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(n Q W � A Zy w O (n iv 3 -gyp -� n O O Q m — v (oi� p' CCDD C G _0 CD v (D �CO CO M Q- 0 rt sll m ° 0 0 CD 0 0 Cn D 3 < CD 0 v < (D -o v - (D �. cD :D o 0 SD m • 0 NJ f / / q $ = cE / CL/ \ 7 / \ ° ° e cn / 2 = a C \ Z D 0 \ cr CD 7 \ } z / \ 7 \ :g © & ° ® § CD \ ] \/ \ = o e / 2L < 0 I _. o > o & a §§ 2 k / k 7 7 0 o k \ j \ m ¥ § 2 E / \ \ \ / m n = a 0 k f n e \ \ \ CD CD kE & _ Z \ / 2 y o g _0 / 7 ƒ / _ 0 / 9 E a n 2 / t § a / / ( J 7 ? \ § ƒ 7 /n (D } ~ \ ea / / \ = / \ oX Ae ƒ k @\ \ \ # D \ \ a a d ƒ / 9 \ � m J PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLI¢ATION Z� 426 W.Cedar/P.O.Box 186,Shelton,WA �584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5 9 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACT INFORMATION Owner To6bi -t f N ,0 i Contractor Na' a -TN Mailing Address , 1',STIJ Mailing Addre LJ-7!4 f:j t .LNErt. 5 4; City i..k k ra State cam_,,,. Zip Code g So S6 City ►- State i a Zip Code �8 "7 Phone( 36 0) 3S" 7-:D?eOther Ph.( Ph.(3LO ) 3-9 12 Other Ph.( ) Lien/Title Holder Contractor Re' . # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System ell Water System Name of Water System 7 PARCEL INFORMATION-12 digit Tax Parcel No. / a / Fire District Legal Description - , I .- Site Address(Please include street name, street number and city) I-u .S ,&/ Directions to site ; O iet,. 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 Run Dff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Other Use 6 Building Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st F dor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year i Length Width Serial No. No. of edrooms No. of Bathrooms :a,' Type of Heat i Purchase Price $ eplacement Unit ?(Yes/No) Installer Name Certification NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHOR14ED 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' 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 t to 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 reg I ting 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 co formance therewith. No changes shall be made without approval. first obtaining ap r val. X Date X Date )/--2 P-01 FOR OFFICIAL USE BEYOND THIS POINT AA Accepted by �.� Date � Submittal Amount I 5�e Receipt No. ,el ' .. ...... ... ........ . ......... .... ........ ........ . ........ .... _ DEPARTMENTAL REVIEW APPRov>_D DEN1f» CDN©IT1+0N CODES _Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $Ua\6t FEES 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 ( `j b ) TOTAL FEES MASON COUNTY PROJECT SITq INFORMATION Case No. Namejo� t77t .Tl. I' 1104011 47RCEL NUMBER .200 5 00(X)-S1 Date /f ^ 2 g 01 SHOW THE FOLLOWING ON SITE PLAN Show Direct! n 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 4thin 100 feet of adjacent property line. adjacent property lined I I <-adjacent property line A PROVED q44 MASON BUILDING INSPECTOR I CHANG S SUBJECT TO AP, r DATE kS 1 I V I THESE FLANS MUST BE ON THE JOB $ITE ' FOf INSPECTIQN. I OHANG5S I I I SUBMIT CHANGES FOR A�PROVAL' I y PRI04 TO PERFORMING WORK I c�01 I Hawk J ` adjacent pro pert line M 8b MUST MEET ALL Ct�R ENT daMnt property line t i So iKo 1Ci. ST SAMPLE SITE PLAN adja t property line- azo' I f-adjac;Gennst.tprop erty line 36 , r tvg TLL J. j P aPG 1 I I VAGn,TMAC.& 3 I� I D0.cPosCO 50' A6R LCLLLTuy(i,AL � I I I 8 0" I \ I ' /00 I L—e-LL I � I I / Z10 adjacent property lined 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 JOPOGRAPHY PROFILE diSfi�MGm to ru.Lt'IiY� dra�t�r,cG to Slops -to dis+an�m 43 Jam` Il Z � - ol Signature Date CONCRETE MECHANICAL MOBILE HOME ~ Footings-Setback date by Ribbons date by Gas Piping date ! O OZ b Foundation Walls date b Set Up date by INSULATION date by FloorsBG/SLAB Insulation Floors dat;�2 by date by date by FIRE DEPT. FRAMING Walls date by date by date by OTHER PLUMBING Attic Groundwork date by date b WALLBOARD NAILING D.W.V. date by date by FINAL Line NAL INSPECTION date by date by date Y Flo ..' f�c/'e"L�-ids/,G�' -i•tr �� �'��� �' /'r/`S ��i vt :giffii 5:- k4l, S i 4bx39P s a �P O� s 0 0 3 26'8' o � m � U, - 0 tA N00 o � w La Mm cb abs fill Mftft 99M"^ EbL Ra* 5. ` o O r- ja i W N 4bx58V Building Permit # r MASON COUNT - J( BUILDING 111 426 W. FDAR SHELTON, WASHINGTO1 98584 (360) 427-9670 CORRECTION NOTICE Job Location /S-c;; � � f � flbo k��- This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Ite s Listed below must be corrected to gain Z e compliance y2 j i/s� ' %/�7�+v � _ ssSzL_/�✓r' k°)i � c�' i''/ �b it`s'/�,J �. �Sfi�A i/ SEf+r Lela 117AX 3 �Hf l IA 2- sae e0aelZ 7Z X r 010e 6 You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURT ER WORK ❑ Call for re-inspection when corrections are made before contin jing ❑ Make corrections, items will be checked on next inspection ❑ OK to ,j,eiIz r 11®/ e-- --// ❑ This is not a complete inspection Department Date 'c Inspector U 5: DO NOT REMOV011THIS TAG Indra Michalovskis Trust Ilze I I ohseni (Trustee) 940E Woodington Or �� 17 Pototbac, MD 20854 ohseni(a�g_mail,com f 301406-4460 March 11, 2015 Mason County Treasurer 426 -West Cedar Shelton,WA 98584 RE: BLD2001 - 01236; Final Inspection; 1150 W Kok St, Shelton WA 98584 Per my conversation today with Arian, I have enclosed check for$73.00 to cover the cost of the Final Inspection for the above-named property. It would be of great help if you would be able to complete the inspection as soon as possible. We are in the process of selling this property and have scheduled to close on March 31 of this year. Please email to me when you have finished with the ap ropriate documentation so that we can provide it to Mason County Title,the closing agents for the sale of this property. Thank You, 1 Ilze Mohseni (Trustee) Indra Michalovskis Trust %% S ATFo� MASON COUNTY �N Department of Co munity Development o N i Planning Division, P O x 279, Shelton,WA 98684 r (360) 7-9670 Z� N Y Y OJ �O 1864 NOTIFICATION OF AQUIFER RECHARGE AREA December 12, 2001 JOHN MICKALOVSKIS 1020 E JOHNS PRAIRIE RD SHELTON WA 98584 Case No.: BLD2001-01236 Parcel No.: 420085000039 Proiect Description: MANUFACTURED HOME 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 Department. This copy is required prior to the issuance of the Building Permit(s). A form has been attached for your convenience. Please complete, sign, record and return the form to this office as soon as possible to avoid delays in the processing of your permit. Please be prepared to pay $8.00 for the first page and $1.00 for each additional page at the time of recording. Also included for your rrral is the Critical Aquifer Recharge Areas section of the Mason County Resource Ordinan Please contact me at (360) 427-9670, ext. 577 if you have questions. Sincerely, v Rick Mraz Land Use Planner Mason County Planning Department