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Home My WebLink AboutBLD2001-00857 Addition, Remodel - BLD Permit / Conditions - 10/15/2001 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Irflo Shelton, WA 98584 RESIDENTIAL BUILDING PERMITr,,Ld BLD2001-00857 OWNER: COLLIN ORR RECEIVED: 8/21/2001 ISSUED: /2 CONTRACTOR: LICENSE: EXP: SITE ADDRESS: 180 E MIKKELSEN RD SHELTON EXPIRES: 10/1205/20 01 PARCEL NUMBER: 321344200010 7/6/2003 LEGAL DESCRIPTION: E1/2 NW1/4 NW1/4 SE1/4 180 E MIKKELSON RD SHELTON PROJECT DESCRIPTION: DIRECTIONS TO SITE: ADDITION OF APPROX 1000 SF AND ATTACHED GARAGE AND FROM SHELTON HWY 3 TO MASON LK RD, 1 MILE TO MIKKELSEN RD REMODEL 2ND FLOOR TURN RIGHT, 1/4 MILE ON MIKKELSEN DRIVEWAY ON RIGHT General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 1 Type of Constr.: V-N Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: R-3, U-1 Lot Size: Deck: 216 Type of Work: ADD Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building:1,062 Garage-Attached 586 Valuation: Building Height: 23 Occ. Status: Unknown Basement: Manufactured Home Information Setback Information Shoreline & Planning Information : y Make: Length: Ft. Front: S 140.0 Ft. Shoreline: Ft. Water Body: No Model: Width: Ft. Rear: N 170.0 Ft. Slope: Ft. Shoreline Desi Side 1: E 100.0 Ft. g" Year: Serial No.: Side 2: W 120.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Gas Outlets 2 Plan Check Fee KLW 8/21/2001 $554.94 57144 Hosebibs 2 Propane Tank 1 Adjust Plan Check Fee JRN 9/6/2001 $13.65 57646 Kitchen Sink 3 Ventilation Fan 2 Building State Fee JRN 9/6/2001 $4.50 57646 Lavatories 3 Heat Pump 1 Building Permit Fee JRN 9/6/2001 $874.75 57646 Showers 1 Propane Stove 1 Mechanical Fee JRN 9/6/2001 $88.45 57646 Water Closets (Toilets) 2 Mechanical Base Fee JRN 9/6/2001 $23.50 57646 Water Heaters 1 Plumbing Fee JRN 9/6/2001 $89.00 57646 Bath Tubs 1 Plumbing Base Fee JRN 9/6/2001 $20.00 57646 Planning Review Fee RAM 9/27/2001 $38.00 57646 EH Plan Review CEW 10/3/2001 $50.00 57646 Total $1,756.79 BLD2001-00857 Please referto the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD20 0 1-00 8 57 CONDITIONS FOR BLD20 0 1-00 8 57 1) This application is subject to Buffer and Landscaping requirements as established under Mason County Ordinance 1.03.036.X 2) 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 3) 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 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) Approved per dimensions and setbacks on submitted site plan. X 6) 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 in the amount of$47.00 per hour(minimum 1 hour)will be charged and must be collected by the Building Department prior to any further inspections being performed or approvals granted. X 7) 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. X BLD2001-00857 Please referto the following pages for conditions of this permit. 2 of 4 8) The plan review check list and corrections, along with the Energy Compliance Worksheet (when applicable) 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 removal of approved documents will result in failure of required building inspections. X 9) 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 of$47.00 per hour (minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted. X 10) All construction must meet or exceed all local ordinances and the 1997 Uniform Building Code 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 11) 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. X 12) All changes to "approved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction. X 13) 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 Mason County Building Inspector shall be made prior to requesting additional inspections. X 14) THE DEMOLITION AND DISPOSAL OF DEMOLITION DEBRIS MUST MEET REQUIREMENTS AS PER MASON COUNTY REGULATIONS. 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 County ordinances and building regulations. X 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 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 granted. X BLD2001-00857 Please referto the following pages for conditions of this permit. 3 of 4 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. 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 and structure for review and inspection. OWN ER OR AGENT: DATE: BLD2001-00857 Please refer to the following pages for conditions of this permit. 4 of 4 FE CO?-CREME MECHANICAL MOBILE HOME FooWV3-Setback date o Z 1, by pas Ptping I date by Four datlon Want date by Set UP da!o bv INSULATION date by EC/SLAB insulation Floors ' . 02 Final to by date LS date by FRAMING FIRE DEPT. date byddatet 11-20'OZ by R�- date by PLUMBING Attic OTHER Groundwork date by date b WALLBOA D IUNG D.W.V. r` date D 17, bygLg date k' ��2 by FINAL INSPECtION Water Line date t - - by �� date by date by lee Q'SS 2-- C�-0Z 2- 02 4v4a 4e'<J -' Q� Building Permit # MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location !80 f5 t kk fc.5oAa -1�c4 ORR This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items Listed below must be corrected to/gain code compliance c -- r > ,l - 71 r - 2 c A C4 Q 1 tigFr-f7 E Lvtil,L �'�' lt1 L r r I C�- 6f 92 Vj P/zw Z You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑ OK to '-j-kWtqTP ❑ This is not a complete inspection Department Date I ( I l�I UZ Inspector IRLS moos NOOT MUV THIaft TA& W 1 r o CONCRETE MECHANICAL MA NUFA CTURE D H OME 0 Footings / Setbacks Date 1� ��'l 0-I Ribbons co Date By Gas Piping ate By V Foundation Walls Date B y Set-up Date By INSULATION Date By B G / Slab Insulation Floors Final Date By Date By Date By FRAMI G Walls FIRE DEPT Date I-), (I k� B - Date IZ- By ' — Date By PLUMBING Attic OTHER Groundwork Date 12 -2 7 / By I Date By W ALL DO�rg D NAILING D.W.V. Date Y By RLS Date 1ar4 OV B FINAL I S ECTION Water Li Date %e l 7,log By-9`r Date Date By Er CD a ODE! I/ caul 0 D Z8Lz)-s am )y Q5b? w O O o00 r r z 0 ' Mason County Dept. of Community Development Mason County Bldg. 3 426 W. Cedar P.O. Box 186 (360) 427-9670 Local (360) 482-5269 Elma Shelton, WA 98584 (360) 275-4467 Belfair I POW to Notice to Obtain Final Inspection December 13, 2007 COLLIN ORR 180 E MIKKELSEN RD SHELTON WA 98584 Case No.: BLD2001-00857 Parcel No.: 321344200010 Proiect Description: ADDITION OF APPROX 1000 SF AND ATTACHED GARAGE AND REMODEL 2ND FLOOR The Mason County Department of Community Development is currently reviewing all permits that are expired and have not been approved for occupancy and use. Pursuant to Mason County Code, Title 14 Building and Construction, a permit and final inspection for this type of activity is required under the 2006 International Building Code or the code your permit was issued and your property is currently in violation status of occupancy and use. Please contact our office to make the necessary arrangements 21 days from the date of this letter. Failure to contact our office to make the necessary scheduled inspections will result in enforcement actions. To bring your site into compliance, you must schedule an inspection. One (1) $64.00 site investigation fee will need to be paid prior to inspection along with any outstanding fees currently due on your building permit. For every inspection required after that, you will be charged $64.00 again, per inspection until final inspection and conditions are met. To schedule an inspection, please call (360) 427-9670 ext. 262. If you should have any questions regarding this notification, please contact me at (360) 427-9670 ext 359. Sincerely, —� L Terry Ryan Mason County Department of Community Development Cc: Property File December 13, 2007 BLD2001-00857 12/8/2004 Case Activity Listing 4:44:54PM Case#: BLD2001-00857 i� Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By BLDB200 Environmental Health Review 4/25/2002 None 4/25/2002 KEF BLDA010 Application Received 8/17/2001 8/21/2001 None DONE KLW 8/21/2001 KLNN' BLDB135 Addressing 8/21/2001 8/23/2001 None DONE GMM 8/23/2001 GMM BLDB138 Planning Pre-Review 8/23/2001 8/27/2001 None DONE KMR 8/27/2001 KMR BLDB201 EH More Info Letter 9/4/2001 None DONE CEW 9/4/2001 CEW BLDBI 10 Building Plan Review 8/21/2001 9/6/2001 None DONE JRN 9/6/2001 JRN review complete,sent to MC for energy review,JRN 09/06/2001 BLDB120 WSEC Compliance Review 9/7/2001 9/10/2001 None DONE MEC 9/10/2001 MEC electric wall heat,opt.#6 9-10-01 MC BLDB130 Planning Review 8/27/2001 9/27/2001 None DONE PBC RAM 9/27/2001 RAM Site inspection conducted on 9/27/01. New construction is greater than 165'from wetland and/or seasonal stream. No slope issues. BLDB200 Environmental Health Review 8/21/2001 10/3/2001 None DONE CEW 10/3/2001 CEW bedrooms match,need satis pump ersreportl0/3/01rec satis pumpers report BLDA100 Approved for Issuance 10/8/2001 10/8/2001 None DONE KS 10/8/2001 KS NOTIFIED BY PHONE(MSG) 10/8/01 BLDA500 Issue Building Permit 10/15/2001 None DONE BLR 10/15/2001 NJP Page 1 of 3 CaseActivity..rpt 12/8/2004 Case Activity Listing 4:44:54PM Case#: BLD2001-00857 i� Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By BLDA990 Plot Plan Revision Received 4/25/2002 None DONE RAM RAM 4125;12002 KLF BLDB130 Planning Review 4/25/2002 4/25/2002 None DONE RAM RAM 4/25/2002 KLF OK for revision. BLDB110 Building Plan Review 4/25/2002 4/26/2002 None DONE MEC 4/26/2002 MEC Plot plan revision.4-26-02 me BLDB007 Plan Revisions Submitted 4/26/2002 None DONE MEC 4/26/2002 MEC plan revised added 2'to garage,also revised plot-plan placed in the resub bin 4-26-02 MC BLDB 110 Building Plan Review 4/26/2002 4/26/2002 None DONE MRG 4/26/2002 MRG BLDC110 Footing Inspection 5/3/2002 5/8/2002 None PASS LAW 5/9/2002 KLW BLDC250 Permit Extension 3/12/2002 10/15/2002 None DONE PIB 3/13/2002 PIB EXTENDED 6 MONTHS FROM EXPIRATION DATE OF 04/15/02 TO 10/15/02. CUSTOMER HAVING TROUBLE FINDING CONTRACTOR,PLUS BROKE HIS ARM IN FALL FROM LADDER. BLDC140 Framing/Plumbing/Mechanical 11/4/2002 11/13/2002 None FAIL RLS 11/18/2002 KLW 1.LSTA 18 STRAPS MISSING TIEING EXISTING HOUSE TO ADDITION AT NEW KITCHEN,2.DSL STRAP TIEING GIRDER TRUSS INTO TOP OF WALL PLATES,3.LSTA 18 STRAP TIEING 6 X 8 BEAM AT END OF CVERED PORCH TO EXISTING HOME MISSING,4.HDAHD22 OR LTT20B COMING UP UNDER WINDOW IN FAMILY ROOM NOT CONNECTED TO 2 FULL HEIGHT STUBS,5.FIRE BLOCK CHIMNEY CHASE AT CEILING LEVEL,6.BACKING BOARDS REQURIED TO SUPPORT RAFTER TAILS ON OVERBUILD ABOVE KITCHEN,7. HAVE ENGINEER ADDRESS OFF SETWALL AT KITCHEN AND LSTA18 STRAPPING AND ITEMS 2,3,4,OK TO INSULATE. BLDC125 Framing Inspection 12/17/2002 12/20/2002 None PASS RLS 12/26/2002 KS BLDC145 Insulation Inspection 12/17/2002 12/20/2002 None PASS RLS 12/26/2002 KS Page 2 of 3 caseActivity.apt 12/8/2004 Case Activity Listing 4:44:54PM Case#: BLD2001-00857 i� Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By BLDC115 Foundation Wall Inspection 12/30/2002 1/6/2003 None PASS RLS 1/7/2003 KLW BLDA510 Reprint Building Permit 12/8/2004 None DONE PIB 12/8/2004 Pill Page 3 of 3 CaseActivity-rpt PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION 4117 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 ' /�W Contractor Name Mailing Address 1?o r In,kk P/tpw /P Mailing Address City S /f a /1`y-✓ State hriA Zip Code 2,f s-d�- City State Zip Code Phone 6 6 ` .i& -2 9 s i Other Ph. 3&o ?,47 - 630 Ph.( Other Ph.( Lien/Title Holder C _.f fib, tti,:/c f L do.•-! Contractor Reg. # Address Six /a A.,C. Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well `X, Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. 3-2 /3 91 / Ll./ 0 00/t7 Fire District Legal Description N v 'li A,1A., Y, 5-,& / Site Address(Please include street name, street number and city) O d11Ao-,P 1.. /r Directions to site ,.,) 14 .//oo- - /I" � So (,� In L,r -1, 'A"" y& rr IA,/n/r1- ;ram /r2 0 ti /01�/A,w- /I /7♦/ GVD'S O.• !�'/9 Air- 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 X_Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt)r _Repair Other Use of Building Describe Work r , / , ; V a i O r A/ir i �rl i ` car r No. of Bedrooms 3 No. of Bathroom `a,S' SQUARE FOOTAGE-1st Floor 2nd Floor efvo 3rd Floor Loft Basement Deck Other sq. ft. Garage 1 Attached ✓ Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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 �G9. ` ' ✓` 1 Date 7 /G 0/ X Date _''( 1 FOR OFFIICI (LOUSE BEYOND THIS POINT Accepted by I �lA Dae { V Submittal Amount Du 49q Receipt DEPARTME VI VV APPRO.VED DENIED» t)NDITI N C7if I . ....... ....... .... ............................ ....... ..................... Building Department Cl/G 01 Occ Grou Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee L\'15 Site Inspection Plan Review Fee Sp1 EH Review Fee Plumbing&Base Fee 114%'oo 00 Planning Review Fee Mechanical& Base Fee 21- ` Other Wood/Gas/Pellet Stove Fee State Fee `1 60 Violation Fee Pre-Paid at Submittal ( '"'1 A4 ) TOTAL FEES PERMIT NO.: pO/-a S 7 MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair(360)2754467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 6.1 Q " Contractor Name Mailing Address IT`.1 7 r Mailing Address City State Zip Code City State Zip Code Phone( ) � 9"y Other Ph. j( �" )�_ Ph.( Other Ph.( ) Lien/Title HpIder dp&' � - °—�'� oa�! Contractor Reg. # Address " ° /y Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. i / 1 / /c Fire District Legal Description /Y " "',:' `% .) ` 7y Site Address(Please include street name, $treet number and city) ' ^t ' s 10'" Directions to site °" Sh fir'^ " f l w 3 S o-- f G R.c. Q�I '1 P✓ / e �G( %1/e/ t Ow. /moo 6,p 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 X Add Alt e Repair Other Use of Building 11iirl, tiri� r�L Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG X Natural Gas Heatpump Toilets �— Type of Unit No. of Units Fees Bath Basins Furnace Bath Tubs Heatpumps Showers —� Vent Fans Water Heater I Propane Tank Laundry Wsher Gas OutLets Sinks t12L Wood/ a Pellet Stove Dishwasher Direct Vent? Other_ _ Other Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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-1 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 7//6/0/ X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENT AL iitEV# Vif':;... . Rf>PI�+�VEt� DENIED CO(VRi€IONCLSClEB Building Department Occ Group Type Constr. Planning Department Other Other . Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES MASON COUNTY PROJECT SITE INFORMATION Case No. Name PARCEL NUMBER 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 line-> I I Fadjacent property line I I I I I I t I I I I I I I I I I I I I , I t I I I I I I I � I I I I I I I I I I I I I I I I I I I I I t I I I I adjacent property line-> I I Fadjacent property line SAMPLE SITE PLAN adja t property line-> 3LO" _ _ E-adjacent property line v 30' �RESaRV .,EACG wJ AL I ^, 77ffCC L �- I c I HOM e. I .GaaE�1 Crz�K I r% I I F Jp• ._ � i�ousa I ) I PIRO POSGD SdL C I 7� R\ I VAGNT I I GARAGE pr�ofose0 So'— T AbR ZCLLLTWRAL I IF-40 I 1 I � I I I � I I \ I c—eLL I I I I � /OO' —� I Ia�GLL I adjacent property line-� Fadjacent ro ert'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 d1S+ArGQ fin 4 ru.ct64_Yt di5'tA►,LL to Slopm t o¢ dis+ancm t e dL Signature Date