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HomeMy WebLinkAboutBLD2001-01221 Cancelled 2 Story Addition BLD5865 - BLD Permit / Conditions - 3/31/2003 Mason County Dept. of Community Development Mason County Bldg. 3 426 W.Cedar P.O.Box 186 (360)427-9670 Local (360)482-5269 Elffia l Shelton,WA 98584 (360)275-4467 Belfair (206)464-6G68 Seatt Notification of Permit Cancellation March 31, 2003 NICOLE KINNEY 590 E DARTMOOR DR SHELTON WA 98584 Case No.: BLD2001-01221 Parcel No.: 321275300144 Project Description: TWO STORY ADDITION Dear Applicant: Upon review of our records, the Mason County Permit Assistance Center has identified that your building permit application has been inactive since 12/6/2001. Permits must make some progress every six months. If you intend to keep this permit active, you need to contact me within ten (10)working days from the date of this letter. If we do not hear from you within the that time, your permit will be cancelled and a building inspector will make a site visit. In the eve t that your project has been completed and a permit was never issued, you will be assessed penalties as allowed under Mason County Ordinance 37-96. If your project has been cancelled or if you wish to withdraw the permit, please notify me as soon as possible at(360) 427-9670, ext. 287. If you feel that you have re 'eved this notice in error please contact me. Thank you for your cooperation. Sincerely, TRICIA WAGNER March 31, 2003 BLD200 -01221 -- BIIILDI27G PERMIT 0 BoD •:kD! DATE �A Planner Area Parcel t( ��a Q7 -t �- �-,r.L{ ? C CHECKLIST FOR PROPOSED CONSTRUCTIO V Comp .Plan Designation UGA _RAC _RCC RA For IR Yes No Within 200 FT of SMP designated shorbline, wetlands, etc. Where? GfccnV3Prly Cxe [X] ( ] Located near possible Critical Area, What Kind? (Wetlands, Streams, Lakes, Slopes) ( ] ( RLC already done? Proposed construction within floodplain 'Y� �5 Eagle nest �/-.PF / ( ] (Y] Six year moratorium ( 1 [ ] Multi-Setbacks [/ \] • (XJ State road access needed [ ] [ Commercial Development (parking standards, sign ordinance, public works review, other applicable agencies) [ ] ( ] Mobile Home or RV Park FORM MUST BE COMPLETED IN INK. PERMIT NO.' BL PLEASE PRESS HARD MASON COUNTY BUILDING PERMIT APPLICATION «� 426 W.CedarlP.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORM TION CONTRACTOR INFORMATION Owner & Contractor Name Mailing Addresses Scl n TDc%r-1-. t-r rr Mailing Address Cityst^lr,lil b� Statd,J� Zip Code City State Zip Code Phone(3(&C Other Ph.6L^0 )r 19C-1512 Ph.( Other Ph. Lien/Title HolderCh Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic x Connect to Sewer System Name of Sewer System Well_Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. 1 /7 / . ' Fire District Legal Description ci Site Address(Please include street name, street number and city) - i Directions to site c A -1 h Will timber be cut and sold in parcel preparation? (Yes/No) Is your property withia2,OU of the following: Body of Water (Name) Cccl,,�1 c c,l C Cef K Sa twater Lake River Creek Pond Wetland Seasonal Runoff—'Stream— Slops or Bluffs PERMANENT RESIDENCE 0 SEASONAL RESIDENCE 0 TYPE OF JOB New_Add AltRepair Other_Use of Building L ,I", Describe Work "N-e 4„- . No. of Bedrooms I No. of Bathrooms_ SQUARE FOOTAGE-1st Floor 4Ve 2nd Floor 3rd Floor Loft Basement Deck 04 Other Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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 strut( res 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-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 awa,e 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. el '—LcLaL" X Date F OFFICIAL USE BEYOND THIS POINT ,fn Accepted by l C_� —Date !J� QJSubmittal Amount Due 15 Receipt o� / b-2 DEPARTMENTAL. REVIEW APPROVED DENIED CONDITION CODES .......... Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ 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 ( ) TOTAL FEES z 1-b�z2� PERMIT NO.: BL V MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 Shelton 360 427-9670 Belfair 360 276-4467.Elma 360 482.6269 Seattle 206 64-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Addresst f1_ Mailing Address Stat4j-A_ Zip Code City State_ Zip Code Phone(3tp ) 21 Other Ph.6tm0 Ph.( Other Ph. Lien/Title Holder Ql +�• eta( F'r^�i�— Contractor Reg. # Address Expiration re a QA 3a00 SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Welling-Se1ptitiater Syste Conn Name of to sewer bystem_Name of Sewer System Water System PARCEL INFORMATION-12 digit Tax Parcel No. 1j_I La-t-I Fire District Legal Description Site Address(Please include street name, str et number and city Directions to site Art A c } h Will timber be cut and sold in parcel preparation? (Yes/No Is your property wit ' 00' of the following: Body of Water (Name) k xct .* Ir<-1 CCQ S Itwater Lake River Cree Pond-Wetland-Seasonal Runoff-'Stream Slo s or i Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ j TYPE OF JOB New_Add Alt�Repair_Other—Use of Building L ;/ie Describe Work w No. of Bedrooms_J__.No. of Bathrooms_SQUARE FOOTAGE-1st Floor -+Vd 2nd Floor 3rd Floor Loft Basement Deck 114 Other sq. ft. Garage Attached Detached_Carport Attached— Detached-MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of B;[throoms Type of Heat Purchase Price $ Replacement Unit?(Yes/N ) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITH 4 180 DAYS OR IF CONSTRUCTION WORK 1S SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER THE WORK 1 COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behal I,represents that lire 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 curr ntly 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 hall be made without approval I 11 first obtaining approval.. tel C X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Datel vl5ubmittal Amount Due4422 95 _Receipt Nvb DEFARTEAEN f11C REYIW APPROVED DENIED.: CDNDITI+ N COS Building Department r MO TAL9 Occ Grou Type Constr.fbi Planning Department Environmental Health Department z Public Works Department ! Fire Marshal �2/(0 Valuation.$��7I ate Building Permit Fee s Site Inspection Plan Review Fee q•s-s EH Review Fee Plumbing&Base Fee a Planning Review Fee Mechanical&Base Fee a3,50 Other Wood/Gas/Pellet Stove Fee State Fee �l Violation Fee IJO 6 N F Pre-Paid at Submittal TOTALFEES PERMIT NO_: LDL ' MASON COUNTY Olaa ) BUILDING PERMIT APPLICATION 426 W.CedarlP.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275d467.Elmo 360 482-6269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner M I'( 0C A- 1 i c,t., n r,( Contractor Name Mailing Address t r T7a 4 t-.,err (Ye . Mailing Address City�, Stat$yr), Zip Co 741 City_State Zip Code Phone('Ae( )q L4-ci211/Other Ph.(el:C: )r-Irt f- -i sf Ph.( Other Ph. Lien/Title HolderCkit :Lfr, Cc. o, Vic.( f'T,r.Ar.-, r. Contractor Reg. # Address �— Expiration 1 3vCC SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System P CEL INFORMATION-12 digit Tax Parcel No. 1 ' 'V / / t7 I L4 Fie District regal Description L f ISite Address(Please include street name, street number and city Directions to site l c } t t ! } a Will timber be cut and sold in parcel preparation? (Yes/No)-} Is your property within 200' of the following: Body of Water (Name) ( r t k t < r .1 { 1 E F Saltwater Lake RivenC�reek_ _ Pond Wetland Seasonal Runoff S m Slopes or i Bluffs j PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ 1 TYPE OF JOB New_Add Alt Repair Other Use of Building i* j Describe Work —j'wL, " f I No. of Bedrooms-1--No. of Bathrooms_SQUARE FOOTAGE-1 st Floor 41?7 2nd Floor >-' 3rd Floor Loft Basement Deck 0, ? Other sq. ft. Garage Attached_Detached_Carport Attached_Detached_ I MOBILE HOME INFORMATION-Make Model Model Year i Length Width Serial No. No. of Bedrooms No. of Bathrooms— Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHI q 180 DAYS OR IF y 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 behal,represents that the i 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-1 certify that I am curre illy 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 aw 3re of the ordinance i requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit s issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes hall be made without approval. first obtaining approval. k. Lc ate I I X Date j FOP OFFICIAL USE BEYOND THIS POINT i P y T' � — Accepted t:b � Datel II AL. Amount Due j Receipt I DER#CRTMtENTAL 11 REVIEW APPROVED DENIED GONDITII3N COp S Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal I I Valuation $ i I a. FlE ',° Building Permit Fee Site Inspection Plan Review Fee EH Review Fee ! Plumbing&Base Fee Planning Review Fee i Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) d�x+ TOTAL FEES PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 4825269 Seattle 206 464-6968 , ,APPLICANT INFORMATION CONTRACTOR INFORMATION ) ,Owner�1, I rIF L- °.l-v� �.� k.� rr�E�� Contractor Name Mailing Addresst- `'` t yr, r� f� c,nf D Mailing Address City�,l �c 1a State(, Zip Code'I% 7. City State_ Zip Code Phone(er, )c. - rf Other Ph.C?t<L' ) - c i Ph.( Other Ph. Lien/Title Holde A I c Contractor Reg. # Address a c. Expiration l "hu v h4 C b0 SEPTICINFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARQRL INFORMATION-12 digit Tax Parcel / / ,CC I it _Fire District LegalDescnption 1 100 ; Site Address(Please include street name, stre number and city) -°cc i , �, f , F Lvr s Directions to site 3 iI c , w Is your property within 2_00' of the following: Body of Water(Name)C (0..�}_sr r.1 �f f f Y` altwater Lake River Creek Pond Wetland Seasonal Runoff t Sl pes or Bluffs TYPE OF JOB New_Add Alt_Repair Other Use of Building Location of Fixtures/Units 1st Floor 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 Heatpu p Toilets �_ Type of Unit No. of Units Fees Bath Basins Furnace Bath Tubs �_ 7. Heatpumps Showers Vent Fans I T7 Water Heater Propane Tank Laundry Wsher Gas Outlets _ 3 Sinks Wood/Gas/Pellet Stove Dishwasher Direct Vent? f Other Other Lt'fr 4re7,-t Other Other Base Fee , ;. BasE Feel' TOTAL PLUMBING t:°a TOTAL MEC ANICAL ! A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIX rURE1UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITH N 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK S COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's beha If,represents that the infomnation provided is accurate and grants employees of Mason County access to the above described property and str lures 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 a are 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 1 11 i 1 , C X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DfT'AR1`MENTAL REVIEW APPROVED.. DENIED CONDFIIOFICQDE5 Building Department Occ Group Type Constr. Planning Department Other Other FEES 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 FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION �* , 11 II!/ /Case o. Name,711oiweN A- NILUI' - �t`lr'r1+ i%j PARCEL NUMBER2i� 1 a,=15�:?b014 Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, Win relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent propertyline. adjacent property line- I I Fadjacen property line I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I 1 I adjacent property iine4 <-adjacent property line SAMPLE SITE PLAN adjacent property line <-4djaceni property line 17 30' I r6SGR VE CRFEIG \ I \ n MOM! \ HO 4 I ) I Prie Porto s¢Pf[� �'rl I R I VACA rT RAr \ I I i 31 P .FP o � ' I� �k \ T Aseieu.�n.aA� So' Iy0.� I R \ I \ i K I ' I I I /00 I adjacent property line4 ; c <-adjacent ro ert'line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dmta. cc to Slops {'n¢ dia+ants fe � f, Signature Date MASON COUNTY PROJECT SITE INFORMATION {�� tCase N D. Name All, A & 011 f if �11�PARCEL NUMBERVt I q Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S. E, W in relation to the site plan Lot Dimensions Fences Existing Structures D'hveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent r ert line. adjacent property lined I E-adjacent property line I I I I j I I CI 1 I I I I I I I I I I I I I I I I I I 1 I I I I I I I I 1 I 1 I I I I I I I I I I I I I I I I I I I I I adjacent property lined <-adjacent property line SAMPLE SITE PLAN adjar�nt property line j a -,3 _ E-adjacent property line I D 30' rFf SGR VE I(-g04l .SE.ase v AL I a ,I_ _,I I CQFEK \ I r fi HOMC Gn u y I I Ha a F\ I ) Pfie PnaGD ssQHa I \ t I r— 6 D• /SO•— +I VACANT I 'f G.1nAu6 I / I PM1n/mC0 I / T M4tCLLLTUJiAL SO I P—qp--31 \ ap• I I I I \ I I I I I lf— /00' adjacent property line- i / c <—adjacent propertV line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dlsinnca. to fuG'Y4YL drnt�ree. Pn Slops ta¢ d QAq m f. a Date Signature MASON COUNTY PROJECT SITE INFORMATION Case No. Name`^{1f1Wn LliltIi kN,nral \i PARCEL NUMBER, 3. 1a=15"�CUggDate SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent riperty line. adjacent property line-) <-adjacent property line I ' 1 I I I I I ' I ' I I I I � I I ' I � 1 � I I ' I I I I I ' I I I I I I I I I ' I ' I ' I ' I ' I ' I ' I I I ' adjacent property line E-ad'acen property line SAMPLE SITE PLAN adjacent property line-) aid �R6SCRVE <-idjacenl property line D 36, L 1 3o-T .� _YPT]L_�I , .SE/LSG V AL t[\ C fi Home I .Gra EN CREEK \ I \ n I He f 1 F\ I PRe Pnscn szpf:� �I \ 1 , IJO�I R VAGn.T I i1�0/mGD � T gyRULLLTUAAL SO I �F.F—90—31 \\ ypl• I 80, I � I I � I I I I A 1 adjacent property lined ; ` c \i Fad'acen ro ert' line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) I SAMPLE TOPOGRAPHY PROFILE dl3i�nCa to ructta_Y� daatar.cc fa Slepa ta¢ dia#ancm re a i I Signature Date J rJarfi�"'�aor —Orly — Ur, ! r' a Y S � oJdhdi ` 0 c C 67. 6t ' $ � Gr.,enbeny Grr��� 1 G�orGr,�1i L69ai L IA4f L,gk,# LATe4ek Div a'1� 6i'�"e flddraSf` �g17 logrtmdor- p✓ lv'.e. Ito ah e. Y I 1 ' - I i - I 1 = I i I 1 , _. d 11 � r I I I i i J , � 1 j i i E 4 VPV Jl c)n1,r L't 1 i 1 i P N3B W nN omimvuO g 91 AB NMYLO :A903AOUJJV /I" �I - I :3-IVO Wit I { r i 1 �[ 1 1 k 9I V 1 a3ewnNvNSMvaa 4PDX07 }sl � hui�b�HnO� i 1 k i r a3ssA3a ! 0 1, OI :3AVa ' I A9 NMVNa All 03A0addV „�,' ' :31V05 Ib9b -?- y' 09 0'3Utn �i �7• � „�a,l,� �,�>.Uur' �7' • I Pip ^ ','v fr c x ii 91 x�f I I I I . ,cj xJ.T,) jl AIgeM 'h�eUVsk a C ^^`�j 21XL a0„7J17E1 $III ! FJM Y. •w..x�Y P"�I ��I � �...._ G7- 1' � 1 I i I � v � I __..— loop i itit vt 14 1r. Ir I lr f i s I f r 1 1 I I i 9 �, __ __.._ _. ___ _. _ . ii s I �s,� Ghl _.�_� _ _ -- --- - � �; �� i {� I 'i ' I 1 _._ . _ _ ,_ _. _._._ _ __ ._.___�.�.J �9 � _ _ __. ._ _.. __ ___._ ..._.. ._ _. .. � ;' ,; �; � i' i. i'. I 1 i s �„r, _ .—__ � --- � -- _ , _5 s x�__ f _ �� � i i ', i 3 __ _ _. __ _ —__ � i q f ,. i i I I 1y+� <3l 1i�1 l i t G { I I i yiI y I 1 6 9 i I j I I i I I i I i i r i ewnN DNIMVUG 5'asrn'AL7 4s,al 0310I14311 A9 NMVMO :AB 03AOtlddV ,/g I - •31vos Ywy VYV ✓a� W o�u0 S"� °l,/ ° I S G I ? Lliw„9 i•:� oil I •l ao , o ys+ 1 Guttl I '�' lkM •ii"I� �'I°I��,LI Y;,� tl bl \ ni IA I ' I i I i - - 1. IA0,t Yll i I .{ Y � e, �1 � ! 51 � kaXGL t� w��, •1-�'� � L f t 1-V p2�JOSl�`'S 0C),, .y=4� ,r JCJ g V ,aI i I f 1 , > . ..� MASON COUNTY DEPARTMENT OF HEALTH SERVICES December 06, 2001 PO BOX 1666 SHELTON, W 98584 SHELTON (360)4 7-9670 FAX (360)4 7-7798 ELMA (360)4, 2-5269 NICOLE KINNEY BELFAIR (360) 2t5-4467 590 E DARTMOOR DR SEATTLE (206)44-6968 SHELTON WA 98584 Case No.:BLD2001-01221 Parcel No.:321275300144 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Report within the last three years from either a septic tank pumper or an Operation and Maintenance Specialist. Please call me at (360)427-9670, ext. 353 if you have any questions. Sincerely, Cindy Waite Environmental Health Mason County Health Services Comments: 12/06/2001 1 of 1 BLD2001-01221 FORM MUST BE COMPLETED IN INK PERMIT NO.: PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98594 Shelton 360 427.9670 Belfair 360 2754467 Elma 360 4825269 Seattle 206 464-6968 PPLICANT INFORMATION CONTRACTOR INFORMATION caner i'tel4 _ AS V4 tit, Contractor Name Mailing"AddressE 59 b Mailing Address City � It—% Statel_.� - Zip Coder1�— City State_ Zip Code PhoneQ, other Ph. Slrfi) ) Ph.( _� Other Ph.( 1 Lien/Title Holde r Contractor Reg. # Address Expiration 1Iaf-e 3000 SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel / / O ire District Legal Description Q Site Address(Please include street name, streeJ number and city) t Directions to sit Is your property wit ' 00' of the following: Body of Water(Name)C!An rq-J Ct f f Saltwater Lake Rive Creek Pond Wetland Seasonal Runoff tream_Slppes or Bluffs TYPE OF JOB New_Add Alt—Repair Other_Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: E ectric Type of Fixture No. of Fixtures Fees LPG X Natural Gas_Heatpu p Toilets 11, y.UO Type of Unit No. of Units Fees Bath Basins Furnace Bath Tubs = 7100 Heatpumps Showers Vent Fans ! �• 0� Water Heater Propane Tank Laundry Wsher Gas Outlets 3. o d Sinks I 7.0� Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other Other L f'6- j Jl" 4t 00 Other Other Base Fee 10• oo Bas a Fee a TOTAL PLUMBING 41.0 b TOTAL ME HANICAL I I 50 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 WIT IN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WOR IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's beh&If,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-I certify that I am cui rently 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 i rware 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 per it is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No change shall be made without approval. i first obtaining approval. Date �0 X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPdRT1u1kNTAt:t ltj t A11011 V D <jiENIED CDNDtTtOAkCODE Building Department Occ Group Type Constr. Planning Department I Other Other 1�ES 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 FeeI TOTAL FEES .. PERMIT NO.: 122 MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATIONll�Zb 42e W.CedarlF.O.Box 186,SMkori,WA 98664 Shelton 860 27.9670 Betair ! 60 276-4467-Emma 0 2.6269 Seattle 206 4.6968 PPLICANT INFORMATION CONTRACTOR INFORMATION ner ; Contractor Name ailing Address Mailing Address City-4` etitt Stat Zip Code City State rZlp Code Phone( W Q,4(eM]Other Ph. Ph.( ) Other Ph. Liii ltle Holde Contractor Reg.# J,N ddress Expiration / / SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel NK / / O 're District Legal:Desdription Site Address(Please include street name, stre number and city) Directions to sit Is your property wit ' 00'of'the following: Body of Water(Name) Ceft altwater Lake Rive Cree Pond Wetland Seasonal Runoff—'stream Si pes or Bluffs TYPE OF JOB New Add X Alt_Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type:E ectric Type of Fixture No. of Fixtures ' Fees LPG_ Natural Gas_Heatpu p Toilets4 `, '7,GO Type of Unit No. of Units Fees Bath Basins r 1r Furnace Bath Tubs �_ 7.00 Heatpumps, Showprs V�Farts �_ 7.ao Water Heater # ropane Tank Laundry Wsher Gas OtjfJetg �_ 66 Sinks Wood! s/ ellet Stove Dishwas er — Direct Vent? Other Other]AG FJe a_ vU Other Other Base Fee N Be Fee 1,50 TOTAL PLUMBItS TOTAL ME HANICALIt A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FI TUREWNIT. NZC-E: THIS PERMIT BECOM%NULL&VOID IF WOgK OIL TRUC AUTHORIZED IS N IN 190 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABAN F 90DAYS'ATANY TIME AFTER THE WOR IS COMMENCED. . .PROOF OF CONTINUATION OF 1NOQKI&BY MEAN"F il RESS I ON. The owner or agent on owner's If,represents that the + information provided,la-AliEurste and grants employees of Mason County access to the above described property and sir ictures for review and !r inspagon.of this project. Acknowledgment of such Is by signature below: ,, OWNER AFFIDAVIT-1 certify that I am exempt from the regyirsments of the CONTRACTOR'S AFFIDAVIT-I certify that I am cui rently registered as a Contractor Reglstratiop"'Law RCW 18.27 and am ewers of the ordinance contractor in the State of Washington and that I am re of the ordinance r requirements for whin this permit is Issued and that all work will be done in requirements regulating the work for which this perrr it is Issued and all work-. conformance therewith. No changes shall be made wfthout;8t'stobtaining shall be done in conformance therewith. No change;shall be made without approval. } first obtaining approval. :... .. Data. —I - <© X Date FOR OFFICIAL USE BEYOND THISPOINT Accepted by Date Submittal Amount Due Receipt No. BuNding.Departirhent Ooc Group Type Constr. Planning Deparbnent - Other Other. . . +x;<. oi , ..u,ti%.n.>c'>xc.:e Permit Fee ; site inspection Plan Review Fee 1 UFC Plan Review Fee Plum &B;#se Fee Other ' Mechanical&Base Fee Other WoodlGas/Pellet Stove Fee Pre-Paidat Submittal Violatlon'Fee TOTAL FEES i carTmooY 60 ? ty- r o i � I �Rif Y -C 1 �- � C r- �-ev i 149 LGgn� \\\L IA4 Like L,;,, ,A C,v s ltL f'OJ�'95>` E -�` 4', � L'.�r"iA^;JJv- l�i"I✓'L .«;r l��'�� 14 IIIIIIIIIIII II IIIIIIIIII Page a of 1744975 I IIIIII IIIII II�EFRIt7IC�NfEhllll�l�l�llull llll llll Mason CO, WA MNa i Return To: b9J L- Daum v Or t ShPlkon , /0A BSdt! CERTIFICATE OF RESIDENTIAL USE LIMITATION ON NUMBER OF BEDROOMS I(We)the undersigned,hereby place this notice on record that the following described real estate situated in Mason County,State of Washington;to Wit:(abbreviated legal description) LRKE LZ1'1[ V cK 1-j 'J-A 1� and having the Tax Parcel Number of: 3Z1Z_7,53 00 11424 is subject to the following understandings and conditions: 1. The use of this parcel will be restricted to no more than '). bedrooms. 2. The on-site sewage system was designed for and the building permit was issued on he basis of no more than a bedrooms, and a maximum residential occupancy of n t more than persons. 3. Use of the other rooms as bedrooms, in excess of the number identified herein, coul result in hydraulic overload and premature failure of the on-site sewage system, and could result in Mason County taking steps to cause vacation of the premises. 4. In the event of any future residential remodeling, expansion, or replacement that results in additional bedrooms to the number specified herein, the property owner will obtain the appropriate permits for expansion of the on-site sewage system. WITNESS 111.5 hand this c20tA day of A10 Patti149 Signature Signature State of Washington ........ p W A j 'u����O County of Mason 11111 1,the undersigned,a Notary Publjck and for the above named County and State,do hereby certify that on this day of /✓Orerlr�/iei { 11personally appeared before me k k//> K11?/1 eta/ t me(mown to be the individual described in and who executed the within instrument,and aclmowledg at he(she) (they)signed and sealed the same as free and voluntary act and deed,for the uses and purposes herein mentioned. GI VEj I under my hand and iici a day and year last above written. Notary P blie in and for the State of Washington,residing at A446.OA 00 v.J T MY Commission Expires: /f- /5-D a2