Loading...
HomeMy WebLinkAboutBLD2000-1404 Final MFG Home BLD94-1019 - BLD Permit / Conditions - 2/5/2001 PERMIT NO. BLD 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 CONTRACTOR INFORMATION Owner t � L . Contractor Name t1.J l\ 1t2G �I�xh�` : Mailing Addre s -12C) Mailing Address Cityt6t-t CI;L,t rZKJ State 46LJa Zip Code City I-,1:1 cbY LY1^1 _State L,.r^. Zip Code ci Phone(',Vtsj 1 11-6,514nOtherPh.0 Ph.(.^ nj ) rj. 4,e therPh.( Lien/Title Holder Contractor Reg. # VN J 1" ,Q�k I Address Expi ratio SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water SystemName of Water System g p g Tax Parcel No. Fire District PARCEL INFORMATION-12 digit Legal Description j Site Address(Please include street name, street number and city) "� i,: ; iJ '�= Directions to sit �;..-K.) 1-�.. -,�'.. 1 G 1. - If ln" n —'1, 1`a f I I idl^•r�-rl WIII timber be cut and sold in barcel preparation? (Yes/No) Is your properly within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek_ Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE❑ TYPE OF JOB New_Add_AltRepair OtherUse of Building Describe Work No. of Bedrooms No. of Bathrooms_ SQUARE FOOTAGE-lst Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq ft. Garage Attached Detached Carport Attached—Detached— MOBILE HOME INFORMATION-Make It l_D-7u Model (�lal.y";'rti� IVt�, Model Year I c-1 -i C7 Length 2_ Width ',U No. of Bedrooms i#" Serial No. �� - ?; '4� '�� No. of Bathrooms Type of Heat tr 1:E Purchase Price Replacement Unit ?(Yes/No) .)y nstaller Name I.t xJ t� -.L�tc1 jZ t' Certification No. Yh l rl i v E' 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 infouriation 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 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 confor arice therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without apprD ilg/ r ' first obtaining approval. X 16Rr it._._ ._. _ Date k�' C1 . Lf �<X Date r FOR OFFICIAL USE BEYOND THIS POINT Accepted by ' 1 Date ' Submittal Amount Due Si Receipt No. DEPARTMENTAL REVIE APPROVED DENIED CONDITION CODES Building Department:/� Occ Group Tvpe Constr. Planning Department Environmental Health Department Public Works Department i Fire Marshal Valuation $ FEES Building Permit Fee , ' j* 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 ( ) TOTALFEES PERMIT NO.: BLD PTR51 ''f•bZ=ar MASON COUNTY BUILDING PERMIT APPLICATION iii19 426 W.CedarlP.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-0467 Elma 360 4825269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ,_)a: % L„ L_I r i4C-, Contractor Name Mailing Addre g c; kQ Cfir=:'t Mailing Address �1 2(.0 JL �..„A t- !^" , Cityt�2t1 C71i 1 talZr) StateUA Zip Code 7b'�-.L.L,.• City r_1L, TY1 State y L/1 Zip Code "Y. I-.) Phone(y,g Other Ph.( Ph.L�-j2i, ) ' 4 therPh.(� Lien/Title Holder Contractor Reg. # •t.J"T j1,2,`t4 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 INFORMATION-12 digit Tax Parcel No. 'I e Fire Di-trict(' L al Description ' A� ! ite Address(Please include street name, street number and city) J Directions to site it-'7 Will timber be cut and sold in parcel preparation? (Yes/No) .d Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek— Pond Wetland Seasonal Runoff StreamSlopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE❑ TYPE OF JOB New_Add AltRepair OtherUse of Building Describe Work No. of Bedrooms No. of Bathrooms_SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make IitA;:, ?_Model ±A Ill.Cr4r IUM Model Yea Length gig Width 2,1, L," Serial No. �� > No. of Bedrooms -ate Ng,�efi�Ba Type of Heat_ L c Purchase Price $ �= 2 I ��r� Replacement Unit f(yYes)N Installer Name { _ N.Jva =-,t.k�11L.I' Certification No. 't ` ;� 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 requirements of the CONTRACTOR'S AFFIDAVIT-[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 approJjl.f first obtaining approval. A!h; X Date P-'� }. _..._..__......_ ,�� l: Ii:J'ti)( Date " """ - FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department- , i ' Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department 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 Volation Fee Pre-Paid at Submittal ( ) s TOTAL FEES Zan -61 Yo PERMIT NO.: BLD_ MASON COUNTY BUILDING PERMIT APPLICATION /o/19 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-46 1 Elma 360 4825269 Seattle 206 464-6968 APPLICANT INFORMATION Owner CONTRACTOR INFORMATION lr t� r yrr� Mailing Address C f L- y - Contractor Name_[ )" II-I Mailing Address Clty;ra i ;.k 11r l State��-1 Zip Code city tate Phone( %A ) I c ,j . Other Ph.rJ Ph ( ) ,tr ,y,SOther Ph Zip Code Lien/Title Holder Contractor Re # f= �� Address g' SEPTICIWATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System_Name of Sewer System Water System Well—Water System—Name of PARCEL INFORMATION-12 digit Tax Parcel No. Legal Description Fire District Site Address(Please include street name, street number and city) Directions to site Y Will timberbe cut and sold in parcel preparation?;(Yes/No) Is your property within 200' of the following: Body of Water(Name) Lake River/Creek_ Pond—Wetland—Seasonal Runoff Stream Slope BluffsBluffs PERMANENT RESIDENCE SEASONAL RESIDENCE❑ TYPE OF JOB New—Add_Alt Repair— Other Use of Building Describe Work — No. of Bedrooms_No. of Bathrooms_ SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other Garage Attached Detached Car ort sci ft. P Attached Detached MOBILE HOME INFORMATION-Make i—i Model ( 1.4,L I-JIl"Vi"f,, Length c Width y' Serial No. { ~ Model Year No. of Bedrooms No. of Bathrooms Type of Heat_ LJ= - _Purchase Price $ ', , . t Replacement Unit ?(Yes/No) Installer Name _ - r' Certification No `..� , ., �, r , 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 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 confonnarlce therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approyal. first obtaining approval. Date; = 1 Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL. REVIEW': APPROVED DENIED CONDITION CODES Building Department Occ GroupType 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 Woad/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTALFEES MASON COUNTY PROJ R117fKT - .� Case No. Name JGjft' L LIA& PARCEL NUMBER Date 1 O• 1 !� .:24 G SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences r 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. adjacep� pr�y �/ f-adjacent property line MUST MEET ALL CUR ENT MASON BUILDING INSPECTOR P- 0 wASWINCTON STATE CODES CH GES;SUBJECT TO QPPROVAL I OAfi 13;51I wry C GE ' t0 M ' I � . SUBMIT CHANGES FOR APPROVAL -PRIOR TO PERFORMING WOK �� 6 HESE PLANS MUST BE ON THE JOB SITE ��(► Oil c► ; N FOR INSPECTIO" I R� I `J >_ I I ad'a ent property Iine� LL <—adjacent property line Ziv SAMPLE SITE PLAN adjacent property line j E-adjacent property line y p 30' rR�SC 3vE gel SEASG v Al_ �. � L Crze£K \ I \ n fi HOM6 I Guaewi �I \ Haus4 I j PrtO PaatO ss pr G -�I 1 , R VACAr.iT I fi C+ArtAne£ \ I � I }I PM1o/mGD I 80, .k � � A6AxGLLLTLLRAL SO'�1 I \ ` I i /oo' I 1 r L..eLL I I I I j /00' A I adjacent property line- '. c \i <—adjacent pro pert' line TOPOGRAPHY PROFILE(Show a side view of property. Show s!opes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dI3+��G6 "1'O 4 TUGtLLYG diSta r�LL to Slopm to¢ ditt�nca +e Signature ate FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name _, L �It�� PARCEL NUMBER Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan 1 Lot Dimensions Fences r" 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 shorelin .or within 100 feet of adjacent property line. adjacent property line4 (-adjacent property line I I I _ I I � I I 1VI\ I I V, I I I lO I — ® Jl` I �+, I (Jn � � I W I V I I � I 41 I SS 1 Q I I I Lentro ne-3 I I Fadjacent property line `+Q0 SAMPLE SITE PLAN adja t property line j 3iO' rryVE Fadjacent property line I � � Ma rHe I Grtaeu CREEK \ I � I Hour¢ ]I I j � PrioPm<O sapt;c � �I VAC-ANT 7f (� 1 PI�oPasCO �\ T pyQ�LLLTu.RAL So 80, I I A I \ adjacent property line-> n"• c \i E-adjacent property 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 dis+anca. to clmt'LL d:ntancc to Slop¢ tom¢ d�ara..�a fo a Signature Date IiV V�GN-bU' b4 :4:J VM L., M,L_UUK VMUMC/r W7' Ltlb rL.� fbL7 Z 3 3 Z -S v - vUvsO * GOLDEN BELL MOBILE HOME PARK N.E Zfl ROL-.1 F5 I.RA. �I BELPAIR, W4. 98528S rY� J60.275-4623 PIIONI✓FAX pdtQe kNdlrnl+mk,Munugnr l November 20,2000 Vol Posl-i1°Fax Note 7671 Uamt - -p gag)' Z. ? Gt`v2r_ .s Fromm QrG✓c G CoMept _ CGZ-2e, Oti Pv d G 1'UIUYC I lornes Inc. Phom# MWt, -725 ? 2^ Silverdale, WA. Fax F'3'coO- y 74^ �x cC A'I"f: Mark 7 As per your request regarding the lot siic for space q2 in the above mobile home park. it is osrablished as 50". 120' '1 . We hope,this is satisfactory for your nzeds. I I Yours truly, I,ido Dil.uck owners ut � �� • `(� SCE \�) �� _.�- -_ _�... _ =�' �:n a ti 0 39 - 38 37 .56 a I 4' or �• \�� �,,,, �^, i .`. ;Wes. :.ram � 92-6105 ; f,"•' s�.6',. :'i:'...x. [ e R(OF qmV v e \ k<\ \ -nmm to ( 0 ° \ j ( 0 - ® \ m 2 ) § m > K \ / \ ® \ m \ j � CU } [ \ m � � \ / - - m zR § § \ § - \ > \ \ ƒ) $ Gm ) m ( e 2 _ g » $ § < ) 9 \ ° = E > § f Q / ( 7 % 6 e ® O ° U) $ ? e ;o m m 2 \ 2 / E = m - �_ a FMZ- 0 [ f ( ( n 2 \ , 22 r0 CD 9, $ m % m CD ƒ � � } 2 \ 2 m 3 0 2 21 CD 0 cn } \ ) 5 \ / m k A � CD ` � � \ 3 \ 9 \ cn E - y ; [ D 2 £ \ } / / / �\ oo � \ k � > o ° \ � ® r 055 / m 2 CD k Bn m . .. .. .. k F § § - m z n 2 0 et CO z / ) ° 2 m 70 2 q M / 73. 9 \ CD ( � 0 2 \ g 0 } n CD ;r097— § \ \ ƒ � . . m ° § 00 q - _ ) 2 CD o rn © # 4 � 2 z ® ID @ z$ Cl) � ( g q § 22 ® ° _ \ \ e m _ > 9 ® 0) ° § m ) qg , } ! ! k c & $ & /o j � - R 22 ) f40 0 P9 k wt D %\ # ksme ! o - . \ We/ ~ kkkkk « \ \ \ ( & ° co O � �, o md � D � ny �--- m �. � � 2 X DZmOC m � MO � o Ao c' ? o3 DN+ nmyOC � 0m T [n � D � tn � W D � a N 'o <o c � .0»v d oL� O -I � � OD a � � m ND v m o 0' 0 :' N M 0 < Z � � mD -i m N ZO > m C OS 3 � - c nn D O >. Z �nO _. Om On c � mm �.m o m z 0Omoo � Z u Xv� O-Ic C) N m o M= N m d O O � OCm � n 0 wo- Q Omv Cr N p m � �-,. mmA5- z a � Om m 0 00 Znm n0 z m (nOm � T on3 �Ac3om0 oNm cn � z0 Cvi OW o0 Dn o. � Na �. O 2 { � Ov Dn � o 3o wm 'O-IM (CODo m Win. _ cn2 � < � Qo O � m O - o 0 D m C ° m m 0 X N : CL 3 0`0 0 0 0 m 20or m o _ M co? � � � � Do ' OpmZma N0 � n000 Xco mm M M • om m o a F f -' � no 0 0 -i �_ Or0 0 �. 0 0 33 ^ c�i �, dm op m O � m0cn a.0 a-q 3 � O � -aG) m � � T f y 3 = c o m o 70zr -' S -• N � .f^+ lnmm3'v a � N CD E; z ADmIWD <° o AO o O f0 O' < 0 0 C m . O T r N O � moo0 mvi Z O -i ;u m � O 3 n n o cam cOQay $ on�i0, O � m � 0 i ry 2 3 a) 0 WD o m m = o Cn d oa z - K m m r Z O CO)o 'o x3,� �, �, � :. o � C O (o -i A g m 0 nn coo -Cc nm N W Z � A f=flc c m O -I G Z o � � � mm � m � X = voi m � ZO � 'i .� n OD CO ' 2� = N n� N o ' O m - O � = C o , Z ' m cc N m m N Q , Sao 3. a, -D--I Owz � m ,ZCI c� p o n Clo 0 o �� -0 3 cT ;1 � o o � Na; oN . m0 3o O r0 ;1X o n c_ 0 5 0 � � -, o O OX00 o q o m � 0 0 � y r - zom A a CL od X G T Ofn .Z) z m ° �No �o fa 0 oc: 3 0 � 0 T = o mm � m 0 O m � Zzm -cn N Co nx0 m noCL DOmA r �o < m D a z a m000. 0yo > > co Z :UO o m o (o w o o nN [n rn 00 o O 0 ooM - mcoi � 3 = � mm D N m w f c � 00 � 0 rtiD� �) (Oil n = � � a0 0 � om � m y o F � 0 CD oN Tz ' O r: T w c n Co m 2 o �° OvD ,-j�j 0 0 m ^ E 0Q0`om n00 0 F. n N f 0 CL0 ao fM - 0 X X f o n of ov .� m � z' pCp = c N o m d m Qv z m Z ZCD X ? 1 mo :E ma <° Nr -im � m m w FW 3 N aN uNi m � Z D ➢ � = ? !Z v o 0 ono d 0 0 0 - o D { m yDd � < � 000 N D < CL <° m %O z o (n m o ] ae ` � \ \{\ y / \ \ & ( \ { (\ 0 ) \ k ( j / ƒCD , _ } ( CD \ {) s , 7 ; / 00 \ 00 2 \ - } ( �_ ƒ ( }} C 3 ( ( \ =3 \ \ { ( E0 CD } - cc CD \\ \ � 2 x as \ 10 \\ \ _ CO ® k 17 \ \\ �\ q ¥G ( � kco n w00 ° \ \\ \\ co 0 \\ 0 Building Permit # ��� �`�` ! MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427.9670 CORRECTION NOTICE Job Location L ll� 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 d- s 4 gel SIT LL �/ i t%G T 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 1� OK to e C —F/� GCS f%l' t S ❑ This is not a complete j spection Department 118 Date 2 � Inspector TA DO NOT REMOVE THIS TAG C NO CF e - MECHANICAL MOBILE HOME ! Footinga setback date by Ribbons date by Gas Piping date b Foundation;Nails date by Set Up _ date by INSULATION date / 2 L,e--1 1:7 by/ ,-I- B&SLAB Insulation Floors Final date by date by date - �"'E�/ by f/> FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Attic Grodndwork date by dele by WALLBOARD NAILING D.W.V. ddate by data by Water Line FINAL INSPECTION date by date by date by // 2,2- S-r T� /2 - /9Ti� Til 2 v L .. 0 Z Z� PHOWNW MASON COUNTY Permit No. JUL _ s ILDING PERMIT APPLICATION qu 40 1q 4 6 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800 562--628 \ PLEASE PRINT / � 1) #1 E"Q�yTO §ELllL1i�CSL_ i �r Phone# Site Address 6t, ` ICY I 4 Fire District# City St Zip - Directions to Job Site U \Cam v') Owner Mailing Address City St—Zip- Lien/Title Holder Address City St Zip #2 Contractor Name Contractor Reg# Address Expiration Date City St Zip Phone# #3 If septic is located on project site, include record . Connect to Septic? P,yblic Water Supply Well stem I' Connect to Sewer Sy ? VOS Name of Syst�e��m (If residential, proof of potable water is required) #4 Parcel No. Legal Descriptiont3 #5 Building Square Footage: (existing/proposed) 1st FI 2nd FI 3rd FI % Loft —'f Basement / Deck #bedrooms #bathrooms / Garage Carport - / (Circle:Attached or Detached?) Other sq. ft. #6 Use of building , , Describe worko C � i #7 Type of Job: New Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year t 7 Make Fri y;,w,,-Model f Length a Width !4l Serial No. :, n 57��q 1, } # Bedrooms # Bathrooms_I Type of Heat a. • j, .- Purchase Price $ L -V-2 #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Indicate Directional by (N, S, E, W) Name of Flanking Street in relation to plot plan Name of Fronting Street APPLICANT TO DRAWSITE PLAN BELOW II . I I i ,APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3 each) Mechanical Fixtures ( 6each) No.—Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other —BathTubs Ng. Units � Fees —Showers — Furn BTy _Hot Water Htr .. _ Heatpumps —Laundry Washer — Vent Sy ms _Sinks Sloot Vent Fans —Floor Drains ; Boilers/C mor or _Laundry Basins _ HP i Dishwasher — , NQ Air Handling nit _Disposal cfm# _Urinals No. Fire Protection Systems —Other Auto. Fire Alarm Sys 50.00 ' Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ A*Fire Sprink Sys 25.00 TOTAL PL�U 4BfNG $ N� Other Gas Outlets Wood, Gas, Pellet St e 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 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $ 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 DEPARTMENT. DEPARTMENT. X OWNER Zzx X BY DATE 24 DATE FOR OFFICIAL USE ONLY:Accepted by: Date { DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold }Approval Planning: SCR "fYY\A C d St� �ce� l S r �dan� G II o r/M1Mo Environmental Health: Building Plan Review Occupancy Group: Type of Const: Fire Marshal Other: FEES c� _ Special Conditions: Mod, E — Building Permit i�� Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee 7 _� Other Other _ i..i =EBuild:injgV�aluation. ZZT� TOTAL FEE Golden Bell Mobile Home Park NE 20 Roessel Rd. Belfair, WA 98528 Phone(206) 275-4623 Deede Schattenkerk, Manager t OQ o D O cn " " � o O 0. = z CD n °(.0 O Q A z 3 N . U 0 n N O Q 000 cn Q 00 C A Z m C Nr aO ,io M w ® m ww m � D t7 Z 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 0k 0 0l t-/—J(fby [�✓ BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by PLUMBING date by OTHER Groundwork Attic date b .5 dale by O` y'-7 D.W.V. WALLBOARD NAILING l date by date by Water Line FINAL INSPECTION date by date by date by O W 0 OZ) V/ X 0 O0 (> O co OS(C) O Q A z 3 00- 7 C 00 N 0 Q cyl OD A O Q O O x 0 O `O00 Q` O Q O S� Q` -F O n `O Q O Q OD RESIDENTIAL GAS APPLIANCE SYSTEM CRECK • FFAI GAS CHECK.. GAS CFECK,. Account Number y� Company/Lowbon — Name J n,/�IFU Date 10� '3'�� Requested Call L a-0 20 k,2J¢L Act Name —Address hi PC y� 1 e"fQ *V I1� 9 8 5' z2 Instructions - Telephone: Office Home Performance Check: Item /nCentral Heating f Space Heater 2 Water Heater 3 Range 4 Clothes^nDryer 5 6 7� Manufacturer 106,f4I 0 IT Model No. Serial No. QIR51 IqLI1 Fuel I—P Manual Shutoff(Inslalled/Exisfing) ✓ v Sediment Trap (Installed/Existing) Control Mfgr./Model No. ✓ `- Pllof(S)/PIIgt Safety System lid- Ignition System(s) Mfgc/Model No. '� v Thermostats Mfgr./Model No. ` ✓ Bumer(s)/Combustion Chamber Venting System/Draft Diverter ✓ `� Combustion Air " Red Tag (Removed from Service)/Recall TANKICYLINDER (Additional Serial NOI SIZE SEflULL NUMBER MFR. MFR.DOTE (AST ' TANK PAINT PIGTAIL FITTINGS GUAGE RELIEF VALVE FITTINGS TESF GATE TION COND. COND. COND. COND. COND. COND. DATE CAP EAK TES l 7�/a 3M yai,<y 1195 v v I ✓ ✓ L tr PIPINGIREGULATOR OPERATION/CONDITION PIPING REGULATOR REGUINOR REG. VENT HOW FLOW LOCK UP SINGLE MATERIAL SIZEMAR, DATE COD MFR' CONDITION MODELPOSITION PROTECTED PRESSURE PRESSURE STAGE 2P 3 y,, Rego A)eIJ `l Y1 own Crd IZ IN WC I NYJC TVJO 151 PSIG PSIG STAGE 2nd IN WC IN s+/c SYSTEM LEAK TEST SINGLE STAGE/ START PRESSURE END PRESSURE TIME HELD SYSTEM OK Comments: 597- 70L Mrf l Co))71 e G7 R) INTEGRAL/ (INCHES NCI (INCHES NCI e ,A , ♦ S SECOND STAGE /1 J /S ''ryrt rwo 15i U 5 Cie% 40V LeahS, IU64 FbLIrK9 STAGE 2nd j!� D This inspection Covers(pmpane/LPyas)items and equipment visible and accessible to the service technician and represents the Conditions existing on the date of inspection. It does not Cover latent or manufacturing defeds,the internal working of sealed equipment.or structural components,and cannot be construed N Cover future or unforseen happenings. rr Reference Invoice No. Date I. A)ar �a }�Gttatl, /�ri (Pleau Priml I, 'r n e l _ • Know hove to turn off gas in case of emergency. (Please Pnnq • Have smelled propane and can detect its odor Certify that I have completed the System Check as prescribed •Have received the Consumer Safety information and material. Performed Odor Ten , Yes Performed Leak Test -C¢Yes • Had gas system deficiencies and/or corrections,if any,clearly mplained to me. •Am satisfied with the service wo rfomled. Placed Safety Decal C Yes Left Consumer Safety Into and Matenal "-Yes gmws Sro�wO (Service Tecf'nivan's SignamreH I z . r _ R 2 0 CJ� J OOD O Q` C Z y - Q Q O cQ � on Z) m 10 a Ol A D -i 2 \ ` m C G § 0 < 3 O n z CONCRETE MECHANICAL MOBILE HOME Footings-Setback " Mate 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 (late by date by PLUMBING Attic OTHER Groundwork (late by date b D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by OQ 0o O x n O0o o1 : z (D o0 :3 Q A z 3 N . UCC (Q G rt o C� D (D 10 Q � Q OD A J; OQ O : OD O olC z n °� O Q A z N . U< Q G O (� :3 N 10 Q 00 cn OD A L(Y5e,,Ai- ► Please 40 A4Ae Ca Mason County Public Records Request Form 426 W. Cedar Street, PO Box 186, Shelton WA. 98584 Phone: (360) 427-9670 X-352 Fax: (360) 427-7798 I would like information: Mailed—Faxcd�.X Picked Up_ Date: `aj No\r Qj- Requesters Name: Company Representing: Address: PO ek-314- 91 5 CO Email: city: -e>2.[1e V V& State-WIC-Zip: 98009 '2-65 d Phone: q-L 3 --233 Fax: Parcel No. Parcel Address: -zo N E o S S Q Q Q ( a t r Owner: l CU-An &—(2� G Previous Owner Please Provide Records For The Following: Environmental Health X Planning Dept. Building Dept. Please specifically describe what records or kind of records you are reg _>�rino a✓\ r�-{, 'SQ is s�c�e /drag AS bt s alvatl+;✓�61s ter vmA'c Cninf RCW 42.56 1 certify that the information obtained from est will not be used for commercial purposes. Signature Required: — Requests may be charged per RCW 42.56. During file review any pages you wish to have copied(excluding non public record documents)must be tagged and charges will be assessed at.I5 cents per copy. Larger than 8.5"x I I"will be charged at a higher rate as established by Mason County resolution. In addition to the per copied page fee standard postage rates will apply. Make Checks Payable To: Mason County Treasurer; Total Fees Due: Official Use Only Completed By: Ext. Date: Notes: f c C lease all w 5 business days for us to respond to your request* If items m being mailed please allow an additional rest✓'1 days until you ra clue the xquest submitted. �7 T d b2bBTZb85B16 Xd3 13CN3SHI dH WdbS :ZT LOOZ 6T "'oW