HomeMy WebLinkAboutBLD2007-00268 and BLD27190 Mobile Home #32 - BLD Permit / Conditions - 7/5/2007 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. C ��
PLEASE PRESS HARD 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 r CONTRACTORINF RMA I
Owner 1�19R T01� ��lt�r4fh Company Name
Maili AddressT///� FJb� Y11 hTae E 7 Mailing dress O�
City �E Statell2�—Z p Code r City State Q Zip Code
PhonArlf 47�-5�7rc4. Other Ph3bt? 7tc 37tot Phone ,-,53 o"-/ OSYD Other Ph. o�
Lien/Title Holder S' r/f_ Contractor Reg. Exp.
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 Sewer Syste Name of Sewer Sy e
PARCEL INFORMATION - 12 Digit Parcel No. Fire District '
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes N
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New_Add_Alt Repair_Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building HnIjif_ Describe Work
No. of Bedrooms a No. of BaXhrooms2Square Footage - 1st Floor /07q 2nd Floor
3rd Floor y�A Basement 4 Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Makes E� t�(P� —Model { 3 Yearxl0l
Length Width 26 4 Serial No. No. of Bedrooms Z o. of Bathrooms Z
Type of Heat & Pur hase Pr i $ 3' Replacement Unit? Ye / No
Installer Name r /N t� c( Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
MEANS APR ESI ECTK9N.IN TIVITYOFTHISPERMITAPPLICATIONOF�1]80DAYSWILLINVALIDATETHEAPPLICATION.
X Date: ,�. -J �`U7
Owner-/Owners epresentat ve/ ontr r (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood /Gas I Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
�0
/FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.
PLEASE PRESS HARD BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584 l
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 Z L L
On the web www.co.mason.wa.us
APPLICANT INFORMATION r CONTRACTORI�RMAIIOwner TDIE �pwht'+M Company NameMaili Address � Q�t �£ 75 Mailing dres
City d+F Statell2Z p Code 9 kb y/ City State Q Zip Code
PhoneTQI 3100 47G-; 4� Other Ph.36t0 -1 t a 'S'] 1 Phone G7 Other Ph.
Lien/Title Holder Contractor Contractor Reg. Exp. Q
E mail address E Mail Address
Drivers Lic. # DOB Drivers Lic. # DOB
SEPTIC /WATER S'(STEM INFORMATION - Connect to New Septic Existing Septic -aft!55�
Connect to Water Syst sm Name of Water System
Well Sewer:>yste Name of Sewer Sy pnn
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description_,
Site Address(Please include street name, street number and city)
Directions to site_
Will timber be cut and :cold in parcel preparation?Yes N
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff—Stream—Slopes or Bluffs 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOBBB�)w_Add_Alt_ Repair_Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building f Describe Work
No. of Bedrooms— No. of Ba hroomEi Square Footage- 1 st Floor /0� a 2nd Floor,
3rd Floor y�Basement 51" Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUF CTURED HOME INFORMATION - Make Model - Sr Ye
Length�W'dth��Serial No. No. of Bedrooms � o. of Bathrooms y
Type of Heat-OM hase Pri�$ 3 Replacement Unit? Ye / No
Installer Name. a !N 6 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 receivo this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, ropresenls that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permitlapplication becomes null & void if work or authorized construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY
MEANS APR E! ECT19N.IN TIVITYOFTHISPERMITAPPLICATIONOF180DAYSWILLINVALIDATETHEAPPLICATION.
x APPLICATION.
Owner/Owners epresentat ve/ ontr r (indicate which one)
FOR OFFICIAL USE: BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department Z 2tc 7
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 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
APPLICtW4T INFORMATION CONTRACTOR INFORMATION i
Owner '-� '.k , : , Y: +, •, Company Name t,,
Mail,[>gAddress /c- L/ MailingAddress
City t^t` State i' Zip Code CityState - Zip Code
Phonnl` �- Other Ph "��' Phone �` Other Ph.
Lien/Title Holder Contractor Reg #� "` "/ . Exp.
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 Sewer System :! Name of Sewer Sy e
PARCEL INFORMATION - 12 Digit Parcel No. '+ Fire District
Legal Description 4
Site Address (Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes( Na
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - I)ew t<' Add_Alt— Repair_Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Buildi Describe Work
No. of Bedrogmg No. of Bathrooms -< Square Footage- 1st Floor I'' ' 2nd Floor,
3rd Floor /L I`' Basement % ' ' Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make"110i '' IL, Model / `��."" �= Yea_r_r''
Length—Li—Width °'�" " Serial No. No. of Bedrooms o. of Bathrooms
Type of Heat— Purchase Price $ ,� Replacement Unit?(Yet/ No
Installer Name `�'' "`y�'/` `k'' '` �''/ `' ' ' Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative, or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
MEAN$.eVA PROS3RESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
— ;c
X �' � t r
�ra *� ', 111 d�.�,�: Date: � r }
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED ENIED NOTES
Building Department ✓ a w �' A/D -TACKS
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee 3S� Site Inspection
Plan Review Fee EH Review Feed
Plumbing & Base Fee Planninq Review Fee �/70
Mechanical & Base fee Other
Wood /Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal 2 3S
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
APPLIC4,NT INFORMATION CONTRACTOR INFORMATION
Owner rr Company Name
Mailing Address 72iI f Mailing Address
City t + —State Zip Cade City State Zip Code
Phone fi '-l' ' Other Ph ' Phone - Other Ph.
Lien/Title Holder Contractor Reg. #i' Exp.
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 Sewer System ✓ Name of Sewer Sy e
PARCEL INFORMATION - 12 Digit Parcel No. + Fire District
Legal Description —={r
Site Address (Please include street name, street number and city) t_ 1 r (.' 1
Directions to site
Will timber be cut and sold in parcel preparation?Yes(No'
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffer 150/6
Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - I�ew Add Alt Repair_ Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building fr' ' —Describe Work
No. of Bedrogms No. of Bathrooms z Square Footage - 1st Floor 2nd Floor
3rd Floor � " Basement / L Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make r ! Model `' f" / —Year_r
Length 3--Width "� 'r' Serial No. No. of Bedrooms o. of Bathrooms
Type of Heat ._`=1 f Purchase Price$ /' Replacement Unit?( Y'jc No
Installer Name "' r t ''" 'A/{ ' ' ' Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
MEAN APRO5 RESSINSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
r
X�/ Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department 3 Z 0
Environmental Health Department
Fire Marshal
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
Valuation $ TOTAL FEES
FROM :HILLS SPECIAL FAX NO. :360 7929506 Feb. 19 2007 03:44PM P2
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Feb 15 2007 12: 04PH Desert Plateau Homes S20-305-0030 p. 2
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C~ d �d Flar Ifs
Kenneth J Vow
W...Qlre`•Rry � WAIN
DEPARTMENT OF L.A30R AND INDUSTRIES
REGISTERED AS PROVIDED BY LAW AS
CCNST CONT GENERAL
CCOl Y,3KSMH0984K9 Cj/'I:J t2Q08'
ErMCTIVE DATE 07J10/1002
' KEN'S MOBILE HOME. SETUP
j 926 136TH ST CT S
TACOMA WA 98444
1
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Feb 15 2007 12: OOPM Desert Plateau Homes 920-305-0030 P. 1
Construction for Manufactured Home
A. Parties lnstaller;Raudy,Marsh
Customer. 14601 1"th awe east
Puyallup Wa.99374
253-381-OW
B. Hume information
Make: ��GG�Cu®d/r length. -112 width:-2- �7
New 4 Used yes Year model as titled Serial Number
Unit sold inspected by the buyer Factory Order lJef Floo&lan: Bed
C.Phases
/of C�oastraetioaL / 1
Pgmest—Item6atiw
Down Payment,consistinuofthe falkow�' s:
A. Earnest btoncy T bOdd-- /
B.Balaneo Cash Down Q Al CPA-W leS77;:M/
Delivery:
a Place of Delivery /nyet P-Vexl
Address:
Cily:
sate: wa. park
Zip Code
11.This agre taant ran be extended by the seller.The installer will use Weaned and beaded
contractors and tmasporters to do all the owassary wont.
12.Theustomer is responsible for taxes earreat on the home.if the home will be mowed tram the
wanly to a sew county you win ban to pay at least 1 year prepaid taxes to move Ilse home.
13.The customer agrees to insure the home wall the borne construction Is eosopld■.
14.Tbc customer 6 rcapeasible far all perwin.
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o CONCRETE MECHANICAL MANUFACTURED HOME
Footings l Setbacks Date By Gas Piping Ribbons
N Intenor Date By Inieriw-Date By Data g D
Y
w Exterior Date By Exterior-Date B
�--
INSULATION
Set-up pp
Point load I Isolated Footings gG f SLAB INSULATION Date — ) Z c By L"'� D
Date B Y Data By FIRE DEPARTMENT X
Foundation Walls Floors W
Date By D
Date. By Data By DECKS
FRAMING Walls Date By L
Date By Data By PROPANETANKS O
PLUMBING vault Date By m
Date By OTHER
Groundwrork Attic
Date By Date By Type-
Date By
[).WV DRYWALL
Type:
Date Int.Brace Wall Date
BY Date By BY W
FINAL I S ECTION p
wWaterline Fire Separation — N
Date By Data By Date$ Q / ByD/ V C
Pass or Request Inspect. r v I
CD
a Type of insp. Fail Date Date Done By Comments t.QCo
a —
m
y ` 2 f'
s
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0 7
0
BUILDING ME PERAN APPLICATION
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 DATE ISSUED
427-9670
PERMIT NO.-
CITY 9 STATE
ZIP PHONE
MAIL ADDRESS
NAME �(]
OWNER j E G cs LL_
DIRECTIONS .G ✓_ L- �(.
kj
TO JOB SITE
LEGAL =,Z�-t- X 6. o LAG S 50,0 'C4'AI YI
PARCEL I/,'S3i._Si: L;ci(�$tl DESCR. N �6 cuva ATE r���XICENSE NO. ZIP PHONE
NUMBER MAIL ADDRESS
NAME
CONTRACTOR p - ppS S
USEOF t`,Z-7.- nE51 Pl?�71V MOVE REMOVE
BUILDING ALTERATION REPAIR
CLASS OF NE ADDITION
WORK ✓ D C E
DESCRIBE Q p N�
WORK I,J=C(X ° l N
a4r
�J o NOTICE
/1 CARPORT—h-- PERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING OR AIR
BEDROOMS DECKS SEPARATE
BATHROOMSTAL SQ FT U CONDITIONING.
TO , . _ GARAGE
6LC' THIS PERMIT BE NULL AND VOID IF WORK 08 RUCONSTRUCTION AUTHORIZED E NOT
t BASEMENT -6' ATTACHED COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION R WORK IS SUSPENDED OR
NO.OF STORIES —1— gBANDONEO FORA PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
TOTAL SQ.FT.I R
FIREPLACE IV DETACHED_1kS�-
PERMANENT F5 SHORELINE /iU
CONTRACTORS AFFIDAVIT
OWNERS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRAOTORS CERTIFY THAT IA A CURRENTLY REGISTERED CONTRACTOR IN THE STATE O
REGISTRATION LAW RCW 181T, AND AM AWARE OF THE MASON COUNTY ORDINANCE WORK F TON AND AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
WHICH THgOPROVAL FROM THE BUILDING DEPARTMENT.
RED IREMENTS FOR RGW18. 7 IS PERMIT IS ISSUED AND THAT ALLWORK DONEWILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OB INING APPROVAL FROM THE BUILDING DEPARTMENT. (�
11
7 C) X BY ---_-DATE-
k DATES
XOWNE "'
FOR OFFICE USE ONLY APPROVED BUILDINGVALUATION
APPROVED DEPARTMENT YES NO FEE
DEPARTMENT YES NO pL p
PUBLIC WORKS
HEALTH BUILDING PERMIT
FIRE
PLANNING /� BUILDING PLAN CHECK
!��
D.O.T. PRE-INSPECTION
BUILDING GROUP R3 b/!�`
SPECIAL CONDITIONS SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE / �✓
TOTAL (S1 L
APPROVED FOR ISSUANCE PERMIT VALIDATION
ppPLICATION ACCEPTED By PLANS CHECK By BY(1", /,_ /,� v CASH QK MQ
cc
Shorelines: Plumbing:
Setback:
Mechanica
Special Interior:
Conditions: FINAL: CC
Mobile omer41Lz2a22-
Smoke Detector:7/=3,%3c 5--iJf,
Renarks:/uv ewu 011,R
ooting: /IiZca/Fy2 itis/ FEf'Tr fed
Setback: TD e // 5,-Z,6
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE fnBILE HOME
Permit No. 27190 No. F1oors 1 Tel Sq Datte 11-29-90
Owner HIND
Address 20 Roessell Rd 4/32 Belfair Z1P
Contractor Legacy Homes Lip
Address
Legal Description Thelers Home & Garden Lot 20 space 32
Direction to project site Golden Bell Mobile Hume Parl.
Mec anica ewer Wo tove
P l 'Ca rage _ arport
Fireplace
e Deck g
Basement Loft _ Other