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O 3 .< (p O N Cn S (D N 7 3 (D O m N CD N N m 0 0 f [ 0 - \co a \\ e � x > § f ' ƒ 00 _ _ - i; ma k } $ 8 / � 0 CD - - . ! � a } { \0 \ } 60 co \ � ® \ � j { B} ( no') CD 3 � \ EErm \ f / §/ \0 / / � \ \ ■ E �/ f / - a BCD § / ( 00 22 | . - * CD CD 2 g }\ ) ) ( x � ` CD CD 9 | ¢ R ( \ - # � » 0 - k 22» 3LA r 2f ® = � * r & $ ■ § - ) f / Cc C } k - { /} ( \ \\ O !f y /\ {/[ (} 2 § | e , _ & ( 0 \ / I &\ - E _ CD - 0 CD - ■ E / - uca , 0 0 \ 0 / a /// ) } k ± ; � W � r O ^' CONCRETE MECHANICAL MANUFACTURED HOM,1 0 0 a Footings / Setbacks Date By Ribbons 6 m Date By Gas Piping Date By Foundation Walls Date By Set-up Per C/ti, Date By INSULATION Datez //&- By LjOit- B G / Slab Insulation Floors Final Date By Date By Date 2 )J vS— By LAr<_, FRAMING Walls FIRE DEPT Date By Date By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILING D.W.V. Date By Date By FINAL INSPECTION Water Line Date By Date By Date By 's �CE. M.bl. ,gr-�P�Ft�tg,L FA�LL� I2�OZ�Oy l.Z�tk3'aV Mils SE£ �ffvw+aly �91y`� s C s c O 0 yy. O \lJ v l 1 to l� O M 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 APPLICANJ INFORMATION CONTRACTOR INFORMATION Owner I f '' ' Company Name Mailing Adores �'- Mailing Address City `r t State j t r Zip Code City State Zip Code Phone / Other Ph. Phone Other Ph. Lien/Title Holden Contractor Reg.# Exp. Email address �' / �,. ( E Mail Address Drivers Lic. -Lj i � ,i) DOB � CI 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 PARCEL INFORMATION - 12 Digit Parcel No. i. Fire District Legal Description I Site Address (Please include street name, street number and city) , Directions to site ' Will timber be cut and sold in parcel preparation?Yes/Ne, Is property within 200'of Saltwater _Lake !tN ? River/Creek-) '1: Pond Wetland Seasonal Runoff ! 1'v Stream i ,i ; Slopes or Bluffs J 15% Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?Ye No' 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 Detache MANUFACTURED HOME INFORMATION - Make '�', Model ar Length Width Serial No No. of Bedrooms —NO. �f Bathrooms Type of Heat f f i Purchase Price $ 4Z Replacement Unit? Yes/;Alo Installer Name O:i o 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 a�the necessary parties.If permission is required from any easement holder or any other party in interest rpp�fl F p tion or the Work proposed in the application, I have obtained permission from them to apply for this Permit and condu /... Xr.;; ! Date. , 'JUN 10 2004 wrier/-Owners Ffiepresentative/Contract or��(indicate which one) FOR OFFICIAL USE BEYOND THIS POINT 13�LFAIR OFFICE Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTE BuildingDepartment --lam Planning Department oil Environmental Health Department Public Works Department Fire Marshal g &1,, / FEES Building Permit Fee $IU =Fee n Plan Review Fee �� ePlumbin & Base Fee iew FeeMechanical & Base fee Wood/Gas / Pellet Stove Fee Violation Fee ubmittal 1 J Valuation $ TOTAL FEES Mason County Permit Assistance Center Planning Intake Checklist 11 Owners Name: 1 / Dale: ca - In •Q� Project: YY)C p Reviewed By: 1 LA_) Commercial Develop YES Comments: Planner: SAL GBM� DMJ YRD Site Plan: North Arrow � Property Dimensions:-SQ X �f Streets and Driveways Shown. Road name: All Existing Structures shown with setbacks _>�, Well Location, Septic and Drain-field Shown with setbacks Identify all surface water(streams, ponds, shoreline, wetlands, etc.) q< Topography(slopes) ❑ Proposed Structure Setbacks (Direction/S tback): F: /_-5 R: / ILI S 1: / IS S2: ❑ Utility and Drainage Easements: Yes No (if yes enter condition #5022) ❑ Other Easements Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: Not Applicable ❑ Agricultural ❑ RR 2.5 5 10 20 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy ❑ Rural ❑ RI e E I v E D ❑ Natural ❑ RAC ❑ RNR 1UN 10 2004 ❑ Unknown ❑ RCC-Hamlet ❑ RT Urban Growth Area ❑ MPR IC`FyIR OFFICE ❑ Unknown 0 Unknown Water Body(type of water if unnamed): SEPA: Yes Unknown Flood Plain: YES NO Map# Aquifer Recharge: YES N(L� Map# Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: YES NO Eagle Nest Tag: YES NO Other YES NO 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: #0046, #4999, and #5019 Golden Bell Mobile Home Park N.E. 20th Roessel Rd. Belfair, WA 98528 (360)275-4623 Mason County Building Department P.O. Box 186 Shelton, Wa. 98584 As required we are sending you notification of a new lease agreement with the following new tenant. Lease agrement will commence when their MOBILE HOME arrives on our pre-existing lot. The new tenant will be serviced by the Belfair Water District #1. If you have any questions please call during normal business hours. Legal Description Tract # 20 Sam B. Theler's Home Garden Tracts Vol. 4 page 20 Records of Mason County. Parcel # 12332-50-00050 NEW TENANT NAME NEW TENANT LOT Thank you Deede Schattenkerk Manager �Q RECEIVED suN t u 2ooa ------- 0 a w X � I � W d � w w o � cA jj N. N r — w o a w a o N N 6� w J LA � I Ln N \�rF A ! Look Up a Contractor, Electrician or Plumber License Detail Pagel of 2 �V I Topic Index � Contact Info f ' ii� li Search Name s; Safety claims a huurance Workplace Rights ':: Trades& Licensing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber General/Specialty Contractor A business registered as a construction contractor with LF21 to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment "t of account and carry general liability insurance. License Information License MIKESS1011KC Licensee Name MIKE'S SETUP INC Licensee Type CONSTRUCTION CONTRACTOR 601897605 Verify Contractor Premium UBI Status Ind. Ins. Account Id Business Type CORPORATION Address 1 4201 KELLY RD Address 2 City BREMERTON County KITSAP State WA Zip 98312 Phone 3603733129 Status ACTIVE Specialty 1 CARPENTRY/FRAMING Specialty 2 MOBILE HOME SET-UP Effective Date 5/3/1999 Expiration Date 8/2/2006 Suspend Date Separation Date Parent Company Previous License MIKESS*044KB Next License Associated License Business Owner Information https:Hfortress.wa.gov/lni/bbip/detail.aspx?License=MIKESSI0l IKC 11/19/2004 Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 2 Name Role I Effective Date SIEGERT, MICHAEL L 01/01/1980 Bond Information Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received Bond Name Number Date Date Date Date Amount Date AMERICAN STATES #3 INS CO 6287442 07/02/2004 $6,000.00 06/30/2004 OHIO CAS #2 1 INS CO 3721292 07/02/2002 09/08/2004 $6,000.00 08/09/2004 #1 1 CBIC I SC0824 J 04/30/1999 11/02/2000 $6,000.00 Savings Information No Matching Information Insurance Information Policy Effective Expiration Cancel Impaired Received Insurance Company Name Number Date Date Date Date Amount Date ATLANTIC CAS INS 45 CO L088001332 07/02/2004 07/02/2005 $1,000,000.00 07/23/200, NORTHFIELD INS #4 CO CP427467 07/02/2003 07/02/2004 $1,000,000.00 07/01/200: NORTHLAND INSURANCE 43 COMPANY CP427467 07/02/2002 07/02/2003 $1,000,000.00 07/23/2001 ASSURANCE CO OF #2 AMERICA SCP33052045 04/30/2000 04/30/2001 MARYLAND #1 CASUALTY/ZURICH SCP33052045 04/30/1999 04/30/2000 Summons/Complaints Information No Matching Information Start a New Search Printer Friendly Version �r About L&I I Find a job at Lfcl I Information en espanol I Site Feedback 1-800-547-8367 It,Washington State Dept.of Labor and Industries. Use of this site is subject to the laws of the state of Washington. Access Agreement I Privacy and security statement I Intended use/external content policy ( Visit access.wa.goy Staff only link https://fortress.wa.gov/lni/bbip/detail.aspx?License=MIKESS1011KC 11/19/2004 - �rmitNo. �J' LI�Rg-otl/ / MASON COUNTY BUILDING PERMIT APPLICATION 426 W.CedarIP-O. Box 186, Shelton,WA 98584 427-9670 (Calling From:Seattle 464-6968, Belfair 275-4457, Elma 482-5269) PLEASE PRINT #1 O er 90ilGK hone# I- 197S Site Address, �• G- �20 r7z SSA rd Fre District# City litl[� ZifL p L-2 Directions to Job Site r r otLO w ;n4o a a, ri PLC HtUhLc home rim i5 acro�3 +he S�roe+ tom (3eC� GLemen3ar Owner Mailing Address '7a7 -7/ Pol-k aJL, ((llLL City er+ Or ' H r St W�_Zip 7036� Lierif itie Holder - e Address city St Zip #2 Contractor Name M•1LE3 A1oU.vt UBI#6V0cll�}9 Ll c� Address 1-001 keLL', 0-d Contractor Reg#MLke55'i! dN`/KB City 13 femer/-on st L-)c, Zip f?3/a Phone 4360)393 3rzyExpiration Date #3 If septic is located on project site,include records- Conned to Septic? 014- Public Water Supply Well Conned to Sewer System? Name of System roof of potable water is required) `VR E' (If residential, p p q ) 770 # arcel No-t�33 - SD - o00SU j Legal Description rac aol-0 Sc n i�Ce✓'f h ,nL rp/en lra 1_t/n( dad rt"rk e4 IYl k n C"4,r 5iQ rn B Home TR.S TV- 2-0 #5 Building Square Footage: tst FI $q/ 2nd Ft 3rd FI Loft Basement #Bedrooms ,3 #bathrooms Z Deck 3x 3,�3x'-/ Other Garage Carport (Circle:Attached or Detached?) #6 Useofbuilding 19r;yh&w . ✓'es;de ce. Describe work #7 Type of.lob:New/l,.>1 iv"'"Add Alt Repair --Other #6 MOBILE/MANUFACTURED HOME INFORMATION Model Year /9�Make��ModelO /n11Lef 197uU,ti Length 66 Width Jc� Serial No,&WOr,230� W0Y1 _ # Bedrooms 3 #Bathrooms `Z Type of Heat G_leer L w�/� ' �_AlIII if Purchase Price$ 3e2 r 5'00 f 0 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 04/28/98 TUE 12:59 FAX 3604277798 MASON COUNTY BLD 0 002 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 Indicate Directional by (N, S, E, W) Name of Side Street in relation to plot plan Name of Fronting Street APPLICANT TO DRAW SITE PLAN BELOW L a sl i i APPLICANT TO D AW TOPOGRAPHY PROFILE BELOW 04/28/98 TUE 13:00 FAX 3604277798 MASON COUNTY BLD 3 f�003 Plumbing Fixtures(S3.45 eachl Fee Mechanical Fixtures ($T 00 each) NO..2 Toilets CIRCLE FUELTYPE: Gas, Iednc 2Bath Basins Heatpump,Other 2 Bath Tubs _NQ gWta Fees Showers _ Fum BTU )Hot Water Htr _ Heatpumps _Laundry Washer _ Vent Systems _Sinks Spot Vent Fans _Floor Drains No. 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 17.25 i Auto Fire Sprink Sys 35.00 — TOTAL PLUMBING �3`/•SD y4 Other Gas Outlets Wood,Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF _ WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- Permit Basic Fee 17.25 MENCED WITHIN 18o DAYS OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR APERIOD TOTAL MECHANICAL $1�.:Lf OF iso 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 1 RCW 18.27.AND AM AWARE OF THE MASON COUNTY AMAWAREOFTHEORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATINGTHEWORKFORWHICHTHE PERMIT 15ISSUED 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 BEMADEWITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT_ DEPARTMENT_ X OWNER:� X BY DATE + DATE e:i.`_P.R�-.i.+++.^ '�IbY '. '/n �. rvn���r +r�en�'b'.". fi Zd.Wu L M' .,gib •E� A w�u'FSd 1wA •`rvq{ �p^^/ � s.5�+� 1«v ,A� — � Y ^�° ' pY. DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: i Building Plan Review l0 O a 60 .56/3Y SOS{ D /000 ..?A , ra c�ri�firt7ir� sc� •shall be .ova eed on v�d.�fwrb�d n a fi�e 46"l Occupancy Group: 13 Type of Const: Fire Marshal: Other: FEES Special Conditions: tPo Od Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Violation Fee Site Inspection Building State Fee Other [LL - Other Other Buildin=Va1uat=on =L7---- TOTAL FEE DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: i Building Plan Review /0 O oQ I— O'J S6 /8Y SOS U i000 � r��ar�' S JAa// be ,a/a��� an Occupancy Group: 'J� Type of Const: Fire Marshal: Other: FEES Special Conditions: Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Violation Fee Site Inspection Building State Fee Other�11 • Ili Other Other [BuIldingVal�uatiory TOTAL FEE Golden Bell Mobile Home Park N.E. 20th Roo"M Rd. tS oft1r, WA 98628 (360)27"23 Mason County Building Department P.O. Box 186 Shelton, Wa. 98584 As required we are sending you notification of a new lease agreement with the following new tenant. Lease agrement will commence when their MOBILE HOME arrives on our pre-existing lot. The new tenant will be serviced by the Belfair Water District#1. If you have any questions please call during normal business hours. Legal Description Tract#20 Sam B. Theler s Home Garden Tracts Vol. 4 page 20 Records of Mason County. Parcel# 12332-50-00050 NEW TENANT NAME JG�L Line ov�k NEW TENANT LOT# Thank you Deede Schattenkerk Manager 20d -7:9i a6. &Z d �d 2Z9v-sZZ-092 : xed Addd dHW -d3H N3009 v OQ D o, o o x n OODo ol : z CD — C � Z 3 U 7 --r on (D -0 Q OD U � aw A - _ - 71 00 77 - po O p :) X O U C :) z S __ 0 OL - = to N L r - 7 10 Q-. 000 00 w _ - m C - o - K -1 V O Z CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date Set Up b Foundation Walls date by date S- •� - by T� date by INSULATION - BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING Attic OTHER Groundwork date by _- date by WALLBOARD NAILING D.W.V. date by date by Water Line FINAL INSPECTION date by date by date by - w - -- - o � cn x 00_ - - O - - D ° O O o CD _ � OL _ s - O cn 7 T _ 00 0 z - � nco o a O� (P _ O (Q O 10 Q 00 Q Building Permit # -0`//5r MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427.9670 CORRECTION NOTICE Job Location4��Lc-rc-e zo / 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 /Y c i� CO �o� rg/Jpr T /- zTic_,rOirG-CS.�Vcv.-O �f!Y//JT/yr cs`.c G�.Sq --� �$ 15+/ d- w/r..cr�✓J TiS�.4i ! �y�, cS-®ciT Lcnsr .E� ryk30/Rs TO iyra/,�7-iyc 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 F3G0 Date -r- 7 X-fO� Inspector 72&4 / 0 V"9-�— DO NOT REMOVE THIS TAG Building Permit # &'e `1/7' MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location Lrcck jPk-- This structure has been inspected by Mason County Building Dep rtment and the following VIOLATION of County Laws and Ordinances hav been found: Items Listed below must be corrected to gain code compliance i)/ +S.G% /NSDfCTr'f"� /-- l70S >3mvf LL^�7c/Y/ /+� ?�9•',�F �'li/fit?i.✓C- iiv,6'F�Y SiY//�T.ht d- t�/�•,� 2 cif i�//✓c..D/ �rv,S-Tr�. r 4 �/ CC��- eacif �C;/�'D, 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 'O� Date -r- Inspector ��/�✓�-+� DO NOT REMOVE THIS TAG " /« Permit No.to�5"da(7(0 MASON COUNTY BUILDING PERMIT APPLICATION PLEASE PRINT 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 i 1cD� #1 w Phone# to ite Address n E o;?U �fgGE _Fire District ity rl St %UZip Directions to Job Site �tii r/ 7��e 1/`a ✓J � �7` 1141 � s1 te'-a L�� � ,�L'� Owner Mai ill, r City St Lien Title Holder (414 Address City 49Q� St �f> zip #2 Contractor Name Z/ n/7 S '04't/;� &I� F Contractor Reg# Address /p J 7 6q Expiration Date City �C%c St��Zip S Phone# / ?t1 #3 If septic is located on project site, include records. Connect to Septic? ✓/ Public Water Supply—__1z Well Connect to Sewer System? Name of System (If residential, proof of potable water is required) rc ir Legal Description �6L7` s2 L���f�h1 ,� � / p, �7L�J22tf�4t7; nl i✓ �r��1`S V01Omq y1,gf1t /��cands {y/aso/v � Cdvn/ l� #5 Building Square Footage: (existing/proposed) / 1st FI 2nd FI / 3rd FI / Loft / Basement Deck / #bedrooms #bathrooms / Garage / Carport / (Circle: Attached or Detached?) Other sq. ft. / #6 Use of building a h Z A h 1t--; r.l /Ye `P Desc4e work #7 Type of Job: New Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year Makey1�4 4odel C/M,n// f Length Width Serial No. # Bedrooms_ # Bathrooms_ Type of Heat Purchase Price$ v .�r G-oo� G`eN�S d mt #9 indicate by circling the applicable source i 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 Name of Flanking Street Indicate Directional by S, E, W) Name of Fronting Street in relation to plotof plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No._Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other _Bath Tubs No. Units Fees _Showers Furn BTU _Hot Water Htr Heatpumps _Laundry Washer Vent Systems _Sinks Spot Vent Fans _Floor Drains No. Boilers/Com ressors _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 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove 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 BUILDIN EPARTMENT. DEPARTMENT. \ OWN R n X BY DATE �� ��1�5 DATE FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: �y •� i Environmental Health: Building Plan Review . UU _J1 Occupancy Group: Type of Const: Fire Marshal: Other Special Conditions: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other Other Building Valuation: TOTAL FEE GOLDEN BELL MOBILE HOME PARK N.E. 20 ROESSEL RD. BELFAIR, WA 98528 PHONE#(360) 2754623 DEPT OF GENERAL SERVICES P.O. BOX# 186 SHELTON, WA 98584 As required, we are sending you a notification of a new lease agreement with the following new tenant. Lease agreement will commence when their MOBILE HOME arrives on our pre-existing lot. If you have any questions please call during normal business hours. Legal Discrepton: Lot 20 Sam B thelers- home garden tracts. Volume 4 page,20 RECORDS MASON COUNTY. PARCEL NO- 12332-50-00050 New Tenant Name: �A& New Tenant Lot: _ THANK YOU, Dede Schattenkerk Mgr. 70@mr mom mam - 00 -40r+ A O m0 . a m a c o D s - - m a m m zg A < A < r z m D m A m - a 0 0 D 0 D m m A a A a D 7' mr rrnmaz ar- C4 r* c '^ w r a0v ® r M . Zzlry i mom -- . aC T O L] -iz*^ -4 D I. � Om I 1 — 2r ID m D Om. m Oi I, O - OAaC r aatn - S N m D Z 7C z x mfn Q I mzm - I R W@@@ 1 S m '; m 0 W rn I �� fA N W 11y -! "fl -fi i @ "� a Jim W y N m m w <y= � F- '•"'" ; CL� OrOm7� A .� v� ami m � f mmmm I M> m - amC - OHO � 01 -! - Oa0 a000 - - I a - O m - a s O w a� arv > = - mm a -Im - r- z -t mr { T� r m - m < z 0 2 m S m C D m - :7 0 D S m = sT' ; �am � W DVi f D mfn z V7 mmm . N •.� 4m mD + mmDxm . m • 0 . . y . .p O O Q COC m 7[ S a r mz tnmm m . 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Box 186 Shelton, Washington 98584 426-5593 DATE ISSUED OWNER .-SAME PERMIT NO.�p G MAIL ADDRESS _ U CITY TATFy� ZIP DIRECTIONS / U jl� PHONE TO JOB SITE /lJ^ LEGAL DESCR. S m ` - A2b II c (O SEE ATTACHED SHEET) CONTRACTOR ,yAME MAIL ADDRESB -T12�C J �R �O _ N USE OF ITV d SiATE .� NEW ❑ ADDITION e�' Q LICENSE NO. PHONE BUILDING D Class Of work: ❑ ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE Describe work: 1 -J X Valuation of work: $ PLAN CHECK FEE SPECIAL CONDITIONS: PERMIT I-kE s BEDROOMS. DECKS BATHROOMS CARPORT ❑ TOTAL SO, FT._— GARAGE Li NOTICE NO, OF STORIES_ BASEMENT L7 ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING TOTAL SO. FT._ FIREPLACE G DETACHED Li OR AIR CONDITIONING. CONTRACTOR AFFIDAVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS I certify that I am a currently registered Contractor in SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER the State of Washington and I am WORK IS COMMENCED. Ordi aware Of the e requirements regulating the work for which FO th permit is issued and all work done will be in FICE USE ONLY c nformance therewith. PERMANENTI SHORELINES , irm SEASONAL G FLOODPLAIN ! f- N E.D. NO.Special ApprovalsSE.P.A. O._ IN OUT APPROVED —Date ZONING VES NO PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. I Certify that 1 am exempt from the requirements of the PUBLIC WORKS contract or registration law RCW 18.27, and am aware FIRE MARSHAL Of the Mason County Ortlinance requirements for which this perml issued and that all work done will BUILDING DEPT. n conforma a ther with. ROAD ACCESS j MOTOR VEHICLE PERMIT r CATION ACCEPTED BY Date APPLICATION.�_ PLANS CHECK BY PROVED ON ISSUANCE N CHECK VALIDATION CK. M.O. CASH ` �� STMASTOWN PRINTING PERMIT VALIDATION CK. M.O. CASH TYPE MOBILE HOME Permit No. 18- -- 287_ No. Floors Ow Geor e E. Sq Ftg 1232 Address #13 275-8270 Date NE 20 Roessel Rd. 1-30-86 Teel Contractor Harbor Mobile Homes - Zip�— Address Gorst Iegal Description Sam Theler Home & Garden TrZ ip Direction 20 to project site Golden Bell Mobile Home Court 32-23-1 Plunbing Mechanical Fireplace Deck Sewer Stove Basement ``soft I Mrage --- Carport 1985 28x44 I Z33Z - So - (f005v J '� ✓V �� O/ `I V V �, o V I Fl V . _ H of I Iw N i I