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HomeMy WebLinkAboutBLD99-1027 Final Mobile Home - BLD Permit / Conditions - 9/11/2000 -7 X, Z ISI YL -V 2-, Z T3F 77 7� 71 :3 x Hi. Is I�lz 0 "A 0 OD rT 4k. .14 cn tD s t� co Cn OD rm iD •'ONCRETE MECHANICAL MOBILE HOME ' =ootirgs-Setback date by Ribbons .date by Gas Piping date b I � oundation Walls date by Set Up 7 :,ate by INSULATION date Z6W by�� i' BG/SLAB Insulation Floors Final , date by date b date by FRAMING y FIRE DEPT. date by Walls date by date by I LUMBING OTHER IGroundwork Attic i date date by D.W.V. by WALLBOARD NAILING date by date by I, Water Line FINAL INSPECTION date by date by date by Ir rY) H' s u.,� 7- /y1 H Se f! / CC /�/1� f i�✓rid �,�fl� t f iJ, ���i-�r�7' 12� Z! C' < 3 s 7 \Af T v'� v IM 0 7�1 77 X n OD ol c cn Z)7 "D Z T I -a.S cn :T 0, zr < IT r4- 00 P- 00 IZ 17 �r4�4 PERMIT NO.: BLD `,1c49 MASON COUNTY 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 Seattle 206 464-6968 AFPLICA T NFORMATION CONTRACTOR INFORIYIAT OI� r Owner t •,/ t`> M" Contractor Name ; Mailing Address � .. t > r�•. Mailigg Address `"7-3ot City V:;/ p,/ State%,, Zip ode'ri 931 3L City V,,J A State 1,,y-) Zip Code ^a Phone lic6 3­0P Other Ph.( $ �) 2311 �, �`�e� Ph.("3 J.9'-44'33"7 Other Ph. c Lien/Title Holder �- �, r ri� e� r-1II f€1 S Contractor Re # 3 r Q L Address 4 5) G-0 1 ur° ' '� Expiration - / _/ c.t.C� 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 /�/ `r L i,% ) Fire District `) Legal Description Site Address(Pleas in ude street name, street r�umber,apd.city) i 5 C uV ` fi ' ttilr3 53 Dire tionsjjto site e � � ""o t'vpev✓ ;�. ,I .� L' , ,_ " I 4 Will timb& be cut and sold in parcel preparation? (Yes/No) Q Is your property within 200' of the followin Body of Water (Name) Saltwater Lake River/Creek PondWetland tit? Seasonal R noff k Stream �� Slopes or Bluffs TYPE OF JOB New X Add Alt Repair Other Use of Building Describe Work -'..Trf—S ! A-t y✓ T^°� rS+c1,,-1i o I ot-a�t � ,�— No. of Bedrooms + No. of Bathrooms cam+- SQUARE FOOTAGE-1st Floor _2nd Floor� `1 3rd Floor Loft VJ Basement_r-I Deck r Other sq. ft. Garage Attached Detached Carport t Attached Detached MOBILE HOME INFORMATION-Make Model A— lj�hz:j ®o `� odel Y ar Length—Width Serial — '1 o rot s athroom _ Type of Heat �:�� r Purchase Pxo w lacem it ? e / o) Installer Name AAc ,~ r fi Certification No. to,%)H I hJ 00-L fS 1 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 obtai ing approv X Date ' q X 9 Date tl 2 7 FOR OF ICIAL USE BEYON T IS POINT Accepted by �f_ f- Date -'I` ; Submittal Amount Due t Receipt No. DEPARTMENTAL!REVIEW: f900VED7 DENIED' CONDITION CODES Building Department Occ Group Type Constr. 1 1004 Planning Department i Environmental Health Department Public Works Department i Fire Marshal r Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) ::.•:;:•;:::»:•.�:;•:•::;<:•:•::::•;:•:�:.,:;.:::::::::::.; .. .... TOTAL FEES MASON COUNTY PROJECT SITE INFORMATION Case No. Name ' 4 ; ( PARCEL NUMBER ! { 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 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 property line. adjacent property line--� I I <—adjacent property line I I iI I � I I II I I I I I I I I I I I I I I I I I W I 1 I I ' I p I I ! I I adjacent property line4 Fadjacent property line 1 SAMPLE SITE PLAN adjaTt property lined azo' _ Fadjacent property tine I D 30' rR`SCRvE 30:.�1 .SfASG u AL. I F _�'PT7L__,� J- I CREEK \ I A fi HOM t i .Gnstw ]I HOu�G I j PM0PauD se.pr:L —�I I 1 , I I VAC-ANT I fi C AMAv6 I �I,`�\ PP.oPmCD T ASR=LLJiAL SO' LTu — I 1F-40--�1 � , , I /,,• 1 1 I 1 B O' I \\ I 1 � I i 1 h /00 1 � I I 1 L- •nLL I 1 1 I 1 I x /00 I I t. r i/ I adjacent property line- i , c \; E-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 d15t�»Ga, to ruci-t.a.r� d�at,r,cc to Slopa -rna dis+a..cm Signature Date FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name �� . �� [et—e- PARCEL NUMBER )X),R 7 77 10031 Date 11 r 12 1 Z �i 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 ►J S 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 property line. adjacent property line I E-adjacent property line I I I I I I I I I I I I � I I I I I I I I I � I I G i �t I 1'1 I ` `a tc4i I I I V� I I i �c I I � ► � I adjacent property line4 17 — -- I Fadjacent property line Ett Cc,,e- IX 7-Q SAMPLE SITE PLAN adja�nt property lined 2La, _ _ Fadjacent property line v 1 30- rR�SaRv&- soil \ Hone t I .GaaEu_ I Hoc,u4 I j PRO Postn I I VAGn,T T CPAMAC.4S 3 o' I I C0.oPmCD I A,&R=LLVrWlAL 50 I 1 I a O' I \\ I I � I I \ I t_....eLL I I I I adjacent property lined ; Ate. \; Fadjacent 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 d15+a.,« +o ructtiNe- d ist'a r,ce. to Slops t-o¢ sit+ar+aQ 4e t Signature Dath FORM MUST BE COMPLETE INK ^� + *ERMITNO.: BLD •�'' O PLEASE PRESS HARD 1 A COUNTY BUILD IN PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 AFPLICA WTANFORMA ON CONTRACTOR INF R TI N Owner i 1 Contractor Name Qr e c�S Mailin Address5 YO S il✓ mail Addres �'U _ City C.- v-J Stater-'Zip Co be�j $3 )0- City( ✓C. r �i✓ State , ip Code 3 Phon(Tc3ca3 5' Jther Ph. 3)i Ph.( 36C)S-3 -C3 1 Other Ph.( 5W 30-- Lien/Title Holder A45p.✓ 6 f �e,,S Contractor Reg. # FbL 3 Address + t✓ Expiration 7? -61-5. 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. 1 / 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 your property within 200' of the following: Body of Water (Name) 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 Describe Work 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 MOBILE HOME INFORMATION-Make Model wtz Model Year Length Width Serial No. ©-S -�0 No. of Bedrooms No. of Bathrooms Type of eat c t P 3se Aice $ E3 0-DV Re lacem nt Unit ?(Ye ) Installer Nam Certification No. O 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-]certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-]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 approva. tt first obtaining approval. Date w X Date FOR OF I IAL USE BEYON IS POINT Accepted by n , Date ��`� Qd�ubmittal Amount Due e— R celpt No. OEF'ARTMENTAi.<REVIEW aftOYE !RN# D CONDIT).N 65 ES Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department i Fire Marshal RECEIVED t Valuation $ Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) :{}:i:{:ti:{:i::i::::i:::tii::i•'.ii::i::ii:::titi:::iiii::ii::i::ii v LfiY$:•:>.:iii:G '::ti::•:•:::i:$CSyiJ''•'::i}i?:L::i:':+..in:::::iiY•iiiii:}:}:`{::i::iiii::l:: ��F...............,.. �:x...........>....:....:..............:............:. TOTAL FEES ...L.:•:;:{;:'4:•:4:`.•:is v: FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION .Case No. 2-Jq) '7 Name�� y r PARCEL NUMBER 12.2 2 577 JO o3I Date-Y/0-'0 SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences .i 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 property line. adjacent property line 1 1 E-adjacent property line I I'll'5 I I I 1 I I I I I I r I 1 1 I s/ �►iv' I w� I I I I I 1 ' E-adjacent property line I adjacent ro ert line-� �' �-- — - - - SAMPLE SITE PLAN adja t property lined <-adjacent property line I D 30' rRE_SCRvE gel SE1Ls�,,.�Al_ I a ,L _ PTsc.__,� J CRF�IG I c I Home, j I � .Gaatn I Hou..s� I j PMO Pawn I w � I �o' I(� 31 PCsca Soy I I I I \ i \ `�s /00' I \ i r_ .eLL I I It- ..•t..t_ I adjacent property lined f adjacent property 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 dis+anGa. i'n ruLtu.Ye- d 2't'a r,L[. t c Slopa tc¢ dis+anaa. to ML 2Y u-0 Signa ure ate oW� — — ---- ---------- co aoW >t' 1 1 "f � uw-v �z HIND O n A-1 WA-14 3 x 7 n O O{L Y Gfw G g W O < ; 0 � a > O o {' Z b -Xo o z � o -" ------------------------- -•===� Opt F.sh o Wa�J WeJum Op.c"I m co Z g I 1 8 § I g _ O i v -O CD WA.11 W�j-T{ A Opt. YI{•. a i 3 � 0 N V 1 O 1 10 O co CO 1 m . I 1 ! MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health Personal Health PO BOX 1666 SHELTON,WA 98584 LOCAL(360)427-9670 BELFAIR(360)275-"67&4468 Application for Determination of Adequacy Instructions I:?< '<:complete Part I No determination can 777 be made unto Part i luf l coin, lid. eomptt oaty thoport�cm;o�I'xtt applytzlg'tihc< p o>"wterysteMAP tttxed ut compfeted; i caho with attaettments:to the:iiealth. le nl::fc rl vievr .,.. PART 1: Applicant/Parcel Iden2?tification Name of Applicant K-2 i I Q, l' l Date l�� Mailing Address I N S V w N L✓ Telephone Assessor's Parcel Number I �a Cj 7 750O-2? 1 T e o Water System Check One): R on for Application : lication Check One Public/Community Water System(2 or more Building permit connections) ❑ Land use application,if so.. ❑ Individual water source(one connection),if so.. ❑ Division of land ❑ Well #of Parcels? ❑ Spring/surface water SPH9 - ❑ Other(explain) ❑ Boundary line adjustment ❑ Other(explain) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated for adequacy: Public Water System Name of Water System Water Facility Inventory(WFI)Number: ©0 A� ❑ The water purveyor has filed a letter granting blanket hookups to this water system. ❑ I am the ger of this water system. The water system has n approved for services. There are presently��connections m use. This will be the connection. is water system is able and willing to p ovt a water to this(these)connections wt ou exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date j0 o� H:I WDATAW RCHIVEI WATERAD3.WP Update:March 22,1999 W - 7 ■ , REED . c@ ���.t a�� _ �..__.. a.. ,. . ......,� sy,_ V•,. .wd r,• MOBILE HOME � „�::\,.+? �. .�e•..,�.......9 u: \'\\ \\\\\ate\\.:t„.\\\�\\\\\\\\\\`?i: . LEFT ON GRAPEVIEW LOOP RD TOWARDS ` SHELTON RIGHT INTO NORTHBAY HEIGHTS MH ,r LEFT ON GILLS COVE DRIVE. z New v IN = PERMIT�PLAi+t m _ s 9 t Copyright©1997-1999 Tidemark Computer Systems Inc. 9/11/00 All Rights Reserved. t� T 7V M. 77 IT 7; Z r �a.F -t7 cn 0 OC) 0, C: -Z !t 7 Z- ZZ a M, CD 0 cn N) 0, Q. w6 a (D -0 C)00 0- cyl 00 GM, Z -r ,l — 77� a ZL .J SL: V 0 Q O O X __j OD 0 0 W c cn � z �� n 0 (10� � = c QNz Q � 0 n Z) 0 -0D 00