HomeMy WebLinkAboutBLD2004-00011 Final Addition - BLD Permit / Conditions - 4/19/2004 00 '
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^'0 CONCRETE MECHANICAL MANUFACTURED HOME
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FORM MUST BE COMPLETED IN INK MASON COUNTY -00C? —
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 INF,ORMAx ION CONTRACTOR INFOR TION
Owner AALA(- 4.. Be-, 'M V 1�1 C.(Otikew Company Name SGS i e�j Cor 41 cc.,: zt-z.
Mailin AddP.Q. Mailin Address V-0• tj / O
City N ' -State WA, Zip Code City 1 r) State W • Zip Code 9 H-IAT
Phone &0 84$-95-3 Other Ph. Phone .360 - 27 S- (&&gy Other Ph.
Lien/Title Holder S Am 1=- Contractor Reg.
E mail address E Mail Address �19
Drivers Lic.# DOB Drivers Lic.#rA E KtZt FT!V Afj DOB 0(9-90-: 3
SEPTIC TER SYSTEM INFORMATION,- Connect to New eptic S ' Existin Septic
Connect t� System Name of C�ystem .�So Q= rG. 0•- 1 +�I el�
Well Water System-,K_Name of Water System Vry k tocycvA)
PARCEL INFORMATION - 12 Digit P4rcel No. pO Fire DisArict
Legal Description S J N N t H
Site Address (Please include street name street number and ity) q(o
Dire t' a tq site
Will timber be cut and sold in parcel pre ara on?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 action?Yesw
TYPE OF JOB - New Add_ Alt Repair her. PRIMARY RESIDENCE SEASONAL ❑
Use of Building (C�� i�c-e- Describe Work Ot 1 - co,P— c1
0 Ll+
No. of Bedrooms No. of Bathrooms Square Footage - 1st Floor to nof 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 RW(- *- r
Installer Name Certification No. ``- L-
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or I�,rNit rww t.�y�
Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contracfor.'I further
declare that I am entitled to receive this permit and to do the work as proposed in the application.I declarath t v t i ed he permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party itst�g [iS applica-
tion or the work roposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed.
X �:cJ Date: d/
Owner/Own s Representative/Contractor (indicate which one)
/ --FOR OFF CIA USE BEY014DTHIS POINT /�
Accepted by: { Planning Pd1 ,`�-eFc# G� ate / -4�oBld Pd'�s 'j� Receipt No.�
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department o Jk s - ND
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
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. Y
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 INFORM A�`ION CONTRACTOR INFOR TION
Owner @.C_ � VX,ti,f ! C..sCc r'.1 fir_ ' r� Company Name ��',
Mailing Address Mailin '°address 4° "�
City tv i a� State W�. Zip Code ' ` City f t+d w° State(/'d Zip Code
Phone C 998-25'-35- Other Ph. Phone 56o • 7'�"- r,gfg'` Other Ph.
Lien/Title Holder 's 4 M I~-- Contractor Reg.#
E mail address NZA E Mail Address d' l`t4
Drivers Lic.# DOB Drivers Lic.#M E lZ Z 1 .F 7" Y,t,' DOB O4 c ) ls:1:
SEPTIC�yV�l TEAR SYSTEM INFORMATION .Connect to New Septic Existing,Septic
Connect t r System Name of System E ` , "" 4-i .C
Well Water System Name of Water System \J nJ ,t; rk)
PARCEL INFORMATION - 12 Digit Parcel No. 3 2 3 : D Fire Dis rict t
Legal Description SJNN v '_:,.,�+.r i 3 .X` T&k x "
Site Address (Please include street name street number and city) E. `�'l ',..}••_ Lk' l [='t:� U-2 x 0tJ 4X- k,
Dire tionstosite '�i ►,aJ 'a. 4jaxkr f (o) i "A00—,42- CAI
Qk-c r S r 4 S
Will timber be cut and sold in parcel p ara ion?Yes
Is property within 200'of Saltwater e _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?Ye
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE N SEASONAL ❑
Use of Building s .' ' - c Describe Work e; Wr Qo L'4
No. of Bedrooms No. of Bathrooms Square Footage - 1 st Floor a't✓ '° 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/ o
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or peri�l�5evRRcatio�;
Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or tV> o�tra�tg f rther
declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtaine e permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party irlliftrqq�r@@��� i�a t applica
tion or the work proposed in the application, I have obtained permission from them to apply for this permit and conddctth�ddM kodposed.
X ,�r�.�,, 'te'� +u.•. (car•.-? fca ...; ✓ Date:
Owner/Own s Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd ,` -Ck# _ �-:�,Date=' Bld Pd' Receipt No. ;
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department I- I a- �!
Planning Department {
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Buildinq Permit Fee a5 Site Inspection
Plan Review Fee I CP EH Review Fee
Plumbing & Base Fee AD+ ®� Planninq Review Fee
Mechanical & Base fee / Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ L TOTAL FEES
MASON COUNTY PERMIT NO. eb))004 - 600 )f
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 IN,FORTION
Owner ;:k CA(. e. ..;: x,. � Company Name t c� } ,
Mailing Address •t '779 Mailing Address
State W ij. Zip Code ` `� y ` Zip Code City p city State��
Phone M (�O q,?d r Other Ph. Phone Lz,i :2 7 �1'7 Other Ph.
Lien/Title Holder 5 Am i:'-- Contractor Reg.JIS 51f— -c' '-() )Exp. i'
E mail address' E Mail Address
Drivers Lic.# DOB (—,I #
Drivers Lic.#1'YR F<tZT, i= '""!S�r DOB :,'`1 A t
SEPTIC [V'/ TEjR SYSTEM INFORMATION - Connect to New Septic '� "� Existing,Septic
Connect t r System �Y-. Name of� ystem :, .,.� .^�.
Well Water System Name of Water System
PARCEL INFORMATION 12 Digit Parcel No. 0 =` '-, Fire Di s nct Q^
Legal Description_ ,t ra Y
Site Address (Please include street 4name,,street number and city) t7�, x1 E. ink. k
Directions to site rwo
Will timber be cut and sold in parcel p e ara ion?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 action?Yeslu
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE 4 SEASONAL ❑
Use of Building ' , � r_F Describe Work {,& I " �: A _-> 1 c:A i1ft
No.of Bedrooms No. of Bathrooms Square Footage - 1st Floor 'o 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/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permiffAUP.V nn
Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or thee,,g� ntractor.I fur`thY
declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I Iy�ol ti�e permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regardln( applica-
tion or the work,proposed,in the application, I have obtained permission from them to apply for this permit and*8clunt the
wor proposed.
X�.�L ' -r�. r"y:.. f (c�r..)�(0 � Date: , � yi $7,i
r Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd I Ck# Date Z Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department T5L 1 (St O
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
Owner t N CONTRACTOR INFORMATION
APPLICAN-,- N,O I, , %I i s v Company Name c ''- 't- �r
Mailing Addressix ' '' Mailing Address t :'
City ti%J State�� Zip Code {
;�" City State '=' Zip Code
Phone ' '� "`O eth r Ph. Phone Other Ph.
Lien/Title Holder rs-, �,,.-- Contractor Reg. #``� f"j, Exp.
E mail address tV 1 E Mail Address
Drivers Lic.# ti. ;'" DOB Drivers Lic.#r6 t:iZ .. �_ ;" t � r DOB
SEPTIC /WATER SYSTEM INFORMATION; Connect to New Septic - '; * "_�'� Existing Septic
Connect to-N 4� r System � Name o�� System
Well Water System_ Name of Water System ,
PARCEL INFORMATION - 12 Digit Parcel No, _ '' ' ".J.. : Fire District
Legal Description
Site Address (Please include street name, street number and city) `r 'F ' ;� f•. ,.' 7't �, �. .-
Directions to site v "
Will timber be cut and sold in parcel p e arafion?Yes Nq°
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?Ye
TYPE OF JOB,- New Add Alt Repair .Other PRIMARY RESIDENCE 4 SEASONAL ❑
Use of Building F'-° I I Describe Work i-i-k ` : = 42`l % ,.L l > °,w
No.of Bedrooms No. of Bathrooms Square Footage - 1 st Floor /04i-1'#0 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.
ONMER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revoca i
Acknowledgement of such is b signature below.I declare that I am the owner,owners legal representative,or AI����ppn��aa or.I further
declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that Yfi�dJe�b e permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party in j erest regarding is applica-
tion or the work proposed in the application, I have obtained permission from them to apply for this permit a nWpt R c gTposed.
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K
Xa . 9 j ' ..�� . ,,�,, `,- Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd. Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department C
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
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
PERMIT NO.:
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.
Shelton(360)427-9670/Beellf ir(360)'75467'Wm
a(360)482-5269
APPLICANT INFORMATION CONTRACTOR INFORM
! TIN
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Own er USA c � � �:`�e. '1 c_.�.�7,..,�� .�.,� Contractor Name `k N'.,.-�, ��� , ::�N _.T•. 'c,, �4- �c
Mailing Address �,'. Z"� Mailin Address " - , r`1,; x r tr U
Cit { ,,� State -ZipCode ° ' Cit �', '
YT„I t,1 I Y rt i'., State .v Zip Code >
Phone Q �.nU y, -� r ther Ph. ! < Other Ph.(
Lien/Title Holder ��
�.,� �, Contractor Reg. #�'f7 5I:—!:,Z :2'3. ,
Address `k1 Expiration / '
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System L" Name of
Sewer System so Dv ! _
PARCEL INFORMATION- 12 di it Tax Parcel No..,�,)a,3.3 Fire District G
Legal Description 5 c4Q: -\ W a C cL. 9 v
Site Address(Please include street name,street number and ity) r
Directions to site ' ")o nc; + F,� r bu ��, < o�
S, -Q,
r�
Is your property within 200'of the following: Body of Water(Name) -a C , � Saltwater_
Lake River/Creek Pond Wetland Seasonal Runoff Stream
Slopes or Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building -c ti rcn
Location of Fixtures/Units 1st loot 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric
Type of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump
Toilets f Type of Unit No.of Units Fees
Bathroom Sink _ Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan —�—
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent /
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
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-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 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
approval. first obtaining approval.
Date p�._0 6' O X Date
r
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
AEPAitT(�+EENTAtREYtE+Y APPRClV:ED. ..:f3ENIEf3 ..:: C4NRiEIQi�IO�?:R7AS
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
.::::. .... .
IrIwE . >::;:.
.. ...... .....
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES
PERMIT NO.: I
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186 Shelton,WA 98584
Shelton(360)427-9670 Belfair(360)�75•4467 Elma(360)482-5269
APPLICANT INFORMATION CONTRACTOR INFORM�kTION
t
Owner 1 . !<, a. ;e �: C_.`� . ;,,, Contractor Name
Mailing Address Mailing Address ;'' /•7>(-)
City �h1 I State ', + '`SZip d � f ; City ( State �� Zip Code
`9`�,''^
Phone QG0 ;Z_-1 ;(Other Ph.( ("J J," Ph.( ) ?,;` Other Ph. 161 .
Lien/Title Holder :� _: Contractor Reg. #=_,C ";;T1. 2 , N ;:i 0
Address S:A v\ (i Expiration
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
Sewer System 2>u iwr" 1 :
PARCEL INFORMATION- 12 di rt Tax Parcel No. S 3 _? / C / X)0 /G Fire District
Legal Description S "1 *4 G:_�,e �. i1 E. U.s /` >, ts•
Site Address(Please include street name,street number and city) `` < ' E . 4 o k- ( .. tc (, L
Directions to site - i .,� t i..: '\\ u ( s:..,
c
Is your property within 200'of the following: Body of Water(Name) 14 i o `L Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream
Slopes or Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Location of Fixtures/Units 1st loor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric
!ype of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump
Toilets / Type of Unit No.of Units Fees
Bathroom Sink / Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
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
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. first obtaining approval.
X _� L_` ✓. l v/1 Date 4I� - X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
f7EP>t1RT11+EEidTi4f #1^HjVSf 311'PRO'!1^D [DENIED GONDI€I:4?N CQUES
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
FIDES.;
XXXXXXXXXX _.................................._...._................._............................................... _... ..
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES
THIS PARCEL
INCLUDES
PLANS, BLUEPRINTS
O; R. - O-VERSIZE�
IMAGES
LARGE FORMAT
AVE BEEN STORED INIMAGES H
FILE CABINET(S) UNDER
-- -- PAR- -'C- E_L- NUMBER
PARCEL # 32235 - Sn - O0OI
CASE
JAN iuu4
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMUff; vv c AR STa
Planning
Mason County Bldg.1 411 N.5th
P.O.Box 279 Shelton,WA 98584
(360) 427-9670 Belfair(360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968
QUEST FOR BUILDING PERMIT EXPEDITION
HAM: 3-0" . , �J (Qtp
MAILING ADDRESS: ��d (�X 339 1
PARCEL NUMBER: Oo / to
LEGAL DESCRIPTION: SV rJ7Jli —N- 3 )( t-k) plS o
SITE ADDRESS: �� 3 � F—, S�-� RA-ems 0(p U1-1 10r� egy
REQUEST DUE TO: MEDICALLY NECESSARY FIRE DAMAGE
EXPLANATION OF HARDSHIP:- v 0'.c 1'Ac' S
N S D oT'j V �f. W'�')-q-A (I a A^r Q v rJ,v S �2
(4--cc,b w. ,/Jti,.�
MUST INCLUDE SUPPORTING DOCUMENTS, THIS MAY BE A LETTER FROM A
DOCTOR, INSURANCE CLAIM REPORT, OR REPORT OF FIRE DAMAGE FROM
APPROPRIATE FIRE REPRESENTATIVE .
I (WE) UNDERSTAND THE INTENTION OF THIS FORM IS TO DETERMINE AND
DOCUMENT JUSTIFICATION FOR EXPEDITION OF A BUILDING PERMIT TO ALTER
OR RECONSTRUCT A RESIDENCE N THE ABOVE NAMED PROPERTY.
SIGNATURE OWNER/AGENT
OFFICIAL USE ONLY
REQUEST DENIED FOR FOLLOWING REASONS)
ST APPROVED. ATE:
S IGNATU: ";
DI ___;ITY DEVELOPMENT
North Forty Lodging LLC
22526 S.E.64th Place, Suite 210
Issaquah,Washington 98027
Telephone:425 369 9290
Facsimile:425 369 9008
PC
NORTH %A FORTY
December 30, 2003
Frank T. Merrill
Jesfield Construction Company, Inc.
P.O. Box 1590
Allyn, WA 98528
Re: Bathroom at McConkey Residence
Dear Mr. Merrill:
As we discussed, North Forty Lodging LLC is the sole owner of Alderbrook Resort & Spa and
South Forty Utilities LLC, which owns the Alderbrook wastewater treatment plant facility. The
purpose of this letter is to confirm that North Forty Lodging is in the process of connecting the
three McConkey residences to the Alderbrook's wastewater treatment plant. While our
wastewater treatment plant is presently deactivated during our extensive redevelopment of
Alderbrook Resort, we plan to reactivate the system this April in advance of our June reopening.
The Alderbrook waterwater treatment plant is a privately owned and only serves Alderbrook
Resort and one other neighboring residence.
If either you or Mason County has any questions, you can reach me my office telephone number
(425) 369-9290 or my cell phone at (425) 890-5005.
Very truly yours,
X
Brian P. McGinnis
President
cc: Betty McConkey
Jen ns of 02:, Of MPTc MEnICAr SERVICES 9Go 929 4GG9�
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