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HomeMy WebLinkAboutBLD99-0522 Mobile Home - BLD Permit / Conditions - 7/8/1999 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 1:3 1.1 1 L_ 0 1 P4 (3 P E" FA M 1 T FOR INSPECTIONS CALL. 427-96 70 BETWEEN 5pm AND Sam 427-7262 8L.D99- 0522 PARC;E L : 1 23 1 7 1 490032 PLAT : D I V :? BLK :? LOT :? JOB ADDRESS: 2383 NE OLD BEI..FA I R HWY BEL.FA I R OWNER : WARREN JOHNSON 651-0121 CONTRACTORS LEGAL. : TN 3 OF SL NE A S1 11 SEC 16 CLASS OF WORK :NEW SEDR : 3 .BATH . 2 ITYPE AMOUNT BY DATE NIECE IPT TYPE AMOUNT BY DATE REfEIPT'l TYPE OF USE . . . . :MH STORIES . . . . . . . .. 1 OCCUP . GROUP . - - t7 F3LDG . HE f GRIT . . O .Oft MNSF 1; 175.01 1(1 #6114/99 1529 x TYPE OF CONST . . :? FIREPLACES . . . . : 0 fHCP 1 50.00 KS 07/07199 6FLfAIR OCCUP . LOAD . . . . . 0 WOODSTOVE:S . . . . : 0 PLRS S 38.00 KS 871N99 BFLFAIR 4 DWELL .UNITS . . . . . 0 PARKING SPACES : 0 10NBt 1 175.11 KS 874411.OhLfA IR INSPECTION AREA : 2 SHORELANE? . . . . :N TOTAL: 438.10 VALVIATIONc 51988 SET"BACKS-- --- --------_-- TOILETS . . . . . . . . . . 1 0 FUEL TYPES--.---------- BO I LERS/COMP---- MOBILE HOME:-.- FRONT . . .N 112 .Ott BATH BASINS . . . . , . : 0 s c 0-3 HP . : 0 REAR . . . .S 212 ,Oft BATH TUBS . . . . . . . . : 0 3-15 HP . : 0 MODEL :VALLEY SIDE ( 1 ) .E 56 .Oft SHOWERS . . . . . . . . . . . 0 FORN < 100K BTU : 0 15 -30 HP . : 0 •-MAKE----._-.- SIDE (2) .W 36 .0ft WATER HEATERS . . . . : 0 FI)RN »100K BTU : O 30-50 HP . : 0 COTTAGE SHRL I NE .S 150 .oft CLOTHES WASHERS . . : 0 FURN - FLOOR . . . : 0 50+ HP . : 0 --YEAR-----.-- AREA - --_._.___.____.____ KITCHEN SINKS . . . . : 0 HEAT PUMP . . . . . . : 0 97 LOT SIZE . . - FLOOR DRAINS . . . . . : 0 VENT SYSTEMS . . . ,,.0 EVAP COOLERS : 0 LENGTH :56 BUILDING . . . . Osf DRINKING FOUNT . : 0 VENT FANS,. . . . : 4i0 HOODS . . . . . . . . 0 WIDTH . :27 BASEMENT . . . . 05f LAUNDRY TRAYS . . . . . 0 -, DOMES . INCINck� DECKS . . . . . . . Os f DISHWASHERS . . . . . . . 0 AIR HANDL I NG'',e ITS- tt COMML . t NC f N :0 GAR/CARP :? Os'F GARB DISPOSALS . . . : 0 <— 10000 cfm . : 0 '-:-FTELOC/RE:PAIRZ 10 AT/DT . :? URINALS . . . . . . . . . . : f0,, > 10000 cf;�! 0 `OTHER UNITS . : 0 M I SC PLM F I XTUHES s1,r 1 GA , OUTLETS . : 0 'YS6�fiC"aF'1C.Bi'Wf[l!Y9aT :'.n'A'..ti:tt'S::S'�.i.:W.-nTiiiII_..SOY4¢tf.!�^.cek5'i PROJECT UESCNIPTIOIJOBILE HOME PROJECT LOCAT011:2.4 MILES NORTH Of 4 MAY STOP AT BELFAIR ON CiU BELfAid N1Y NE>~i SlQi $fi, RA�. �� TOIS 091111'BECOMES NULL ANO VOID IF NORM ON CONSTRUCTION AUr110N1tED IS NOT COMMENCED 11T1 184 DAYS, ON IF CONSTRUCTION OR 1081 IS SUSPENDED FOR A PERIOD Of 181 BAYS AT ANY TIME AFTER MONK IS COMMENCED, EVIDENCE OF CONTINU+ATION Of NORM IS A PNQ&N SS' 1g-PECTION WITHIN To[ 184 DAY PERIOD. FINAL INSPECTION MUST FF AFF101:1) B�fONE BUILBINB CAN BE OCCUPIED, OWNER 11 AGENT:_,-..e�.�+..�...t,�t....-• .t.ta.r_ __..�..._ __. __.� D A fi E c .�_ ..` __ _—__r CONCRETE MECHANICAL MOBILE HOME c c'l-C Footings-Setback date by Ribbons A date by Gas Piping date — �_/ b Foundation Walls date by Set Up date by INSULATION date - C>25 by / BGIStAB Insulation Floors Final date by date by date ��'�'� .- by FRAMIN' Walls FIRE DEFT. 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 114SPECTION date by date by date by c cam+- s , — 3P 5,0> MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 PE RM I T CaNU I T I CUNS Case No . % BLD99--0522 For - WARREN .JOHNSON Pages $ 1 1 ) Approved per dimensions and setbacks on submitted site plan ; home shall be located to have a 150 font eetback from creek . X i --- 2 ) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or properties . Silt fencing or, straw matting must be Installed and maintained anti ! upland vegetation has become established . X 3 ) 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 4 ) This application Is subject to Buffer and Landscaping requirements as established under Mason, County Ordinance 1 .03 .036 . X 5 ) The use, handling and storagge of hazardous materials or, flammable and combustible liquids in excess of 10 galtons is not allowed without the approval of the Mason County Fire_ i Marshal . 6 ) Provisions for surface/ subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely Impact ad lace}nt parcels . Under the requirements of Mason County Stormwater Ordinance, dither private ditches and drains will meet requirements of the stormwa�ter 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 REOUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason Count Road, Contact the Mason County Public Works Department prior to construction at Ext 4y 0 . For any construction which is proposed to he located within 5 ' 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 . r 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 date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER GrourKlwork 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. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 x 7 ) Owner / builder assumes all responsibility if draiofieId/ reseFrve, area Is encumbered . X 0 ) PURSUANT TO 1997 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 AS ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL6E ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS . 9) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL . X. 10)jThe approved plot plan is required to be on-site for inspection ppurpposes . If invpeotlon is called for and plot plan Is not on site, Approval WI NOT be granted . In addition , a Re.- I nt:,pect i can fee In the amount of $42 .00 per hour inn i n i mum 1 hour It w l„i i be charged and must be collected by this department prior to any further inspections being performed or approval l granted . 1 1 ) REQUIRED INSPECTIONS ( Footing Inspection--prior to pour , Set-up Inspection-prior to skirtinr?, Final Inspection--prior, to occupancy) . I have received a copy of the General InformatIon rind Guidel ines--Mobiles/Manaifactured Housing Instal lrat ions HanduA�t - for detailed descriptions of all required inspections on my mobilelmanufaotured home installation . I hereby assume all responsibility for the gehodu I i ng of these required inspections . If these required Inspections are not requested, Inspected and Signed off ( approved) by the Inspector in the prescribed order , ! understand that r.e►i nspect i on fees and an hourly Investl gation fees pursuant to the 1994 UBC, Table SA 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 . 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 BGISLAB Insulation Floors Final FRAMING by date by date by Walls FIRE DEPT. date PLUMBING by date by date by Attic OTHER Groundwork 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. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 OWNER/CCNI'RACTOR ( indicate which ) Signature X l,. 12 ) All mobile!manufaotured horns landin s or decks must be freestanding ( sell supporting ) . The largest landing or deck permit?ed without drawinr s or a building permit Is 120 sq ft or less AND MUST be under 30"' In height from surrounding rade . NO second storx decks , or decks above 30 can be b�u i l t w i th€�ut apermit . Any Ian I ng or duck 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 . 13 ) Placement of structure must comply with standards setforth per 1997 UBC Chapter 18 regarding descending and/or ascending slopes . X �� _ Case No . s BLD93•-0522 I CONCRETE MECHANICAL MOBILE HOME J 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 date by date by date by FRAMING Walls FIRE DEPT. date by PLUMBING date by date by 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 -',.,-2:-A jn r A. Z. IL- -7-7= tit I-S L LI TT ifa iwzl% 7. �� t0 O � C� �\ ��- _� -� Site Plan J �� Suite B•16521 Highway 99•Lynnwood,WA 98037-3199 PI ose Check After Doing Site Plan: Septic and drainfield L�J of size raw North Arrow in Circle Town &CounM Everett: (425)258-4171 Puyallup: (253)840-9552 Property dimensions ❑ ewer lines ilevation of property POST FRAME BUILDINGS Administrative Headquarters: (425)743-1555 FAX: (425)742-4378 Toll Free: 1-800-824-9552 ❑ xlsting buildings ZSetbacks of proposed&existing buildings ❑Bodies of water I , Contractor's Lic.N:TOWNCPF099LT roposed building Rain road with name ❑Floorplan s ccsa: 12s311 Easements Access to proposed building Slopes&Contours(5'increments) Quality:Our Future Depends On it. � Job Name: WARRCN 40411SOH Job Site Address:�ar3 GQi WE:, 0I1 BEaFAIR tllfbH01N Legal Description: "IS, 3-8 DIP S E N t= -r R X 'F S4-FA i R Il Il w A Tax Account A 13 (f �f 0032 OF S?'!f;Z!53Z!ff (1201 b"I 8 196� rfl c. NuNC o Fop- alag )a.. � r �11 o O .► I rn S r r i rp RgYoSvb 90 MIWPq,0 w\ r �ARAGG PR U?obLrn (,PA to IN t3o' ' 3 o.o oro. -ro arty $6►FAtR 14 1(,H w.^Y Site Plan NWtiS — - Suite 8•16521 Highway 99•Lynnwood,WA 98037-3199 PI ase Check After Doing Site Plan: J J g y y g 10 Septic and drainfield L�J of size Draw North Arrow in Circle Town &Country` Everett: (425)258-4171 Puyallup: (253)840-9552 Property dimensions ❑ ewer lines Elevation of property NEW POST FRAME BUILDINGS Administrative Headquarters: (425)743.1555 XlStln bUlldln S ewer tin of proposed f FAX: (425)742-4378 Toll Free: 1.800-824-9552 9 9 p p sed&existing buildings Bodies of water / 1 Contractor's Lic.k:TOWNCPF099LT roposed building 91 ain road with name ❑floorplan \`�J CCBR: 129311 Easements Access to proposed building Slopes&Contours(5'increments) Quality:Our Future Depends On/['" Job Name: WArz FILE H 4()48 SOH Job Site Address:1383 WE, ODD br- -FAIR t416,H rY Legal Description: —rR 3"8 Q F S E N E =R Sl 3�61-FA!P. kj)A Tax Account A �'� 3 �� �0032 O F SP!!q2!S3ZIF �001 (►&1 8 =moo 19(0 I R o�cTi�D ri +l t17 �p pLl WD z _ Fop- �Ielag )a.. D ?� OO ' r I r Mt 171�►� ,�� �' P RU705ri 6ARAGC PRc�PoSi:n 6 •AV l 'D t E 1 o.o o�o' To a :96LFAA NiLtiUJAY MASON COUNTY DEPARTMENT OF HEALTH SERVICES POST OFFICE BOX 1666 SHELTON WA 98584 (3W0) 427-9670 WELL CONSTRUCTION PERMIT FAX 42 7-7798 Receipt No: Date of Payment: INSTRUCTIONS 1. Complete Part One. 2. Pay $40 fee and submit this application a minimum of 24 hours in advance of initiating construction. Make check payable to: Mason County Treasurer 3. Attach plot plan. 4. 24 hours prior to drilling the well, contact the health department to give notificatio of starting. Fax to: 427- 7798, or Telephone: 427-9670 ext. 358 (8:00 a.m.-5:00 p.m.) PART 1: APPLICANT/PARCEL IDENTIFICATION .............................................................................................................................................................................. .............................................................................................................................................................................. ..................................................................�..�..,..`..........................�.�....�..................................................................... SITE HOUSE ADDRESS A/� �7�II� i�6( DRILLING FIRM NAME �2,4 Y T /C f LC-1/V & START CARD NO. W PROPERTY OWNER NAME 12 14 0, / J A TELEPHONE MAILING ADDRESS I , V Lt o i a e zip ASSESSOR'S PARCEL NUM�ER SUBDIVISION (If Applicable) DIV,/ BLK LOT DIRECTIONS FOR LOCATING SITE { C� Z` 7 L; W. ATTACH PLOT PLAN DATE OF ANTICIPATED INITIATION OF WORK: DATE OF ANTICIPATED COMPLETION OF WORK: PART 2: DEPARTMENTAL USE ONLY .............................................................................................................................................................................. .............................................................................................................................................................................. .............................................................................................................................................................................. TIDEMARK NO. A " S�J� CALL-IN DATE CALL-IN TIME AM/PM START DATE START TIME AM PM COMPLETION DATE COMPLETION TIME Aid PM f-1 TAGGING AND SEALING SATISFACTORY? Yes u No COMMENT Sfi � 99 INSP TOR DATE OF INSPECT' H: WDATA\ARCHIVE\WELL-IN REVISRD 01/ File Original with WATER WELL REPORT Notice of Intent Department of Ecology Second Copy-Owner's Copy STATE OF WASHINGTON UNIQUE WELL I.D.# Third Copy-Drillers Copy Water Right Permit No. (1) OWNER: Name Warren Johnson Address P_n_ Box 24O7, Belfa�-r, WA9-8528 (2) LOCATION OF WELL:County Mason SF 1/4 E 1/4 Sec_ 17 _._T_21 N.R._1W VVM (2a) STREET ADDRESS OF WELL:(or nearest address) NE 2383 Old__Be]fai r HWY., Bel fair,r, WA 98528 TAX PARCEL NO.: 1231 7-14-90032 (3) PROPOSED USE: K Domestic ❑ Industrial ❑ Municipal (10) WELL LOG or DECOMMISSIONING PROCEDURE DESCRIPTION ❑ Irrigation ❑ Test Well ❑ Other Formation:Describe by color,character,size of material and structure,and ❑ DeWater the kind and nature of the material in each stratum penetrated,with at least (4) TYPE OF WORK: Owner's number of well(if more than one) one entry for each change of information.Indicate all water encountered. X] New Well Method: MATERIAL FROM TO ❑ Deepened ❑ Dug ❑ Bored ❑ Reconditioned N Cable ❑Driven ❑ Decommission ❑ Rotary ❑ Jetted Top Soil 0 2 (5) DIMENSIONS: Diameter of well 6 inches Drilled 50 feet. Depth of completed well 50 ft. Brown Con lomo e (6) CONSTRUCTION DETAILS Casing Installed: N Welded 6 _ Diam.from_� ft.to 45_ft. ❑ Liner installed Diam,from ft.to ft. ❑ Threaded Diam.from ft.to ft. Perforations: ❑Yes ExNo Type of perforator used SIZE of perforations in.by _in. perforations from ft.to ft. Screens: X7 Yes ❑No )o K-Pac Location _ 43 � 5� Manufacturers Name Cook 5 Type stainless wire wrap Model No. n Diam. 5 Slot Size 40 from 45 to 90 ft. , Diam. Slot Size from ft.to _ft. 2 Gravel/Filter packed: ❑Yes X1 No ❑Size of gravel/sand Material placed from ft.to ft. Surface seal: X7 Yes ❑No To what depth? 18 ft. Material used in seal Betonl tp Did any strata contain unusable water? ❑Yes QWo Type of water? Depth of strata _ Method of sealing strata off (7) PUMP: Manufacturer's Name Goulds Type; sub. H.P. 2 (6) WATER LEVELS: d-surface elevation above mean sea level ft. j Static level ily ft,below top of well Date Work Started 6/l/99— Completed 6/-3/C) Artesian pressure Ibs.per square inch Date Artesian water is controlled by (Cap,valve,etc.) WELL CONSTRUCTION CERTIFICATION: (9) WELL TESTS: Drawdown is amount water level is lowered below static level I constructed and/or accept responsibility for construction of this well,and its Was a pump test made? ❑Yes X]No If yes,by whom? compliance with all Washington well construction standards. Materials used and the information reported above are true to my best knowledge and belief. Yield: gal./min.with ft.drawdown after—hrs. Yield: gal./min.with ftr drawdown after ___hrs. Type or Print Name Ed Nelson License No. 1886 Yield: gal./min.with ft.drawdown after _ hrs. (Licensed Driller/Engineer) Recovery data(time taken as zero when pump turned off)(water level measured from w Trainee Name License No. well top to water level) Time Water Level Time Water Level Time Water Level Drilling Company —-- (Signed) Q A�L� License No. 1886 (Licensed Driller/Engineer) Date of test — Address ___—Bel fair,r r_ WA 98528 Bailer test _-15 gal./min.with 10 ft.drawdown after 1__ -hrs. Contractor's Airtest _—gal./min.with ft.drawdown after _hrs Registration No. D"1S 11 10QA__ Date__Iunp___q9 Artesian flow g.p.m. Date _ (USE ADDITIONAL SHEETS IF NECESSARY) Temperature of water Was a chemical analysis made? ❑Yes X No Ecology is an Equal Opportunity and Affirmative Action employer. For special ECY O60-1-20(11/98) accommodation needs, contact the Water Resources Program at (360) 407- 6600.The TDD number is(360)407-6006. f •�^s APPLICANT NAME: C1_IL�-��) �--�� DATE: BUILDING PERMIT CHECKLIST SITE ADDRESS If site address has not been issued refer the customer to Community Dev. ext 291. FIRE DISTRICTS Please make sure the fire district is included in the application information. Refer to map located at counter. DIRECTIONS TO JOB SITE Needs to be as complete as possible (i.e. major roads, is house on left or right side of road, etc.). Be sure to read for clarity (Landmarks, signage, owners name on mailbox, etc.?). [� LIEN/TITLE HOLDER Who holds the mortgage (Bank or name of private owner holding contract)? ONTRACTOR REGISTRATION # AND EXPIRATION DATE O !Y This information needs to be provided. The Building Department may be able to research expiration information if Q customer does not know it. We must have a signature in 1 of the 2 boxes, either the applicant or the contractor. SEPTIC RECORDS New systems must ha"c test holes dug prior to submission and Septic Application must be filed and paid in full. A B WATER COMMUNITY PRIVATE SEPTIC EXISTING DESIGN APP. DEV REMODEL NEW STATUS IS THIS A REPLACEMENT UNIT? YES NO IF SO: MASON COUNTY BUILDING PERMIT APPLICATION SECTION #5, BUILDING SQUARE FOOTAGE, MUST BE FILLED OUT COMPLETELY. AND: SECTION #6 MUST CLEARLY STATE, "REPLACEMENT UNIT" PARCEL #/LEGAL DESCRIPTION II►ICHECK PARCEL NUMBER FOR PARCEL FLAGSIIII Parcel # must be included. If number is not available contact Addressing at Ext. 291 l BUILDING SQUARE FOOTAGE T` Clearly show existing square footage and that of which is proposed. If there is a garage, verify whether it is attached ,[ or detached. Include square footage information for mobile homes.(ie. 1 OX20=200 square feet.) III USE OF BUILDING T` I Residence, garage, greenhouse, designate if it is commercial. DESCRIBE WORK T (i.e. mobile home addition, addition to a house, etc. . .) TYPE OF JOB TT Verify appropriate boxes are marked. WATER ADEQUACY For new residences and mobiles. PRIVATE WELLS MUST HAVE WELL LOGS OR CAPACITY TEST AND BACTERIAL TEST. If they are on a public water system, check for signature to verify that the system is not on the State's "out of compliance list" 1 MOBILE HOME INFORMATION Verify appropriate boxes are marked. If factory order, please put factory order #in mobile home serial #. If unit w assembled prior to June 15, 1976, refer to procedures handout for "Obtaining Installation Permits for Mobiles assembled Prior to June 15, 1976." FLOOR PLAN Manufactured/Mobile homes require a floor plan of the home be submitted. FEE DUE A fee of $175.00 is due when application is accepted. This is half of permit base fee of $350.00. SHORELINES/CREEK/WETLAND If property is within 200 feet(including adiacent properties) of Shorelines/Creek/Wetlands, #9 must be complete. none of the conditions are present please enter "na" or "none". SITE PLAN DRAWING MUST SHOW THE FOLLOWING: ' LOT DIMENSIONS ' DRIVEWAYS ' EXISTING STRUCTURES ' SHORELINES ' STRUCTURE SETBACKS ' WELLS ' SEPTIC SYSTEMS ' NAME OF FRONT STREET PROPOSED IMPROVEMENTS * EASEMENTS • NAME OF SIDE STRE4 ALSO PLEASE MAKE SURE DIRECTIONAL IS FILLED IN ON APPLICATION IF PLOT PLAN IS ATTACHED TO PLANS OR IS NOT ON CARBON FORM, (3) THREE PLAIN PAPER COPIES ARE REQUIRED. TOPOGRAPHY DRAWING If property is flat write "flat" on the topography section. If house or structure is near a slope or hill, drawing must reflect this. This should show an accurate side view of the property. PLUM BIN G/MECHANICAL This form must be completed for any structure with plumbing and mechanical excluding mobiles/modulars. OWNER OR CONTRACTOR AFFIDAVIT Owner or contractor must sign affidavit statement and date it. ACCEPTED BY Whoever is accepting permit information must sign your initials and date form on the bottom of page 3 or use dat( stamp and initial on back of permit. PRINTS Need three sets of prints unless it is a stock plan. For stock plans, we only require one copy. Commercial proiects require four sets of plans. WSEC & V & IAG CODE Required for all residential,additions and commercial buildings. Energy Code compliance form needs to be COMPLETE( Verify heat source (no wood or pellet stoves are permitted as primary system). Window schedule must be filled of and reflect what appears on submitted building plans. If applicant has decided to go with the PUD in a Long Term Super Good Cents program, we require a copy of the signed agreement with the utility. ROAD ACCESS PERMIT If you will be accessing your driveway from a County road, contact the Public Works Department in Mason Count) Building I, 427-9670 extension 450. Access from State Highways requires Department of Transportation approva Contact office (206)895-4753 (Port Orchard). klist.2 mber 17, 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 LAIA { AJ Contractor Name Mailing Address P.D. lio2c 2 +0 7 Mailing Address City a,gg!! d 1� State—� Zip Code City State Zip Code Phone( Ph.(3/,* 4,- Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic c� Existing Septic Connect to Sewer System Name of Sewer System Well_V Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. 2 / / / / 9oy,32 Fire District Legal Description OF S F S'P� Site Address(Please include street name, street number and city) A 3#71 O Directions to site-2,y M/LIs S /IIoAT'/f O` 4/ 6..0,4fl IrI20P .4t- 8r0A X*Ki/1 eiv OLD /31aL101,5914,111! A/LAY 1..J'Co I- 4r/,or aJ:�" Azo"Oy Will timber be cut and sold in parcel preparation? (Yes/No) ;< Is your property within 200' of the following: Body of Water (Name),CV,0 #W (ZKOOk Saltwater Lake Rive r/Creek_ Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New_X Add Alt Repair Other Use of Building t O^,0 Describe Work MO y 0055a4A4-r9ifT, oe, es+u0/,,<.f Wo.*pA0 4- 040e-rf-7fC/IL No. of Bedrooms �No. of Bathrooms -2 UARE FOOTAGE-1st Floor/493 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Co F dyModel Year /p97 Length��Width�G��Serial N ?'SSffRG Bedrooms -3 No. of Bathrooms �2 Type of Heat o C of/ Purchase Price $ DO Replacement Unit ?(Yes/No) /1Jp Installer Name VA4,eAcy 42AeWA1rZ 'es 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. PROO�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 Date — - Submittal Amount Due Z. Receipt No. IS� DEPARTMENTAL: REVIEW OVED DENIED CONDITION CODES Building Department Occ Group Type Constr. Planning Department I Environ ental Health Department Public Works Department I Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) 3.:... ::....................:.. .:., .:..... O AL 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 LJ2AOR A., I4 IVA.O�ran-' Contractor Name Mailing Address )?& Sa:c ` 4o'67 Mailing Address City ,& ,C /R State Zip Code!W<Xg City State Zip Code Phone they Ph. Ph.( Other Ph.( ) Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic 6= Existing Septic Connect to Sewer System Name of Sewer System Well_�Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Legal Description rA 1,6 0,4-5 .�' Site ddress(Please include street name, street number and city Dir ctions to site .a. /f O Will timber be cut and sold in parcel preparation? (Yes/No) I, \ 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 i Describe Work No. of Bedroo -1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached RMATION-Make Model C 47`rzI6 4r.29, YModel Year � 2'> 71nstaller gth . Width ; " "< Serial N e A E 'A4 lPW,4,0edrooms No. of Bathrooms e of Heat f ._" A",,C Purchase rice $ 40 Name �" a >, L? ~ " °k Certification 5 Ogg— 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 1 Environmental Health Department Public Works Department I Fire Marshal Valuation $ F>E:>ES Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) E TOTAL F ES :�t'ic;��`:?::�:�:`•:'<':';:'y`.�:i:: <:::r3:S :?%;;%%:r:::$5:�; #i:: :::`•Si:>.<r::'''.'>3f:�:�ii5 I o m 100' 0' 100' 200' SHORT SUBDi�SiON # m (s 86-58'59' w) SCALE: 1 " = 10�)� DA/ APPROVED v o s 86'54'13` E Dl,?L OR Orr COVYUNITY DEIEZOP,4/rN7 S FOUND 1' IRON PIPE 659.25' N 1/1 b =OR�1E2 W (659.83') SHORT PL A T s�•no>� A�, Ib 2� o FOUND 1" IRON PIPE FOR �� � = ALBERT C, & �� co BETTY ANN �zQt1e -coM EVERSON Z�,d o 10 w LiX77CAT1/4a- r,7�-sE1/4OF7&-Af- I/4a ►� S rl: 1 �• (N 1/2 OF THE NE 1/4 OF THE SE 1/4 OF THE NE 1/4) z n co i� to S't C 7? Z O/d 17, QQ �� SEG'1-aD� TOWNSHIP 23 NORTH, �oQS- 17 o fl �� RANGE 1 WEST, W.M. Q Q FOUND 1/2' IRON PIPE NE 2381 OLD BELFA/R HWY C -�o INSIDE 3/4' IRON PIPE z s 7.55'40 BELFA/R, W.Q. 98528'•w -LINE TABLE PARCEL N0. 12317-14-000.30 io -co 10.71' `. (WEST 660.00' WATSON) L=1 K Bs-3s'sT w 113.54' N 86'56'28` W 659.42' L-2 N 18'03'10' w s214' "200.00' 25' 160 00, L=3 IN ss•5�'28' w 431.4,T .MERIDIAN & SUB—DIVISION 82.80 160.00' 139.42' L @� _ L __� - _ - BASED ON VOLUME 2 PAGE 37 1284' FVERSON�--�3.65 6 oof _ ,�, LOT 4 125` —— --- ----- N OF SURVEYS VOLUME 17 PAGE 69 1.25 ACRES "-� 1 0 60' OF SURVEYS & Wm. 0. WATSON'S Z r - PRIVATE EASEMENT \�' - • co 3 © 0 /` LOT 2 ® — �� �N 8636's7' 7 1952 SURVEY OF THE SOUTH 1/2 �' ❑ - '36' __ 30' OF THE NE 1/4 OF THE SE 1/4 OF LOT 3 0 SHED 1.25 ACRES Q ���f �. _ THE NE 1/4 OF SEC710N 17, .T 23 Iv Z 1.25 ACRES 3 yi' -1 ^ �o R 1 W, W.M. sss .... / SHED f O o �,w ... =� / EMSTING . o LEGEND 100' 'R r-' � 100' R EXl WELL G— rn l DRIVE 441 O� 0 SET 5/8' REBAR Ec p� _� 3 PLAS>1C CAP LS #18918 a y �00' R Z / FOUND MONUMENTS AS NOTED o Og�'05�� GARAGE a.c ._� Q �Y N ■ SET STAKE ON LINE llole -. yT� car. /V> io �cA O'er 7 LOT 1 ❑ �j• 2c�3 Q O SD(L LOG HOLES FOUND 1 1/2' Q���' �, ``�'r� 1.80 ACRES SHED �� / L LA i ` IRON PIPE S / a{,,.,� ..• r C� (M) RECORD BEARING E�tREs 8-19-95 do DISTANCE 120.00' FOUND 3/4' 160.00' ��>� IRON PIPE 160.00' sE-tlE- •.N 86 58" w s5s.5s' 21s.59" - —. N u RICHARD B_ . NO_RRIS P.L.S.. 0 1/(o'a n1 _ (N 86'S8'44" W 659.5R'1 S 86'44'38' E / O�' " a " P.O. Box 397 (206) 427-5530