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HomeMy WebLinkAboutBLD2013-00630 Final Replace Caretaker Structure - BLD Permit / Conditions - 12/4/2013 ! 1M mspecuon Line tseu)4zi-tzt>z� 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 RESIDENTIAL BUILDING PERMIT BLD2013-00630 OWNER: GREEN DIAMOND RESOURCE COMPANY RECEIVED: 7/30/2013 CONTRACTOR: LICENSE: EXP: ISSUED: 8/14/2013 SITE ADDRESS: 1050 E MASON LAKE DR WEST GRAPEVIEW EXPIRES: 2/14/2014 PARCEL NUMBER: 221073000010 LEGAL DESCRIPTION: TR 1 OF SW1/4 1050 E MASON LAKE DR W GRAPEVIEW PROJECT DESCRIPTION: DIRECTIONS TO SITE: REPLACEMENT CARETAKER STRUCTURE MASON LAKE RD, L ON MASON LAKE DR WEST, FOLLOW TO GATE WILL NEED TO CALL FOR INSPECTION General Information Construction&Occupancy Information Square Footage Information No. of Bedrooms: 1 Type of Constr.: MH Type of Use: MH Insp.Area: No. of Bathrooms: 1 Occ. Group: Lot Size: Deck: Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building:365 Valuation: Building Height: Occ. Status: Basement: Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: 32 Ft. Front: S Ft. Shoreline: 180.0 Ft. Water Body: MASON LAKE Rear: N 180.0 Ft. Slope: Ft. SEPA?: No Model:4f137VU Width: 13 Ft. Side 1: E Ft. Shoreline Desig.: Urban Year:2013 Serial No.: Side 2: W Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Mobile Home Submittal Fe( GMM 7/30/2013 $264.25 S1201300000001 Mobile Home Issuance Fee GMM 7/30/2013 $ 103.00 S1201300000001 EH Plan Review GMM 7/30/2013 $ 103.00 S1201300000001 Planning Review Fee GMM 7/30/2013 $205.00 S1201300000001 Total $ 675.25 BLD2013-00630 Please refer to the following pages for conditions of this permit. Page 1 of 4 CASE NOTES FOR BLD2013-00630 CONDITIONS FOR BLD2013-00630 1) Prior to final approval, all upland areas disturbed or ne jt oreated by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 2) Appr5 per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 3) 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 WAY. X 4) 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. �c X / 5) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Appro�,�S`ffie Plan"to ensure these structures are shown and meet the setback conditions listed. 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 (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Depart�rior to any further inspections being performed or approvals granted. X 7) Owne_, )rnt is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X (( `` 8) 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 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 Buildingment prior to any further inspections being performed or approvals granted. X BLD2013-00630 Please refer to the following pages for conditions of this permit. Page 2 of 4 a► yJ Any retailer, manutacturer or contractor wno installs a manutacturea nome warrants tnat the manutacturea nome is instaiiea in accoraance witn the z5tate Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified installer responsible for each major part of the installation. RCW43-63B.090 An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily located in plain site within three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each installer performed ailed. certification number and signature of the certified installer responsible for each major part of the installation. WAC365-210 X 10) If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American National Standards Institute (ANSI). To order the ANSI instructions you may either get an order form from the Mason County Building Department or you can coolaSA the Offfice of Manufacturing Housing (360) 725-2800. X 11) All construction must meet or exceed all local ordinances and the international codes 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 tion. X 12) 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 current fees adopted by the Mason County Building Dept., 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. OWNER/CONTRACTOR(indicate which) Signature X 13) Applicant has indicated this is a replacement unit. Prior to Mason County4lgwing any occupnacy of the new proposed unit, the existing unit which is on-site and is being replaced MUST be removed from the parcel. X _ 14) Proposed structure(s) must maintain a minimum of a 5' setback from all property lines, easements and 25' from all County and State Road right of ways. Set are measured from the furthest projection of the structure. X 15) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance regulation, must be reviewed and approved by Mason County prior to construction. X 16) All property lines shall be clearly identified at the time of foundation inspection. X 17) 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 MasQp<cunty ordinances and building regulations. X BLD2013-00630 Please refer to the following pages for conditions of this permit. Page 3 of 4 18) 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 hold ve prevented action from being taken. No more than one extension may be granted. X 19) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, conne and flashing. Install metal connectors approved for contact with the new types of pressure treated material. X C 20) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Appro ite Plan"to ensure these structures are shown and meet the setback conditions listed. X TJ This permit becomes null and void if work or construc ion 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 contin ion f work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuatio f work is by mea of rogress ins .The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees ofM unty access the ove descri operty and structure for review and inspection. OWNER OR AGENT: DATE: Cp ( ( - 2-©1 BLD2013-00630 Please refer to the following pages for conditions of this permit. Page 4 of 4 co o CONCRETE MECHANICAL MANUFACTURED HOME o Date By m w Footings I Setbacks Gas Piping Ribbons Z 0 Interior Date By interior-Date By Date By 0 0 W Exterior Date By Exterior-Date By Set-up D 0 Point Load I Isolated Footings INSULATION Date By E BG I SLAB INSULATION Z Date By Data By FIRE DEPARTMENT 0 Foundation Walls Floors Date By Date By Data By DECKS M FRAMING Wails Date By p Date By Data By PROPANE TANKS C PLUMBING vault Date By 0 Date By m OTHER n Groundwork Attic O Typo- Dale By Date By Date By D.W.v DRYWALL Type- Int.Brace Wall Date By W Date By Date By FINAL INSPECTION 0 v y Water Line Fire Seperation N CDDate By Date By Date •- 3 By, m W o Pans .or Request Inspect. c Type of Insp. Fail Date Date Done By Comments w 0 0 1MI I;e'f-�t e� 1 ��. 1� 1 b 3 i 1 -Z�5-1 3 pox--CA s-e� 0 a C 5 CD 0 Permit# l3 MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location Id s-() �- ,&W-1- Le— k 1 G.-/ 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 compliance 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 ❑ Please contact our office 0 Make corrections, items will be checked on next inspection regarding possible structural ❑ OK to damage incurred by recent "natural/man made" ❑ This is not a complete inspection disasters.This is Nora Date 1A I ;—q Department j''?' CORRECTION NOTICE. ��� Inspector �� N*7T , '���1 �'� ' T 'I ' T , -oqr ' P LA PkJ I N cv, ' •'.� V �a1 3(jam/—,O oC ',. SWIMM IN r AREA PLAY AREA � IQ RAFT wECED D O C K . ' W.. :., 426 W,, 'R: P LA -` �. \` \X I S T I N'G r " ALL SETBA RRI MEASURE[;: FRO FU.-RTHEST . H ELT EFL , ' PROJEC ?F�' 1E.BUILDIi�OY 6 W1 -. ICNI C EA g • .1 •� \, 1 f I c --TOILETS i. ,.. r.�� x� tt r },�'• � '1,h<4 i ` �} i/ I-' '�'Y l E J I I x �' . r �� �` w L, f r �J �I �+ O f3 I L E H O Nl E ( R ' \l .7�� �,ttsE,�n r'�" f,. y,,4{ �„Y:_� •.�.'ve:i; .3...;��t1^ere. `,����. ... -. .i .a.��;���4�� y�1.1 ( /r iS' �•� � ,( :N, N. X I S T I _.A_T E5,, t- `,• + .0 5���� : ���k`fit}� �.� 1"l,,i � �.,• � �. �' �� LO CAT E /T ., ��, .,;. 1►;� N T R 1f ' I A TO ODE vl PEMASM,'d6§NTY DCD FLAN G PLAN REQUI[rED TO BE .SITE CHANGES SUBJECT TO PROVAL By 9JAU Ito H EX 15T I N .. F.,-)OT BRIDGE I SHELTE BOAT LAUNC, H E E�P E L, (RELOCATE) Zoe h au POWER VA Lf LT w r­I�R VA LV E I c f�j::�,E A G#tE PICN R AFT mol OVERFLOW AREA SWIMMING NG PARKI Ml EXERCISE TRAIL (RELOCATE ) PLAY AREA n it/ tyl GAT RAFT DOCK 013L[7'ERAT�, ROAD TURNARCUNN, v-L Vl- XI STIt4 5-m§TING TO.ILET' RITCHEN (NNT ERI S E �H ELT ER a 'RAN c AA..E, EX I ST I N 6 PICNIC P� A'.SHELTt,P W I N T�iE R 15 E OILETS c ( EXISTING M 0 6 1 L E. HOM E (R 42 XISTI all- e m i 6A & V 4 (RELOCATE T F<,oQP CAMPING ENT Li AREA TO BE OS E D FOR OVEF,,' ::'LO*IW BARKING AND EX T R' CAMPER CARS S-TAFF .2 "Nov I GATES PA r K �N ., (--)[ All, MeA W U's ................ 1�j 4 ~ A V ,a I e , ".r u i.l I..>�,w....,r....,.,.. ...., .......... ... ... ..n....,wrn.w..n•.n....,...,...•.} +vw.n...:.:.w.-.i::,...w:rr—.rt .w,w.-nv..........n:...wn:n. .r.v nnw.w-v.'..,wvMnw.w.n.:i-,.,..v^..•......,.,M....�+wnw..n......M�.n..w.n....w.wv.,«-_..:_.... W !M'iG,tfR4iri�11Cf.1 X..4<:.P.'J.<!. r I' r y r ay r t4 1 I i r .r Ik k _...... __...._.__._ _ ._ r�4 _ s ... ,4�ii fr'i 4n• � I 0115 4 Y £ f , VENT FILE , 'PMCr7 s £IT ; . q Ft COPY _ _ F MUST I MEET fits 4 � • i a � £ F .mY.N Fvn'.wrr__.--r••.rev+rrr++.a,4..,...wvva.wawa.....•..-,.vrr:a......_,i:-..«...+_..._...v.,• -•.�x�a.,�:_ ..H.,w,.r.._ra,v n.-w.r.w,.......t._.. ..-.«...,.w.,.w:ew� w�.,..rr.,v rw.!"1 4,+<. n�. .. .,... a-.�._ �.•^ .. r r r.: f ' t ''�'c� ;• A �. tit a �Yr Oct. 18,2013 Page 9 of 2 - MET Engineering, PLLC To: Green Diamond Resource Company 1301 Fifth Avenue, Suite 2700 Seattle, WA 98101-2613 (206)224-5819,(206)491-7551 c. Alm: Rhonda Scott Brewer,Project Manager/Analyst,(206)491-7551 Subject: COMPACTION TESTING for a Manufactured Home Pad at the Green Diamond Resource Company's Recreation Site located at 1052 E. Mason Lake Drive, Grapeview,WA 98546, (Parcel No.22107-30-00010,Permit No.BLD 2013-0063) On Wednesday, October 16, 2013 this geotechnical engineer, registered as a professional civil engineer in the State of Washington,was at the above site to verify compaction for the manufactured home pad. A geo-probe, which has the capability to apply up to 2000 pounds per square foot of pressure on the subgrade, was used by this geotech engineer to verify 95% compaction of the completed manufactured building pad. Digital color photographs were also taken by this engineer for documentation purposes. Site Preparation A backhoe was used to excavate for the manufactured building pad. The native dark brown silty loam soils were relatively soft and this soils engineer was able to push the geoprobe down 18 to 24" depth indicating soil bearing pressures below 1000 psf. Typically, soil bearing pressures of at least 1500 psf are required to support a residential building. Dave Backstrom, the Green Diamond's Harvest Planning and Engineering Manager, had 3"minus crushed rock stockpiled at the site that was hauled in from the Little Creek Quarry. After the initial 12 to 18" layer of crushed rock was placed on the excavated site, a 900 pound vibratory plate compactor was then used to densify and compact the crushed rock into place. Since the 3" minus crushed rock was well-graded, it compacted into a very dense, concrete-like condition. This geotec engineer was not able to penetrate this initial rock layer by more than an inch indicating soil bearing pressures of over 1500 psf. Additional 3" minus crushed rock from the Little Creek Quarry had to be brought in the following morning, i.e., Thursday, Oct. 17 since some of the rock, when vibrated and compacted into place, was pushed into the softer dark brown silty loam soils. The 900 lb vibratory plate Wacker compactor was used to densify and compact the well-graded 3" minus crushed rock along with a final crushed leveling course. 1018 E.Wishkah St.,Aberdeen,Washington 98520 (360)289-0958 Bus,(360)961-8493 Fax,(800)590-0458 Toll Free Smorts(a?aol.com 1..3 . Oct. 18,2013 Page 2 of 2 MET Engineering, PLLC Results of Compaction "Test After compaction of the manufactured building pad, this geotechnical engineer was only able to penetrate the pad surface by less than an inch indicating a soil bearing pressure of at least 1500 psf resulting in 95% compaction and, therefore, this engineer has approved the compaction of the pad and it can now adequately support the manufactured building. It is to be noted that all four corners,edges,and the center of the pad were checked for compaction. All these locations passed the 95% compaction criteria. Reference is also made to the attachment that shows the test locations. Any questions or comments can be addressed by e-mailing this geotechnical engineer at Smorta(tbaol.com or by calling(360)289-0958. Respectfully submitted, Steven P. Morta, A.E. 20r9 P. 'yo WAS Np kO30758 O rA Expires: 1018 E.Wishkah St.,Aberdeen,Washington 98520 (360)289-0958 Bus,(360)861-8493 Fax,(800)590-0958 Toll Free Smortar)aol.com r - Thi� home sh 54njY_+ th..shs_!RQ.Qw-N9_s. o ^r 3_ lLOi ..N.c. .vau.o.ro.cv Palm IN 9sninatorl: 1)PARK TRAILERS MUST NOT EXCEED 400 SO.FT. Harbor NFPA70 - 2008 NEC Article 552 IN SET-UP MODE. ANSI A119.5 - 2009 2) FLOOR OF PORCH MUST BE STRUCTURALLY FLOOR PLAN Homes WA. Chcpler 296--150P-300 thru 0720 INDEPENDENT OF VAIN FLOCK - ANSI A119.5 —----- rk__,0dC1 cOPYfiiG&OQ 2011 Cream: Pa"wr0u►iomu,Inc.i OAR Chapter 918.525 371 SQ.ft. AXR4?6Rawnd OAR Chapter 918.534 20-Milleburg ORS Chapter 448 °ie°°'"'""`•' 3/8'=1'-0" - rs 0 -Cadet 30' Electric Baseboard Heater w..e.. ANSI A119.5 - 2004 Model/ 2F500-1 (4.17omps/12OV) GJA_ NFPA70 - 2005 NEC Article 552 ow &W13— _._ Perlcserles 0' __ _�-- - — ---- 27'-�" _ _ _ - ---- --- -------------- 4G127VU 27-0 3615x59 H6/2x59 oa o.w.r --- RAIL bwa EuterNo.T Mtelwd 10) w wl` x (A 0. (fit) :5 .._ __.._.- Approvals x CJ` � UVING ROOM � 290.41 SQ.Fi. �1 � 2 aW O 67 SQ.FT. UNDER COUNTER RUER r- 30 � v i w -y RAIL - - 'j 36/2x59 1, c� 1a1hxa c-P. x Dro;tt STOP 'C- oxtki _ __ I HAVE REVIEWED THE 5•_Q•_._-._ — y_,p" CONFIRMATION BUap As 15 6U110 WC NGES Cl 13 Oct. 18, 2013 Page 1 of 2 MEN'Engineering, PLLC To: Green Diamond Resource Company OCT 2 9 2013 1301 Fifth Avenue, Suite 2700 Seattle,WA 98101-2613 426 W. CEDAR ST (206)224-5819,(206)491-7551 c. Attn: Rhonda Scott Brewer,Project Manager/Analyst,(206)491-7551 Subject: COMPACTION TESTING for a Manufactured Home Pad at the Green Diamond Resource Company's Recreation Site located at 1052 E. Mason Lake Drive, Grapeview,WA 98546, (Parcel No.22107-30-00010,Permit No.BLD 2013-0063) On Wednesday, October 16, 2013 this geotechnical engineer, registered as a professional civil engineer in the State of Washington,was at the above site to verify compaction for the manufactured home pad. A geo-probe,which has the capability to apply up to 2000 pounds per square foot of pressure on the subgrade, was used by this geotech engineer to verify 95% compaction of the completed manufactured building pad. Digital color photographs were also taken by this engineer for documentation purposes. Site Preparation A backhoe was used to excavate for the manufactured building pad. The native dark brown silty loam soils were relatively soft and this soils engineer was able to push the geoprobe down 18 to 24" depth indicating soil bearing pressures below 1000 psf. Typically, soil bearing pressures of at least 1500 psf are required to support a residential building. Dave Backstrom, the Green Diamond's Harvest Planning and Engineering Manager, had 3"minus crushed rock stockpiled at the site that was hauled in from the Little Creek Quarry. After the initial 12 to 18" layer of crushed rock was placed on the excavated site, a 900 pound vibratory plate compactor was then used to densify and compact the crushed rock into place. Since the 3" minus crushed rock was well-graded, it compacted into a very dense, concrete-like condition. This geotec engineer was not able to penetrate this initial rock layer by more than an inch indicating soil bearing pressures of over 1500 psf. Additional 3" minus crushed rock from the Little Creek Quarry had to be brought in the following morning, i.e., Thursday, Oct. 17 since some of the rock, when vibrated and compacted into place, was pushed into the softer dark brown silty loam soils. The 900 lb vibratory plate Wacker compactor was used to densify and compact the well-graded 3" minus crushed rock along with a final crushed leveling course. 1018 E.Wishkah St.,Aberdeen,Washington 98520 (360)289-0958 Bus,(360)861-8493 Fax,(800)590-0958 Toll Free Smorta(diaol.com Oct. 18,2013 /7J Page 2 of 2 MET Engineering, PLLC Results of Compaction Test After compaction of the manufactured building pad, this geotechnical engineer was only able to penetrate the pad surface by less than an inch indicating a soil bearing pressure of at least 1500 psf resulting in 95% compaction and, therefore, this engineer has approved the compaction of the pad and it can now adequately support the manufactured building. It is to be noted that all four corners,edges,and the center of the pad were checked for compaction. All these locations passed the 95% compaction criteria. Reference is also made to the attachment that shows the test locations. Any questions or comments can be addressed by e-mailing this geotechnical engineer at Smorta e.aol.com or by calling(360)289-0958. Respectfully submitted, Steven .AMort�a,P.E. �r/�2o3 cl y � 30758 �SSjONAL ECG Expires: 1018 E. Wishkah St.,Aberdeen,Washington 98520 (360)289-0958 Bus,(360)861-8493 Fax,(800)590-0958 Toll Free Smorta@aol.com This home shall comply with the following standards: nu na mn.�o.ce.nwc Palm Washington: 1) PARK TRAILERS MUST NOT EXCEED 400 SOFT, Harbor NFPA70 — 2008 NEC Article 552 IN SET-UP MODE. FLOOR PLAN Homes ANSI A119.5 - 2009 2) FLOOR OF PORCH MUST BE STRUCTURALLY WAC Chapter 296-150P-300 thru 0720 INDEPENDENT OF MAIN FLOOR - ANSI A119.5 Park Mode 1 coPrw104rr02011 Oregon: aMm Horbw Hamas,Inc. OAR Chapter 918.525 371 sg.ft, nn Mgt*ROSWV u OAR Chapter 918,530 20-Millersburg ORS Chapter 4-48 °afebo"d°01r" 3/6 =1'-0 — gP � -Cadet 30" Electric Baseboard Neater Nunbr ANSI A119.5 — 2009 Model/ 2F500-1 (4.17omps/12OV) GJA } NFPA70 — 2005 NEC Article 552 SM13 — Q —32'-0" — SWIM Park series 5'-0" --27'-0" 4G127W 36%x59 32'-0" cs� 36'/2x59 (10 o.Monrbn, 1 RAIL baseboard b"ter bs,eMred►aster e>r- rn x W CP alo — ,'`r Approvals L x r$ rr tp ® UVINC ROOM 290.41 SOFT. o t-y i sa PsiM PORCH 67 SQ.FT. UNDER COUNTER REFER 30 .--- 1 I I I I M 0 I I RAIL I i swr 36'/2x59 1Dfss 14'4x4 f� Mist N .a. xad STOP 7'-10" 1 HAVE REVE'YVEDTNE CONFFt1101ATION BUILP AS IS OUR)NNW s AnstE CA _ DA78� MASON COUNTY PERMIT NO. 2l�13"' �La BUILDING PERMIT APPLICATION r[V 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670• Belfair(360) 275-4467 • Elma (360) 482-5269 Gvz On the web www.co.mason.wa.us APPLICANT INFORMATIO CONTRACTOR INFORMATION '11 Owner(3rt�n Di 'Kesotru Lo ktro j amwer Company Name +++ OO Mailin Address o 0. Mailin Address 1391 S /A-.�e. wilt 2 g, City lta State 1&) Zip Code City )k"" State t Zip Code Phone - 1- _ I Other Ph. Phone kov' 9�o-q`}2-,4 Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address rbr6w ceencli xid. L o'-In E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic. Existing Septic � Connect to Water System Name of Water System Well Water System.X Name of Water System C e.n -'^on ar- PARCEL INFORMATION-12 Digit Parcel No o O — 000 1 Q Fire District Legal Description Site Address(Please include street name, street number and city) 4 t ✓� W e Directions to site Will timber be cut and sold in parcel preparation?Yes/ o Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye TYPE OF JOB - New,}—Add Alt Repair Other X PRIMARY RESIDENCE a SEASONAL ❑ Use of Building �SSA�1�� Descnbei ork Q - e �� w No.of Bedrooms—�No. of Bathrooms Square Footage 1st Floor S 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make Model F13-7 VQ Ye�r Length aL= Width 'J' 'O@ Serial No. No. of Bedrooms o. of Bathrooms Type of Heat ��P� hr�- Purchase Price$ " `� -7 Replacement Unit? e /No Installer Name Certification No. 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 the contractor.I further declare that I am entitled to receive this pemut and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is and grants employees of Mason County access to the above described property and structure for review and Inspection. PROOF O N71 UATION 0 ORK IS BY S OF A PROGRESS INSPECTION. I Z X Date- Owner/'3wners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date -36 -Zc 3 DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing 8 Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee 1 State Fee Violation Fee Pre-Paid at Submittal Vile CEDAR '