Loading...
HomeMy WebLinkAboutBLD2003-01332 Final Replacement MFG Home - BLD Permit / Conditions - 1/22/2004 / � 0 0m ;e§p r § ƒ( E ; E ;)« 99 q0m « ) � \ \ k § / > § ( ¥ E ƒ /° Cz xo \: co ) � k@ % Q k { D w \ § - / ) % N) = r � 7 @ c ' - / w 2 2 � \ \ § } [ 2 . . q § mop z .. .. _ _ a 2 Fn Cc, ) CO C ° C> 0 < m \ » ° = P = 8 3 % J � 2R G. \ m ; ( q ? R § 5)00 2 � a • _ . a. !tm z « \ \ 0 ; | > mo0 � m p_ ~ ° m Eq . . ~ § w ) K § CAa cow 00 () ) z ~ k \ o § } § ; / ik § � § R (- § } 2 -0 / 0 3 z o O -V 5 - » 2 m m d < ( . 3 » � � 3 ® ( \ m \ � ! IT . , } § \ Cl) \ § 9 f � � , j § « 2) m m ] Z m ) ƒ ! § ' CO k 2 ! § ! ! f $ \ m z s 3a � � § 3 $ In _ � 96 - k » 0 ` cnj .x x / \ 0 cc ( ) ° ( ; § E | Er2 g ( § \ ) � _ ` /\ - \ - 2 § f X 0 - - ) - z mmm § _ a , , , . .. § .. .. .. oto \ W � N C) W w m-0730 - 0 7 � cD m ? < Qv7i (CD X � m (oJ X � -40 Cl) � 0 5 3 3 0 N. > j n 3 v �' m -= CD'D o 0 ...0 Q m O m 0 N .810 .°-. d M 7 0 n f° f0 a' O�D (Q j J C 0 .O. (� 00 O m m CD Co o m-o 0 ° p 6 m v 3 m o o a m ° o 0- m o X� dM � ° 10 Xm3m = — CC7 7 � 0 MN3 o ' O O O (� O. N N CD 0 M * :E DMZfC-@D � m t:l- cCD mi m 3 °) J N c � c Xo Z — o.�CD o (n (D f NON c TT 0'(0 T 0 n C n � 0 m C m 7 N N m Ny m Qm N "-I CV 00 m 0 N � m m y 0 (D O S 0 ((DD 0 w Q m O J' 0 7 m O N '0 7 d 7 Vi.O Q O N n n Z N N N N O m 0 C (D N p) F r7o � N ' c 0 m -In o. nZ m 7 0 (D F � OQomc ° a3 3 � e o � <n a � Doio � o. N . c CD CD m nd � a � � � n N m N`< j -oCN wm mmmf° ° 0m 3 M0N 0) 0 � - C) J ON N _ 0 0-. N 0- 7 W J JCc o .0 0 0 M - 0. A ' o c 3 � 0 w gym ° d 7 0) °- D) N m m O Co N 0 N'° �° o 0) 0 CD - 0 0 y a -0 m of a O � ."0 CD N o0 -tii CD O m y j (D - p Ol o n j - J J � mfO � J OpF 7 JddO _ N"O � O. 5_ N 0 7' c ? N p 3 3 N -°+. 0 n.0 0) y "O ° y N y O N 7 m C (D J 3 d C C S ��'' - N m o L N N o m y N m M n O 0 7 O "' m N ^'. J' ^- °^ m p 0) N m m N O N K ° C (O C O' 'O N O C 7 0' J m 0) J j -0 J 'p ^^ 0 S O co m J m m N n CC.. m m N 0 J N 7 N o n � � (D m M C O or _ c (O did M V 7 S C 0 J 0 -O O co y O m O -0 7 CO 0 `� C m m : J O m 3 N (D N ? C X I N , W CD N S J N J' 7 n 0 0 0- x. 3 $ dn m m 0m c � m � 0) o m m o00 OD � t d W 7' m J j 7 Q. o N M O C co C O ° 0 6 Z m C f0 m m C J 7 C O Q v .< vmc° mn mZ_ ° - Nn . N f* a0- o vcim o 00 ^; mC J .C.. O N (3D ° N d N .°-.,f0 m m 7 d w Z w -i 2_ N G D - a S N N �. O O ' 7 � 0 O O. _ 4] Q b b m N O 0 w 7 O N J O J' N 7 p J m 0) `< W JC n m j N m j V `G 3 Or C N J m 'm0 C (w.f O Ww 8 (O N cn a o � (D d'°O N m .0..U a M. V .J.. 7 NCC N A N 0 N CD (n d N 0 d N n J (3() �. O O 3 m �v -Ud m. � �. o 0. ° EF 9 J m m �+ ° (n D n � m � 3N. CD N c01 00)) N m C ^ 0 O O •� N N d ' N o 0 N J � m m m n m m .i J C CO N JC :; m Q S o 3 -ima. o 'O0m o °� < 0) z o c d - Qm �+' 7 < m H J (D J J p m� 0 y m o 3 0 ° 3 � o � Q 3 D 0 m o m s CD � o. d > CD CD 0 � �t0 CD CD I MmcM Qw � , o m m m _ ooNnmm � Z v °) v Cmm (o � � tom m n N .D w m a o 0 0 C n u7i h '^ m t° t o O N c ry C d () C a O(p N Cep N j 7 m n N O' N C m O - O m n j o N O 0 0 fD 'NO .o. m o N a _ J N n t0 � d 0 m 0 O N °, m _ < 7 j 0 =' J =CD < .J.. -� N CD O'-6 O D d N N y a 0 (D f C n O m f� m O i X � � Fm � JID 7CD yo.v m3 C .°.. - m O' O 0 m CO n0 N .O 0n. ° w 0 N 3 7 J' m N O m - N U1 D m d Cr N j 1 j C(O o N O O m O 0 O n (CD K 7. c 0. N d W J C m 7 0 0 0 7 o m o m CO N S a N m m ° N 0 7 N J n'O 'C -I A 0 m m J � 0 SIv 0 duo M. C Z O 0 C 0 J d v <D 9 m 0 �� m o CD 0 3 c n m � ° f.� _ o (o m ° °Qn o N 3 � �'0 0C CD ^) `mG 7 a N '° N m N <O N N ° m < 5' 3 O O N <CD 1 m = 7 N J' D) m CD ID j 7 D m � M 7. C m O N CD CD N n ID n N N A [) O Om y '. O O ? CDO' m n m. y fD m 0 (OD c (D `< D m 0 N N (D Q 3 7 N (D 7 0) (D m m 7' N m m p SN i a < o nm 3 m ° ° CD7 7 CD y 0 N N O = J to r _ . 14 0 v A V) co N O O O W o X �o� s -I D (D _D XQm _ ' D ° a m > 0 o D 0 7 P ° Z X W nO (D m Oc m °- W � D`J< G OO DymJ yy0 7 -. 0 NOD a) CD N O N V T CD O m O, CD j 7 N 5­0C) O m N W N'd0 O O C O d C N d m C F 0 O m D 2 V O y m m W V �. N J d m C n y m wS o g nm 3 -O N O ((DD I- d � � �_`dG N m �' � N � O V N 0 y 7 m 0 V1 � C �to m j Ol � O O: D n NN to CD � CD zgo OOmn m " m � jy 7m � F y y g D o 7 3 0 > 7 T n 3 a d 2 m CD y o m o•- O 3 n m n y m 3 y m X 3 y y w o m d m d — o d n m o m 3 o m CCy 7 'D _ = O 3 9 c � ._.. Z 7 m N y y G m V Q. n 0) V 7 O c S Q.O O: „° m (O -° (/� y ."S, C _.(O OS = m n ]' mfA O N m y Sol Cjy mam 7 y y Sp aN O3m73 NCD m yy m 7 X O O a N 3 0 m _ 0 n J N C y O S N S m n - 3Fc 0)m0 m 'md So (° ° mmm do < - = o C n N = m F = 7.IT 3 m 0) Cn > > O j m 7 N (l) �` Z M. Cl O m C CD �. a• �- _n r- m C N• N 7 C O 3 O m O 0) D 0 0 " n J C. 0 7 = y CD j ° N (D 0) m C ^ m O C m 'O Ei m A. (0 m L^ `) -'• -A S 7 N d � = d CO j d m m 0 an d N y p n C n d o m m D O' co 00 3 � J y 0. O'0 v � C = C. 7. N N CD -� l m 0 " p 3 = OT F A = m m d m o m n -L. H C 2] 1�1 y m = m m 7 0 l� O C CD m coC "O 0 y y (7 O' p 'o 0) 7 C p) m d 3 y C y V m G 5. V1 n 0) O O C O ffi CD a. O Q. o a� � < � ^ m ' a 5mN wPLo Jnf. ° <. m j 7 y Z N .0.. 3 m 3 ^ 0) p^ 7 m m 7 0 Tl y ('p m VO cn O Q ° ^ (° mm c m o m ° a 0) 0 c nz _ ody3 m m3 �0o p m 0 Z L 7 O N -_r'( m m g 3 m y y S ? 3• N N S n a CD a, O m C 0 a m C O) - m O O ? m O (D C COD 7 0 0 D M m 0 M m m m ;0 -1 a , N C < C m X m O N'O -� < ' - O < O 7 N'O C d m d CO<(Q 0 CO p m 3 n .° (n 3 c C X T D m 7 m T y p C (D O G 0 ° C O O S m m d N F a o 0 W N C y 3 -o 637 p z l N CD S ti. W N On D O m 7 -o an d (� m C y p m CD Q.< - _N m ? o o m (D w v mn CD _ o °c d a o � m m j CD z - c m.v m N �CD m m d o-a °) 3 3 d - 0. T y y =n D 17 .'� in O d 0 2 0 0 7 CO O m m m O' m l0 �. m -0 p- 0 O - O 7 m 0 m 7 C O W F `< p m .< O d O < m j y m m C Z °- m ._7. m N (D O m N = m O n Vi y 7 < m °CD n Q. C 0) S N M.. J 7 C! 0 FD CD .0. n = 3 (° m m 2L co C•-o (n m -0 O' "^ n- S y ' t° y n � C Cs CD O J J d ° J m CD n C O 1 O 0 S , 7 m J 0] m 7 0 O_ y 0 (p C o m N m = C ^ f" < (D m N(Q (D n m m y d S y .m.. '0 O V m N a (D 0 m .0. -0 0. 0 fn Q. 7 m . O m S S m 7 m O X 0 0 0 0 0 0. = n m 7 3 �' 7 , �< n „� 3 y 7 D 0 7 m J O. m = p- S 0 � 0 m < Gi' m m 7 = G �, O I III (D d 0. (p m m m (D C n m c � 0 � Q T 3 0 M 0 M 0 , 0 mid o 3 n W � N 7 a 3 y (0 .y..�< (d0 CD c 7 3 .y.. m y m m m ' (D O C' D V CD m m m c m 0 Q � a 0 3 < M a C a = y, y y a 0 m O 0 D O pG 0 EH N C O C m (O (° m v n 7 7 C ° a. O m C P 0 m CD 0 0 C c' 3 c v O_ CD 0m3 vm -o - s F' m Mo � c , , 0 CD n- aa � od_ 3 m � 3 o � CD < n = 3 (oSyM = p ccCD 3y m3Ml � m 0 a m O 0 ° � m O Q m .J-. N .y-. cr M N y m o m 0) m So s � m3 m � m e `o' m g m � m CD 7 � cp'n� (0 CD N O .=m.. .T7 m .7. m V N m m O 0CD n = (7 n' °- 0: m m y V O m O n - n 0 C n m N C T C 1 C 0- m 3 .0 < y v (D 7 J "O d p y c n `< CC m 3 0 m y, g n 0 ,'� O v m O. (D C ti '_^.C J G (D Dmj 0; C j m y W p d -O 0 ()) an d 0 m .y.. S m y y Cr 0 c D O C m. 7 w C m 0 C (/1 0- 3 m C d 7 m C d D J (D 7 3 07 n D N O CL p (D ,... 7 T 7 N .' ^`G 0 N 3 0 N O O O 0) n coJ S (Q X (O O C O 7 p. d Om 7 -6 y W 0 O N .0.. O . 0 0 0 7 (D O d o_ o d � � 0 3 CD m (n0 -oD 7m j °0y N 1 S m mmCN C CD 0 = O a m 0A d OO O O = N CC S m (D m 'O CD 0)m n mJ CD S - m7 ._.. = 0 (O te 3 "O O 0 _ �0. C (O N j m m O CO dI an dm O 0. m C S (p W O 00 N N o 3 F co w Wm N . w nQ » Xo D D Xy D c � s O N m `� N 'O C L V c °' 0 ON O O O m a 3 m ° 'o _^ tr rn C � c CD -..,..9 0) .J. a) 3 CD J 0 N a) N to (p V A C a < al y `G N W c N 0 0 7 C. N N N 0 o = m m v x - 3 a CD , o a 3 o0 M m _O. CL < O N N C J0 CD j = N J O tQ 0 J CD a tD O m a 0 3 a) � � fn a1 0 0 a) O N .y+ 0 0 Tl d c O O a _ �. ' a N J N J O N a d X CL a) cr > 3 O O N N O� F CD 0 .0.. 0 `< N 7 f0 CD p) O (D W 0 (a N 41 ' 0 N n m N _ CD p O- y O a a) 7 0 00 M c 'y a) x 0 N CDa C m (CiiCD 3 Qv a � � l< ad X ° 0 -�� Qom (D cm 30 m y C, ?. a3 ; m j3m N d m 3 0 � y n o - d. mv a 7 m 3 CDN N to �< O "O O M 0 < ~ W c N N N O. aO�j N a W v �O Qom, ' 00 m 30 -o c 3 m �i o a � ' Z .J.. m a Q - m = m O T O J' 0 3 a 7 — n N CD F o 3 0 3 0 ' m ° m n _� O CD N 0 ° 0 0 y to N 8 CD 0 W oLD. O N N n 3 w O ° W N 3•-0 N 0) 0) O0 N N z m �' 0 0 j O N a 'a a 60 a 3 N 0 1 m O J O N O < CD 7 n - a) aOj F O mfC <D � oom o' F Rl '< a X 0 (D M. I 7 CL — c < N N mCD oo v � � � �� m m a J J tn. X N a � � fD � n 0 c 3 ° a 3 m 3 ^. o X 3 m ° v c n 8 � `< M 0i aW d � c T N (D O 0 C' C N d Q X a ° m a 0 D m b t0 C 0 J a) —CO O� = C A a) ton _0 N f0 n J 0 .O N 'v CD < CL d O N a) a �+ 7 J a n`' a m a 0 N N O O O N ° CDN 3 J 6, 0 -gyp O O j'N JD d J x mOis t0 a, 7 c F -n O tD tp M 0 Vn C0 CD J m B CD O 3 0 u O N O 0 a J J O 'a -' m 2 n.a ° N J tJ 6 C 1 •-OO a) J N t0 t° CD _n O 0 y W < a N y 0) 0 m (D J C. 0. 0 O 0 to 0 a 0 d 0 O 0 V gOO=. N N n O N 03 J 0 - CD t0 N C N N O ° � o � oo. Jo m 88 (D J 0 00 N < a) N O o m n m c 3 3 C J f a X to (D N <D m 3 m a 5' c a y to o � O CD o o S A (U C J X 0 V CD — O O ° o m 0 `� °- m 3 A 0 CL N 0. 0. z CD CD� o ° a F to m 3 0 0 p_ N < O O D c C CD CD < x _ E a J X a N n < 0 ca e r 0 ^ CONCRETE MECHANICAL MANUFACTURED HOME 0 Cl) Footings / Setbacks Date B y Ribbons 0 w Date By Gas Piping Date 1112skj By ro Foundation Walls Date By Set-up Date By INSULATION Date 1zl>z/03 B G / Slab Insulation Floors Final Date By Date By Date 12LI01-1 y FRAMING Walls FIRE DEPT Date By Date By Date By PLUMBING Attic OTHER Groundwork Date By 1111yl0.f — "A,HI (23Z. Date By WALLBOARD NAILING ZIZZ/03 - w4"No z2/5- LDt=e W.V. Date By te By FINAL INSPECTION t�ZZI( r 1 2}L DateBy By Date By � C _n/ m it 12-1-/0 Scr 0 1 izz/04/— Ozo bU, m N O 8 d y b O N O v��jy W l J 0 1� W tI� N 0 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 APPLICA14T INFORMATION CONTRACTOR INFORMATION Owner V _ v If V Contractor Name /J/YQ✓ MailinwiN dres Mailin lAddress Z 7 Z `' 5 F City v State p Code Y4 ` City 'l+ 1 lv State Cv Zip Code Phone (3C;%) 2 -K7/®ther_Ph. ( ) Phone �) 3�� -Z'gther Ph ) Lien /Title Holder Contractor Reg. #LAX,C 7u6 15�/�y�p Email Address Email Address 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 PARCEL INFORMATION - 12 digit Tax Parcel No. D / 7,06 U Fire District Legal Description SF // 3 a Site Address (Please include street name, street Lnumber and city) "w d s Y Directions to site Y G di A Jed 7 u ab i(( Le- ,.a t1 r r r 6h lQhf -C r P-Fl-- n Q » h Will timber I cut avid sold in parcel preparation? (Yes/No) Al LJ Is property located within 200' of saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB - New ✓ Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice Correction Notice or other enforcement action? (Yes o) Describe Work ' ¢- ', i } 1, }j, No. of Bedrooms No. f Bathrooms SQUARE FOOTAGE - 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUF _TURED HOME 1NFORMATION - Make d/ odel A?/4 model Year oJ603 Length_]L_Widt Z� Serial No. No of Bedrooms 2 No. of Bathroo s Type of Heat Purchase Price $ S� Replacement Unit? (Yes/No) Installer Name P h No a SP r Certification No. S Z. 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 STFW�CI ES FOR REVIEW AND INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACQE'(u�yp ATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT'OF SUC}i��IS�B�1AIGfJ tE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I C. ifyJh; It xurrently regis- ment ofthe Contractor Registration Law ROW 18.27 and am aware tered as a contractor in the St,1e14'W`aasthington��hat I am aware of the ordinance requirements for which this permit is issued and of the ordinance requiremen s g iQEID or which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conTdRnance there- shall be made without first obtaining approval. with. xm" shall Ike without first obtainingapproval. X Date X ✓/ ate / FOR OFFICIAL USE BEYOND THIS POINT Acceptecy.gy Planning Pd 4 3 J Ck# Date / / ) Bld Pd. Reciept No. 3� pI ARFWIENTAL 'View, A#P OVIED DENIED CONDITION CODES Building Department 4� 3 F r' Occ Group rou -3T a Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Budding Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing 8 Base Fee Planning Review Fee ( 5C Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal 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 APPLICA T INFORMATION CONTRACTOR INFORMATION Owner `'V w� Contractor Name i r Mailing �dres� `� -- "9= - 7 i �•—t Mailing Address City State✓f/ Zip Code > City r /� State Phone (=�) � Other Ph. (_) Phone (_)` ( � ISDther Lien/Title Holder Contractor Reg. #e vt' rl-J'% jp. Email Address Email Address SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic V' Connect to Sewer System Name of Sewer System Well %. - Water System Name of Water System PARCEL INFORMATION - 12 digit Tax Parcel No., 21 / G;• - '<% 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 located within 200' of saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs j PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?(Yes/No) _ Describe Work w' I`. No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUF/.CTURED HOME I FORMATION - Make r/ odel 7 ' tdfodel Year �! 3 Length / _Width ` Serial No. / No. of Bedrooms No. of Bathrooms Type of Heat i °� Purchase Price L. `>Z Replacement Unit? (Yes/No) � Installer Name K '+ J a 5,9 v' Certification No. L Z A i A, G /L L. !I 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 j EMPLOYEES OF Mason COUNTY ACCESS TO THE ABOVE DESCRIBED PROPERTY AND STRU ES FOR REVIEW AND INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCT, I�IpjtJ1lION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IIQS� BY S N/1(�TQQ BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT- I CArt�hlt �6r��jqIrrtfently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State Washington arftf114dt I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements 61a%fa r which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done iont��nce there- shall be made without first obtaining approval. with. No changes shall be m'ddp without first obtaining approval. 7i�,, .I v e 1 . ' :h X Date X U ' ,, / i /Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd Date Bid Pd. Reciept No. _ Ehl?AL REYI>z1Ai , FlPRt7YEDi ©ENTER CONDITION CODS Building Department - '' ' - ' r-7 _ Oce Group ., Type Constr 'I r• I'�' - - Planning Department i Environmental Health Department Public Works Department Fire Marshal Valuation$ FEES Building Permit Fee Site Inspection Plan Review Fee - I I 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 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 Contractor Name Mailing,tddress c.. Mailing Address , City State . . Zip Code City _State=Zip Code i < Phone O Other Ph. (_) Phone (_) Other Ph..( ) Lien/Title Holder Contractor Reg. #: p. Email Address Email Address 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 PARCEL INFORMATION - 12 digit Tax Parcel No. 2 f Fire District Legal Description ' Site Address (Please include street name, street number and city) Directions to site , I- Y Will timber be cut and sold in parcel preparation? (Yes/No) Is property located within 200' of saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE ♦ SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? (Yes/No) Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE - list Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make: //l-Model 4: Model Year Length Width _- , Serial No. I No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit? (Yes/No)L' Installer Name r Certification No F 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 STRUC URES FOR REVIEW AND INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCI� ATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS RE j3ELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I cerwltla I Qq�m�rurrently regis- ment ofthe Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington r I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements 14'"t ,� tework for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done int6oMormance there- shall be made without first obtaining approval. with. No changes shall be made without first obtaining approval. X Date X y Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd Ck# Date Bld Pd. Reciept No. h3 Af ME. Td4 . �11� It PpR ►VED :f)EFi1E� C�?NbtTVON CODES Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation$ SEES 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 .t16 v 2 0 PLANNING MASON C�UNTY DCD PLA^JN!',4G SITE PLAP REQUIRED TO 13E ON SITE CHANGES SUi3JECF TO APPRUVAL By — Dcte 9N I 0 'X _r6nce I � I wo pose,b �}E al — _ J SHED N 'Y,�I I g ----- l 00 r � SHf,GTo IV i Mason County Permit Assistance Center —1 Planning Intake Checklist Owners Name: I u (Q.r Date: q—i-7-C 3 Project: �g nJ2KP 2VM m, Reviewed By: Commercial Debelo ment: YES ?4(�) Comments: Planner: SAL BM' DMJ Site Plan: North Arrow .-a Property Dimensions: X a :5 6 �a Streets and Driveways Shown. Road name: lan ' (/) f��, C�E ,P' All Existing Structures shown with setbacks ,W" Well Location, Septic and Drain-field Shown with setbacks Identify all surface water(streams,ponds, shoreline, wetlands, etc.) 'o' Topography(slopes) d Proposed Structure Setbacks (Direction/Setback): F:�_�/ _R: S 1: E_/5 S2: (,v / X� ,tea Utility and Drainage Easements: a No (if yes enter condition#5022) 'p Other Easements 14,re eS-�' ❑ Accessory Appurtenances ❑ 6 YR TIP Would you like to be present for site inspection? YES / IO ) Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning,: ��Iot Applicable ElAgricultural Pl t 2.S/5/10 20 ❑ Urban ❑ In-holding ElRMF ❑ 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): SEPA: Yes'X_O�Unlmown Flood Plain: YES NO n Map# Aquifer Recharge: YES NO e!" - Map# Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: YES NO Eagle Nest Tag: YES NO Other YES NO Addressing: Check box if needed Reviewed by: ❑ County Access Permit Needed(add condition#0010) ❑ State Access Permit Needed(add condition#0020) Standard Conditions to be added to all Building permits that planning reviews: #5019 and#0700 a�;Ka:'rnaM 3� u l o ill•��uE'tar.:���ll � 4 �� III n I�.��'jiilll • iV y a� rm � r a 9 IMF lob $ as a %4 2