HomeMy WebLinkAboutBLD2014-00327 Final Waste Storage - BLD Permit / Conditions - 5/16/2014 Inspection Line (JbU)4L/-/LbL
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 279
Shelton, WA 98584
i�
RESIDENTIAL BUILDING PERMIT BLD2014-00327
OWNER: FLOYD SAWYER RECEIVED: 4/7/2014
CONTRACTOR: PRIDE IN CONSTRUCTION 1.360.769.7328 LICENSE: PRIDEC1895JJ EXP: 7/2/2015 ISSUED: 4/15/2014
SITE ADDRESS: 4833 ESTATE ROUTE 3 SHELTON EXPIRES: 10/15/2014
PARCEL NUMBER: 321353400050
LEGAL DESCRIPTION: TR 5 OF SE SW EX, LYING NWLY OF S.R.3 R/W: SEE SURV 8/60 & 18/9 PCL 1 OF BLA 99-48
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW AGRICULTURAL WASTE STORAGE STRUCTURE"""OPEN ON ALL FOLLOW ST RT 3 TO SITE ADDRESS ON THE LEFT SIDE
SIDES
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: U Lot Size: Deck:
Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building: Carport-Detached 4,320
Valuation: $ 88,041.60 Building Height: 21 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: E 200.0 Ft. Shoreline: Ft. Water Body: na
Rear: W 105.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: S 140.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: N 400.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Plan Check Fee GMM 4/7/2014 $595.89 S1201400000001
Planning Review Fee GMM 4/7/2014 $205.00 S1201400000001
EH Minor Plan Review ALP 4/7/2014 $ 100.00 S7201400000001
Building State Fee LDK 4/15/2014 $4.50 S1201400000001
Building Permit Fee LDK 4/15/2014 $916.75 S1201400000001
Total $ 1,822.14
BLD2014-00327 Please refer to the following pages for conditions of this permit. Page 1 of 5
CASE NOTES FOR
` BLD2014-00327
CONDITIONS FOR
BLD2014-00327
1) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/Reserve requires a 1 Oft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. No foundatio drains within 30ft, down gradient of drainfield/reserve area.
X %/
2) Prior to final approval, all upland areas disturbed or ne�wly cr/�ated by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X Mly f
3) Approved per limensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X C;
4) Application a cnowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Residential 5.
X
5) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR RO_—�Y,
6) Water quality is nqt to be degraded to the detriment of the aquatic environment as a result of this project.
7) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan" to ensure
these structures meet the setback conditions listed.
X `'\J��
8) Landings and stair must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Site PI "to ens to these structures are shown and meet the setback conditions listed.
X
BLD2014-00327 Please refer to the following pages for conditions of this permit. Page 2 of 5
W) contractor registration laws are governea unaer Kuvv -iu.zt ana entorcea ny the vvH Mate uept of vapor ano inaustnes, Contractor t ompiiance uivision.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-0982. Th, person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X KA .I
10) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Department prior to y further inspections being performed or approvals granted.
X
11) Owner/Agent i responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
12) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of tho project. Failure to comply and/or
removjl of�appr ved documents will result in failure of required building inspections.
X
13) THE F ITA
AT N SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
X M 1_'
14) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the "approved" site plan is not on site, then
approval will not b 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 Departm5pt prior to any further inspections being performed or approvals granted.
X
15) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan"constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system
of this, or any other, parcel. You may also wish to 41onsult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contra for is a owledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
16) This structure is kmited to U-occupancy use only(private garages, carports, sheds, and agricultural buildings.) Any other use will be in violation of the
internati n I co and Mason County Regulations unless a"Change of Use" permit is applied for, reviewed and approved.
X
BLD2014-00327 Please refer to the following pages for conditions of this permit. Page 3 of 5
1-7) Any changes in proposed construction snail oe reviewed oy the engineer or arcnitect of record and suominea in writing to the mason Lounty 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 do merits are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour) will be
charged and all be are
by the Building Department prior to any further inspections being performed or approvals granted.
X I AA
18) All construction ust meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of Washin o Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permitTepcaf n�
X
19) 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 ounty Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located ithin 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
20) The placement of buildings and structures on or adjacent to slopes steeper than one unit vertical in three units horizontal (33.3% slopes) shall conform to
the International Residential Code Section R403.1.7 for descending or ascending slopes.
Alternate setbacks may be approved subject to approval of the building official based upon the investigation and recommendations of a qualified engineer
licensed in the State of Washington. Such an investigation shall include consideration of material, height of slope, slope gradient, load intensity, and
erosion c acteristics of slope material.
X
21) All changes t "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordi ulation, must be reviewed and approved by Mason County prior to construction.
X nc or
22) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENTAND THE ADOPTED
BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the internatio al codes as amended and adopted by Mason County. Any corrections, chang s or alterations required by a Mason County Building
Inspect s 1 de prior to requesting additional inspections.
X
23) All property lines shall be clearly identified at the time of foundation inspection. X
24) 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 spection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason un finances ti building regulations.
X
BLD2014-00327 Please refer to the following pages for conditions of this permit. Page 4 of 5
-25) 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 per' d not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
hold r have p vented action from being taken. No more than one extension may be granted.
X
If Q-
26) Pressure treatgo wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, a f shing. Install metal connectors approved for contact with the new types of pressure treated material.
X
27) Retaining walls needed to support a su r Isch as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
OWNER/ BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by
signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the
work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The
owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s) for review and inspection. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if
construe ion work is suspended for a period o 1 -d s. PROOF OF CONTINUATION OF WORK IS BY ME S OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATI F 180 DAYS` L`I ATE THE APPLICATION.
/S .Z U
i ure Da e
VA l/le OWNER - REPRESENTATIVE - CONTRACTOR
Print Name (Circle one to indicate)
BLD2014-00327 Please refer to the following pages for conditions of this permit. Page 5 of 5
o CONCRETE MECHANICAL MANUFACTURED HOME D
� Footings I Setbacks Date By
Ribbons
Gas Piping
o Interior Date By Interior-Oahe By Date By
vExterior Date By Exterior-Date B Set-up _ _�_._ TI
Point Load I Isolated Footings INSULATION Date By Q
BG I SLAB INSULATION — _<
Date By Data By FIRE DEPARTMENT p
Foundation Wails Floors Date By
Date By Data By DECKS
FRAMING Walls Date By
Date b t, By Data By PROPANE TANKS
PLUM IN vault Date By
Date By
OTHER
Attic
Groundvoork
Date By Date By Type.
Dzte By
D.w.v DRYWALL Type-
Date 8y Int.Brace Wall Date By
Date By FINAL INSPECTION �
co Water Line Fire Seperation N
CD � g�
CD Date By Data By Date By �-6� o
m �
g Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments tw
4
d
CD
aw CA L61m_ 5 1111
a
0
a
o'
_
0
rn'
v
m
3
v
co
ro
0
i .I
Name flo y d Sid 1 JuAlr 1� Parcel#22 l-3 — 3 y OOOsd BLD#ZQ 14—DO'�722
14
BUILDINCO Mason County
epartment of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development,or redevelopment',with more than 2,000 square feet of impervious surface.
`Redevelopmerrt means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
�c 'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwatma.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
TV atc late Impenr�flr s Su'rmces_PfeasE Corrip ete'This 1'ab7Q_
.
Surface Type Length X Width = Area *All dimensions in feet
Buildings X =
X = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
X = eaves/gutters)
l5
Drivewa X =
X rl — Length of drive begins at the right of way
X =
Parking Areas X =
X = Any paved, gravei or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = `tf,the total_impervious area-of the proposed-site
X = developmeril is.-greatet than,2�D0 square feet a
Small Parcel Stormwater Site Plan is lqutred
Total imprvious.Sarface�;rea(sum ofa�areas)`
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read,acknowledge and sign below.
Based Upon the information you have provided a Storrnwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Aclrnowledi; ubmission of inaccurate information may result in a stop work order or permit revocation_
Acknowle ent of such is by signatur elow.I declare that I am the owner,owner's legal representative,or the contractor.I
further ac Ow
that the info - p�ded is accurate and employees of Mason County are granted access to the above-
des bed perty or review echo as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surfac ATER THAN 2000 Square Feet,please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
Name7-/oyJ Parcel# 1a1 36" - )y^('70 BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a StormwaterSite Plan 1S Required for this development activity.
Title 14, Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
httn//wv✓w.co.mason.wa—us/code/commissioners/index htm
Please follow the links to "Title 14,Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48.section 14.48.70). You will receive a copy of the Public Works document
entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan".This document will assist.
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health
information below). If an altemative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout'
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
Mail: P 0 Box 1850,Shelton WA 98584
Physical:415 N 6th St,Shelton WA 98584
If this development has, or will have,a septic/draintield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other,parcel. You may also wish to consult with the septic design professional involved with the project.Mason
County Division of Environmental Health can be reached at:
Phone: (360)427-9670 EXT.352
Mail:P 0 Box 1666,Shelton WA 98584
Physical:426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
OwnerA3uilder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative, or the cont-actor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
des property for review an inspection as may be required. /y
X Owner/Agent/Contractor(circle one)Date:
Page 2 of 2
tit
bu i� �i., .ate � N}x .� • _ � �i a y,� �' , .a
"TIN
2
t
b � �
V�l
`
Ott-
41�
t
F
s
°
s.
a
,r. 4
x
4.
^L
jpI r - -
i�
5�� CCU
map MASON COUNTY
1 DEPARTMENT OF COMMUNITY DEVELOPMENT
Mason County Bldg. III, 426 West Cedar Street
PO Box 279, Shelton, WA 98584
I854 www.co.mason.wa.us (360)427-9670 Belfair(360)275-4467 Elma (360)482-5269
REQUEST FOR BUILDING PERMIT EXPEDITION
Date: Permit No.: -?)IG#2014 - 00324
Name:
.1:/0 54
Mailing Address: 4 3r244A
No X.) /q
Parcel Number: 2 _
0
Site Address: WO 33 S` �/Lo
�
Request due to: ❑Medical Hardship Fire Damage ❑Other
Explanation of Hardship: r:� ;PA_ 'e"Wie o y/ F,
Must include supporting documents, this may be a letter from a doctor, insurance claim report,
report of fire damage from appropriate fire district representative or other relevant
documentation.
I (WE) understand the intention of t is form is to determine d document justification for
expedition of a building permit to alt r or rec nstruct a str yr on the above named property.
Signature Owner/Agent: 19
OFFICIAL USE ONLY
Request.----U Approved ❑ Denied D . t
Request denied for the following reason(s):
�I5 26I3 - 000ZLP
Signature:
Director of Community Development
Since 1894 OREGON MUTUAL INSURANCE COMPANY
WESTERN PROTECTORS INSURANCE COMPANY
• 19000 336 Ave.W,Suite 110, Lynnwood,WA 98036
425-672-3442 . FAX 425-672-2913
OREGON MUTUAL INSURANCE GROUP 800-766-3211 • www.ormutual.com
Wyman Lee
October 30,2013 Senior Claim Adjuster
425-712-5716
Floyd Sawyer wymanl@ormutual.eam
4833 E State Route 3
Shelton,WA 98584
RE: Insured : Sawyer,Floyd&Morris,Robin 11
Claim# : 169303 APR 0 2014
Date of loss : 10/19/2013
426 !N CEDAR ST
Dear Mr. Sawyer,
It is my understanding that Lyle Umvin at Premier Property Adjusters has provided you with the repair
estimate for the shop,barn and demo for review. Attached are the estimates again for your file.
I have request a check of$29,318.74 made payable to Peninsula Community Federal Credit Union
(mortgagee)and you for the actual cash value repairs(ACV). Please make sure that this payment is
properly endorsed before cashing it. The check will be sent from our home office under separate cover to
you. Details of the payment are as follows:
Barn estimate $ 31,816.80
Shop estimate 980.74
Demo/debris removal 1- ,562.49
Total repair cost $34,360.03
Less depreciation ( 2,541.29)
ACV Loss $ 31,818.74
Less deductible ( 2 5, QO.QO)
ACV repair payment $ 29,318.74
Once the repairs are completed,please take digital photos of the barn and email it to us. Afterwards,you
are entitled to the remaining amount of$2,541.29 to make up the difference of the Replacement Cost
claim. To help us process your replacement claim,please sign and notarized the attached Statement As
To Full Cost Of Repairs or Replacement form and return it back to our office.
If your have any further questions,please call me at(800)888-2141 est,2879.
Sincerely,
Wyman Lee
Senior Claim Adjuster
WI,
Enclosures
APR 0 8 2014
OREGON MUTUAL INSURANCE COMPANY 04008(8-W
STATEMENT AS TO FULL COST OF REPAIR OR REPLACEMENT CEDAR ST
UNDER THE REPLACEMENT COST COVERAGE
SUBJECT TO THE TERMS AND CONDITIONS OF THIS POLICY
Policy No. Claim No.
PP 722213 169303
Date of Loss Agency
10/19/2013 Tim Quigley insurance Services
Insured Type of Property Involved in Claim
Floyd Sawyer & Robin Morris fire loss to barn
Location
1. Full Amount of Insurance applicable to the property for which claim is
resented was: $ 47 200.00
1 Full Replacement Cost of the said property at the time of the loss was: $
3. The Full Cost of Repair or Replacement is: $ 34 360.03
4. Applicable Depreciation is: $ 2,541.29
5. Actual Cash Value Loss is(Line 3 minus Line 4): $ 31,818.74
6. Less deductibles and/or participation by the insured: $ 2,500.00
7. Actual Cash Value Claim is(Line 5 minus Line 6): $ 29 318.74
8. Supplemental Claim, to be filed in accordance with the terms and conditions of
the Replacement Cost Coverage 18o days from date of loss as shown
above,will not exceed: $ 2,541.29
(This figure will be that portion of the amounts shown on Lines 4 and 6 which is
recoverable)
Insured's Name: Floyd Sawyer & Robin Morris
Insured's Signature:
County of
State of
Subscribed and sworn to before me this day of
Notary Public
My commission expires
G4008(8-00)
(330C8PDF
Z w
Z � 0
a- W ! z
¢ � � oN
a -, (U PLANNING
p N r
> r-
b �S
W
� = a� , ' 4- LANNING:
Q o w d AL�SE BACKS ARE MEASURED
z _j z FR M THE FURTHEST
Q O = �._. V P JE ION OF THE BUILDING
w
U V r
Yl
'M L
' o N
f A u) co
*V1
i � W
ul
105
�f
i3
f �
_ C
a (j 3 V)
qj
O 0
loft,
o�
in
to 3
so►�s
w�
� s
„tIP
f
R
I�
r Co�.
BUILDING�Tt MASON COUNTY PERMIT NO. ZUI -
_ DEPARTMENT OF COMMUNITY DEVELOPMENT -32
L BUILDING•PLANNING•FIRE MARSHAL .t
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext. 352
lRc� PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext. 352
BUILDING PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMAfTION:
NAME: I b l� NAME r t r.l N
MAILING AD SS: MAILING A DRESS: .0,
CITY: o-p,J STATE: 4, , ZIP: M,8'/ CITY: t f 64o&gTATE: ti-) ZIP: !7 3,�
PHONE: 6-3 - CELL: PHONE:3 - _ ELL: 6J - *7 - 1�r
EMAIL: S Aul tb 5 AAl -Gv At_. EMAIL : C. s ,2+t c CN It,�AV i!C A
L&I RE # ,d g C l Jr�, ' SJ EXP. r
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) 13 S �?q b 00 ,'�O FIRE DISTRICT
LEGAL DESCRIPTION(ABBREVIATED)L:�S' of o F.5 U�1�s awiv of s,A.3 " zm g4,wTA?94� 4 �l � of$ ,j'-yg
SITE ADDRESS Y633 , CITY Zk4/hIv DIRECTIONS TO SITE ADDRESS F 40 nt, lS t,x f d o`1 v J, N .olzf- v A/ 5 j R7!°G �f. _3
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ® STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROTECT-GREATER THAN 14% YES❑ NO
TYPE OF JOB: NEW �5 ADDITION ❑ ALTERATION❑ REPAIR[] OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) AqlMc-(4/�V,014J NJA9`7& Sla�gg-
IS USE: PRIMARY❑ SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
DESCRIBE WORK{_o,.,s`f�+ten/1L �1 u, i�g 40"o0i - ,0,- Lon-5foli 5><9Lr4s� f:
SQUARE FOOTAGE```
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq. ft.ST -q THER�3?� sq.ft.
GARAGE sq.ft. ATTACHED❑ DETACHED CARPORT sq.ft. ATTACHED ❑ DETACHED ❑
MANUF OME INFORMATION: *4 COPIES O��THE N
MOD LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary
parties, including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for
review and inspection. This permit/application becomes null 8 void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF
INSPECTION. IN/CTIVI Y F IS PERMIT APPLICATION OF 180 DAYS 7LL IN ALIDATE THE APPLICATION.
X l t
Signature of Applicant Date
XL4 2 nyti (h . cam R47 OWNER / REPRESENTATIVE /CONTRACTOR
Print Name (CIRCLE TO INDICATE)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CgXgITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL