HomeMy WebLinkAboutBLD0245 Awning BLD9927 Mobile Home BLD2007-01463 Replacement Mobile Home #23 - BD General - 7/2/2007 PERMIT NCL- )IIcc-/- I / q G3
FOR� LL 'rgW�IPLETED INN MASON COUNTY -�-�-�--
PLEASE�P�ESSHARD 96ILDING PERMIT APPLICATION �I�un� 00-A
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
it Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
CONTRACTOR INFORMATION
A P IC ANT INFORMATION 1 Company Name
_ a . Yl._Ot,C.� L�3uJl r
Owner � Mailing Address P
Mailin Address I State Zip Code
:,• State p Code `1°« City �L a Z _ G�S� Other Ph. .�
City zV,n 775 87)50 Phone
Phone �"5 3✓ A2S Other P - Contractor Reg.* iQ Itd-1 Exp.
Lien/Title Holder f
E Mail Address DOB
E mail address DOB 1 O y` Drivers Lic.#
Drivers Lic.# o� W Existing tic I
4- SEPTIC 1 WATER SYSTEM INFORMATION - Connect to New Septic 9 Septic
Connect to Water System Name of Water System
G Well Sewer System Name of Sewer S ste Fire District
PARCEL INFORMATION - 12 Digit Parcel No. t^ a ��� hAma � tyt �i��pw. T(QS
Legal Description ,
Site Address (Please include street name, street numbe and city) 46UU
Directions to site
Will timber be cut and sold in parcel preparation? es/ No River/Creek- Pond
Is property within 200' of Saltwater Stream Slopes or Bluff s ��v
Wetland Seasonal Runoff
Is this permit submittal the result of a Stop Work Notice,CMAh
orrection ction Notice oPr other
RY Rr SIDen C act ion S SEASONAL ❑
TYPE OF JOB - New_Adcl lt_Rep
Use of Building Describe Work 2nd Floor�—
No. of Bedroom No. of Bathrooms Squar Footage - 1st Floor Other Sq. ft.
3rd Floor Basement Deck Covered Deck Detached
Detached Carport Attached
Garage Attached Year-
,,, Model
MANUFACTURED HOME INFORMAATIONZ�1k�uX�_N . of Bedrooms' —No. of Bathrooms �—
Length LA —Width Serial No. Rep]acement Unit? ®/ No
Type of Heat C&E Purchase Price $ Ce tiflcation No. ����� -
Installer Name result in a OWNER/BUILDER Acknowledges submis low I declace that urate IlI am the owneon r, owners legalorepresentatve, or the contractor I further declare
Acknowledgemen= � t'an t 'w the work as proposed in the application. I declare that I have obtained the permission from all
that I am entitled t easerr
the necessary parties. If permission is' ed eyfrom themtto alpply fora this permd and conduct in tthe work propos this edlicThe owner ation or the
or
proposed in the applicationlaye9bt permission
l & void if work or authorized construction is
agent e owners behalf;�e r s 4NN t the informaticn provided is accurate and grants employees of Mason County access to the above
described propert`t and structu�ree+fforr,�(ree`vvi�ieff yw�acn oin work is suspn. l cod for permit/application eod ofb180 daysecomes nPIR WILL
L I CONTINUATION OF APPLICWORK ATION
S BY
not MEANmmenced (i1R1E SS aPECTIOM.1t TIVITY OF THIS PERMIT APPLICATION OF 180 DAYS�W7ILLINVALIDATE THEAPPLICATION. )
FAPR
Date
X O'er' caner%pwners Representative I Contractor (nd cafe which one) Date Ol f
FOR OFFICIAL USE BEYOND THIS POINT NOTES
DEPARTMENTAL REVIEW APPROVED DENIED Accepted by
— Buildin Department
Plannin Department
Environmental Health Department
Fire Marshal FEES
Site Ins ection
Buildin Permit Fee EH Review Fee
Plan Review Fee Plannin Review Fee
Plumbin & Base Fee Other
Mechanical & Base fee State Fee
Wood /Gas/ Pellet Stove Fee Pre-Paid at Submittal
Violation Fee TOTAL FEES
Valuation $
MASON COUNTY PERMIT NO...'
BUILDING-PERMIT APPLICATION bsj if t
426 W. Cedar• P.O. Box 186, Shelton, WA98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Ell (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
+h �uE � _
Company Name n r
Owner Kil e
Mailing Address L���
Mailin Address " I 11vS13 City - , ' _State Zip Code 5� �ti
City State -Zip Code Phone 1bD S 015o Other Ph
Phone L 5Q5 7)0 A2 S Other Ph. 3lio-0 ,775 020 a Contractor Reg. '.t4an 1 Exp.
Lien/Title Holder E Mail Address
E mail address W O DOB 1 0 'i Drivers Lic.# DOB
Drivers Lic.#V oL Existing Septic
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Sept r g p
Connect to Water System Name of Water System 1-1 1
Well Sewer System Name of Sewer S ste Fire strict
PARCEL INFORMATION - 12 Digit Parcel No. Di
e .k _14, I c. _
Legal Description
Site Address (Please include street name, streethumbe nd city)_ ✓lE
Directions to site
Will timber be cut and sold in parcel preparation?
oake Yes I No River/ Creek Pond
Is property within 200' of Saltwater Stream Slopes or BIuff�15%
Wetland Seasonal Runoff
Is this permit submittal the result of a Stop Work Notice,�Correction Notice or other enforcement action?Ye o
TYPE OF JOB - Pf2EC '��d_ Alt_Repair Other PRIMARY RESIDE C 714
SEASONAL ❑
Use of Building Describe Work 2nd Floor_--�—
No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor
Deck gq. ft.
Covered Deck Other
3rdFloor Basement Car port ___°_. Attached -- - Detached '
Garage Attached Detached
Model �• Year
MANUFACTURED HOME INFORMATION'- Make ux�N . of B'ecirool —No. of Bathrooms �--
Length�-Width Serial No. — — � Replace�.ent Undo Yes/ No
Type of Heat Cke_k ` Purchase Price $ �----
Installer Name
el-`. Q Certification No.
n.
OWNER/BUILDER Acknowledges'submission of inaccurate information
owner,owners result nl a stgalop work ord representative,er r the contractpermit or o. I further declare
Acknowledgement of such is by signature below, declere-N� the application, I declare that I have obtained the permission from all
that I am entitled to receive this permit and to do the work as pr0175'0 c , PP
the necessary parties. If permission is required from'anygasement holder any other party in interest regarding this application or the work
proposed in the application,if
I have obtained permission frorn�rr-ht to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the informaticn provided is acc4urate and grants employees void
Mason work
or authorized access to the above
described
property and
structure
days for
rif review
const and
in work on. This
is ded foea p ats�]ofb Bt7 d ysnPIROOF OF CONTINUATION OF WORK tIS BY
MEANS OFA PROGRESS INSPECTION.INACTIVITYOFTHIS PERMITAPPLICATION OF 18o DAYS WILLINVALIDATETHEAPPL(ATION.r
4 Date —
x IiL Lr"�
Owner I Owners Representative /Contractor (indicate which one) Date
" Accepted to - /L
FOR OFFICIAL USE BEYOND THIS POINT NOTES
DEPARTMENTAL REVIEW APPROVED DENIED
=L Buildin Department
_ Plannin De artment
i
Environmental Health Department
Fire Marshal FEES
I Site Ins ection
Buildin Permit Fee EH Review Fee
Plan Review Fee Plannin Review Fee
Plumbin & Base Fee Other
Mechanical & Base fee State Fee
Wood /Gas/ Pellet Stove Fee Pre-Paid at Submittal
Violation Fee TOTAL FEES
Valuation $
FORM MU3 -B ' % fItlIPLETED IN N
MASON COUNTY PERMIT N(rl� _; ��
PLEAS P�iI SS I11AFi1) 9MILDING PERMIT APPLICATION I F U�7q
;) 1 lS. .! 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
"tom' CONTRACTOR IN
PPLICANT INFORMATION 12 ^- —
1`1� Company Name
Owner OS' Mailing Address_ p �5� ---- b
4. Mailing�A�d�dres�s_)� I y f�,�4P�n( o r� -_StateAgeir— Zip Code 9
City—iacac ----State ipCode �laS� Cit —gl �� C
_Other Ph. z�i° ;T77S 8290 Phone 1ba Z Yii2 OZ OtherE p
Phone 5O -1� _ -_i,, n_rli_1e Contractor Reg.
Lien/Title Holder,- E Mail Address_
E mail address--.—. Drivers Lic. # DOB
Drivers Lic.# o7tKl+1 DOB 1 O `t Existin Se tic
SEPTIC /WATER SYSTEM INFORMATION - Connect t New Septic sl1 9} p
Connect to Water System Name of Water System-
Name
Well Sewer System Name of Sewer S ste Fire District
PARCEL INFOFMATION - 12 Digit Parcel No. pp pw �pS 1
1 SSA t/�'tnt 1Q.� �^ srvLnd ✓J
Legal Description-�ii r—n r
' and city)
Site Address (Please include street name, street numbe�
Directions to site.:i
Will timber be cut and sold in parcel preparation?Yes/ No River/Creek Pond
Is property within 200' of Saltwater Lake Slopes or Bluffs 15%
Wetland_ --Seasonal Runoff Stream p
F Is this permit sabm ttal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye
TYPE OF JOEI - Naw_Add _ Alt_ Rep r Other PR RY R SID q SEASONAL ❑
Use of Floor
Building"—' Describe Work 2nd Floor----
e
No. Bedrooms—•—No. of Bathrooms —S quar Foota g - 1st Floor Other Sq. ft.
3rd Floor —Basement Deck Covered Deck Detached
Detached Carport Attached
Garage - Year114
MANUFACTURED HOME INFORMATION - Make
Model
Length�`�--Width 2�_Serial No. �b LZ'7 I1 L-1X kA N . of Bedrooms--No. of Bathrooms _�—
tn Svc Re lacement Unit? �/ No
Type of Heat�dde43� 5 Purchase Price $ - 0. Rep lac
No.
Installer Name-Sljg work
OWNER/BUILDER Acknowledges submission°declare that II am the owner,owners legalon may result in a orepresentalve or the contractor. I further declare
Ackthat I a entitled
entTil°.>�,rn''IpY• lication. I declare that I have obtained the permission r permit revoc tio from all
that I am entitled tdd..ledeivlyy� e it:an t do the work as proposed in the app in the necessary partie rmisstoen ism ed ed from permission f omthemtto apply forder or this permit and conduct lthe work proposed! The owner the
work
proposed in the applicationi ��'
agent a owners bell ; n r se t the information provided is accurate and grants employees of Mason County access to the above
described pro pert and si-ucture for review and inspection.
ork i Thlenderd foraeplenoion d of becomes180 da s PIl &void k or authorized ROOF OF COwoiNTINUATION OF construction is BY
notcommenced 1,408 fdays:QrS' �TIVITYOFTHISPERMITAPPLICATIONOF180DAYSWILLINVALIDATETHEAPPLICATION-
MEANS OFAPROGRESS INSPECTI
Date: ,. ��7_---
4— p
X Owner 1 0I Ouners Representative/Contractor (indicate which one) Date O' �b
Accepted by'
FOR OFFICIAL USF- BEYOND THIS POINT NOTES
DEPARTMENTp_L REVIEW APPROVED DENIED
Buildin Department
Plannin De artment
Environmental Heath Department 0
' Fire Marshal FEES
r Site Ins ection
Buildin Permit Fee EH Review Fee
Plan Review Fee Plannin Review Fee
Plumbin & Base _ee Other
Mechanical & Bas fee; State Fee
'm Wood/ Gas/ Pella_t Stove Fee Pre-Paid at Submittal
Violation Fee TOTAL FEES
Valuation $ „�,
PLANNING :
ALL SETBACKS ARE MEASURED
PROJE ON OF THEBUILDIIbHM Ll"K F _
rye, PLANNING `
r
b n
Fig TA/tD
�h
r 0 A
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Page I of I
Amanda Reynolds - RE: Golden Bell Mobile Home Park
From: 'Benson, Richard(DOH)"
To: "Amanda Reynolds"
Date: 9/7/2007 6:04 PM
Subject: RE: Golden Bell Mobile Home Park
Hi Amanda:
I ha%e no objection if the number of bedrooms in the new(replacement)home is the same. Thanks for checking.
Richard M.Benson,P.E.
WA Dept.of Health/LOSS Program
(509)456-6177;Tichard.benson j�dohm -90v
From: Amanda Reynolds [mailto:Adr@co.mason.wa.us] r�(^ICJ �
Sent: Friday, September 07, 2007 2:43 PM ,l.
To: Benson, Richard (DOH)
Subject: Golden Bell Mobile Home Park
e1 sb v'S
Richard,
I have a building permit for a replacement at space 23. Does your office have a concern with Mason County allowing
this replacement unit. Please let me know.
Thanks,
Amanda Reynolds
Environmental Health Specialist
Mason County Department of Health Services
P.O. Box 1666
Shelton, WA 98484
(360) 427-9670 est. 279
adr@co.mason.wa.us
Always working for a safer and healthier Mason County
file://C:\Documents%20and%20Settings\adr\Local%20Settings\Temp\XPgrpwise\46E19291Maso... 9/10/2007
From: Trish Woolett
To: Karen Matheney
Date: 8/16/2007 12:35 PM
Subject: Re: Golden Bell Mobile Home Park
Attachments: Trish Woolett.vcf
The system is a L.O.S.S(larger on site septic system)These are under jurisdiction of the state department of health. So
send the permit on to me.
Tricia Woolett
Permit Tech.II
Mason County Heath Department
Environmental Health Division
360.427.9670 ext. 554
fax 360.427.8442
tw@co.mason.wa.us
>>> Karen Matheney 8/15/2007 3:56 PM >>>
Do we have a special place for the septic records,they don't seem to be in the legal file up here. I have an incoming permit or
space 23. Parcel number is 12332-50-00050.
Thanks,
Karen
Mason County Planning Intake Checklist _
Owners_ me: 6annk�-�m'1)0_LL ate: 8- l'07
Project: , anln,o I—I Reviewed By:
Commercial[evelopme S O ' Comments:
PLANNER: GBM TSC(CMM BC RDH REC �'
Sit Plan:
North Arrow
'Property Dimensions: 58 X na�5 C TJl �J i � -tam P
Street nd Driveways Shown. Road me: DA
istin Str u s s n acks
We Loc tion, Septic and Drain-field hown with setbacks
e ' u e �attti`( , ponds, shoreline, wetlands, natural or historic drainage,
defined drainage ditches) C5ryl M U n 1 ,} v
G Topography (slopes) -PA �— I
❑ Proposed Structure Setbacks (Direction/SetbSalck): � E S2: w
F: Ib /r S R: I /�_
❑ Utility and Drainage Easements: Yes No (if yes enter condition #5022)
Other Easements
now' Accessory Appurtenances: Pr ne / Heatpump
❑ Variance applied for: Yes / No parking spaces allotted Yes No
❑ County Access Permit Needed C ondition #0010) Ex 154-1 VY
❑ State Access Permit Needed (add condition #0020)
Standard Conditions to be added to all Building perms that planningiews: #5019 and #0700
Site Access: Are there any impediments (dogs/gates) that my restrict access to your site?
n
Is the site clearly marked? How? Address
' ❑ Name
Critical Areas: ❑ Other:
Setbacks: Shoreline: Slope:
Sh tine Designation: Comprehensive Plan: Rural Zoning:
Not Applicable El Agricultural
❑ RR 2.5 5 10 20
❑ Urban ❑ In-holding ❑ RMF
❑ Rural ❑ LTCFL ❑ RC 1 2 3
❑ Conservancy ❑ Rural ❑ RI
❑ Natural ❑ RAC ❑ RNR UAA
❑ Unknown ❑ RCC-Hamlet ❑ RT
k Urban Growth Area ❑ MPR
❑ Unknown ❑ Unknown
Water Body (type of water if unnamed): no
SEPA: Yes/ No Unknown Flood Plain: YES/N Unknown Map#
Aquifer Recharge: YES/N Unknown P#
Tags/Cases:
RLC/SPI Case: hO 6-Year Dev. Moratorium: YES
Eagle Nest Tag:
YES O Other YES/
Revised: 07-10-2007
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BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATEISSUED� ;d _
PERMIT NO. a_
�
NAME MAIL ADDRESS CITY ESTATE ZIP PHONE
OWNER �G , S II ATr e iR O o eIGPcP;a3 'R a a
DIRECTIONS
081817E de elMpb, L onia
PARCEL /0�3 5a LEGAL
NUMBER O� CXJ � DESCR. ardfn 7r5'.
NAME MAIL ADDRESS CITVSSTATE L EN ENO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASSOF NEW ADDITIO ALTERATION REPAIR MOVE REMOVE
WORK ✓ /
DESCRIBE In w N 1 b.! s �b M LTA WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSO.FT. _ GARAGE CONDITIONING.
NO.OFSTORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED ANOTHAT ALLWORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN C FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONAPPRORMANCVAL THERE THE ITH. OCHANGES DEPARTMENT
BE MADE WITHOUT FIRST OBTAINING
OBTAI ING APPROVAL FROM THE BUILDING DEPARTMENT.
X NER
DATE _'? X BY DATE
FOR OFFICE USE ONLY
APPROVED APPROVED BUILDING VALUATION C It G�
DEPARTMENT YES NO DEPARTMENT vqs No
FEE
HEALTH PUBLICWORKS
PLANNING FIRE BUILDING PERMIT
D.O.T.
BUILDING PLAN CHECK C L'
SPECIAL CONDITIONS
BUILDINGGROUP 1 PRE-INSPECTION
�-7
WOODSTOVE
PLUMBING
<�C) MECHANICAL
STATE BUILDING FEE
STATE SURC.— --
APPLICATION ACCEPTED BY PLANSCHECKBY Fl-`::J APPROVEDFOR ISSUANCE PERMIT VALIDATION TOTAL
c"�� ��I; 7a p B D� 1 tJ- CASH CK MO
Qom! i-?L
PLOT PLAN
ADDRESS SS F—L QDa 3 PERMIT NO.
s
i P
0
LEGAL 'n
DESCRIPTION LOT BLK ADDITION
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS,SHOW BUILDING.SITE,AND SETBACK DIMEN.
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION AND SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
OINDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
S�
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no charges will be made without
firer obtaining apprwel.
IPRIN IGNATUR IOW NERIl1 OR AUTHORIZED RI ED REPRESENTATIVE
mAmIttap OF OWNER(S OF SITE a STRUCTURLM TI
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
Shorelines: Plumbing:
Setback: Mechanics :
Special Interior:
Conditions: FINAL:
Mob i le Hie p
Smoke Detector:
Remarks:
Doting:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE NOTE A!lfdIPdG
Permit No. 0245 No. Floors Sq Ftg 202
Owner SCHATTENKERK, Deede B Tel 275_3gl3 Date 3-20-90
Address NE 20 Roessel Rd #23 Belfair Zip
Contractor Self
Address Zip
Legal Description Sam Theler Home & Garden Tr Tr 20
Direction to project site Golden Bell Mobile Home Park
Plumbing _ Mechanical Sewer Wood Stove
Fireplace Deck Garage Carport
Basement Loft Other —
BUILDING PERMIT APPLICATION 4AZ3
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 G�
DATE ISSUED
PERMIT NO. -
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
� . 4 `i tiv �r j iy ' 7T )>r
FBUILDING
C
—, ( (O_SEE ATTACH EE
L���-=� 7��L /� �. i r )/' 1� 3e1 a.3— I
NAME MAIL DRESS CITY&STATE LICENSE NO. PHONE
Class of work: X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE [- REMOVE
Describe wor •-
2
Valuation of work: $ es 0 PLAN CHECK FEE PERMIT FEE,_S
G C1 O: -
SPECIAL CONDITIONS:
BEDROOMS_. _ _. (DECKS_ _ -_ I CARPORT NOTICE
BATHROOMS__. _ TOTAL SO. FT._ GARAGE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES _ BASEMENT L: ATTACHED L OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE L DETACHED '. .
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR W CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I
the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT W, SHORELINES I '..
SEASONAL FLOODPLAIN i
Firm. E.D. NO.__ S.E.P.A. L
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
PLICATION ACCEP ED BY PLANCS ECK BY APPROVEWOR ISSUANCE
Owner _ BY�Date � ��/ .i-�Irsz� �'l�
n 6
i« k
, PL CHECK VALIDATION • CK. M.O. CASH RMIT VALIDATION CK. M.O. CASH