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O'CD (oco c y w C) N N o CONCRETE MECHANICAL ate 146 � L MANUFACTURE HOME � 0 Footings I Setbacks PIpI Ribbons. G) o Intenof Date By Interior-Date By Date By m j Exter Date By Exterior-Dote B Set-up — Point Wad t Isolated Footings INS ULATi QN Date By r BG 1 SLAB INSULATION Date By Date By FIRE DEPARTMENT in Foundation Walls Floors _ gate By —I Data By beta By DECKS FRAMING Walls � Dale. By Dt6 /gj0q' BYLOL— Date 1�'��I �` k Date PROPANE TANKS PLUMBING Vault Date By Date (,� j&j j0& By L, OTHERGroundwork Attic Gate By Type Cate By .,.. Date By, 0M V DRYWALL Type_ ',�/� InL Brace Wall Date By W Date t o r6 .02 B y I/'�-'" Date B r FINAL INSPECT[ 0 m Water Line Fire Seperation iV Date By Dated By ( p � Date4 � By Date �k � 90 Passi,or Request Inspect. c 3 Type of Insp. Faiilf Dante Date Done By Comme is y 1 -71n1W 6Sloq� C.QY- 0 :3 i o 8 l" (c..1 ill SS f% [d G� l.✓a� Q5 0 0 MASON COUNTY PERMIT NO. BUILDING PERMIT APP 11ICATION 426 W. Cedar- P.O. Box 186, Shelto WA 98584 Shelton (360) 427-9670 - Belfair (360) 275-446 • Elma (360) 482-5269 -ArA ry On the web vmmco.mason. a.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name R*- ir00"La Mailing Address - Mailing Address I11II � i-' City State Zip Code City State ip Code Phone Other Ph. Phone_ LA Othe Ph. Lien/Title Holder Contractor g. I A 'kQ Exp. E mail address E Mail Add s �� Drivers Lic. # DOB Drivers Lic. DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. '` 70 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 within 200 of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 151/o Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE: ❑ SEASONAL ❑ Use of Building Describe Work No. of Bedroom.-, No. of Bathrooms Square Footage- 1 st Floor 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 permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative,or the con rector. I further declare that I am entitled to receive this permit and to do the work as proposed in the application I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the informaticn provided is accurate and grant' 'employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null & void if work or au horized construction is not commenced within 180 days or if construction work is suspended for a period of 18 ,days. PROOF OF CONTINU TION OF WORK IS BY MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION O '',180 DAYS WILL INVALIDATE HEAPPLiCATION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Acce ed by: Date DEPARTMENTAL REVIEW APPROV DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee 5,_ Site Inspection Plan Review Fee YO�Z EH Review Fee Plumbing & Base Fee -2-S 9 Plannin eview Fee Mechanical & Base fee �° 29 Other qT Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at, Submittal I 0Q-2_"0,- IValuation $ TOTAL F ES PERMIT NO. MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATIO14 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 V",5. -< d Company Er ' e Mailing Address " o c t fF" Mailing Ads City State I Zip Code"�'6'�'ti City Stt' tate W' Zip Code Phone Other Ph. Phone - `t `r�` Oth r Ph. PlkVC.9 t Lien/Title Holder Contractor g. Exp. E mail address E Mail Addr ss Drivers Lic.# DOB Drivers Lic. DOB SEPTIC INFORMATION - Connect to New Septic Existing Se is Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 1z&1a 300-10 Fire District Legal Description ( c) i' rm -Tm-1 soL '4 Site Address (Please include street name, street number and city) Directions to site e'" s r, ty. Is property within 200'of Saltwater Lake River/ reek Pond Wetland Seasonal Runoff Stream Slopes or B uffs > 15% 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 Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LPCz_ Natural as Heat Pump_ Toilets Type of Unil No. of Units Fees Bathroom Sink Furnace J Bath Tubs Heatpumps Showers Spot Vent Fan �l Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/ olletStove Dishwasher Kitchen Exh st Hood Hosebibs Dryer Vent Other 01c. s 1N Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a st work order or permit revocatic n.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the ontractor.I further declare that am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the p rmission from all the necessa parties.If permission is required from any easement holder or any other party in interest regarding this application o the work proposed in the appli tion,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for revie and inspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X 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 Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES LA-:� LA 1 6 o- A......« v..«^'@w.w..r.....�:.«......:„.„,.. ... .�w.._,.:w+«««.. ^� .�<, ...,�....: F t t .«w�.._.:.ruu. .....ww.._..<.«...�. .......-�4»r...1...«.«,:..� 333333 r t r t «...y,..._...,..>.w..«..ti«.».... ..., .«.,. .P..�:.,. k. rt.:_. er :..,_.....,,m..,�,._. ...:«..dam.«.« ,..A.«. .«....--y..» .«. ...,.. �..w. .:. ....:»._...�_...,....3 { t 1 ,.. m S m_t U: TYi �) ° PIRA IN1 ? P_ I A �Q i IF 1U E3E SIT C iv SU 3JL ip vAL Da a BY --r — t .,...,_. .__. a _. f d 60 ? E I s , «.. ,..Z.��,�,. — C F fo rah ,. _. _.. _.«. _. .. _ _ s _. ._.. . 56 _.tw t M I _ t 1 f ( ' t 1 1 € ; � i I I E �►�5 � i� � ��� TOPOGRAPHY PROFILE: ��R,y, LI G. .-To PLA-7 C < ZOO rc�vrc, Y Zvi Building Permit number: Direction: tca�e t� BukinApprog : for otficeuse ©k_ !�8 1 O g: Owner/Applicant: Date of Planning: Parcel Number: application: En . Health: i Name Parcel#42cc8— 60 BL Mason County EDepartment of Community Development 3 =- Small Parcel Stormwater Management Applic tion/Worksheet (ps ge 1 of 2) Per Mason County Code, Title 14, Chapter 14.48 a stormwater site plan is required whenever a building application is made for residential development, or redevelopment',with more than 2,000 square feet of impervious surface'. 'Redevelopment means,on an already developed site, the creation or addition of impervious surfaces, struc 1 development including construction,installation or expansion of a building or other structure, d/or replacement of impervious surface that is not part of a routine maintenance activity, and land disturbing activities associated with structural or impervious redevelopment. 'Common impervious surfaces include,but are not limited to,rooftops,walkways, patios, driveways, parking I ots or storage areas, concrete or asphalt paving,gravel roads, packed earthen materials,and oiled, macadam or other surfaces whic i similarly impede the natural infiltration of stormwater. Open,uncovered retention/detention facilities shall not be considered as iml ervious surfaces. :::::::i'i::iY:i':::::::i:`i:::::i'''i::::::i::i'':is�:::,H,.isi:::i'iii'i::::::i::::i::::::i`ii'''"::::::::i::i;::::_i'•:iii::.::.:.:i:�ii::::.:::::iiiY.j!i!!;ii:i::ii::i i::=::::i::i::i::: ii::i:::::i:: ::::i::::S4iii i ;:i::::::::::::.....................:::i::i:::: i:.:::.::::::i':•:: :i:.:i::i:::isis•:i:::i:ii::i:i :::i::::::i :::i:i:::::ii: :i :i: .:.,... :.:• '.i: .:.. .: :4::. .:..... .:ry: i.:.' ... .........................................................:::.::: Surface Type Length X Width = Area *All dimension in feet Buildings X _ - X = LO r7 Measurements for buildings are taken at the perimeter of the farthest projections (example: X = eaves/gutters) X = Driveways X = X = Length of drive begins at the right of way X = Parking Areas X = X = A y paved, gravel or packec area per definition above table X = PatiosNllalks X = X = Any paved, gravel or packec area per definition X - above tabl Others X = th rs X = :::>::>::>'::;h:,:: dtat Etlpetir�taus area €ttte preposed site > E.. ,...... X ....= I ........:.;: ram. 5.. .Plan.ls.l�� . .utr€�d..::.. 1.:.::. :........ e al..lm. . furl :: ::<:::::::...... <>:::<:::::>::::::::>:<:>::<:>::::<::::::><:>::>::>::>:::::: :::::;:: :::::: : a..e.Atea..su.m.: f: ll:.ar s........ ......;.:.:;:>::>::::::::>::>::>:::;.:<;:;:.:;:.;:.:;.;;:;.;:;;.;:.:;;;:.;:.;:;:.<:;:.;:.;:..:.;:::.::::.;::..:.::.::.:;:.;;:.;.::;::.:.....:..::.. ..::::::E ..:::::.::..........:.::::::::::::::::.. :t::::::::.::::::..............: ;::::. If the Total Impervious Surface Area is LESS THAN 2000 Square Feel, please read, acknowle ge and sign below. Based Upon the information you have provided a Stormwater Site Plan I NOT required for this development activity. Owner/Builder/Agent Acknowledges that submission of ina urate information y result in a stop work orde or permit revocation. Acknowledgement of such is by signature below. I declar that I am the owner, o er's legal representative,o the contractor. I further acknowledge that the information provided is ac rate and employees of anon County are granted ac ss to the above- described property for review and inspection as m y be quired. X Owner/Agent/Contractor(circle one)Date: If the Total Impervious Surface Area AT R THAN 2000 Square Feet, please read, acknowledge and sign the information provided on page 2 of 2. Page 1 of 2 MASON COUNTY Department of Community Development Planning Division, P O Box 279 Shelton,WA 98584 (360)427-9670 NOTIFICATION OF AQUIFER RECHARGE AREA June 10, 2008 TORI KRUGER-WILLIS 60 E SYCAMORE CT SHELTON WA 98584 Case No.: BLD2008-00676 Parcel No.: 420081490070 Proiect Description: NEW SFR Dear Applicant: The subject property is located within an Aquifer Recharge Area. The owner of any site within a designated Critical Aquifer Recharge Area as identified in the Mason County Critical Aquifer Recharge Areas map, on which a development proposal is, submitted, must record a notice with the Mason County Auditor. Once the Title Notification is recorded with the Mason County Auditor's Office, a copy of the notice is to be submitted to the Mason County Planning Departm nt. This copy is required prior to the issuance of the Building Permit(s). A form h s been attached for your convenience. Please complete, sign, record and retuhn the form to this office as soon as possible to avoid delays in the processing of your permit. Please be prepared to pay $42.00 for the first page and $1.00 for each additional page at the time of recording. Also included for your referral is the Critical Aquifer Recharge Areas section of the Mason County Resource Ordinance. Please contact me at (360) 427-9670, ext. 295 if you have questions. Sincerely, d'awni-, C Tammi Wriaht Land Use Planner Mason County Planning Department I a 1 r;l N Dail 1 I - r �1� .I I //,,: � �/. ,�. I-� �' �� �• _IP az _ s I � 1 / 1 P I/o I L .. ddd I � � I � /J I 1 ., • — I ' I r d A _ I - e i JJ(( eto0np. /` I.ry I Ol3Itl tl. 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