
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ( )
TOTAL FEES
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION
Case No.
Name N PARCEL NUMBER -32135—,3' I Date 1
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
Well Location (including adjacent) Drainage Plan
Names of Streets Easements
Names of Fronting Streets Septic System
DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line.
adjacent property line- I I f-adjacent property line
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adjacent property line-) I I E-adjacent property line
SAMPLE SITE PLAN
adjart property line IIIIIII nDa1 II
.
E-adjacGHeGnnuat espnG�r
_o perty line
30' rR�SCR uE _ "e
ES /A L _ J
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OM L•
CREE j P—.4
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adjacent property line4 ; f \; <-adjacent ro ert'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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a(�O rsctL�Y�
boo 8i8't'or,LG to
+ancm
1 DO
Signature Date
i