HomeMy WebLinkAboutBLD2002-00227 Final MFG Home - BLD Permit / Conditions - 2/19/2004 MASON COUNTY DEPT. OF COMMUNITY Inspection Line (360)427-7262
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 BLD200 -00227
OWNER: BETTE VANMANEN 425-255-3308
CONTRACTOR: LICENSE: EXP: RECEIVED: 3/5/2002
SITE ADDRESS: 160 E CLONAKILTY DR SHELTON ISSUED: 3/21 /2002
PARCEL NUMBER: 321275400040 EXPIRES: 9/21 /2002
LEGAL DESCRIPTION: LAKE LIMERICK 5 TR 40
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
MANUFACTURED HOME HWY 3 LEFT ON MASON LK RD., LEFT ON CLONAKILTY DR.
General Information Construction & Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.:
Type of Use: MH Insp. Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: S No. of Stories: Occ. Load: Building:
Valuation: $70 566 Building Height: Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline & Planning Information
Make:REDMAN Length: 56 Ft. Front: W 62.0 Ft. Shoreline: Ft. Water Body:
Rear: E 5 0.0 Ft. Slope: Ft. SEPA?: No
Mode1:4563Y Width: 28 Ft. Side 1: N 14.0 Ft. Shoreline Desig.: Not Applicable
Year:2002 Serial No.: Side 2: S 30.0 Ft. Comp. Plan Desi .:
gural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qtv Type Qty Type By Date Amount Receipt
Mobile Home Submittal Fee KLW 3/5/200,$194.50 58584
Address Fee KLW 3/5/200; S15.00 58740
Building State Fee JRN 3/7/200; $4.50 58740
Mobile Home Issuance Fee JRN 3/7/200,$194.50 58740
EH Plan Review CEW 3/11/20( $75.00 58740
Planning Site Inspection PBC 3/15/20( $70.00 58740
Total $553.50
BLD2002-00227 Please refer to the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLD2002-00227
Please sign, date, initial all CONDITIONS FOR
conditions and mail flack BLD2002-00227
to me.
THANK YOU
This application is subject to Bu fer and Lan scaping requirements as established under Mason County Ordinance
1.03.036.X---46J_1(-__ - 31Ls10 z.
The use, handling and storage of hazardous materi s or flammable and combustible liquids in excess of 10 gallons is not allowed without
the approval of the Mason County Fire Marshal. X_ _ ___3Jz5J4>Z �S(.1,-
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 s ggested to contact that of ice to review future planned work which may affect your project.
Proposed structure or any portion thereof greater than 30" in height from grade I'ne,, must maintain a minimum of 5' setback from all
property lines, easements and 10' from all County and State Road right of ways. X-0y a ---/Lr/oZ 15L-V
A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact
Charell Holcomb, at (206)427-9670, ext. 450. X j 3� s[oZ 13t v
Approved per dimensions and setbacks on submitted site plan. X (,1pa„� 3�Zs�oz BLV
In accordance with the Uniform Building Code, all sites shall have approved numbers or addresses located 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 re-inspection fee based on rates as adopted by the jurisdiction and the Uniform Building Code will be
assessed if the owner and/or contractor fail to post the address on site prior to requesting inspections.
8� THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X _ __ ���Z T3l,V
BLD2002-00227 Please refer to the following pages for conditions of this permit. 2 of 4
The "approved" plot plan is required to be on-site for inspection purposes. If an inspection is requested and the "approved" plot 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 Department prior to any further inspections being performed or approvals granted.
1 REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I
hereby assume all responsibility for the scheduling of my required inspections. If the 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 1997 UBC, and 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
OWN ER/CONTRACTOR(indicate which) Signature XAA,-D _ -_, oz -6L,V
1 This permit is for
p the placement and Installation of the ma ufactured home only and does not imply approval or review for any other items
indidcated on the plot plan. X. 1f",-0-_-_�2j�z__3W
1 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-/ z 73LV
Proposed structure or portions thereof with an projection over 30" in height from grade line, must maintain a 5' separation distance
between adjacent structures and that furthest projection. XD,„e( lua..�� __� �oL__1jL✓
//p�!, All changes to "approved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason
Co my o din nce or regula��jjion must be reviewed and approved by Mason County prior to construction.
All, The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in
conformance with the Uniform Codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a
M on C unty Building Inspector shall be made prior to requesting additional inspections.
Z&X OZ__ LV
1 The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions,
/ including installation instructions, shall be available in this location OR placed in the location specified by WAC 296-1 SOM-655. Support
configuration shall be clearly marked in the installation instructions. 3/zee)2- E;L.V
All property lines shall be clearly identified at the time of foundation inspection. X1 3 7.Sl0, 31..✓
1 �) 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 CQunty as being non-compliant with Mason County di pc and building r� ulations.
X� -- - - --3MOLJ3LV I� � (gh, cater In�Pial all
cenditiont and mail baG.,
tO 1111U.
THANK YOU
BLD2002-00227 Please refer to the following pages for conditions of this permit. 3 of 4
1?� 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 period not exceeding 180 days, upon the receipt of a written extension request indicating that
circumstances beyond the control of the permit holder have prevented action from being taken. No more than one extension may be
gra ed.
.> --- 31Zsfo2 6;L v
This permit becomes null and void if work or construction authorized is not commenced within 1 80 days, or if construction or work is suspended for a period
of 1 80 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 1 80 day period. Final inspection must
be approved before building can be occupied.
OWNER OR AGENT jErJLC1V_""" tom----------------- OA (----�i }
Please sign, date, initial
(. mall baCP"
A Nft YOU
BLD2002-00227 Please refer to the following pages for conditions of this permit. 4 of 4
CONCRE i F, MECHANICAL MOBILE HOME
Fochnt;:, Setba, date by Ribbons
vutc 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 by L��—
FRAMING Walls FIRED PT.
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
12, (p-0 Z 5E-�-gq $ N �i4/ ,0 �f �L /Z' /8-CZ
D i o Ger-BACks ,��,� - 5 9L5 vi�C�B 0 3
G'5 - &IZOJ63> 1AASeT ,i L Aj Qe l
• RETURN ADDRESS
11>>slflrectr SIIINGION MANUFACTURED HOME
L/ r�liunsim
'r � 1 ITLE ELIMINATION
APPLICATION ❑TRANSFER IN LOCATION
Anyone who knowingly makes a false statement of a material fact Is guilty ❑REMOVAL FROM REAL PROPERTY
of a felony, and upon conviction may be punished by a fine,Imprisonnronl,or bolh.(RCW 46.12.210)
MANUFACTURED HOME
IPO/PLATE NIJM13EII YEAR MAKE LENGIII/WIDT11(FEET) VEIIICLE IDENTIFICATION NUMBER(VIN)
X _
LAND LEGAL DESCRIPTION ON PAGE
�REAL FIOPER Y TAX PA ,E}N BER
MANUFACTURED HOME WILL BE [:] AFFIXED ❑ REMOVED
LOT BLOCK PLAT NAME SECTION/rOWNSIIIP/RANGE
El RANTOR(S)REGISTERED/LEGAL OWNERS) ADDI F IONAL NAMES ON PAGE
COUNTY NUMBER 7MBEn OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS
NAME OF REGISTERED OWNER
NAME OF ADDITIONAL REGISTERED OWNER
ADDRESS ITY STATE ZIP CODE
,;9-
NAME OF LEGAL OWNER 7--
NAME OF AODITIO AL LEGAL OWNER
i
• ADDRESS CITY STATE ZIP CODE
GRANTEE
NAME --
I DO SOLEMNLY ATTEST UNDER PEN ALTVOT PERJURY TIIAT I/W[AM/ARE TIIE REGISTERED OWNER OF TIIIS
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signaturo of Registered Owner and-f ilia,W APPLICABLE
Signature of A(k
qWV"qjRqqjsIered Owner and Title,IF APPLICABLE
No`````PE c�sNt� NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE f
tale ofWashington Signed or attested
County of � before me on
MOT,ur - - -
—� bycS1Z �.F rI1 luR2�
Siynalure _
Z IF► C, --PRINT NAME OF REGISTERED OWNER R EN
VBL�
'��/��'� ' T NAM OF REGISTERED OWNER PIIIUI ED NAME OF NOTARY
W A
County/011ice No.OR
IOSH ��� Title AND: Dealer No.OR
r1 13JI.EffiS111P POSITI AGENT/NOTAnY Notary Expiration Date
T TLECO%1PANYCEnT;r;CATI0N
I certify that the legal description of ilia land and ownership is true and correct per ilia real property records.
NAME ITYPED OR PnINTED) TITLE COMPANY/PI IOIJE NUMBER
SIGNAI LI IE r POSIT ION --- -—--� -- UA I E
Finalize thls applicallon with a Licensing Agent within 10 calendar clays of Ilia dale Title Company Ropresenlativo signs.
BUILDING PERMIT OFFICE CERTIFICATION
I Certify that: Cl the manufactured home has been affixed to the real property as dosclibod.
CI a building permit has boen Issued for this purpose and Ilia attachment Will be Inspected upon completion.
NAME(TYPED OR PnINTED) BLDG PERMIT OFFICEmi IoNE i l BLOC PEFIMI1 II
SIGNATURE/POSITION DATE
TO.420.729 MANLIF I IOME APPL(R/a/98)On Pape I of 2
i
i
SIGNATURE OF LEGAL OWNER
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR EL NA ONPF T /REMOVAL FROM REAL PROPERTY.
Signature of Legal Owner and Tille,IF APPLICABLE I ` /
Signature of P.ddilional Legal Ow^arand Title,tF APPLICABLE_
NOTARY SKAL-8MSTAIAP -
�� NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE
Stale ofWashin ton
f' U.•.';,Otf'E,. 1'l 9 Signedorattested
S—to—Oi J
c� „•,,• 111 County of __—.—_-- before me On—_—_-
�_
Signatur PRINT NAME OF LEGAL OWNEn AnY n ENT
iy
��S ,••,•G .V r. PRINT komE O LEGAL OWIJEll 1'111NTED NAME OF NOTARY
iii
County/011ice No.On
C`.��" ✓I Till()DEAL EnSlI P POS ION/AGENT/NOTARY AND: Dealer No.OR�
Notary Explrallon Oalo
LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office
/ ICC L rya�—rQ t OU,,5- do&--»,e- /7 ®F
DEALER'S REPORT OF SALE
I CERTIFY THAT THIS INFORMATION IS CORRECT.THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN.
ANY REQUIRED SALES TAX HAS BEEN COLLECTED.
DEALEn NAME(TYPED On PnINTED) WA DEAI En NUMBER DATE OF SALE
- l_ -
UIICIIASE PRICE -- TAX J11111SDICTION/(AX RAIE I DEAI-Erl'S AUfnORIZED SIGNAIUIIE ----
❑USE TAX EXEMPT Sale to a Certified Tribal momberon the reservation(attach notarized statement of delivery) i
jj COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents)
1 certify that 11 te above appllcallon appears to have been comple led correctly,and the applicant has sufficlentdocunlentatlon to proceed with the recording of this form.
NAME(TYPED OR PRINTED) COUNTY OFFICENFS OPERATOR NUMBER
SIGNATmE -------- ---------- ---
DATE
TITLE FEES
FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES
TOTAL FEES 6 TAX
I1
IMPORTANT: Once the application has been approved by the County Auditor/Vehicle
Licensing Office, lake your application fo1N1 to the, County recording Office.
Retain proof of the recording lees paid. If the Recording Office retains
your original application form, obtain a certified copy of the recorded form.
APPLICANTS: Once recorded, you 111US1 return to a Vehiclo Licensing office to file 1110
Manufacturod I lome Application, paying all IOrµlifed IceS. Vehiclo
licensing subagents charge a service fee.
For full instructions on completing this form for-title Elimination, Removal from Real Properly
or Transfer in Location, see form 1 D-420-730, Manufactured Home Application Instructions.
The Department of Licensing has a policy of providing equal access to its services.
It you need special accommodation,please cal(360)902-3600 or TOD(360)664-8885.
T0-420 72B MANl1F(TOME APPL(Fi/8/98)OR Pape 2 0l 2
it
NOV-04-2004 THU 11 :29 AM FLEETWOOD HOMES FAX NO. 503 981 2327 P. 02
MQPE:F 'ACTION: Unit File Maintenance (48) OEHUNTMNT/OEH310-5C
Oi) Unit Serial . . 18628 14) Prod Start Date, 05/16/1994
02) Product Code: LP LAKE POINTE 15) Prod Completion Date:
03) Model. . . . . . . : 5483B 16) Ship Date. . . . . . . . . . . : 05/26/1994
INACTIVE RETAILER 17) Retail Date. . . . . . . . . : 10/21/2004
04) Retailer No.* 508857 PACIFIC II NORT 18) Invoice Number. . . . . . : 7820
05) Sales Rep No* 4 19) Original Invoice No. :
06) Comments. . . . : 20) V1N Number_ :
21) VIP Amount. . . . . . . . . . . 24,455
SLM Amount. . . . . . 24,455
07) Base Price. . . . . . . . . . 110MM Last Dept Completed. : 30
08) Option Detail. . . . . . : =F� Last Dept Date. . . . . . : 05/24/1994
09) Casual Sales Derail: 22) Order Number. . . . . . . . : 8049
10) Omit Detail. . . . . . 23) Model Year. . . . . . . . . . . 94
11) Account Dist Derail: 24) Number of Floors. . . . : 2
12) Freight. . . . . . . . . . . . . 25) Sales Programs. . . . . . .
13) Sales Tax. . . . . . . . . . _
----------Invoice Total. . . . . . : Last ActivitU Date. : 05/26/1994
L-VA=no
Unit has aleadg been invoiced in COL, CANNOT be changed.
NOV-04-2004 THU 11 :29 AM FLEETWOOD HOMES FAX NO. 503 981 2327 P. 03
Affidavit And Indemnity Agreement
The Undersigned,
Hereby makes oath and says:
1. That the manufacturer's certificate of Origin heretofore issued by Fleetwood
Homes of Oregon, Inc #48 on or about
Covering the following:
Brand name and model
Serial
Year: number
has been lost, misplaced, or stolen and after diligent search cannot be located or
produced.
2. That no Certificate of Title has ever been issued covering said manufactured
home by any government body auth oolissue such
n any state.
of title, nor has said
manufactured home ever been registered
3. That the undersigned is claiming title and ownership to said manufactured
home, or is asserting some interest therein.
4. That the undersigned hereby authorizes and requests Fleetwood Homes of
aid
Oregon, Inc. #48 to issue a duplicate
uirat�on ofOe gssuancete of oriin covering
Manufactured Home, and as indcement to and incons de
thereof, the undersigned agrees as follows:
5. (a). To save, indemnity and hold harmless Fleetwood Homes of Oregon, Inc
#48, against any and all liability, loss, damage, expense, attorney's fees and costs that
may arise or be asserted or claimed by any party in connection with or as the result of
the issuance of said duplicate Certificate of Origin as herein requested.
(b). That should the original Certificate of Origin be hereafter found, located, or
come into the possession or control of undersigned, undersigned promises and agrees
to immediately return, surrender, of deliJer the same to Fleetwood Homes of Oregon,
I'nc. #48,
Dated this Day of , 20
Affiant:
Name:
By :
Address'
Subscribed and sworn by
Before me this day.and date last hereinabove set forth, to certify which witness my hand
and seal of office.
State of: Notary Public:
County of: My Commission Expires:
14
11 SIDEYARD SETBACK r
C z..�UI structures, or Any portion thereof, greater
rrt an 30-;riches in height above grade must
f amain a 5400t setback from property lines �ja. p�
easements and 10-feet from all county
J
► ,� state road right of ways. Structures shall
UI A roof overhangs, gutte(s, decks,
lF lice. mechanical equipment, etc.
Y
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O
MASON COUNTY DC ) LANNING
I
SITE PLAN REQUIREDTO ON SITE E � : �
CHANGES SU✓JECf TO APPROVAL
E +y/✓►" ;;o,exl — Dat rye . 91 '
y t
Q I
✓ 50-Gallon Water Heater 'Package Only On This Home, No substitutions, Or Omissions.
56'-0"
BATH ; -F� UTILITY
BEDROOM#3 0
DINING ROOM BATH
1o'-s"x13'-2" 9'-�"x13'-2' KITCHEN - -u -
-SHU/M R — oPr i
-,9ElF/oPr o1D— �
FOR
-------------
SFIEIF i
HALL I air
CrR
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N �
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WAUc—IN
CLOSET
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MASTER BEDROOM
BEDROOM#2 LIVING ROOM 15'-3"x13'-2"
WALK-AN10'-9"x12'-11" 23'-1"x13'-2"
� CLOSET
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*Corner Bath Layout Part Of Winter Special Package,
Ask Your Retailer For Details.
I
3 z)Z 7_ 5-1+ -000 4 o PLAN- NMG
. VAZ45
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PLA o Evisiory REVISED
RECEIVED
DATE DATE
{� 1 ROBS 6XCAUATING FAX NO. ; 426 6697 Feb. 21 2002 01:55PM Pj
f1►^},,�I SIDEYARD SETBACK
I structures, or any portion thereof, greater 1 1
an 304nches in height above grade must f
jnlain a 5-foot setback from property lines
easements and 10-feet from all county
l state road right of ways. Structures shallt �r
,GUQe roof overhangs, gutters, decks, T ! `
ft.lre:j, mechanical equipment, etc.
�, .. CHANGE
SUBMIT CHANGES FOR APPHOVAU
PRIOR TO PERFORMING W RK
T; HESE PLANS MUS BE.
ON THE JOB SI E r
fi + FOR INSPECTIOIJ, "
MUST MEET ALL CURP ENT"
WASHINGTON STATE CODES
I;
C i I
APPROVED
MASON BUILDING INSPECTOR
CHANGES SUBJECT TO APPROVAL
C*YDATE03-Q-1-0a
LICENSE DETAIL INFORMATION Form �34 ot,a 7- &y- 00 416 Page 1 of 2
STATE OF WASHINGTON
DEPARTMENT OF LABOR AND INDUSTRIES
Specialty Compliance Services Division
P. O. Box 44000 Olympia,WA 98504-4000
THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS:
LICENSE DETAIL INFORMATION
Current Filter: None
Registration#or License NPRHL**990MZ
Name NPRH LLC
Address P O BOX 3479
Address
City KENT
State WA
Zip 98032
Phone Number 2532263826
Effective Date 7/9/2001
Expiration Date 6/17/2003
Registration Status ACTIVE
Type CONSTRUCTION CONTRACTOR
Entity LIMITED LIABILITY COMPANY
Specialty Code MOBILE HOME SET-UP
Other Specialties CARPENTRY/FRAMING
UBI Number 602123276
* * *VIEW CROSS REFERENCE FILE FOR THIS LICENSE*
* * *VIEW PRINCIPAL OWNER(S) FOR THIS LICENSE*
* * *VIEW CONTRACTOR BOND/SAVINGS INFORMATION
* * *CHECK INQUIRY FOR SUMMONS AND COMPLAINTS*
* * * VIEW CONTRACTOR INSURANCE INFORMATION
New inquiry by CITY, NAME, PRINCIPAL OWNER NAME, NUMBER, UBI NUMBER or
return to the L&I Construction Compliance Home Page
https://wws2.wa.gov/lnl/bbip/TF2Form.asp?License=NPRHL**990MZ 12/10/2002
i
APPR. NO. CHG. REASON PAGE OF
SIZE MOBILE HOME FAC.T=Tf�
a-i
MAKE
4. C;
MODEL N E I Giu,00 R H 0 0 D R L�A
SERIAL NO.
USE CODE
L.Gi T 4'D
- � i-�� --r! - p%.- r
PARCEL NO. --f-0: -1 4 3_� . : �. : 1 ;
j
ASSOC. R/P PARCEL NO. i c n n.rin.i
BUILDING TYPE CONTACT CONDITION BUILDING LIFE
DATE BUILT RENTER CONSTRUCTION STYLE'J E'
BLDG. USE CODE 3 = i REMODEL DATE EFFECTIVE AGE MARKET MODIFIER
CHARACTERISTICS PLUMBING FLOORING BUILT-INS
QUALITY = SINK FLOOR CONST, �: --- —
ALLOWANCE INTERCOM
EXTERIOR W.H. FLOOR COVER ALLOW RANGE-OVEN RANGE-OVEN VACUUM
ROOF COVER LAV. TYPE DISHWASHER MICROWAVE
FOUNDATION TOILET TYPE % GARB.DISP. HOT TUB
SHOWER HEAT TRASH COMP, SAUNA
BEDROOMS TUB SHOWER HEAT-COOL REF.
BATHS OTHER FIREPLACE(S) HOOD&FAN
TOTAL
BLDG. SIZE BASEMENT GARAGES CARPORTS PORCHES
1St FLR. !Ii BSMT.QUAL. GAR,QUAL. C.P.QUAL, PRCH.OUAL.
V,FLR. !I BSMT.TOT. ROOFING ROOF CVR. CONC. 11
2nd FLR. q! FINISH I] EXTERIOR C.P. III DECK a)
3rd FLR. I FIN QUAL. GAR.TOT. DIRT FL. BALC. f1:
SPLIT LEV. MISCELLANEOUS GAR.TYPE DEPR. ROOF Ill
ot
ATTIC !I ASPH .,DEPR. SITE VALUE ROOF TYPE
CONC. III P-1
F WELL ENCL.[11
SKIRT MH 4-
SEPTIC DEPR.
ASSESSED VALUATION RECORD
REP.COST zi L. �7 MH/OTHER BLDG.
A-Yr. CURR.'USE MKT. LAND IMPROVEMENT TOTAL %DEPR. LUMP SUM
%comp. LAND VAL
ADJ.BLDG.VAL. TOTALAV
OTHER IMP. N.C.
TOT.BLDG.VAL. 3 5 C?S 5 TOT,M/V O.S.
METHOD CLASS WATERFRONT VIEW RD.1 TOPOGRAPHY AMEN.
o LAND
> 0 Z Z Z
0 USE QUANTITY RATE VALUE as <<< V)cr o i: oo
>a: M M
0(L CODE 0 w t: > 0 z z
cr'r u m T Z <
cr a- o E 0 0
u 0 0
0 d 4 0 z'o m o
Q. Lf) , owso 0 Nuu
01
o z lowgwwo U)
C). J T.m co�-0 0<(D .�:-J(n rr C) (r. z
1 1 213141112 1 114 1 1 1 2 3 1 1 1 T i TTTT TTTT 1 1 1 1 1 7 1
----- -----
Mlv
OPEN SPACE QUANTITY METHOD RATE $
VALUE
APPR. NO. - _ CHG. REASON `P z c°_°, ,I I i T T flik i =_ _: PAGE OF
SIZE MOBILE HOME ;•�t iR �••fc�N �ri;l i- i� '! rG E !-TOMES
MAKE T r>=1 f, SHEET 01
-ATE R
MODEL F.r.Evai — s
SERIAL NO.
USE CODE 1 4 k- i •, -- -
_ It
it_
I _I
PARCEL NO. - LT7 c;; n'•�i'v a,�?�
ASSOC. RIP PARCEL NO.
BUILDING TYPE CONTACT CONDITION BUILDING LIFE
DATE BUILT RENTER CONSTRUCTION STYLE
BLDG. USE CODE i C G i REMODEL DATE EFFECTIVE AGE MARKET MODIFIER
CHARACTERISTICS PLUMBING FLOORING BUILT-INS
QUALITY SINK FLOOR CONST. ALLOWANCE INTERCOM
EXTERIOR W.H. FLOOR COVER ALLOW RANGE OVEN VACUUM
ROOF COVER LAV. TYPE °i DISHWASHER MICROWAVE
FOUNDATION TOILET TYPE % GARB.DISP. HOT TUB
SHOWER HEAT TRASH COMP, SAUNA
BEDROOMS TUBSHOWER HEAT-COOL REF.
BATHS OTHER FIREPLACE(S) HOOD&FAN
TOTAL —
BLDG. SIZE BASEMENT GARAGES CARPORTS PORCHES
1st FLR. '1i BSMT.QUAL. GAR.QUAL. C.P.QUAL. PRCH.QUAL.
v: FLR. BSMT.TOT. ROOFING ROOF CVR. CONC. 11'
2nd FLR. FINISH I EXTERIOR C.P. ;II DECK(f)
aid FLR. FIN.QUAL. GAR.TOT. I)' DIRT FL. BALC. '11
SPLIT LEV. ; MISCELLANEOUS GAR.TYPE DEPR. '- ROOF III
ATTIC I ASPH. DEPR, 9•; SITE VALUE ROOF TYPE
CONC. :( 1 _ 9•: WELL ENCL. Q)
SKIRT MH — -_ _ °•- SEPTIC DEPR. -
ASSESSED VALUATION RECORD REP.COST MH/OTHER BLDG. %, GCcz
A.Y,. CURES.USE MKT. LAND IMPROVEMENT TOTAL — +
DEPR. LUMP SUM
i i_} i %COMP. LAND VAL. i ?ii:•
7 C ?+ '• _{3?' ADJ.BLDG.VAL. TOTAL AV.
' ii OTHER IMP. ^, :_:::: N.C. _ _
TOT.BLDG.VAL. — !_'i:- :- TO MN O.S.
METHOD CLASS WATERFRONT VIEW RD. TOPOGRAPHY AMEN.
w LAND n
Z w O USE QUANTITY RATE VALUE Z Z Z w ~
O _0>¢ ¢<<< cr wO w� 03 c�c�
cr ¢¢N¢2 CODE Z 0 TL).>or Z¢m => Qomwa J M¢ _J
aO°�a <oo�z 0 _0wL i awOzmw¢ �ooW> 0 0 5
O co J�SmHO �_wD O Q 0 O�-i v)a: t O N O
1 2 314111213 4 1 1 1 2 3 1 1 1 1 1 1 2 1 2 1 1 1 1 1 1 1 1 1 1
111111 IRR
MIV OPEN SPACE QUANTITY METHOD RATE VALUES
MASON COUNTY LAND AND IMPROVEMENT SHEET
19 SALE IMP
19
—SALE MP-
19 SALE—IMP
19 SALE—IMP
UPLAND Pf' WATERFRONT
JOPOG: ACCESS LEVEL SLOPE COVER
CLEAR —VIEW BANK BLKHD BCH ACC
BEACH DRAIN WATER 60 i'l-r' SEWER
19
19
TOTAL TOTAL TOTAL
1 18- 19-
WF_-____(d____T wE �d____-T_______ WF ((v____
_________(a_
� �______ ________�------_T__-_-------- �
-------__�--___-_ _________
xvFA______-0-_---_- vvrA________,,&_______ wFA (d_______T__________
IMP ___���7��� |mp __�� ��T |mp ��_�__�___�
___---_-(d-_____T�---___-__' _-__--_'d)-_----_T Ira-___-_]'_______-_'
UN| _(6-T Vm| ___,a_T Uw/ _CU_T_�__
__--_-_a--__-_T_-____-_-_ ------__'ro_____-J----___--_
`~
TBR____---_0 TBn_______o'_______T ToR _____]'___________
TOTAL TOTAL TOTAL
,.� � r •K y� _ tr
~�liKY WIT-
"Jill IIIIII I �� �
y
IMPROVEMENT SHEET
BUILDING CONSTRUCTION STORIES 1 2 1/2 B 19
Cabin Frame No. Rooms 19
Dwelling Double Living 19
Apartment Conc. Blk. Dining 19
Commercial Kitchen 19
Farm PLUMB BASE Family Year Built Year Remod.
Sink Lay. Bed Cost Condition
FOUNDATION D.W. Toilet Bath CLASS 1 11/2 2
Concrete G.D. Shwr. SQUARE FT.
Post & Blk W.H. Tub-Shr. INTERIOR WALLS
A.W. Dry Wall Rate Adjustment — +
EXTERIOR WALL HEATING/COOLING Panel Base Rate
" Cedar Siding Plaster Heat
Shingles Fireplace
Shakes Fir./WI. FLOORS Ad'. Base Rate
Conc. Blk. Frcd. Air Soft ADDED FEATURES — + Extend
Vert. Ply. H.W. B.B. Hard Basement/Rooms
Brick Ven. EIec. B.B. Carpet Heating
Ht. Pump Concrete Plumbing
ROOF EXTRAS Fireplace
Flat Oven-Range BASEMENT Attached Garage
Hip Exhaust Fan None Conc. Fir.
Gable Part Dirt Fir. Attic
Shed Full Garage Deck
Da liteUo. Rms. Porches
, r 1
.f�
i
<_ al
R "Y' /DepIOUs
VALUE
UILDINGS Full
Value
},
TOTAL
Z
}. �... .
4 4-
4. O f t t 4
2-
Revised 7-77
ar�
PERMIT NO.: BL�
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 crs'7J1,Y44e f-02 Contractor Name
Mailin ' ddress Mailing Address
City -.StateWA Zip Code City State Zip Code
Phone er Ph.( ) Ph.( Other Ph.(
Lien/Title UWger , Contractor Reg. #
Address : /A1!f7 Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic 4'",, Existing Septic Connect to Sewer
System Name of$ewer rystem Well Water System Name of
Water System L
ARCEL INFORMATION-\ 2 di It lax Pa el2 ire Distr' t
--�, , . � h f-Legal Description I
Site Address(Please i clude strut name, s et number ands /ty) %)
Directions to site A✓ .� L�e /f�u fl-
Will timber be cut and sold in parcel preparation? (Yes/No) ca
Is your property within 200' of the following: Body of Water (Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE SEASONAL RESIDENCE❑
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
MOBILE.WO}1IIE INFO ON-Make odel ;j odeI Year - '�..'-,"-'.-,:
Length---L dth Serial No. . of Bedrooms No. of • hroorp9�
Type of Heat �` Pur u�se Price $ i Repl ceryent Unit ?(Yew--
Installer r/
Installer Name �f°' 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
approvaal.l..� p first obtaining approval.
X �(,�((.Q7 '�7►�/' Date 1/ 0- X Date
FOR OFFICIAL USE BEYOND THIS POINT
r
Accepted by _ Date Submittal Amount Due Receipt No.
DEPARTME Al. REWf» APPROVED DENIED`` CONDITION CODE$
Building Depa e - / , O��'G
Occ GroupType o str.
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
_Y_aWaff—on $_oEtm—
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing& Base Fee Planning Review Fee
Mechanical&Base Fee Other t-�-4
Wood/Gas/Pellet Stove Fee State Fee �d
Violation Fee Pre-Paid at Submittal ( CA
� )
TOTAL FEES