HomeMy WebLinkAboutBLD2004-00047 SFR - BLD Application - 1/20/2004 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 ai i of , ,tv u t Lc C/0n.. Contractor Name UW Mav
Mailing Address 6o c S nmo ,.. ,moo,. Mailing Address
City. _(_ 1",J State let&Zip Code City State Zip Code
Phone (2bo ),ASS. Wk-00ther Ph. Phone ( ) Other Ph. ( )
Lien /Title Holder Contractor Reg. # Exp. /
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 /-7'%_/ 000:10 Fire District
Legal Description 'TR rJq�. ^+ -7 i 4 0 �� . ,�r
Site Address (Please include street name, treet number and city) 6uJah h6 l (,,,tl A _ 11,./
Directions to site �-
Will timber be cut an sold in parcel preparation? (Ye
Is property located within 200' of saltwater Lake River/Creek_ L Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
PERMANENT RESIDENCE 19 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 - 1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make C6,L, Model 4A7u AS- Model Year 2oo-1
Length '1 U Width L_, Serial No. 'TSL No. of Bedrooms K No. of Bathrooms -`
Type of Heat r'I.a,_ Purchase Price $ 5?,? -7 Replacement Unit? (Yes/l
Installer Name yi ue- =:,jC Certification No. tj, A, A C.��'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 ACCU TE AND GRANTS
EMPLOYEES OF Mason COUNTY ACCESS TO THE ABOVE DESCRIBED PROPERTY AND STRUCTURE IEW AND
INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INF�il=' yRESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY A RE
OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certifi t I am c�i ryregis-
ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washin at I am aware
of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the wo hich this
that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformancg4ere-
shall be made without first obtaining approval. with. No changes shall be made without first obtaining approval.
X DateJ_�4 Cl X Date
FOR OFFICIAL USE BEYOND THIS POINT
r-�
Accepted by Planning Pd " Ck#
Date --� �)- 0 Bld Pd. �1 1 Reciept No. 31')! ))4- L)J mot
DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES
Building De �rtment <.� �
tJ
Occ Group, Type Constr.
Planning Department
Environmental Health Department I(
Public Works Department
Fire Marshal
Valuation $
FEES
Building Permit Fee l _ Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planning Review Fee /;/�
Mechanical&Base Fee Other V l
Wood/Gas/Pellet Stove Fee State Fee
dq
Violation Fee Pre-Paid at Submittal ( ( V"
TOTAL FEES
Cindy
Jan. 271h9 2004
In reference to the building permit for Greg and otene Lacombe. Lot 3
of Goldsborough Estates. Building permit numbe Bld# 2004-00047.
Attached is a copy of the title report with the ease s you r nested.
There will be another building permit coming ac o s o esk in the
next couple of weeks for Richard Olsen for t 2 f ldsborough. You
might want to keep a copy of this ha
If you need further information or.h tions, feel free to cal me at
427-6667 at work or on my 1 41 0AjT-,,, .2 K
Thanks
5
�x
dy
Jack Smith
41 9tb
purchase by virtue of a contracturai conaiuon requnuiy Litt;-1--, . caus- - _
e)to represent the insured as to those stated causes of action
Gf marketable title. caus
and shall not be liable for and will not pay the fees of any other
This policy is valid only if Schedule B is attached
MASON COUNTY TITLE INSURANCE COMPANY
Schedule A
Policy No.77337
Date of Policy:October 30, 1998 at 4:56 p.m.
Policy of Title Insurance
Policy Amount:$55,000.00
Premium:M.00
I. Name of Insured:
GOLDSBOROUGH ESTATES,L.L.C.
2. Title to the Estate,Uen or interest insured by this policy is vested in:
THE NAMED INSURED.
3. Estate,lien or interest insured:
FEE SIMPLE ESTATE
4. The land referred to in this policy is located in the County of Mason
State of Washington and described as follows:
SEE EXHIBIT"A"ATTACHED
I
I
POLICY FOR TITLE INSURANCE
EXHIBIT "A"
IN MASON COUNTY, WASHINGTON
Order No. 77337
All that portion of the Northeast quarter (NE 1/4) of the Northwest quarter (NW
1/4) of Section seventeen (17) , Township twenty (20) North, Range four (4) West,
W.M. , lying Northerly of the Northerly right-of-way line of the Simpson Timber
Company's railroad main line, as described in Volume H of Deeds, page 535;
excepting therefrom road rights-of-way.
Parcel No. 42017 21 00000.
TOGETHER WITH an easement for ingress, egress and utilities, 40 feet in width, as
described in instrument recorded August 18, 1998, Auditor's File No. 673194.
TOGETHER WITH a perpetual , non-exclusive easement for road, utility and drainage
purposes, 40 feet in width, as described in instrument recorded October 30, 1998,
Auditor's File No. 677926.
Schedule B
No.77337
DEFECTS,LIENS,ENCUMBRANCES AND OTHER MATTERS AGAINST WHICH THE COMPANY DOES NOT INSURE:
In addition to the paragraphs numbered 1 to 4 inclusive set forth on the inside cover sheet of this policy under the heading
Schedule of Exclusions From Coverage,you are not insured against loss,costs,attorney's fees and expenses resulting from:
STANDARD EXCEPTIONS:
(1) Encroachments or questions of location, boundary and area,
which an accurate survey may disclose.
(2) Public or private easements, streets, roads, alleys or
highways, unless disclosed of record by recorded plat or
conveyance, or decree of a court record.
(3) Rights or claims of persons in possession, or claiming to be
in possession, not disclosed by the public records.
(4) Material or labor liens, or liens under the Workmen's
Compensation Act not disclosed by the public records.
(5) Water right or matters relating thereto.
(6) Any service, installation or construction charges for sewer,
water, electricity, or garbage removal .
(7) Exceptions and reservations in United States Patents.
(8) Right of use, control or regulation by the United States of
America, in the exercise of powers over navigation.
(9) Any prohibition or limitation on the use, occupancy or
improvement of the land resulting from the rigpts of the
public or riparian owners to use any waters which may cover
the land.
(10) General taxes not now payable relating to special assessments
and special levies, if any, preceding the same becoming a
lien.
(11) Indian Treaty or aboriginal rights, Indian tribal codes or
regulations, including, but not limited to, fishing,
harvesting of shellfish, commerce or navigation, including
easements or equitable servitudes.
Schedule B
No.77337
SPECIAL EXCEPTIONS:
1. 1998 Real Estate Taxes paid in full ; original amount: $134. 18.
Parcel No. 42017 21 00000
OPEN SPACE TAXATION AGREEMENT.
Between: Donna Coleman
And: Mason County, Washington
Property classified as Farm and Agricultural or Timberland.
Agreement for at least 10 years; any change during ten year period
shall be considered breach of Agreement, and subject to applicable
taxes, penalties and interest as provided in RCW 84.34.108 for
Removal of Designation and exemption from penalties.
2. UTILITY EASEMENT.
To: P.U.D. No. 3 of Mason County, Washington, and
Pacific Northwest Bell .
Recorded: June 26, 1964.
Auditor's File No. 205185
Granting right to construct, operate and maintain a power and/or
communications line, including �
ri ht to remove any trees and/or
brush which may interfere with said operation, with the right of
ingress for said ur oses.
p P
3. Subject to the terms and conditions set forth in "Easement
Agreement" recorded August 18, 1998, Auditor's File No. 673194.
Includes maintenance provisions. Refer to instrument for a more
particular statement.
4. Subject to the terms and conditions set forth in "Easement
Agreement" recorded October 30, 1998, Auditor's File No. 677926.
Refer to instrument for a more particular statement of same.
5. DEED OF TRUST. Subject to the covenants and agreements set forth
herein an terms of note of even date.
Grantor: Goldsborough Estates, L.L.C.
Trustee: Mason County Title Insurance Company, a
corporation
Beneficiary: Westlands Resources Corp. , a Washington
corporation
Dated: October 29, 1998.
Recorded: October 30, 1998.
Auditor's File No. 677922
Secures the payment of $44,000.00, plus interest.
Provisions in said Deed of Trust stipulate that the entire balance
shall be due and payable on or before October 30, 2003, as well as
other financial conditions.
6. None.
"End of Schedule B"
�I
�I
I
i
I
I
I
i
II
MEMO TO BE KEF'T IN THLE
To: Bob PARCEL FILE
From:Michael (toS
Date: 3/15/02
Re: Goldsborough Estates
Last week we talked about the wetland study originally done for the
Goldsborogh Estates. All I had was a hand drawn map. I've talked to The
Coot Company and they confirmed that no written report was commissioned
for this project, although extensive field work was done, and the map is
based on that data. The person at Coot admitted that is was not common to
not write the report, but they were not paid for it, so they didn't write it. The
question is: can we accept the map as good enough, our do we need to insist
on the written documentation?
Also, unfortunately I have only today realized that I was supposed to have
contacted the Shelton School District on this project. I am doing that now
and hope that their review can go quickly as we are nearly done with this.
C>
� I 4L a �3 C--k A�:> fCY 7
`- o a1 o-1% G%L o-y9 )a SOU C-i
y
Lut
CED
CE
- RE�E1v ED
2 + .
DCsF rOF UE TL.4ND --------------
d
I
cph
h
74
r
277 / �'r1s1 5'U77IL
�C2S259 _ R4/1�G
�cs2 2s \
� O �? / C N �79 1J787
W
J
//n�f `/ "f.. - _.... s .ait..�:.�'�E<%LS:^13se..: .. .i1...r..... .. ..�•. ...tr.. .5.'!a• 2>- n+,ac}.Fr... i.�-:._. � �; - - ..�.... . ., .� - .-y._•r,-.rY�.•.r .S1T:Jti.T- •.y'r"s"H�r' ;. r r
mow
'Y i-.r.d - ;l.' .`Cj.'> .ti!! �">.-'s.. � •� �r ` s�1�{.a asOr .v- try__ _�
rU yE -b S ! b''•�l �� -
f
0 � .
IVLA
�j k;�reN
Nook) f Flo,sJ of PIS .
40
jC CA
woolo
ep
f"u Gtcc css } M
T� BE KEPT IN TF�L
PARCEL FILE
ut/ !� e "sue" r�..r,;.+.�` r>� '�� .� • -{
/( r lr
R: IN ,
•• Ciro �/ �
Gam, a
,�, � _ Z • . . : �