HomeMy WebLinkAboutBLD2017-01088 Cancelled MFG Home Replacement - BLD Permit / Conditions - 4/14/2020 o o �
CD< Q -� � o
O n < O N O w cp (D
n r �m
CD - —{
O CT (D < Cr (D Cr CO N o n < C 2 m r D �` o
OD � � m < _ < 3 c � ism 7 on Cn --- C) hr: ;���q'
mm 7 a m � � r- > z TIT
cn = m = °-' cn � � ZoX
o c° CD ° 3 m o C: >
CD -n
v � CD ° C com -niz Cn °� � �
�- a co -'� 0) CDz m cn N
y -ch. owo 0) CD r N 00 r D C� Q
q r r N N T � E- o Z
p TI T 3 n Z O (00cyl
D � �_
- - — — — — N :. K ooV � ncn OD Q
cn m ;KZ CA
C
z -4o W
-� `n m m Z
—I
> pO
< mom co 0 0 cm p
CD C � � 0-a - �. Z o -/�� � X m
33 CD � m m m m o Q o -., o �-�`' m
CD -' v c N - v - co ao n � Q° w
CD 3 o= (D (nZ m m, o o a m Q
CD
o O 3 3 c=i v w CO)Q .. .. .. co -n
3 U7 U1 U1 U1 (D °
OOOO � � _' � N 90 Z z Q
m
(D .. -n -n -n
a Oic
° D
ic
W r C
�-�'
y A O � o c3i T. W Z
m = , n n J C
O
cyo p o fD :3o o o ' r m ao r
N - - a 7' c N c N r n r
o m m cn a 3 i_ O -� Z p
a; ::�> O m
a C!O � �
o: 0 o m m
o r
ai -am g -nT W (n Q° Q
el 2 nl nl 00
a m 2mm � r m
a r Z
e r
3 f m m 07 Z O
< y c W
fD m 3 0CD
3 n (n = 'o
�' m 3 � COcC m Z O
-P m o -. oD r
Q Q � � W � Z
_ (D N :3 m
-no o m ; (D
s m inn inn, D o go -nr
V V V V m m (3 J`< m ° r
_{ N N N N Cl) :. :. N Z
O O O O O C c
cr
V V � 7 CD K O In
fH fA cA kn C6 D 7 3 O N CD
N N N 3 � "� 3 co � _ C
^^
W O COT A A C Ul -a '�' r m m Lo �•
o oocNi+ Ui N A) _ - (nm �- - r
cQ � °: O O m m m N N
CD CD
c, cncnc, D 0 0 = � Cl) 0o � iflw
N N N N CD CA
CD 0)
o 0 0 0 N D y Vo C)
Ul V -1 v v
O O O O
0 0 0 o a N N V
0 0 0 o
p j 0 w N
0 0 0 o OD v `4 00 N N
00
N
C�
v
b Xoov -I XC O ° XO X0 � D_ X -10 � XD XD CD �
o � � m 3Eom CD ° � om � p tea- PC<D
�°, oCL •
°° 7 <<� a Q1 n �cQ N n 0 v O 0
o
CCD :E. E33 =r (n CD PU:) CD 6-0
N = CD CD N � ��(� Q CO °(Q ° VCD
0 t!1
3 � M CD i'ro w00 � ' ( P 3v � � � - (n � w �+ O 3 � o
(0 � _ � ° Qo ° y. o �, N. v
o x � Q_ o O- r.-
p 7 7 o Q — l< -, N cn N 3 N j N
N c CD r - to c O -0 N sli N _
0 0 3 �. CD W a = 0 � cn
_ CD CD Cn _0 m � � Q v
a? v
vo fl
CDw ° mQ. T- 3CD cn 0a� N at No O CD
c Q@ ( O
O_ (n -O (r ar < c CD
0� �' - cn O0 (D 0 CD N CD
O N
0 0 CD :33 0 O 3� 3 _ N
m � cr cn & 0 0 CD o � � �, - CD 3 0 cn q
= CD CD Q 0 0 ' 3
� vco .ter. .- En N cn :3 n � c � � � vc
° ° o cn . (D o = CD CD cn = _
m m m (n' Cr m �, n =' a a �' _ cr
� m �' v �� CD moo = moo cr 3 � CD
m o cn c v c0 0 —
O QCD 0 CD o CD a CDcr O �
.
co PCD
0 3-0 cn o A CD l<m =3 CD
m a,^ 0 m CD m-0 � o m � � o 3 m
m O � O- o Q. - = � CD o n n
o m-a cr - < v - 0 � � 0 0 Cn m 000 W D
o CD 3 =-a 0- o -0mm 30 � y c c rZ rN
Quo �� �� ocnU) rno -h lb N v `< pp pm
0 0 N Q 0 N < O o CD 0 0 C Z
c CD (Q < O 0 N =,, = 0 (D 0 � 0 0
v � cn CD v � Qn� � c0 O �' :3 � 0 v —i
_ cn cn m Sli cn (O = CD S k N v q Z
CD o v m (D 0 0 (D — cfl N. CD _ o Cl) o N
o = O- CD m cD = m CD coo 000
0 NCD Cn Q O sll co
o' = o• 0 v 3 a vi' � �- - O-
:3 CD D <' 0 CD CD N (D CD
Cl) Q _ Z3 (n Q 7 tll 3 Cll O lD C 0 cn
3 Fn CD 3 CD 0 CD � Q 0 3 cn
Q. CD Cr CD v Q N 00 (D (D -
in ° o 0 CD w 7 CD
a C .� O Q_ O 0 �, cr
CD CD 3 O = - @ ti. N = CD
3 .O. CD Q — 07 7 N 0 t— j N
3_ CD Q(Q (n' (D Q. " O ili � CD
= CD fn' Q 0 -0
(D Q O CD CD
0 Q. '. S (Q 0 (a cn Q
= Q O 3 Q � � O -0 CD
a O CD N (Q Cn (D Q
�. N Q X (n 0 - CD o CD CD N
CD O 0 CD Q7 Cll Q 0 � _ 0 CD
CA 0
0 -0 -a * N � O � � t CD 0 ((DD
w ° cr N C n 3 Q O_
< ? —
(a CD CD 0 `G .0+ o = N 0 CD °
CD Q= 0 _ CS N 0 Q
CL N " � CD CS n :3O� �• � <.
Q (D N '" CD fll 0_ O O N 0 Q
N 3 l/1' c
N a E 0 a) p (D Q cr 0
=r -s M.-0 .n-F V) =Q• CD .-« CD 7
O :3 CD N -0 (D (Q
NN O O w ° < .. O 0 D =
Q 0 Q � .< CD N O <.
(Q CD
C) 0 3 � � � CD � N
CD O 0 O O CD N D 0- CD
N a) C
N O Q `< 3 3 W-0 Er N Q
CDcn j N N CD CD
Q O N COD D -a
O =CD N �• O
= Q - N
CD (Q j
r
co
N
O
v
o � -i ° D E LM0S" � X N � o 0 �-0 0 ' D X0 z �. �' a D " o = D
—� m � ? ° to in" O (n (n fll v CD cn 3 N 0 cn j `< D 0 0 3 ,in- ,Or�
O Vl to 0 c -O p O — 07 _�-0 v = - D o O O N v N v cn v
w o my 0 < . o : c o =.N � -0cc o m o o v m 0) m Qa mo v m
Q 0 Q _. :3 O (a N m m m m j n \ 0 .+ >' N CD -O CD cn (n N
^ c ~'(a O O : O n 3 0 m X 3 3 to �
�" C N = 3 m
o cc � CD(0 m� N m m o 3 CD 0 � O 4y v o m cn c3v
� '" c> v � o N -1-1 3 m� � �' = CD m � - 0 o va -
n. 0 � 0 v0CD 0CD3 cn ° � 0 � � ,-mac
n v 3 Zm0- � m CD v n : � � m N ° c cn m m
, m 0 � � m Q � c Uzi m � m . � = m 0 � � m �, � �' 3 � 0 � N �
Q � o � ° - � m � � o '" mm 3 � o
� v n � - ° (Q o 0 m X, °o O- D n Q N O 3 N O
N C m OL CCD O °O m CD 0 � 5 0 - j N cn O v = cn -
Cnm 0 � - - � 3 .- (D '< -- o v 0 =3 gym, 0' 0
-I� � m a) ch0 N c 3 � v � v o m m Q - (0 c (° �(Q ? � �
v CD n m ? 0 m cp vOi X ? N, �. CD ov N (a o 3 v 0v p DO
m v � � m cm 0 ° pCD0 mom � Qm � 3m - one
0 < ° m 7 Q Q 0 cn< CD O" O O m C v 0 (n .. n _7 (n (D ?� o.
N En
v v n. �.00. ( n 0 0 CD 0 � ((DD = WD0 m m v 0 CA F v (n
� ° 0 =" m O � O -h m - W m � z � m m a - F -
m 3 3CD 30 - cn o o c <- D' � � �m 3 o v (cn 3
v m o _ ° � a --- - m (n ° CO N) � 0S r« 3 3sv
o ° - 3 m N O Q o m a � 0 .< (n (Nii � v 0 (D m
Erro v m�< (° o ` z ' CA ° N � < � m ;o -_-A Q �
CD 0v 0 �, m o �' S" � 3 � Onm ° oDm m n�
m 0 X cNi °. � 3 cn cQ s � � � -I ° 3 3 00 3 ' O -
o CD m m 3m •-- 0 v m � U oN m � � o A3Qc
Q Xo CD CD
v0 �.c- =r CD ,< mo =r wn� oQ
� my N c v -0 CD m �(a f pv CL m 0) ::3 s
co ° Qm Q � N 0 0 v cno � � � 3 �' � cr3 Co CD m °
m CE) v � Qo o cL = - o 3 v m Q v m m o0 CD
m `< o cn
m O o " � " �� 3 m o - 3 � (n m � �, o � 0
y 3 :3 a) 3m (o" m mw m0tl1
m CD m 0 � m Om m m m a3i m m o v
j (a. N ° �. O p' N 0 -' Q v N o N (Q r �• -_*. CD to ;r n
O O Ul (n N N 0 -w cn � m m cn c (n a m N .. S
N 0 O Cl) N N 3 a �1 O 0 m a M 7 O ° �_
(� ° c < mx m3 -�� 3 °C 03 0 m 5' c- �
O 0O : N N O c N (DN < O O Q (D iU Q (fl (D m
Cl) 3 ai -0 5 a) - CDC 3 0 0 =r= � � v, 6 ° o 0 CD
-0 _ CA 0 3
m `< O 0 m mo v < 3 w o o � 0 CD a w � m m
0) "a cn v m Q N O to ' cmn Q �,`< cr
- 0 � ;31- Q n
a � 0 c -. �' p 0 m o o �. 3 C
m ° 0 Q � 3 m 3y� m � 3 0 0 < v CD CDv
p<j CD
m O 6 N ]• � —`< — m N Q (o N = c (D O O c O-
o <_� � � m m < 3 (n m 3 � c 3Q CD
a � 0 °
° vv ° � � 3 � 3 �p °� � � 0 � v � � o � m
< CA a- 0 CD Q� � m v a - mEro o - v - � UQc
Q o m 0 v o" �, ° Qom 0' m o m m =r
� 0 a � << o� m 0 0 � v 0 g -0 °
cn
o � 30 (D o cn mew 3 ( 3m5' c 0_ cv
Q m
m o07mmc = � � 3 map W -. c0 � cn5'
m o NQo < � m u QCD �. � m CD vvv
0 = m v nC 5 �; co0
m ai n� 0 � o�< CLOD mv � - 0 � (Q 0 m u, 0
(n -„ w
O 0 m N a cfl -" - = O
m (a W WN-° — :3 CD W 0N � " :- pm - - O - cv
l3n s. - (D m 0 m Q) = � � ° O
(a � l< 0 � < m o' erCD (n � 3 � fD o -*cfl v 3 o m v m Qm
a CD w
CD << (n �' _ o _�a cr 3 o o �
0 n CD m < N Q 0 - m o " N m 0 j N x m CD m .3.
(n v 3 m � -Y �, � 0 � o v m
Q F. m (n 0 N m c W cn n 0 vv Qm m
O 0 3 :3 mm CD � `< CD m Cn
° 0 m m = 0 ' CD
cn �'
W N
N
O
V
b X - w D X � g > D XO D X w Dm 5• m 3 �. D -0 -I = D O cn 30
0 _0 — w 0 —cr _ �_ _ O Z (n w V1 -+ — w = C m m
Oor(D
om o � C � 0 (n � m _� c w m 0 (D C X m 77' 3
OD 0 � s w � w O_ (n O -u m cn c0 (D 3
Q
r: "t M
O N 0 -�(O � m m m � � _� -0 � m � O �CD � (n O0' � 3 s � O
m w "a — . c w (n 0 m w : v a UlF D
D X m 7' O m n m O — m O o m O_
(MD a '� 3 � (D m _ C � z 6 O cn � O .� � m a 0 a' O N O a. D' O 3 cn 1 a m —I c N cn (n(nCD CD .' - O < cD � < 0 �, (D 7 -' d 7' cn cn � "0 O — -o cn -0 � 0 (p N m m a 7 m cn
C O O W "a �cn w p 0 p .0 m @• 0 Q O N w �` 7 N O_ a 3
w X OL N n (�D CD W7 Q j O Q D �. O 3' N N cn Q 0 O N
= m can �' � W 0 c a w ? � a �. :3 w v = 3 W c 3 � v cD a
� CD 0 a_ 0m ni � �• apO � _ o 0CD 3 Q cn o ::3 CD
3 z (D a' D ,, O_ -� 0
o (o CD so °' `< Q m m 0 m z � D � 0 42 m a- w 3 o O
3 a c 5' (a w w cn (D z cn m ~, (D cn m a_ m Cl -
Cr oo (CD O. cr w CD < -a � n Q � C�m � m � rn < CD ai a' m o O_
S' O 3 ca �' �' , a m vi p (D a (n N Q N 7 o %
�< � corm Q- Qg � - yCL 0) (D 3 O. ~` mw O_
c c a w v Cl) c w O O CL 3 O N 2 �' O �'
car
c
CD o w cr
m w ? � � m ° umi cn c : � x 0 m v 0 �,
v - - = -a m -« w O w w = v 0 = 0 -: O
y o30 Nam 3 o : -emu, -0 � -� �, a 0 v w acfl 0
CD 3m � cr m oo � c oQ oc0 m m wm � w CD 3
O (D00 m3 0 m3 m � 30 < rn o = l< � C
— 0 O O_ m O a n m O CD a 0 (a ° 3 m
,Er D �. O. p O a' w (CD m O- 3' — m 0 w 0 0 0 r: O
ai �`< c o m n c � -0 0 m cn 3
O (n O_ 0 O (O (D - cn 3 a c (D twn
O CD w w m w aim 0 � a- �' - ° o � �
o
o CD (D �� � 3 c � � � CD Q5. a .) pC
CD � Q N 0 '-' O O" O N Q 0 CD a O 3 CD CL Q
cn CD � m � m n 0 3 o Q v � o
NCD ma 0 � � � � � � ao `� mo rn w mm
CD o ^' `< o m � o v, n � � 0 3 -a
(n MCD5' CD � 3 3 � � � m
0 30.E wm X -0 � � o � o � m 0r.
w o m r. o O m o m < w QO
- W 0 � 0 0 =r �' v m 3 3 CD
0
a- - v r. �
CD -0 O O 0 cr m X O (n
vCD0 o cn
a � :3 CD m wg 3 cn
(n 7 ^' O C m CO (O �, a m O w m
_ _ m _ �• 3
O -"' <' m 0 0 -a w a O m
p -- 1 O cwn 0 m m p -p. M• �0 0O
0 (n ? w O O 0 O w O = N Q �•
� a v0, CO 3 (�D o (D 0 a - Q
a C 3 � @ O m
(O m C -� < (D 3
w3 m U C In mm m (D
CD 0 w w 3 cn 0 3 (D
0 D : m (D w = m m (�
S w O(n CL -N- (O Q N c
3 CD
O. (fl a 7 N — O_ (D O
(n m twn CD O C m w m w �` j
�_ w ..
w co O -' CD o m w cn m 0
O_ O — O
m � 0a O � s w � � c O_
(n �' O p' 0 w -n m a' m -a O m
m 3 CD 0 _ r:
CD O 0 cn 0 w (n >_
O . w _ w CD c0
a v (n CD O - O
S (D 3 m 0 (D a' O Q
(D 3 � w m O
00 OL) (O -0 w 7 cn 3 Q cn
w X O o -h (n (n. w
(a 0 C 'a v O p CO) N N a_
m — a 0 0 C7 () O (n
Q 0 7 O m O 3
O 0 3 -0 (3D w C w
CD O
�. N m — CD O 0 (n O_ O
V, = w m s -a N
a =!
6 A
(D n 3 0 U1
_. p 3CD 0
w 7
IQ
0 mo : oc-a• O rn CA
C
o � 4 � m tea) z
v = c o o m
co Do ° � -0 m XO 'DD X - r Xa 3' -{ X � -I 000 Xo -u
oCD �� CO0 CD � Or -o a o v = v m � rz cn
N
� O O cn �' Q � 7 n a O S2 cn O c
00 r o � o, 0 r 0mc °< (Q � 3 °' cn p CD z � �
nN Q - � � � (D cn = (a 3 O w o m
D o m - Qm -ITS Q w °� w - - Oc cn
Qw m w 3o w � mn Q 0' v ( Q � o 3 � � 0) a)
c < cQw � ° D m mN N � � = w0 cD
Om mm : z0 r v ° m m mo m0 °
�l CO Q Q- Q Z m O C CD CD
y Q 00 CD O �' Q
c0 U) (D m w m ny m v o v cn � v mm n v
� Q- 3 mZ (n 3 �. cn - w = �• y m a
> w m v, m � cn y0 c m � c _ � o w 3cn
cn
\� N a cD c cn m CD (Q O (D -� cn a w w
� o o a3 O m � .. ° cD _a ° w m - 0
Q o• � v �, � 3 � � mm � � < 0 CDCD O 3 �
ro _? m � m o' mz m y Xai c �,� m ao• m R Q
In Z � v' �' � < � c 3 cram CD w
Coop o ° o_ mD c co o - m Q 9' Q " m o m
rQ � 3 3 J Or u, w 3 cQ (n r
y`a, n�io � N0 Oz cwnn f t cr o � v QQa O o �
<D � c� -
-1 � 7 O w T C O O w
v, m a v w mm m o 0 o . � w �
`� � � � o CD CD rT (n � W CD Qo m �
m rn00 QN � �, 0 � o N � � a, n o 0
> Oa ° w m m � o � � mK D m
cn awn Q-
m r00 cD w -0 w mm CLcn N O o 0 ccnn O v
DZw c - N - 0 3 to m w O cn N m O n
� tOir O w � � N `< 0 Q. n c `a 7
7 OZc (D w
:3 cn Z � � � Q n��c0 CD O CD3 _cn m � mD ?o _ � � o v5.
< Q D O ;�°m o w cn
Z ~ Cl. o `� oQ- W 0— : c0 w � n 0 CA o ' mo
O w 0 x� m-ncn :3 (n Z Q � a n
Z CD l< - - nn v CD o
:3 ° w = ° w
m � 3 m ° O o a w D 5 CD Q
O Oo o m a cnao � m =- �, 0 - O -
y `< 3 0 oy j � o D ° (n �o z o
c m
o _� N CD :3 ZQ cn L m ac- 3Q 0 O (n
v, O
(-,M-�,
I WNoo00CD � � 3 CD C N �< of c -o °
a � cD � Qw o yy Q w D-0 CD U) CD cp -°o
_3 moo m v-0 mrr- CD c� v ° W ca
0 0 0 .� (D Z N m ry Q ao m
(
CA
cn- W v � � O o c rn � m 3 r- m
c o 3 � Q m o w
7 N 7 0 w p � Y Z Q S
o o °
Z3w a � zm .< -a 0o En D p 3 �cN o Q - � � O w cn m o m w Q
m ' m cn
m -moo � v <"� a ��
Z � c a
O ° � � -n m � c -i
x
0 < o
Z rn I
z am Q m a� mm m � n Q � m
� a z o
Cr
OL � D � o 3C � nD � o - O -a c D
7w
Q CD (a -a N G) Z (D 5. c � z (D
0 „ CD � � 0 3 c� 3 0 a 0 3
-1 Er
O � - m F 3 m � D m '-' " cn m CCD
w "� c .0 ;:w :3 00 0 o 00 -• = w
CD oo m CD Q -„ z 0 n w cn (� O D w
77 c a (n
o% moQ � � c Gym m � Q- 'zo p m
-1Qa ° a Z o w �' co - Q
(n 2 w -I Q a -� o =(Q c. 3 -u (D
fn can m CD O' � N CD m
oCD
m'< m cfl m 0
-* 0.
o CONCRETE MECHANICAL MANUFACTURED HOME p
Footings ISetbacks/1-aZ® I 7 Date By Ribbons N
trams Piping
o interior Date By is interior-Date By Gate By >
00 Exte' Date By Exterior-Date B r
Point Load I isolated Footings INSULATIONSU Date By
BG I SLAB ihiBtit_ATiC3N'
Date, By Data By FIRE DEPARTMENT
Foundation Wails. Floors Dais By
Date By Data By DECKS
FRAMING Walls Date By
Date By Data �y PROPANE TANKS
PLUMBING Vault Date By
'Data By OTHER
Groundwork Attic
Data By Type.
CaLs By Date By
D.w.V DRYWALL Type:
int Brace tail
v Qate By Date By 00
CD Data By FINAL INSPECTION p
v
Cn Water Line Fire Separation N
m
Date By Date By Date ByCD
O
m V
o Pass or Request Inspect. o
Type of Insp. Fall Date date Dane Icy CommentsCD o
oof/�� �`-z ®l� o0
s'
v
CD
0
0
a
o'
En
0
N
fD
3
N
(Q
lD
0
PLA IRECEIVED
Z2.1
p IS a MT232017
615 W. Alder Street
PLANNING:
/ rate V ALL SETBACKS ARE EASURED
h FROM THE FUR HEST
s sc v JECTI
I 1 ;' � R OIV OF THE,BUILDING
� dk � � r� ��
75''
5
1
P_.r k{rt
�-- -Z-3 `f
t APPROVE
50 MASO OUNTY DCD PLAN, ,.
SITE PLAN REQUIRED TO BE ON SITE
CHANGES SUBJECT TO APP GVAL
LtJ -- By Date
TOPOGRAPHY PROFIL :
now_
39
���20I -7 _��O Direction: Scale: Approval: for office use
Building Permit number: i �3 ' Building:
Owner/Applicant:I� / Fi<� �`y 11 �1� ��►. - -� � .f,t� Date of Planning:
31 4, U. application: Env. Health:
Parcel Number: 2�-'Z- 0— S -7.7��C?1 / 'G + s t-5`.
4021 STATE HWY 16 W
Bremerton, WA 98312
RECEIVED F: 360.479.4663
Future Homes F: 360.4n 12-50
Mon-Sat 9a-Sp Sun 12-Sp
of Bremerton OCT 2 3 2017 WWW.f Lit urehornc hremertonxom
615 W. Alder Street
PLANNING �;
ALTERNATE FH_�_LFOPPTOR
KITCHENDINING LH
AREA --6'-0^xir_e
------- I
D%WDW D=_WDW.
�IPOOR
Opr. _
Z.
CLoSEr J �' UTlLrlY KITCHEN
89-0ROOMZ 2 OPT i MASTER BEDROOM -
BEDROOMC3 ts'-rx�r-z ; 0
i2'•z•xz'-B^ /�
lJ ==--
BATH ' AREA
— _
_=OPT.PORCH'"-'
�e'•o•xzs'-4•_
O ® $ I L. C.OA'I BEDROOM42 ® LIYIN6ROOM9=0'x12` OPT BEDROOM#2
-
I BATH#Z 74'-1•X 7!'•z• WALK-IN I --_- -- --
CL09Er I - -
O
2 Bedroom • 1 Bath • 886 Square Feet
Fleetwood WESTON SUPER VALUE
aro MASON COUNTY COMMUNITY SERVICES /��
PERMIT ASSISTANCE CENTER: Permit No:fi,)2DI 7-
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 2?CU k� b aI_
/ 615 W.Alder Street,Shelton,WA 98584 IG �!
Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone � ������
ttu Belfair.(360)2754467•Phone Elms:(360)482-5269
BUILDING PERMIT APPLICATION off
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
•..l 6�§r�Y.• " sheet
NAME: AL Gale's NAME: F vTU r G p m e,
MAILING ADDRESS: P O o d U 3 MAILING ADDRESS: 0 2- +,
CITY: ��LY� STATE:_ 1/ ZIP: SZ CnY:Bro.rt�"}on STATE: IA)% ZIP: IZ
PHONE#1: t:4 .2 S'3/a!7 PHONE: ELL:
PHONE#2: _S 3 a 3 2 D 1 G Z EMAIL:F t. u C- vv%c o/Y G ek o I .G a PIN
EMAIL /,d tE sl/G A79i G'a L&I REG# EXP.
PRIMABX CONTACT- CONTRACTOR, OTHER k,NAME
^ EMAIL 1�t1� C l�h e- A(
MAILING ADDRESS d 1 � Q CITYRC4e,,r.r+fj-r STATE�ZI
PHONE':3 6 CELL
PARC,ELINFORMATION: 061wef
PARCEL NUMBER(12 Digit Number) ZONING 16y) VGA 10-
LEGAL DESCRIPTION(Abbreviated)V oGG 7 S,7 1, 7 g 4'7 11, j S FIRE DISTRICT U
SITE ADDRESS /6 Z,O q Ro u n- 3 @j*W �S' 3� CITY �11 N WA qi ssLN
DIRECTIONS TO SITE ADDRESS R o UT E 3 tb A u ST to-+ Ind G 02A of i'1 tiIQ p�_
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO K
IS PROPERTY W ITIIIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW jQ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER
USE OF STRUCTURE(Awdence,Crarnge,c..eclal Bldg,Etc.)
IS USE: PRIMARY K SEASONAL❑ NUMBER OF BEDROOMS Z- NUMBER OF BATHROOMS T
HEATED STRUCTURE? YES(WholeBldg),X YES(Part[sJofBidg)❑ NO❑
DESCRIBE WORK j I OU4 I rj neW_t1nf6
S ARE FOOTAGE;(propase+exiRtrrg)
1ST FLOOR_ sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.& STORAGE sq,ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
ry `
MAKE Y 4 1//�5 T 0 MODEL 2 LF 3 P/ � � YEAR, ��/ � LENGTH ..3�
WIDTH 0 �2.`i BEDROOMS Z BATHS / SERIAL NUMBER
ENVIfs OWENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC❑ SEWERg NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES 1' NO❑ If yes,attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES❑ NO191 EXISTING SQ.FT.
EXISTING BEDROOMS Z PROPOSED BEDROOMS_ TOTAL BEDROOMS—._ —
OWNER acknowledges that 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 and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and stnxture(s)for review and Inspection. This permit/application becomes null&void If work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION, INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08A2)
Signature of OWNER(Must be signed by thg OWNER) Date
DEPARTN ENTAL REVIEW APPROVED DATE, DENIED DATE TAGS/NOTES/CONDTPIONS
BUILDING DEPARTMENT j6 7
PLANNING DEPARTMENT
HAL
PUBLIC HEALTH