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Home My WebLink AboutBLD2003-00395 MFG Home BLD11808 Mobile Home BLD25408 Mobile Home #28 - BLD Permit / Conditions - 12/3/1981 FORM MUST BE COMPLETED IN INK MASON COUN LY PERMIT NO.c2aA��g5 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 CONTRACTOR INFORMATION Owner Da AAAOc ?' Company Name /.Y/I IK r S S�i -uf f TAAf Mailing Address 4,910 F3cpcN nC ClfSf Mailing Address 7� / t(�/�� k'�7 City AirOCc11,gk,0 State I�d__ZipCode `Jd3�� City $Pr'+>r6T_�!1 State t Zip Code 98ai1 Phone h 0- 38 Other Ph. Phone 310- 373 - 3/a i Other Ph. Lien/Title Holder 5AX' Contractor Reg.#/r/iKe5's/oii,CC Exp. 06 Email address — E Mail Address Drivers Lic.# T3S_ DOB G e>' Drivers Lic.# S/EGE/1rLY7/SB DOB - SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Fxisting Septic Connect to Water System _-Y, Name of Water System 5'c-LF1?112 (Jn7, Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. r a 3 3 1 -5-0—c2c7r)SO Fire District Legal Description Site Address (Please include street name, street number and city); 6C.1561 Directions to site sywy 3 7o 1D EoEst'c'L 6) Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater Lake River/Creek—Pond- Wetland-Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement actiorl?YesMo TYPE OF JOB - New_Add_Alt_Repair_Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work No.of Bedrooms No.of Bathrooms Square Foo 1 st Floor 2nd Floor 3rd Floor / Basement Deck Cove ed D'eck Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make S KVL'11 ' Model 77 Year Length 2�K Width2—Serial No. - 6: `yyyysSHe No. of Bedrooms A No. of Bathrooms Z Type of Heat t/ecTri< Purchase Price$ is;, c. Replacement Unit? Yes/ Installer Name I'XII 'u -� So P=TU w Z r/t- Certification No. n 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 parry in interest regarding this application or the work proposed in the ap 'p�roro� r d permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,repr e n frfabon PROOF OF accurate ONTINUATIONtOF WORK IS Y MEANS County A PROGRESS access to the INSPECTION.ove described property and structure for revieMAR it 0 2005 X Date 340/o�:_ Wrier Owners Re re ntative/ ontractor indicate which one AIR. OFFICE FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Perm=fee Site Inspection Plan Review EH Review Fee Plumbing & BPlannin Review Fee Mechanical & Other Wood/Gas / State FeeViolation FeePre-Paid at Submittal t Valuation $ TOTAL FEES I EA 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 INFORMATION Owner 4 Company Name , Mailing Address " - Mailing Address City <' 1 Rtate A Zip Code City State Zip Code Phone » ,a "Z b; 13 Other Ph Phone - Other Ph. Lien/Title Holder is Contractor Reg.# r f..T ,Z/t Exp. E mail address E Mail Address Drivers Lic.# : G t�T : < DOB r 4 Drivers Lic.# -r i, DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Sxisting Septic 'r Connect to Water System _Name of Water System Well Water System Name of Water System 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/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs J 15% 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 � Describe Work No.of Bedrooms,�r No.of Bathrooms—Square Foo�ad'e.- 1st Floor 2nd Floor 3rd Floor----/—Basement Deck Covered Deck Other Sq.ft. Garage Attached Detached Carport Attached Detached r MANUFACTURED HOME INFORMATION Make %= ve" Model f -'aF sl Year Length ] Width Serial No. ' ; , No.of Bedrooms No.of Bathrooms Type of Heat < < ' ', Purchase Price $ % ' Replacement Unit? Yes/Nq Installer Name "`! f- ' / Certification No. OWNER/BJLDER 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 ptje6rlt is required from any easement holder or any other party in interest regarding this application or the work proposed in the appf t 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 revie"irTpVigrya5 PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. IR� CUu X Date, BELFAIR OFFICE owner/Owners Re resAntative/Contractor indicate which one FOR OFFICIAL USE BEYONDTHIS POINT Accepted by: Date 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 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 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Mailing Address - - I I I Mailing Address City State_ LZip Code City State Zip Code Phone Other Ph Phone = Other Ph. Lien/Title Holder Contractor Reg.# aA Exp. E mail address E Mail Address - Drivers Lic.# DOB Drivers Lic.# / r 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. -: :• "' 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/No Is property within 200'of Saltwater Lake River/Creek Pond— Wetland—Seasonal Runoff Stream Slopes or Bluffs J 15% 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 Xw. Describe Work No.of Bedrooms,,' ' No.of Bathrooms Square Foo gL�. 1 st Floor 2nd Floor 3rd Floor Basement Deck Cove; Deck Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make i 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.Acknowled ment of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare t0=011 Peive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the neces i .If rmission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have ined permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,reprttlatoenation provided is accurate and grants employees of Mason County access to the above described property and structure for rev dlihhspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. 3ELFAIR OFFlct 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 1 i Planning Department ($ Environmental Health Department Public Works 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 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 INFORMATION Owner Company Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address E Mail Address Drivers Lic.# DOB I 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. 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/No 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 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/BULDER 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 th �4 "ve this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necess }} r on is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtped permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,repreepJJhl t i lion provided is accurate and grants employees of Mason County access to the above described property and structure for revi�9kMM arts PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. BELFAIR OFFICE 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 Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee `7 6 - CDC) 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 Assistance Center Pi nning Intake Checklist Owners Name: Date: 3--/ Project: Reviewed By: / Commercial Deve opme S NO Comments: Planner: GBM TSC CMM KJM SG I 0 howSite Plan: m� . " � s' North Arrow ja' Property Dimensions: . X � S Streets and Driveways Shown. Road name:: Y ❑ -AttLRtSit Structures shown with setbacks ❑ W becation, Septic and Drain-field Shown with setbacks ❑ +&-rtK7-a7l surface wa et, eams, ponds, shoreline, wetlands, etc.)VIC ❑ Topography (slopes) Proposed Structure Se acks (Direction/S tback): ' ' 1 F: �/ R: S1: `V / 7 S2: / W"'Utility and Drainage Easements: e No (if yes enter condition 45022) ❑—Qgw �ts ❑ ces ❑ ess ermit Needed (add condition 90010) ❑ ,gate AQLLs nPrmit Needed (add condition#0020) Standard Conditions to be added to all Building permits that planning reviews: #5019 and#0700 Are there any impediments that may restrict access to your site? (dogs/gates) Shoreline and Planning Info Setbacks: Shoreline: - � /A 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 ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT urban Growth Area '❑ MPR ❑ Unknown ❑ Unknown Water Body (type of water if unnamed): _Ind n�Q I v t SEPA: Yes (9 Unknown ' ^ Flood Plain: YES NO Unknovv 'via # MAR 1 0 2995 Aquifer Recharge: YES NO nkno n Map# 3E9 FAIR OFFICE Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: nES Eagle Nest Tag: YES NO Other O Addressing: Check box if needed ❑ Reviewed by: Revised:02-04-2005 IVLANNING\CHARELL&RENEE ILANNING INTAKE 1 Golden Bell Mobile Home Park N.E. 20th Roessel Rd. Belfair, WA 98528 (360)275-4623 Mason County Building Department pp P.O. Box 186 8 U'L PD fjV Shelton, Wa. 98584 :.J 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# Mgs-t gE SHESE��E30 51SE Thank you pOR NSPEgTtoN Deede Schattenkerk Manager RECEIVED LIAR 10 2005 8ELFAIR OFFICE \ n - �ifriryi;E/ W II D C3 @ CA a d w L w a � r(f:. w, N ' N m r _ w � o fJ N W CHANGE +l SUBMIT CHANGES FOR APp�V<..L PRIOR TO PERFORMING WORK try N \Y V C l RECEIVED i ° MAR 1 0 no 3ELFAIR OFFICE I I H -1- 1 ---------- - I LL 01 A S jjj FO 1 B IT :L TOPOGRAPHY PROFILE: MAR 1 0 2005 13ELFAIR OFFICE Direction: Scale: Approval: for office use Building Permit number: JJNBuilding: Owner/Applicant: Date of Planning: application: Env. Health: Parcel Number: buAA/L�- MAY WE [ e- ��y�i,cl Cjou9LEW�De ��Jk SUS ES T P 0 7 CHANGES FOR q 0 PERFORMI ROVAL NG WORK i p i MaR �'�v ® o £ $ ƒ * r < 02 = o \ \ ( 3c o � � � \ a 7 / m \ § g { ) ) cr x M % \ G � mZom0 R. } § � R 1 \ \ C3 ) \ / r § _ _ } § D .. .. \ ( - / ° � - N ` 0 ® � » § / � \ ) j { z & C.n . . / .. 2 = omm \ \ / \ + ® mZ # r / eI » \ � § pm % § m [ Q 22 � 2 C. / + § M .. .. .. - } C CD 0 _ 2 i a ® \ \ \ \ aaa o = X mo ! \ \ § ; " y m � \ � - � Q / \ Eo 2 . . . ~ § ) ^ � } ± � \ � , � � ( ƒ o o�k z \ cn _ 0 R - $ 0 rzaz ° ® oo 2 ? ? 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Box 186 Shelton, Washington 98584 426-5593 7 DATE ISSUED / � � J •� PERMIT NO. / o " VAMENAME MAIL ADDRESS CITY&STATE ZIP PHONE aw Robert Gtar "t 1 Box ;>4- � �� 3elfa-ir, 0 5:D8 // _ yy�� '� ; Qk S ruc -5 (C SEE ATTACHED SHEET) lden Bell Mobile Tome _ ark NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONEChaCo of "shimton 9215-5', t. n: .i>� E -rbor, ;TD . F58-7718 rivate residence Class of work: q NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: - - 60a14(�6Xlf+ aCtllal) 1982 2 ber.re�m 8 .f, Valuation of work: $ , PLAN CHECK FEE PERMIT FEE SPEC'AL CONDITIONS: BEDROOMS L IDECKS_ - _ _ CARPORTX NOTICE BATHROOMS_. TOTAL SO. FT.� '- GARAGE '. I ATTACHED X LOS EPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES-, BASEMENT R AIR CONDITIONING. TOTAL SO. FT. FIREPLACE DETACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANY TIME AFTER I certify that I am a currently registered contractor in WORK IS COMMENCED. the State of Washington and I am 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 SHORELINES ', -n�a Film r -0 O E.D. FLOODPLAIN � aon 1 _ E . NO.__ SEP.A. i BY •N"�" ' Special Approvals IN OUT YES APPROVED NO Lic. No. LF�_ Date 11 -25-R1 ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. IZ _ 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 of the Mason County ordinance requirements for BUILDING DEPT. which this ermit is issued and that all work done will ROAD ACCESS be in conformance therewit MOTOR VEHICLE PERMIT ALICATION ACCEPTED BY PLANS CHECK BY APPROVED F R ISSUANCE OwSr)er _ Date/ __ i Cf ti- �1 wit PL CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO 'Y QO OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE 3 ev S. E . �o 49 DIRECTIONS TO JOB SITE 3 _ c� MBUILDINGcesi QI- �-3' �l�hdDESCR.TOR NAME MAILADDRESS DITY&STTE LICEN E, PH%IGMs161 e cesi y (/�NEW 6� ADDITION ALTERATION REPAIR MOVE REMOVE m P ILAA BEDROOMS 3 DECKS CARPORT NOTICE BATHROOMS TOTAL SQ.FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING. HEATING, VENTILATING OR AIR CONDITIONING. NO.OFSTORIES��111 - BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT TOTAL S0, FT. �Y FIREPLACE DETACHED COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE SEASONAL,? OWNER AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIF THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTR ION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIRE ENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CON RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINI G APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X W ER DATE X 8Y DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED YEs No ves NQ BUILDING VALUATION HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING \�L PLAN CHECK SPECIAL CONDITIONS BUILDINGGROUP �_'� a^Cy.ia- PRE-INSPECTION WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATESURCHARGE APP`L/ICA,TvI( I ACCEPTED BY PLANS CHECK BY A VED ISSUANCE PERMIT VALIDATION I y `-Y - / /f BY �.,� CASH CK MC TOTAL �� i f PLOT PLAN ADDRESS N �[(� �« / P� PERMIT NO o ! ! LEGAL DESCRIPTION LOT ) BLK ADDITION w SITE AREA L1.5 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.I FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,ANDSETBACK 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' UL 1 r I- a- 1/We certify that the proposed conetrumion will conform to the dlrnerniohe and uses shown above and that no changes will be made without first obtainirp approval. N AMEUI OF OWNERIaI OF SITE a STRUCTUR[OI'(PRINT) GN-AT U IS OF R0) OR U 1 m OR I k M V "E F WE E N TAT I V E DO NOT WR/TE BELOW THIS L/NE APPROVED DISTRICT AS NOTED DATE ":olden ell aj 1 D -e 0wo„I Relfair, N , .'el. o _iom Lois ., y co;ncw—n; 7 his is o c -r i ; Mic �"�•/ vacant bnd All qccorod1 tC it",, - Kin 1r or do 1' i_ o''ilr VOme Tithout in. sin n: i by of V a n � k k is n t up to Uccn;ao ', a D" r 00 ) : __. le nd r4lf -ouble ,-ide , he p, 7t c rig o Ic orhybo) units �uth n- gone rr.r �; , � r. V, a 1 nm bolo , tAt ii-u Pa. r f her_ Mom 'tion ir, n 1 O, , 1 crll ke pt el. o. 709- o !olden 'ell n"i 1- one Join �cic _ nwror, Shorelines: Pltmbing: Setback: MechanicaTT Special Interior: Conditions: FINAL: Mobile Home: Smoke Detector: Remarks: Doting: Setback: Foundation Walls: Framing: ? sir 'IT Fireplace: n.:• ALL. a , .,M Wood Stove: - DA BY TYPE MOBILE HOME Permit No. 25408 No. Floors Sq Ftg 924 Owner BRE+'EYER. Kevin Te1432-3003 Date 4-4-90 Address 20010 SE 206th Maple Valley Zip Contractor Designer Hanes Address P 0 Box 98823 Tacoma Zip Legal Description Sam Theler How & Gar. Trs. Tr 20 Direction to project site Hay 3 to Roessel Rd to Golden Bell Pbbile Hale Park Plumbing Mechanical Sewer Wood Stove Fireplace Deck image _port Basement Loft Other 1990 14x66 3 bdrm