HomeMy WebLinkAboutBLD2009-00502 Replace SFR, Final - BLD Permit / Conditions - 3/30/2010 Line
360)427- 262
ection
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phonpe: (360)427(9670,ext7352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
IP10 Shelton,WA 98584
RESIDENTIAL BUILDING PERMIT BLD2009-00502
OWNER: CAROL ROBINSON RECEIVED: 6/17/2009
CONTRACTOR: GR WILSON &ASSOCIATES INC (360) 275-9045 LICENSE: GRWILA1011QQ EXP: ISSUED: 7/22/2009
SITE ADDRESS: 100 E NORTH BAY PL ALLYN EXPIRES: 1/22/2010
PARCEL NUMBER: 122205400072
LEGAL DESCRIPTION: LAGE 5 TR 72
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
Existing dwelling taken down to subfloor+ 161 sf addtn plus covered entry Lakeland Villiage
and back porch
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R3U Lot Size: Deck: 170
Type of Work: ADD Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building:2,650 Garage-Attached 492
Valuation: I Building Height: Occ. Status: Primary Basement: cov porch 170
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: W 60.0 Ft. Shoreline: Ft. Water Body:
Rear: E 22.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: N 3.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: S 5.0 Ft. Comp. Plan Desig.: Urban Growth Area
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee KKK 6/17/2009 $1,060.90 S22009000
Hosebibs 1 Fireplace 1 EH Plan Review KKK 6/17/2009 $103.00 S22009000
Kitchen Sink 2 Gas Outlets 5 Planning Review Fee KKK 6/17/2009 $205.00 S22009000
Laundry Tray 1 Propane Tank 1 Building State Fee DLC 7/8/2009 $4.50 512009000
Lavatories 4 Ventilation Fan 3 Building Permit Fee DLC 7/8/2009 $1,632.15 slzbbsbbo
Showers 2 Heat Pump Mechanical Base Fee DLC 7/8/2009 $28.50 512009000
Water Closets (Toilets) 3 Dryer Vent 1 Plumbing Permit Fee DLC 7/8/2009 $145.40 S12009000
Mechanical Permit Fee DLC 7/8/2009 $201.40 S12009000
Water Heaters Plumbing Base Fee DLC 7/8/2009 $24.70 S12009000
Bath Tubs 2 -------- -
Clothes Washer 1 Total $3,405.55
BLD2009-00502 Please referto the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2009-00502
CONDITIONS FOR
BLD2009-00502
1) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Department r�further inspections being performed or approvals granted.
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2) Owner/Agen V'ble to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
3) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
X removal of appr _ d 1J nts will result in failure of required building inspections.
4) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved"site plan is not on site, then
approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Building Depart en_tKior any further inspections being performed or approvals granted.
X
5) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Existing Heat pump with Electric forced air furnace, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max
U-Factor):0.58, Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see
exception), Slab Insulation R-10.
Exception: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the
undersidenyp, f e�hing is less than 12-inches and there is 1-inch vented airspace above the insulation.
6) Per 2003 IRC -SECTION 1609 -WIND LOADS- 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BASIC SEED,(3-SECOND GUST) the wind speed for Mason County is 85 MPH.
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BLD2009-00502 Please referto the following pages for conditions of this permit. 2 of 5
7) Per IRC - SECTION R905- REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
accordanc a plicable provisions of this section and the manufacturer's installation instructions.
X
8) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan"constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system
of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contractor is ack la that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X T_
9) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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10) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charged and n
le ted by the Building Department prior to any further inspections being performed or approvals granted.
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I-, -
11) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocation.
X
12) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the
stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be loca within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your project.
X
13) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or reg do u t be reviewed and approved by Mason County prior to construction.
X
BLD2009-00502 Please referto the following pages for conditions of this permit. 3 of 5
14) . CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector sh prior to requesting additional inspections.
X
15) All property lines shall be clearly identified at the time of foundation inspection. X
16) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason Cour�typrdres and building regulations.
X )) JJ
17) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action for a perlpd not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder have p niiadao ion from being taken. No more than one extension may be granted.
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18) Contact Utilities before disabling the sewage pumping system for instructions.
X
19) Approved p f di nsi ns and setbacks for modified footprint on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
20) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647 098 V he�son signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X 4,
21) Prior to final approval, all upland areas disturbed or ne c to by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
22) All construction and demolition debris must be removed from the site after project completion. Proper mIV construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters. X
23) Temporary erosion control measures must be implemented to prevent water quality de gr do nd rosion of adjacent properties. Silt fencing must be
installed and maintained until upland vegetation has become established. X
BLD2009-00502 Please referto the following pages for conditions of this permit. 4 of 5
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at anytime after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described property an ructur for revie and' spection. ,,llQ
OWN ER OR AGENT: DATE: Z2 V 1
BLD2009-00502 Please referto the following pages for conditions of this permit. 5 of 5
o CONCRETE MECHANICAL MANUFACTURED HOME 0
o Date 2 - 7—09 By W
C1 Footings/Setbacks Gas Piping 11 Ribbons Z
oInterior Date By Interior-Date /2'7'D`1 ByC✓ Date By _.^
o O Exterior Date By Exterior-Date B Set-up Z
INSULATION
Point Load I Isolated Footings Date By 0
BG I SLAB INSULATION --~ -- D
Date By Data By FIRE DEPARTMENT 0
Foundation Walls Floors Date By
r
Date _ p By f Data By DECKS v.
FRAMING Walls Date By
Date By Data /2 -�- By �✓ PROPANE TANKS
PLUMBING vault Date By
Date By OTHER
Groundwork Attic y2 t
Type..
Date By Date /Z- 7 — By
Oate By
o wv DRYWALL Type_
Date /r— 2 5_ Int.Brace Wall—07 BY L `� Date By
Date B W
y FINAL INSPECTION 0
ni Water Line Fin Separation
Date By Date By Date By C1
Pass or Request Inspect. c
s Type of Insp. Fail Date Date Done By Comments c
s
dT i✓G- /}Ss 8..2So�
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Untitled Page Page 1 of 2
General/Specialty Contractor
A business registered as a construction contractor with LEtl to perform construction work
within the scope of its specialty. A General or Specialty construction Contractor must
maintain a surety bond or assignment of account and carry general liability insurance.
Business and Licensing Information
Name G R WILSON Et ASSOCIATES UBI No. 601741567
INC
Phone 3602753852 Status ACTIVE
Address P 0 BOX 1499 Licens QQ
License Type CONSTRUCTION
Suite/Apt. CONTRACTOR
City ALLYN Effective Date 11/18/1999
State WA Expiration 11/13/2009
Date
Zip 985241499 Suspend Date
County MASON Specialty 1 GENERAL
Business Type Corporation Specialty 2 UNUSED
Parent
Company
Business Owner Information
Name Role Effective Date Expiration Date
NW ADMINISTRATIVE SERVICE CO AGENT 11/18/1999
WILSON, GARRY R PRESIDENT 11/18/1999
WILSON, DIANE L VICE PRESIDENT 11/18/1999
Bond Information
Bond Bond Effective Expiration Cancel Impaired Bond Received
Bond Company Account Date Date Date Date Amount Date
Name Number
2 CBIC SC4634 11/12/2001 Until
Cancelled $12,000.00 11/26/2001
1 JCBIC SC4634 11/12/1999 11/12/2001 $6,000.00
Insurance Information
https://fortress.wa.gov/lni/bbip/Detail.aspx 7/22/2009
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION �����
426 W. Cedar• P.O. Box 186, Shelton, WA 98584 'y
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICA T INFORMATI N CONTRACTOR INFORMATION
Owner /40qU Company Name ,'e ! �µ
Mailin A dress o
Mailing Address P10 x
City State Zip C de City State LV1 Zip Code `' 24
Phone a 2 Other Ph. 60 7 r. Ot Sy Phone Other Ph;Cam, ,/ /
Lien/Title Holder Contractor Reg. L is OQ Exp. /t i3 a
E mail address E Mail Address�c�� * w
Drivers Lic.# 0 30 � DOB :� "f Drivers Lic. # DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic,;,. ing Septic
Connect to Water System o Name of Water System—
Well- s + �� s
Sewer System ✓ Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. �• Fire District
Legal Description 0%W
Site Address (Please i clude street name, street u ber and city) D D d Al A
Directions to site el on
f f. r U
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - ew _Add Alt Repair then PRIMAR RF�SIDENCE ❑ SEASONAL ❑
Use of Building ��T escrib ork
No. of Bedroom No. of Bathroom uare Footage- 1st Floo 2nd Floor
3rd Floor Basement De Covered Deck Other Sq. ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price$ 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 contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. 1 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 grants 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 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 IS BY
MEANS OFA PRPCG>RESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X LJ, f"7�++ '' /,y-rl,�i�,J Date: & • 1 7 , 01
Owner/Owne s Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: t Date
DEPARTMENTAL REVIEW APJAROVED DENIED OTES
Building Department -of)
Planning Department /
Environmental Health Department 1 v
Fire Marshal
FEES
Building Permit Fee l Site inspection
Plan Review Fee liU. f� EH Review Fee
Plumbing & Base Fee S.440 f a Planning Review Fee
Mechanical & Base fee 1/�X - Other
Wood /Gas/ Pellet S ove Fee State Fee
Violation Fee /� �`�C.C� Pre-Paid at Submittal
Valuation
le9�• } 0 x o,a TA FEES
MASON COUNTY PERMIT N0. W 50c)--,
PLUMBING/MECHANICAL 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 Company Name L
y
Mailing Address Mailing Address 1.2
City State Zip Code City State Zip Code `
Phone Other Ph. Phone Other Ph.
Lien/Title Holder -- — Contractor Reg. # A' -716A is° Exp.
E mail address E Mail Address�40 r }�
Drivers Lic.# DOB Drivers Lic.#_ DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description_=,- •- -4,r
Site Address (Please include street name, street number and cit ) +
Directions to site 1" 4 4-
dG�.
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 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 o. of Fixtures Fees Fuel Type.-Electric LPC�_ Natural Gas Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps 1-��►
Showers �' Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/PelletStove
—
Dishwasher i Kitchen Exhaust Hood
Hosebibs I Dryer Vent
Other 4
Other
Tr Base Fee Base Fee
Q TOTAL PLUMBING TOTAL MECHANICAL
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 contractor.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 information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X -1�-ram• I i 1 L"j it./a 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
MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
Environmental Health - - � Personal Health
PO BOX 1666 SHELTON, WA 98584
LOCAL(360)427-9670
BELFAIR (360) 275-4467
Application for Determination of Adequacy FAX(360)427-7798
Instructions
1. Complete Part 1. No determination can be made until Part 1 is fully completed.
2. Complete only the portion of Part 2 applying to the type of water system utilized.
3. Submit completed application, with attachments to the health department for review.
PART 1: Applicant/Parcel Identification
Name of Applicant cc►C'! k4r-_5't,0-1 Date f 7/0?
Mailing Address Pc &x 967 f���y�' 9��"2¢ TelephoneZ.S? - 50 95 73
Assessor's Parcel Number -514 --O 6(_)1. �
Type of Water System (Check One): Reason for Application Check One):
❑ Public/Community Water System(2 or more ❑ Building permit
connections)** ❑ Land use application, if so..
❑ Individual water source(one connection), ❑ Division of land:
if so..
Well #of Parcels? _ SPL__-
Spring/surface water ❑ Boundary line adjustment
u Other(explain) ❑ Other(explain)
**If you have more than one residence ❑ Replacement(please indicate name of water system
connected to this well,check the Public box. below if applicable—no signature required)
PART 2: Water System Information
Complete the section appropriate for the type of water system being evaluated.-
Public Water System
Name of Water System a
Water Facility Inventory (WFI) Number:
(write "none" for two party)
❑ I am the manager of this water system.The water system has been approved for services.
There are presently connection(s)in use.This will be the connection.
I am the manager of this system.This connection will be to upgrade or change the use of an
existing connection on this system(ie:recreational to full time. Please indicate on the following
line the nature of this change: kja/ o Cr_�
This water system is able and willing to provide water to this(these)connection(s)without
exceeding the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager ate
Lltor-
Update:Apnl 2006
Page(6/2912009)Amanda Reynolds - 100 North Bay PL. 1
From: Tom Moore
To: Amanda Reynolds
Date: 6/26/2009 5:06 PM
Subject: 100 North Bay PL.
Amanda,
There is a grinder pump control box on the outside of the house that needs to be removed and protected.
The sewer line needs to be protected and prevent rocks and dirt from entering the grinder pump
chamber. Please have them contact me before starting and I will tell them the best way to protect the
sewer facilities during construction.
Have a nice weekend
Tom
. a RECEIVED
r' JUN 17 2009
MASON COUNTY
North Bay Place
pQ �
L S)
' �a • � PLANNING
Ilks♦ \ 49.E Q.!
PLANNING:
k71 �;, ALL SETBACKS ARE MEASURED
/* FROM THE FURTHEST
w'sc�.FT.ADDITION ST
PROJECTION OF THE BUILDING_ rlb ��
EXISTPYs DRIVEWAT
APPROVED
-MODIFY ASIMQV. [�_ FT.ADD1r1ON MASON COUNTY DCD PLANNING
�' I ee'-16/8• �`� �;� SITE PLAN REQUIRED TO BE ON SITE
CHAN ES S BJECT TO APPROVAL
By Date (�
n I EXISTING HEAT PUMP
TO REHAM
MI I 81 SQ FT.ADDITION
al I I
Lu
z
I / I
I / I C9
zz g
Z
I------------------------------ — \\ `� I NN!2
THIS PORfICN OF
HOUSE REMOVED
NEW FMM�ILT RESIDENCE
ON EXISTING FOUNDATION
I
W'-1 3A6• 56'-1'iW
51'-4 L3/16•
PARCEL NO.:
12220-54-00012
LEGAL DESCRIPTION:
LAKELAND VILLAGE 5 PCL 2 OF to Plan � ..
BLA 001-40 REV I
SITE ADDfRESS:
100 E NORTW BAY PL. NORTH
ALLYN, WA 98524 NORT14