The URL can be used to link to this page

Home My WebLink AboutBLD97-01334 Final Replacement Mobile Home - BLD Permit / Conditions - 3/11/1998 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O, Box 186 Shelton, Washington 98584 r # iJ 1 l.__ D I N Cis PI F 1 4 InA /1"T" FOfi I NSPECT I ONG CAL_I. 427 -9670 ra RE I WF E N 5pm AND Pam 427-- 1262 h1-D97-.1334 P)mCEL ,32136149060 PI-AT : D I V : 81_K ; 1 0T ,)08 ADDRFSS . 143 F AV . -R IN St1E'L TON r OWNER : PATTY .-53 -870--1539 CONTRACTOR : CAS D 1"vFNT �Pfi r60- 458-6804 . LEGAL, : TR I OF SE OF TA i OF�SP YA21, SEE SVIVFY 3183 i 141 LAVFNDEN IN CI-/lS`y 01" WORT , . .t?FP RMI'l ;' 1AA'III . ? 11YPf AMOIIUI HY.. OAlf Rf(,fIPI TiPa ANOINT 91 OATF RE"FIPi , Y F OF 1lSF I`1Ii F,T' 1 s. t7rC.CUP GROUP? '1`33 EZ L.iD(; I(:YIIT . ; 0 0,i t 1010:'.�.r3arm+:„�mw.x�c:-u+r�^.�.::-e..ux:erx�.�r,..r�ycs^-..:as-�ccrx:.s ams nxruz:.�r..xx-^�rx->xccm.,aa::ar..�:x sv is+::r..,v�..,..-r.,.•-. 1 I 1`+5.00 NJP 17103/97 46009 `T TYPE OF CONS . . ^`t f' 1?iF t.AT'F-S' . . . . : 0 STfE f 4.50 RJP 1r'1D3197 46009 OCC(lP . LOAD , . . . . 0 w0y)§TOv.FS 0 FH(P 3 26.00 NJP 121#1191 46009 i i'.*FLI .UNITS , , . 0 PA KING SI'A( F=S ; 0 IRISPF=CTION AREA '"41011FI INF7 :. , . :N 4 TOTAL, i8`. .50 'VA011A110R; 59119 • / kxs:sarrsr.xax.ram:tea:^z—...x:a.e-ac� �aw--st.-^-rr-sr=�-.-m...x,.:,K.: . -._ T Y_C..FT"i?'1. . . . . .. 0 FUEL TYPFS- - _ _-- - BOILFRSJCOMP - - NIOBII F HOME -. . . . FRONT . , .N �'S kq1`i E3P."iFf E3A5 I N r , . . . . . : 0 0 ;> lip . 0 REAR . . . .S 90 .Oft RATH Tt8S , . . . . . s 0 3 -15 HP . ; 0 I,4017)E t r--t FF TWOOD S I DF ( 1 ) .0 15 ,0f'I :'HOWF-RSr. . . . . . . 0 F0IlN ., 1094K BTEI z 0 15--30 HP . z flf MA�'.E` I PF= (2. ) .YY 2.0 .Oft WATER HfATERS . . . . z 0 FUPN >-100K BTU : 0 30 ,50 HP . : 0 L.AKF PO I NT SHR1. i NF .N 0 'Of t c1 0THE,& WASHt:R`; . . : 0 F URN - FLOOR 0 50-f of - N YEAR.__.. _.._ AREA KITCHEN SINKS . . . . : 0 HEAT PUMP . . . . 0 G,f3 LOT 617F= . . : 110011 DRAIN,-, , . , . . . 0 VENTT SYSTFMS, . . . 0 rVAP COOL_FRIS ; 0 1 F-NGI'ii :;+f; hUILDING . . . : 1568sf DRINKING FOUNT . : . . 0 VENT FANS :, . . . . . . 0 HOODS . . . . . . . 0 WIDTH , :28 BASEMENT . . . _ O:: T I AUNDRY TAAYS . . . . : 0 DOMFS , INCINzO SERIAL # - DECKS . . . . . . . 0"'r DISHWASHERS . . . . . . ; 0 A I i-1 HANDLING UN 1 TS- COMML . I NC I N :O GAR/CARP :7 OiJ GAPS DISPOSALS , 0 10000 r:f'm . : 0 RFIOC/RFPAIPT 0 AT/DT . :7 URINALS . . . . . . . . . . . 0 10000 cfm . : 0 OTHER UNITS . : V, M i Sr,, PI_M F l XTURF=S z 0 GAP OUTI.FTS . : L1 cesms...::te�rsrn ^-.:istw:x�-,fia::;.t+zu:czas_rs:�cnrr_�s...ace.•,r:.xrts.3.eea.smisRsr�-�tstaxacc.ssrcv�ar..arxas.hi,:tet::hxraa�r::v.:o'a�e'u aare�,:::aomL�:rsz:cs.-:yx-wmsas,:xeai�a�.�nrc^s:.m:'^:aam.:z:+'�s:::vcxz.mmsaz:.:x:t--.�xssa- ::tmer.�i::<..a> PROJECT UESCRIr'TION+NOB#tE REPIACfMfIf PROJECT IOCATION;APPROX 10 I1fS FAST OF* �Hfl101 00 HNY 3, 90 mi PAST DFfR cREFK S10RE TURN zff), 60 TO TOP Of IIIH AND 1AK€ �HARI' KIN 10AF, 'tlli 13 ON TEFT SIDE. THIS PERMIT 11FC0111S Nutt AND VOID if WORK OF 011STNUCTION ANTHORIIIIa IS NOT CONN.ERCf.D WITHIN Is# DAYS, OR IT .(:ONS11100ION OR WORK IS 1,11E/INOED IOR A PiRIOJ Of I90 RAYS AT ANY TI0 AFTER 1091 IS COMMENCED, EVIDENCF OF CONTINUATION Of 1011( IS A PAO9RFSS INSPECTION VIT910 THE LIP DAY PF1100, FINAL 1U PF.CTION NST BE. AFPNOVFO PffORF RUIIOII'G "AN RE nr:CUPIFD. _ OWNER / E1.0. PRNT, rev; O^/'r1191 (;+t?MPI.. IANCF TO ATTAt;Nf:D CONDITIONS IS 11170111RED r � CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons ? date by Gas Piping date 7 —y b � _� /1 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 Attic OTHER Groundwork date b date b y .W.V. WALLBOARD NAILING date by date by Water Line —11 FINAL INSPECTION date by date by date by S% T 'yie -1 J '-4 - Page No. 1 CASE HISTORY FOR CASE NO.: BLD97-1334 PATTY LAKE E143 LAVENDER LN SHELTON 03/10/98 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By ------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- --- BLDA010 Application received 11/17/97 / / 11/19/97 DONE KW 11/19/97 KW BLDA011 WARNING!! SEE PARCEL FLAG / / / / 12/03/97 DONE NJP 12/03/97 NJP BLDA200 (H) Hold / / 11/21/97 12/01/97 Need proof that both mobiles on site are DONE MMS 12/01/97 MMS to be occupied by family members. Trying to contact: unable to reach by phone, will send letter. MMS Talked to Ms Lake 11/24, she will send letter. Taken Care Of 12/01 BLDA500 (F) Issue building permit / / / / 12/03/97 DONE NJP 12/03/97 NJP BLDB110 Structural Plan Review 11/24/97 / / 12/01/97 Please return to Planning when done. DONE DC 12/01/97 DLC BLDB130 Planning Review 12/01/97 / / 12/01/97 DONE MMS 12/01/97 MMS BLDB134 RLC Review / / / / 03/28/94 DONE AHB 12/01/97 MMS BLDB135 Addressing 11/19/97 / / 11/20/97 DONE GMM 11/20/97 GMM BLDB137 Site Address Notification / / / / 11/20/97 MAILED ADDRESS CHANGE NOTICE TO PROPERTY DONE GMM 11/20/97 GMM OWNER, ADDRESS WAS E 143 KIM LANE, EASEMENT WAS RENAMED IN 1994. THEY ARE STILL USING THE OLD ADDRESS!!!! BLDB138 Planning Pre-Review 11/20/97 / / 12/01/97 DONE MMS 12/01/97 MMS BLDB200 Environmental Health Review 11/19/97 / / 11/19/97 this is a site with history. This is a HOLD CAJ 12/01/97 NJP replacement of a one bedroom mobile home with a two bedroom mobile home. There is another existing mobile home on the ^/ lot. The septic system was sized for two bedrooms. Both mobile homes are /^p//%►' connected into the same septic system. This was allowed in 1994 because both homes only had one bedroom. This is an expansion--the septic system must meet code. ENTIAL USE TURNED IN E/ AND ADDED TO THE TIN BIN. BLDB200 Environmental Health Review �1j2/01 7 / /01 7 e ne to re-r cord a cert. of res. HOLD PSD 12/01/97 PSD '.7y�/�✓��! e �` ! ice/ /� y �� qe`c#F0!a � /¢1 ��/V V`^ use. re are 2 resi enc and 1 septic system. I contacted the applicant.psd BLDB200 Environmental Health Review 12/03/97 / / 1 /�97 The new cert. of res. use was submitted DONE PSD 12/03/97 PSD y and recorded sd BLDC199 Mobile Strip Foot i g 12/30/97 12/30/97 12/30/97 Alf PP&','$ �Q`J��/3C9/�98 KW BLDC200 MH Setup inspection 01/29/98 01/29/98 01/29/98 1. LOWER SEWER LINE TO PROVIDE 121, OFl FAIL TR!01/30/98 KW COVER 2. SUPPLY INSTALLATION MANUAL ON M/H 3. THIS WAS NOT A COMPLETE INSPECTION. v Page No. 1 CONDITIONS/CORRECTIONS FOR CASE NO.: BLD97-1334 PATTY LAKE E143 LAVENDER LN SHELTON 03/10/98 1) Buffer & Landscaping Requirements -- This application is subject to Buffer and Landscaping requirements as established under Mason County Ordinance 1.03.036. X 2) Flammable & Combustible Liquids -- 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) Sideyard Setback -- 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) POST ADDRESS -- PURSUANT TO 1994 UNIFORM BUILDING CODE, SECTION 305(C) AND SECTION 513, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE, BASED ON RATES IN TABLE 3A OF THE 1994 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS. X 5) MOBILE/MANUFACTURED SPECS. -- REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I have received a copy of the General Information and Guidelines-Mobile/Manufactured Housing Installations Handout for detailed descriptions of all required inspections on my mobile/manufactured home installation. I hereby assume all responsibility for the scheduling of these required inspections. If these required inspections are not requested, inspected and signed off(approved) by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the 1991 UBC, Table 3A will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. I further understand that this investigation will be scheduled as time allows. Until resolution of any/all problems no occupancy (Final Inspection) will be granted for the residence. OWNER/CONTRACTOR(indicate which) Signature X 6) Mobile/Manufactured Landings/Deck -- All mobile/manufactured home landings or decks must be freestanding (self supporting) . The largest landing or deck permitted without drawings or a building permit is 36" x 36". Any landing or deck that is 30" or more in height from walking surface to finish grade requires a guardrail. Any landing or deck that has 4 or more risers requires a handrail. Any landing or deck larger than 36" x 36" must be permitted which requires structural drawings and a building permit application. This Installation Permit does NOT include any landing or deck larger than the 36" x 36" size. X 7) Structure Setback -- 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 8) Field Correct -- CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE.x Page No. 2 CONDITIONS/CORRECTIONS FOR CASE NO.: BLD97-1334 PATTY LAKE E143 LAVENDER LN SHELTON 03/10/98 � 1 Building Permit #yam r�,�� MASON COUNTY t BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location . 3 e--/L 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 � T/G-H��✓ �� Shy/�.S 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 �1(01<to,S6i177- Department /3c-�0 Date 2--Z -9eg Inspector ■ �� 0 NnT Mo *V I'H' 'l' T " ,� Building Permit # `7/.3 k MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location i-Akl- / y �A✓F.YDi �I!/ This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Z— Items listed below must be corrected to gain code compliance Ile " S�/ L i I yDT.9L /Dr✓ /rl /Y(J ,� d y M �_— 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 Department Date l-Z 7 7 7 Inspector Thy moos NOOT MOOV TH11 - Tm ,olmi MASON COUNTY Mason County Bldg. III 426 W. Cedar `� P.O. Box 186 Shelton, Washington 98584 Case No . : BL097 -1334 Fora PATTY t-AKE Paget i 1 ) Th i s app t i cat I on I r ,f.Jb lent to ntiffer and i.andsoap i nil refyu I t-emenI & as e t rjb I i trod urtdI►r Ma;,on C_Q,unty Ordinance 1 .03 .036 < 2 ) The use, handling and .tora a of hazardous materials or flammable and combustible t inks idrs In exoe^s of 10 qa 1 on., I s not al lowed without the approval of the MA�cfn Cotrn1 y Fire Marshal . 3 ) Proposed s t root rare or nny port ion thereof gr a Hter than 30" i tr hea i rthl from clrade I I rye. Must maintain a mirflmum of 5 ' t>etback from all property lines, easements and tag ' from all County. . frrW State Road right of ways . 4 > Pt.rEtSlIANT TO199 t iIN 1 T ORrA BUILD I NG t ()UE '�F.C T 1 ON 305 (C ) AND SECTION r,13 , Al I I TF S, Altl�;t HAVE APPROVED NUMBERS OR ADDRESSES PR6V 1 ICED IN SUCH A POS I T I ON AS 'TO BE PLA I Nt-Y V I I BI..f AND LEGIBLE FFIOM THE STRFFT OR ROAD FRONTING THE PROPFRTY . MASON COUNTY BU 1 LI)1 Nr; DEPARTMENT REQ#)I RES THAT THIS BE COMPLETED PRIOR 10 CALLING FOR ANY SITE INSPECTION, . A RE I NSPE CT I ON FEE BASED ON RATES IN TABLF 3A Of' THE 1994 UNIFORM BU I I.D 1 NG CODE Wilt (3F ASSESSED IF OWNFA/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REOUEST1NG INSPECTIONS . 5 ) HE01)1 RED 0 I NSPF CT I ONS ( Font i nq i nspect l can pr l or t o p-nit rr , ` et up I ne;Peo t i orr - pr l or to sk i rt t ny Final i nspect i can-pr i car to ocoupAncy ) . I have re oe i ved a co "y of the Gonera t Inforutra lun and GuldeI Inet<- Mot)i Ie /Manufactured liotisinct insl r ! lat ican . Ianclout ror i detailed descriptions of all required Inspections on my mobile./manufactured home 1 nsta I l at i fin . I he.r•etiv "ssumfa all responsibility for t toe schedu I i nq or these refits i t ed Inspections . If theses t equ i red Inspections are not requested. inspected and s i gned off (approved ) by the I nspeotor in the prescr i bod order , t tinclertattand that re 1 ni:spent i oo fees and an hourly investi . anon Fee pursuant to the 1991 1IBC , Table 3A wi 1 I be ,af3�es,3ed in addition to my rvr i q i na 1 hermit fey:! to resolve any tjtte�;t i orfab l e pr a o t i c:et, co pf,oblems that have be6h disoa-verred . 1 Further understand that this Inve.;tigation, wi l l e scheduled Fa-< time i l lows Unt. i_ I re�,o i Alt l can of any/a l t problems no ocnup)nf v ( T r na I MASON COUNTY Mason County Bldg. 111 426 W. Cedar RO, Box 186 Shelton, Washington 98584 I n OWNER CONTRACTOR ( i o4(Jl (,a*1e WhI00 ,:; 1 pit altire X 6 ) Al I mobi lo/mantifactured home landings or, decks must be freestanding (soft suppoutiiiq � The) largest l and inn or, deck norm iturd withottt drawinqf, or, a but Iditic! permit l � 36" x 36" . Any landing or, deok that 13 30" (it, more lit height Fi,ont walking surface* t U f I it I sh qr-ade reqti i re!; .4 L p u a r d r a I I Anv l and ino or df-!vk 1116t Wq:i 4 or, move ulsor,s ioqk# 1r,tts a handt,ai I Any landing or, deck larger than 16" x 36" must be permitted which vieq11110f") strijotur-al drawinos sind ;A littildinq per,mlt This I nsl a I I a t I on Porm I t doef.; NOT 11,1011j4rie anv lanaing or deck lat,qei, than 'tile 36" X 36 " size , X 7 ) Pr-oposed eat runt uve or, port ione: thereof with an over '10" Ill heichit ticlivs 4,11 ad* - line, must maintain a 5 ' separation d I stance between ad (acent sii,ucttires; and that fuuthest Pro i oot I or) n X 8 ) CONST'RUCTION PROCESS TO BF FIELD CORRECT17D AS RFQ(JlRr-D PER MASON COUNTY BOILDIN(.1 CIF FIARTMVNT AND I)NIFOPM BUILDING C.ODF , x f LA en Ilk -73S I R, IV 1 � IV � I avo-y 'OE i � � I i f a�a _ /1179 ---- - -- - i i /y 1 AL.LAA' T. 6R01 C.i;L 1111 DEC --3 ,/\ 10. 2 b REQUEST OF: Return To: Patty Lake C/O P.O. Box 1985 Shelton, WA 98584 AMENDED CERTIFICATE OF RESIDENTIAL USE LIMITATION ON NUMBER OF BEDROOMS I,Patty Lake, the undersigned,hereby place this notice on record that the following described real estate situated in Mason County,State of Washington;to Wit:(abbreviated legal description) TR 8 OF SE NE TR 1 OF SPE#329 SEE SURVEY 3/83 141 E Lavender Lane & 143 E Lavender Lane and having the Tax Parcel Number of: 32136-14-90080 is subject to the following understandings and conditions: 1. The use of the two residences on this parcel will be restricted to no more than 1 bedroom each. 2. The on-site sewage system which serves both residences was designed for 2 bedrooms. And the building permits for these residences were issued on the basis of no more than 2 bedrooms total, and a maximum residential occupancy of not more than 4 persons total. 3. The use of the other rooms in the residences as bedrooms,in excess of the number identified herein,could result in hydraulic overload and premature failure of the on-site sewage system,and could result in Mason County taking steps to cause vacation of the premises. 4. In the event of any future residential remodeling,expansion,or replacement that results in additional bedrooms to the number specified herein,the property owner will obtain the appropriate permits for expansion of the on-site sewage system. WITNESS hand this day of c, , 199 . Signature ,,�`` , �► �`,'R., State of Wad County of Ivlasohe ,��>T� w•y•+► I,the under"si ed qo,"' %b' lia-;n and for the above named County and State,do hereby certify that on this day of , 09 personally appeared before me� �-� A . ( to me known to ba'#t®jndi_yi y41 escribed in and who executed the within instrument,and acknowledge that he(she) (they)signed and§eale a same as free and voluntary act and deed,for the uses and purposes herein mentioned. GI MN undF my hplid,and official se4the day and year last above written. No ry lob e in and for the State of Washington,residing at My Commission Expires: R L L Irk UDI1'G[? i`i P S0 COUidTy— .. ALLAH 1'. BPOTCHE 1W OCC - I A 10: 1 1 REOLEFS T OF: Return To: 1. /, ) CERTIFICATE OF RESIDENTL4L USE LIMITATION ON NUMBER OF BEDROOMS I(We)the undersigned,hereby place this notice on record that the following described real estate situated in Mason County, State of Washington;to wit: (abbreviated legal description) N� 'F NC' 4 9$ NW1' + SC � 1 l 36 iouti 14•� No Ro,.� 3 W, and having the Tax Parcel Number of: 32.134 — /4— 90080;'_ is subject to the following understandings and conditions: 1. The use of the residence on this parcel will be restricted to no more thanes bedrooms. 2. The on-site sewage system w s designed for and the building permit for the residence was issued on the asis of no more than� bedrooms,and a maximum residential occupancy of not more than persons. 3. The use of the other rooms in the residence as bedrooms,in excess of the number identified herein, could result in hydraulic overload and premature failure of the on-site sewage system,and could result in Mason County taking steps to cause vacation of the premises. 4. In the event of any future residential remodeling,expansion,or replacement that results in additional bedrooms to the number specified herein,the property owner will obtain the appropriate permits for expansion of the on-site sewage system. WITNESS hand this ` day of `' 199 7 Signature Signature State of Washington ) County of Mason ) I,the undersigned,a Notary Public in and for the above named County and State,do hereby cert�f that on this 2 day of Nov ' x 1992,personally appeared before me tome known to be the individual described in and who executed the within instrument,and acknowledge that he(she)(they) signed and sealed the same as free and voluntary act and deed,for the uses and purposes herein mentioned. GIVEN under my hand and official seal the day:and ast above A'AN�F40* Notary Public in and for the S of Washington,residing atOAF ;�► F}•. , 0 My Commission Expires:—5; NOTARY ;Z df T .qAY 30.2 i,� ^lea , S t CIAA- DEC O 1 MASON CO. PL4NNING DU,,. November 21, 1997 Charles Walker P.O. Box 1985 Shelton, WA 98584 Dear Mr. Walker, This letter is in regards to a buildi g permit request by Patty Lake to place/replace a mobile hom on property at 143 E Lavender Lane that I understand that y also live on. I am writing to you because I have been u le to reach Patty Lake by telephone. According to Mason Count ordinance, if two mobile homes are located on the same par, 1, the residents must be related to each other, or the pr perty must meet mobile home park standards. If Patty Lake is rel//ated to you, it will be necessary for either you or her to provide this department with a notarized statement to that effect . Please call me at your earliest convenience, so that we can straighten out any confusion. I Permit No. MASON COUNTY \ BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1 800-562-5628 A (Calling From: Seattle 464-6968, Belfair 275-4467, Elma 4�2-5269) k- PLEASE PRINT "T #1Afte !��// y �.� � Phone#-�.- 870 Address 1� L_ Gjkk �:zr)P Fire District# �o St Gy.� Zip yg��'`/ Directions to Job Site 109Prye oX Lc�T 'U -U /( i/f�i� Li�/✓C i % /S o ..C/ Lam' % S/ �r Owner Mailing Address );-1 o City St Zip Lien/Title Holder Address City St Zip #2 Contractor Name <29� S i?�r/'L��'�it/I�NT /�� Contractor Reg# Address.22f 09 3-�-S-rA c Z� Expiration Date�,1!V/ io / T 8 City %� v y St u-/ Zip Sg'r8c-� Phone#,-36O #3 If septic is located on project site, include records. Connect to Septic? ✓ Public Water Supply Well Connect to Sewer System? Name of System (If residential, proof of potable water is required) #4 rcel No.�o2/ 3(6 -�- 5�'4 U � egal Description 'r/Z S a SE . /V"C 7 1Z #5 Building Squar ootage: 1st FI / 2nd FI 3rd A Loft Basement # Bedrooms #bathrooms Deck Other Garage nn Carport (Circle:Attached or Detached?) #6 Use of building r 7 Describe work v rV U ZVZ42� 67W #7 Type of Job: New Add Alt Repair Other. #8 MOBILE/MANUFACTURED HOME INFORMATION C U O D Model Year Make Length 5-Z� Width 2--,<-, Serial No. NOV 1 7 179ee 7 #Bedrooms 7- #Bathrooms Z Type of Heat L L=�i.e� L Purchase Price$ y, // ' , y7 PERMIT ASSISTANCE CENTER #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the-site-plhn Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Drainage Plan Wells Septic Systems Easements Proposed Improvements Indicate Directional by (N, S, E, W) Name of Side Street Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW i Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins 7 Heatpump, Other Bath Tubs No. Units Fees Showers Furn BTU Hot Water Htr _ Heatpumps _Laundry Washer _ Vent Systems Sinks Z� _ Spot Vent Fans Floor Drains No. Boilers/Compressors Laundry Basins _ HP Dishwasher No. Air Handling Units _Disposal _ cfm# Urinals No. Fire Protection Systems Other Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 16.75 _ Auto Fire Sprink Sys 35.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER X DATE DATE 77 FOR OFFICIAL USE ONLY: Accepted by: Date: �� DEPARTMENTAL REVIEW FOR OFFICE USE ONLY ` Approved Cond. Hold Approval Planning: q4— 0-%-7 Environmental Health: p� Building Plan Review Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit M Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Violation Fee Site Inspection Building State Fee Other E Other Other Building Valuation: TOTAL FEE