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Home My WebLink AboutBLD98-01092 Mobile Home Final - BLD Permit / Conditions - 4/4/2003 Inspection Line (360)427-7262 MASON COUNTY DEPT. OF COMMUNITY Phone: (360)427-9670, ext. 352 DEVELOPMENT Mason County Bldg. 3 426 W. Cedar P.O. Box 1 86 Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD98-01092 OWNER: LEVY C BOSWELL ��-�yj �(�^ �y.�L RECEIVED: 1 1 /16/199 CONTRACTOR: LICENSE: EXP: ISSUED: 12/7/1998 SITE ADDRESS: 1031 E VICTOR RD BELFAIR ez/ 'aerrn/ EXPIRES: 6/5/1 999 PARCEL NUMBER: 122211490014 LEGAL DESCRIPTION: TR 1 -D OF SE NE TR 4 OF SP #2067 #524846 PROJECT DESCRIPTION: DIRECTIONS TO SITE: MOBILE HOME HWY 3 HWY LEFT ON VICTOR RD FOLLOW ROAD AROUND General Information Construction & Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: ? Type of Use: MH Insp. Area: 4 No. of Bathrooms: 2 Occ. Group: ? Lot Size:O Deck: 0 Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: 0 Building:0 0 Valuation: Building Height: 0 Occ. Status: Basement:0 Manufactured Home Information Setback Information Shoreline & Planning Information Make:FLEETWOO1 Length: 52 Ft. Front: E I 15.0 Ft. Shoreline: 0.0 Ft. Water Body: Rear: W 50.0 Ft. Slope: Ft. SEPA?: No Model:HICKORYHI Width: 25 Ft. Side 1: N 310.0 Ft. Shoreline Desig.: Year:98 Serial No.: ORFLW48AS I Side 2: S 60.0 Ft. Comp. Plan Desi .: Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Final Expired Permit KS 3/20/20( $52.30 58722 MH Submittal Fee KW $175.00 1294 Address Fee KS $5.00 1302 EH Plan Review KS $50.00 1302 RLC Checklist Fee KS $44.00 1 302 Site Inspection KS $42.00 1 302 MH Issuance Fee KS $175.00 1302 Total $543.30 BLD98-01 092 Please refer to the following pages for conditions of this permit. 1 of 3 CASE NOTES FOR BLD98-01092 CONDITIONS FOR BLD98-01092 1) Approved per dimensions and setbacks on submitted site plan. X--------------------- 2) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or wetlands. Silt fencing must be installed and maintained until upland vegetation has become established. X--------------------------- 3) Applicant acknowledges that this residential development and the uses on this property are subject to the policies and regulations of the Mason County Comprehensive Plan and Development Regulations. X-------------------------- 4) Proposed structure or any portion thereof greater than 30" in height from grade line, must maintain a minimum of 5' setback from all property lines, easements and 10' from all County and State Road right of ways. X------------------------- 5) This application is subject to Buffer and Landscaping requirements as established under Mason County Ordinance 1.03.036. X--------------------------------- 6) The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fire Marshal. X--------------------------------- 7) 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 located 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------------------------------------------------ 8) OWNER MUST SHOW PROOF OF SATISFACTORY WATER SAMPLE PRIOR TO TEMPORARY/PERMANENT OCCUPANCY OF THE RESIDENCE. X------------------------------- BLD98-01092 Please refer to the following pages for conditions of this permit. 2 of 3 9) PURSUANT TO 1994 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE, BASED ON RATES IN TABLE 3A OF THE 1994 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS. X------------------------------ 10) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X----__ --------------- 11) The approved plot plan is required to be on-site for inspection purposes. If inspection is called for and plot plan is not on site, Approval WILL NOT be granted. In addition, a Re-Inspection fee in the amount of $42.00 per hour (minimum 1 hour) will be charged and must be collected by this department prior to any further inspections being performed or approval granted. X_ --------------------------- 1 2) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I have received a copy of the General Information and Guidelines-Mobile/Manufactured Housing Installations Handout for detailed descriptions of all required inspections on my mobile/manufactured home installation. I hereby assume all responsibility for the scheduling of these required inspections. If these required inspections are not requested, inspected and signed off(approved) by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the 1994 UBC, Table 3A will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. I further understand that this investigation will be scheduled as time allows. Until resolution of any/all problems no occupancy (Final Inspection) will be granted for the residence. OWNER/CONTRACTOR(indicate which) Signature X------------------------ 13) All mobile/manufactured home landings or decks must be freestanding (self supporting). The largest landing or deck permitted without drawings or a building permit is 120 sq ft or less AND MUST be under 30" in height from surrounding grade. NO second story decks, or decks above 30" can be built without a permit. Any landing or deck that is 30" or more in height from walking surface to finish grade requires a Permit. Any landing or deck that has 4 or more risers requires a handrail. X---------------------------- 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 any time 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. OWNER OR AGENT: ----------------------------------------------- DATE: -------------------- BLD98-01 092 Please refer to the following pages for conditions of this permit. 3 of 3 .:ONCRFTF_' MECHANICAL MOBILE HOME igs-�Sel,ack date by Ribbons Jate ' by Gas Piping date Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date y y `�,3 by FRAMING Walls= � FIRE DEPT. date by date by date y PLUMBING — OTHER Groundwork Attic ate date by d b date — WALLBOARD NAILING date by date by Water Line g` FINAL INSPECTION date by date by date by Ap tj-44 MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 E011 IN5,ftCTIONS CALL 427-9670 BETWEEN Spin AND 8$m 427-.7262 BID98-- 1092 PARCELt122211490014 PLAT - DIV :7 BL�K :7 LOT :? ,.JOB ADDRESS : 1031 F" VICTOR RD BELFAIR OWNER : LEVY BOSWELL 277--3819 PERMIT CONTRACTOR : ROSWELL CONSTRUCTION 360-895-8560 NULL & VOID SY EXPIRATION LEGAL t IN I OF SF Of DATE b 0 _BY IZMl CLASS Of WORK iNFW BEDR ., 3 BAIII - 2 111PE-_ _00011,141 DATE RECEIPT ' "'Pt AM441 tv UA)i Ri(lk tell TYPE Of' USE . smll STORIES _ . . . _ 0 OCCUP , G*ROUP . . . '.7 BLDG . HE I GHI . . , 0 .0f t INSf 175-90 KI 11116198 1244 �NH1L 1 176.011 %S 12107198 11FLfAIR TYPE Of CONST , - %? FIRFPI_ACFS . _ : 0 ADDA t 5.00 KS 12107198 gftfAllt OCCUP . LOAD — 0 WOODSTOVFS . _ 0 f"r,P 1 50.00 KS 1210708 B1'IfA;8 DWFLI,. .UNIT'8 , _ m 0 PARKING SPACES : 0 !Ric t 44.00 KS 12101 BFIFAiR INSPUCTION ARFAi 4 SHORFLINF7 _ . . iN 1 NS? $ 42.00 KS 12117190 BFIfAIR ITOTAt. 441.80 VAIAIATION: Ni SE TBACK S-- TOILFTS _ . . . . . . . ! 0 FUEL TYPES- ,-- BOILERSICOMP----- MOBILE HOME-- F-RONt . . .E 115 .Oft BATH BASINS . . . . . . : 0 0-' HI' . . 0 REAR . . . .W 50 .Oft BATH TUBS . . . . . . . . : 0 3-15 HP . : 0 MODELsFLEETWOOD PIDE ( l ) .N 31010ft SHOWFAS _ . . . I , ' . . ! 0. VURN -, 100K 13TOr 0 15-- 30 HP - ! 0 SIDE (21 ) .S FAO .Oft WATER HEATERS . . . . : 0 TURN 100K BTUi 0 30--50 lip . .. 0 HICKORYHIL SHR L I NE .N O .Oft CI OTHPIS WASHERS . , 1 0 FAIR N - FLOOR . . . - 0 50+ lip t 0 --Y E A 11- AREA - - KITCHEN SINKS . . . . z 0 HEAT PUMP — _ . 0 98 LOT SIZE _ t FLOOR f)RAINS . . . . . i 0 VENT SYSTEMS . ,, . : 0 FVAP COOL ERSt 0 IFINIG-11-it'52 BUILDING . . . t 0,31' DRINKING rOUNT . . , : 0 VENT FANS . . . . . . . 0 HOODS . . . . . . . 4 0 WIDTH . t25 BASEMENT , t Osf LAUNDRY TRAYS _ - t 0 DOMES , INCIN -0 SERIAL# -- DECKS . . . . . .. OST D1314WASHERS . . . . . . 1 0 AIR HANDLING UNITS— COMML . INCIN -0 ORFLW GAR/CARPt7 Ost GARB DISPOSAL".; . . . i 0 < 10000 ofm . " 0 RELOC/REPAIR - 0 ATIDT . t7 URINALS . . . . . . . . . . : 0 > 10000 ofm . ! 0 OTHER UN'ITS . j 0 mlSC PI FIXTURES , 0 (1AS OUTLETS . 1 0 1`160CT DESC11IF1161144811.1 Noff PROJf0 10CATION.-NNY I HWY LFFI 00 VICTOR RD 1`01101 0,01,0 AR'(0110 THIS PfRVII 61CON[S IIIIII AND V4310 If W44K OR t,*0NSTRV0I0N 011,00110 IS VOI (OfflI100 WITHIN I$# OATS, OR If CONSTRUCTION OR WORK IS SUSPfNDIP FOR A PFRIO11 OF 180 DAYS AT ANY TINE AFTER 1Q1W 15 0101108. EVIDENCE ff CONTIPtATION Of 1099, 13 A PROGRESS INSPECTION 1111111 THE IIIII DAY Pf.0100, FINAL INSPECTION NUql BE APPROOD BEFORE BUILDING CAN OF Oct,9FIED. Offif 01 Afif#lt DATE, '811A...F11111, tent 431a,1191 COMPLIANCE TO ATTACHED CONDITIONS IS REOUIRED CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping dateby Foundation Walls date Set Up date by INSULATION date 7- L f f y by BG/SLAB Insulation Floors Final date by date by date by FRAMIN' Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by cl000, MASON COUNTY Mason County Bldg, 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 I-A M I '11' Cl; C>N U') I "T 1 (7) N Case No . s BL.D981092 For . LEVY C 130SWFLI. Pages I I Approved per dimensions and sot backt, on submtt ted r- Ito plat) . X.__ --- - -- 2 ) Temporary erosion control measures must be implemented to prevent water quality d"qradation of adjacent waters or wetlands . Slit fencing must be installed and ma I tita 1 ned unt I I upland vegetation has become established X 3 Appl I oant acknow I edge-, that th I F; res i (lent I a I (love lopmont and the uses on this rop art V afle subject to the policies and regulations of the Mason County Comprehensive mn and Development Requia tions . X 4 ) Proposed struct ure or any port lot) theroof qreate. r than 30, " i ri height from grade line , must maintain a minimum of 5 ' setback from all property lines , easements and 10 ' from all County and State Road right of ways . X 5) This application Is subject to Buffer and Landscaping requirements as established tinder Mason Gounty Ordinance 1 .03 .036 . X 6 ) The use, hand iiiiq and stora e of hazardous matrials or flammable u and combstible liquids Irs exc ess of 10 qaly e orris Is not ii I I nwod w I thout the approva I of the Mason County Fire Mac,*hal . X------- 7 ) Provisions for surface/ subsurface drainage control must be Implemented with new 000struction or development on site and MUST NOT adversely impact adjacent parcels . tinder, the requ I trements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of tho stormwater ordinance or, prior approval will be granted to use an existing utility and drainage easement dedicated for that s ealfic purpose . For fur-ther Information rf-garding Oils ordinance and the REOUIREMEP to obtain an ACCESS PERMIT for the Installation/construction of a driveway or access connoctinrl from a Mason County Road, Contact the Mason County Public Works Department CONCRETE MECHANICAL MOBILE HOME Footings-Setback data by Ribbons date by Gas Piping date b Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date b PLUMBING date by OTHER Y Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 1�,�o TV r ir, ! T on at rx T 4r10 - For ally construction which is, t,opo�,,f�d I ( 1 (�cajprj within 25 ' of tinty all right of way, it Is suggested Vo contact that offl (.-,e to review future planned work which May affect your- 8 ) OWNFR MUST SHOW PROOF' OF SATISFACTORY WATER SAMPI. F PRIOR TO TfM11ORARY/PFRMANE.NJ` OCCUPANCY OF THE RESIDENCE . 9) PURSUANT 10 1994 UNIFORM BUICI)ING CODE ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION As TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING, THE PROPERTY , MASON COUNTY BUILOING DEPARTMENT REOUIRES THAT THIS BE COMPLETED PRIOR TO CALLING rOR ANY SITE INSPECTIONS . A REINSPECTION FEE , BASED ON RATE,13, IN TABLE 3A OF THE 1994 UNfrORM BUILDING CODE Witt BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUEST ING INSPECTIONS . X 10) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDAGTURBFI), NAtIVE soft. . 11 ) Theag)roved p I of 1) 1 all Is requ I red to be on--s I to for i n I Ott urrses . It ills ec ion is called for, and plot plan is not on site , OctUpt")val Mt., NOT be granted , In addition, a go-. Inspection fee in the amount of $42 .00 per iour (minimum I hour ) will be charged and most be collected by this department prior to any fjjt*ther inspections being performed or approval or-anted . X 12 ) REOUIRED INSPECTIONS ( Footing Intipention,-prior to pour , Set-,t1P Ins;)ectI01`1-- P1' I (►r 't(, sk, 1rtIn?,.,t,FlnaI Inspe o ll ctionprior t occuPac)/) . I have received a oo y of the General Intorma ,n and Guidelities--Mobile/k4anutaottired I-lou-sinq Installations riandout for detailed descriptions of all required inspections on my moblle/asanufactured homo Installation . I hereby assume all responsibilitY for the scheduling of these required inspections . If these required inspections are not requested, Inspected and s Igned coff ( approved) by the Inspector in tho prescribed order understand that reinspection fees and an hourly Investlg8tiOn fee pursuant to the i 1 994 OBC, Table 3A will be assessed in addition to my originof permit fot-% to resolve any questionable practices or CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final FRAMING by date by date by Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 pf kib 1 171"s t lid t linvyl 11 z! 1 5713 ,,7,717.71, , i 1 9 1 1.11 Eli U!I U 0 1 ��i t d IT 1 I I,i t 1,�i 1 - t 1 be scheduled as time a I I caws . Until resolution of any/all problems no nocupancy f F 1 na I I nspen't I on ) w I I I be granted for the res i donco? OWNER/CONTRACTOR ( indicate which ) Signature X..----, 13 ) All mobile/manufactured home landir) s r decks must be freestanding ( self supporting) . The larfAest landing or deck permitV o ed without drawings or A building permit Is 1?0 S(4 ft or less AND MOST be tinder, 30" In height from surrounding grade . NO second story decks , or decks above 30" can be built without a permit Any landing or deck that Is 30 or more In height from walking surface to finish grade requires a Permit , Any landing or deck that has 4 or more risers r-equirens a handriii . E EPA ® - A -pCO3Eo £'� n £ � ■ 7 , § § aEa / E } Ei / a A § § § � m E 0 E i , � et z au M t / / § k m - § CD k V. % > A 0 a :1 z z E z 0 F cr £ cr [ § ƒ MCDP(D 2 ■ m \ m 2 ■ m # F 7 (7 � , � r ,► A^^ INSTALLER T WASHINGTON STATE COMMUNITY, TRADE AND INSTALLER CERTIFICATION ECONOMIC DEVELOPMENT NJIMBER SIGNATURE Buildi ig Foundations,for the Future 5'r FOOTINGS SUPPORT PIERS ANCHORS Cie EARTHQUAKE BRACING (if applicable) PLUMBING CONNECTIONS U� SKIRTING DATE OF FINAL INSPECTION INSTALLERS: PLACE NEAR BUILDING PERMIT. FILL IN CERTIFICATION NUMBERS FOR WORK PERFORMED AND SIGN. INSPECTOR: NUMBERS AND SIGNATURES MUST BE ON TAG BEFORE FINAL APPROVAL. DATE AND SIGN. HOMEOWNER: STORE TAG IN HOME AFTER FINAL INSPECTION. Office of Manufactured Housing,800-964-0852 ' July 1998 PERMIT NO.: BLD MASON COUNTY 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 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Z, �y= Mailin ddress Mailin Addresssic, I City. :Mate Zip Code City State Zip Code Phone Other Ph. Ph. Other Ph.f� ) Lien/Title Holder — — Contractor Reg. # Address Expiration_/ n / SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing eptic Connect to Sewer System Name of Sewer Sy em "��W�Sekku ~J _Well Water System Name of Water System S c-\rj PARCEL INFORMATION-12 digit Tax Parcel No.- ''� 1 L / Fire District Legal Description 't O-S� S at-?t Site Address(Please include street name, street number and city) Directions to site v ♦ -C,,'T 't VN 1,0Q,A nri Will timber be cut and sold in parcel preparation? (Yes/No)_� Is your property within 200' of the following: Body of Water (Name) �14 Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt- air iaW r Use of Building Describe Work No. of Bedrooms No. of Bathrooms Q Uj)kRE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Bas nit sq. ft. Garage Attached tached CarportDe Attached Detached MOBILE HOME INFORMATION-Make Mod Model Year 1 Length.-a? Width,4P5" Serial No. yf N , o. f Bedrooms No. of Bathrooms 2 Type of Heat �. Purchase Price $ Replacement Unit ?(Yes/No) Installer Name / 1 i2 Certification No. 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 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'S 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 State 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 regulating 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 conformance therewith. No changes shall be made without approval. first obtaining approval. Date X Date l� FOR OFFICIAL USE BEYOND THIS POINT G Accepted byJALL Date //hZ/?�/ 7 Submittal Amount Due / 5 Receipt No. �Z DEPARTMENTAL.REVIEW AFROVED _E NED A CONDITION CODES Building Department I /1tr tw , � r 5 Type Constr.Occ Groupp Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ �.... FEES ...... . Building Permit Fee Site Inspection Plan Review Fee Fee Plumbing & Base Fee Public orks Review Fee Mechanical & Base Fee Oth Wood/Gas/Pellet Stove Fee OtherA Violation Fee Pre-Paid at Submittal ( ) iiF<:is ii>':My;J:::ii::::Yji>,i:•:;:................. :y}Sy•::?j;:;:'i's�:$::ii::::iiiiiiiiiii?i:>.�i}'r$ ::w,...:,..>..........................:::.::::.:::..... TOTAL FEES PERMIT NO.: BLD MASON COUNTY 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 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address , a Mailing�ddess City State Zip Code City ` 3, s t Lc State Zlp Code Z6 Phone( Other Ph.( ) Ph. � k. f,Other Ph. Lien/Title Holder `mac «` Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System ,..4 Well Water System Name of Water System ARCEL INFORMATION-12 digit Tax Parcel No. �" Fire Distri S egal 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 your property within 200' of the following.- Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building 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 ake.. Model Model Year Length Width Serial No. No. of Type of Heat Purchase Price $ a R`•,„ Installer Name Certification No 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 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'S 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 State 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 regulating 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 conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW: APPROVED DENIED CONDITION CODES: Building Department . . Occ Group Type Constr. Planning Department Environmental Health Department ( I Public Works Department i Fire Marshal Valuation $ FE1*S Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other /1C� Wood/Gas/Pellet Stove Fee Other "t Violation Fee Pre-Paid at Submittal ( ) :::>:�:<:�:�::`r<<:::�:�>:......:.... ..:N:.:.:....:::.::::....:.....................:::::::..... TOTAL FEES MASON COUNTY PROJECT SITE INFORMATION _ Case No. Name ' -'°1�t✓�'' � PARCEL NUMBER "� — 1C� -3c) ,1L { Date SHOW THE FOLLOWING ON SITE PLAN Show Direction 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 within 100 feet of adjacent property line. adjacent property line4 I I adjacent property line -7r I I I adjacent property lined <-adjacent property line SAMPLE SITE PLAN adjacent property line-� 3io' _ _ _ Fadjacent property line �� I D 30' rREScRU& I CREEK \ I HOMt _ I .Gaatiu �I I £ �• i HOuSG. j I I PRO Pn3GD S¢Qf:L I. 1 YI � I rF— b o R VAC.A�vT I fi c,ArtAc.CS P0.oPoser) I� �\ 7 A&RILLLLTta.ILAL SO 1 I: � I I 8 0 \ I I - ' � I I \ I L—e-LL I I i I I I R I I adjacent property line-� Fadjacent property 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 TOPOGRAPHY PROFILE di 5+�..cQ to Srt ru.Ltt.a.YL d -st'ar.Le. I-o Slop' ta¢ dls�ar.aa. 4o t Signature Date FORM MUST BE COMPLETED IN INK ' PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No.Name I rlugo__FCSI4��M PARCEL NUMBERJ2221' VA -'�GQ)JLJ Date J\ -a-9IAA ? SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S. E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography 5 N 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 within 100 feet of adjacent property line. adjacent property line4 I \ I E-adjacent property line — 14dA e 7a GaI'- I e 36 F� I \ I I � I I � I I tie I 1 ,7 I I I I adjacent property line--) I V G t f-adjacent ro ert line SAMPLE SITE PLAN adjar�nt property lined 3zO� _ _ f-adjacent property line D 36' FRiSsa v&_ I HOnn 6 I Gnaeu I j 1 — I I4— bo' —/SOLI VAG'JT I I I 30. I /i pM1oPosCD �\ T A&R=L&LTuJlAL So 1 I I \\ SO, I I � I � I I I I /00" I \ I I I r t.—aLL I I xi /DD' I I \ I adjacent property line-;� i c \i E-adjacent property 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 TOPOGRAPHY PROFILE d13+ar,GQ to rur_t'L. r'e_ d;atar,cc tc S�opa. tc¢ d i�+a►cm Y o t. IJ Signature Date