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HomeMy WebLinkAboutBLD99-00004 Final Mobile Home Replacement - BLD Permit / Conditions - 5/3/1999 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 E3 lJ I I._ C) 1 N ti P Fri M 1 1 FOH h:;F'E_C 1 I uN %.ALL 427-9670 BETWEEN 5pm AND Sam 427-7262 8I-099-0004 PARCEL :223254492001 PLAT - D i V : RLK : LOT - ,JOB ADDRESS : 1177 NE. MISSION ('REEK RI) HEL.fAIR OWNER : STEVE ANDE=RSON 275--3362 CONTRACTOR.- FUTURF HOUrS, INC, 479--4663 LEGAL : S1l2 SE SF ' PAR t Of ILA 194-12 TO I OF Sp f2.4Q5 NE till MISSION C1 ND ' ..<_.=r.�,s�•¢.�_:.-rac::���-::-ter.+sayn-acoer-:-:mom-exacxr_-.r.-x:,�sr.�:.:.act•arm,::ezracz:..r.:-.=x:x:�vra.��arr.=sr-r:>r_s..^_:rr 1 C_. CLASS OF WORK . . :fif.P BF"DRi 3 BATH , 2 1YPE AN00111 BY DATE RECEIPT J1YPF A101111 BY DATE RE(11Ill TYPE OF USE" sMH STOR IFS . . . . . . . s 1 OCCUP . GROUP ' . 7 Bt MI . HE I GHT , . : O .Oft NNSF = I15.00 1(1 01106/99 1324 TYPE OF CONST . , : 7 FIRM ACES . . , : 0 JIM t 115.00 KS 0M8199 49324 OCCUP . L OAI) . . . . .. 0 WOOD STOVES , , . . . 0 ISTFF t 4,50 KS 01128199 49324 DWELL .UNITS . . . . : 0 PARKING SPACES ; 0 IRtf. t 44.00 KS 01128199 49324 INSPECTION AREA : 1 SHORELINE? . . . . : Y 100 t 50.00 KS 01128199 49324 iTOTAI: 448.60 YAI UM ION: 0 ti6�3t>�...1A.�C M•Tflm"'M1'CSrJT�^.>!FC.iC'STSC� �X:.tfi^.3IF:��:91=t;.'�:A'T.-..3'2'CA5'..'fr�v�'.�'CT3��'=-_."'S=�•S.�LT.�=�=. SETBACKS- -_. __._._.,___._..__.._. TOII_.ETS : . . , . . . . . . 0 FUEL. TYPES---- - --- BOIL.ERS!COMP---._.— M01381-E HOMF,FRONT - 1 F 300 .0f t BATH BASINS . . . 0 0--3 HP . s 0 REAR . . . .W 100 .Oft BATH TUBS . . . . . . . . : 0 3- 15 HP . : 0 MODEL. sLIBERTY S I DE M , N 200 , Oft ` IIOWFR� . . . . . . . . . . . 0 FURN w- 100K ST11 ; N 15- 3f0 lip . � 0 MAKE _. _ .. _. .. S I DF (2 ) . "500 .Oft WATER HEATER`; . . . . : 0 FURN >-100K BTU : 0 30•-50 HP . : 0 MFADOWBRK SHRL_ INF .W E10 . 0ft CLOTHES WASHFFIS s 0 FURN - FLOOR _ .-. 0 S0-( 1-I1' . ; 0 -YFAR AREA - -- _.. ._ KITCHEN SINKS . . . . ; 0 HEAT PUMP . . . . . . . 0 98 LOT SIPF . VI.0014 DRAINS . . . . . : 0 VENT SYSTF MS, . . , . 0 FVAP CO01_F:RS : 0 1,FN(;1II :66 BUILDING . . . : 08f DRINKING FOUNT — s 0 VENT FANS . . . . . . . 0 HOODS— . . . . : 0 WIDTH . :42 BASEMENT , . . 0r:f I.AUNDAY 1RAYS , . . . ; 40 r)OMES , INC1Ns(h ;ERIAI_# DECKS _ . . . . . Os f D i S14WAS14ERS .. . . . . 0 AIR HANDI 1 NG UNIT",",-- COMML . t NC I N :O 09432 GAR/CAAP :7 Ost GAPS DISPOSALS . - s (3 x- = 10000 ct"I . : 0: REL.00/REPAIR : N AT/DT . :? URINALS . . . . . . . . . . s 0 > 10000 cfIII . : 0 OTHER UNITS . - 0 MISC PIM FIXT1)RF"S : 0 GAS OUTLFTS . F N tcttx 4c�rrs�c-sgar._-rr,en+em.-,-:nrsn�s..r�v_..-:-s-:z:sau.^..::-.a�s.r..an.uams.:=:rs-:r ae:::s_:xane:s-:�.->.ssnavc,rarsr.x-:_-e�_.......::c::.-�_.a e:x._^r..�:z�::_.r,e-t.:s•s _-�_:__-:-.s_+'.u:-zrr.•a aanxYr-•xur.-:.-.s.r+�.�r.z.z+r.a:r:.-.�-:=.-:::-.-a,.-s^usmrs_�¢a:<xs._xzo--�..ca:::-. F1011 T DESCIIPI loll NOM E HONE RE.PIACENFNf PROJECI I.00A110110.2 1114 UP MISSION CREEK ROAD ON IFfT. 1111S PF11111 Bf(,ONfS It(ltt AND VOID IF NORK OR CONSIRUCIIRN AUTPCIRI�ED IS NOT iAMvff2M 1I1N111 ISO DArS, OR IF r,ONSTRU(110N OR 14RK 13 S11111vPENDED fO@ A PERIOD Of 181 9A)S Al ANI 1*101 AFTER MORK IS CONNFNCEO, FVIOFNCf OF OF WOOF i s PIOGAESS INSPF(TION 11111111 TNF 180 DAY Pt1100, FINAL INSPECTION Jim Bf APPROVED f1FORt PIMPING CAN 81 OrN&PIFO. OfIIfR OR AGE111c DAIS:8i8 _PleNT; ;eYo A l31191 OMP1 IANfE TO ATT'ArHF'li �,ONf11T{DNS IS REQUIRED CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date - O•- by Gas Piping date � �' b Foundation Walls date by Set Up date • by INSULATION date - by — BG/SLAB Insulation Floors Final date by date by date by Walls FIRE DEPT. date by date by date by PLUMBING OTHER GroundworkAttic date date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by 3- z Y- 3 ' ' S MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 Case Nu . i BLD99--0004 Fort S fFVF ANDF111,30N Page : 1 1 ) Approved per rl i menu i onrt and �:et bar.:k e, on �;ubm i t t od i t e plan , west end of homes Is 80 feet f r oars rr es ea k . 2 ) Temporary erosion control meastire-, must he implemented to prevent water, quality degradation of adjacent waters or wetlands . Silt feint'. i n. must be i nsta 1 1 cad and ma i ntta) nee! unt i i r.ir 1 tend vegetation bas become est ab 1 i shad 3 ) fl-ee proposed pr o tec-t mun t be ( ony: i f:t&gin t with all app l i r; ati l e po t i c l ee. and at her pprovisions of the Shoreline Management Act , its rules , and they Mason County Shoreline Master Prevc)ram X. 4 ) All constrere-t. ion and deymalItiear► debris mirth be removed from the shoreline area otter project completions . Proper disposal of construction debris must be on land in such a mangiQr •-thlt debris, c;trnnot enter or cause water quality degr'•edat ion of State waters . X t' ) Proponed stru(,ttsre or any part ion Cher-oor greater than 30" in heright from grade, line, must maintain a minimum of 5 ' setbzark from all property 1 i nes , easements and 10 ' from a t l Cou,rit y� and State Road right of ways . 6) This application is subjeot to Ruffer and l ands-onpinq requirements a`-= ostabl ished under Mason,- County Ordinance 1 .03 .03Fa . X 7 ) The use, handling and storage's of hazardous materials or flammable and combustible l i qu i d s In exe::N s> of 10 ga 1 f ons i s not at lowed without 'the approval of the Mason County Firms M&rshal : X MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 8 ) Provision,: for surface/ subsur faco drainage control must be implemented with new construction or, cieve i opment on site ;and MUST NOT adversely lmpac:t aci i acent pmrne I s . Under the requirements of Mason County Stormwater Ordinance , either private ditches and drains will meet rest u i roments of the star mwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that speoific, purpose . for f!rr t her I nformat ► on rc:gai'd i no -th i c, ordinance and the RFQU i RFMFNT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason Countyy Road, Contact the Mason County Public Works rle�partment Frior to construction at Ext 450 . or- any oonsst rust i on wh i oh I s propo ,,;e i tt.,,j he 1(�cateed within 25 ' of a Mason County road right of way , it Is suggested to contact that office to review future planned work which may ect your- pro jest . X.__ 9) PURSUANT TO 1994 UN I FORM 81) 11 1)1 NG ( 0C,F Ai t S I TF S MUST HAVE APPROVED NUMRF RS 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 RE01,11RF'.S THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A REINSPECTION FEE , BASED ON RATES IN TABt-F 3A Of THE 1994 UNIFORM FEU I ED I NCB C OPF W i 1_t. [IF A SSE'SSED IF OWNFR/CONTRAC-rOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS . 1 0) TILE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE S0i1- . r 1 1 ) The approved plot p l An IS required to he on-site for Inspection ttour ppose" It Inspection is called for and plot plan Is not on site, Approval Li_ NOT be granted . In addition, a Re-- I aspect I can fee In th(; amotin t of $42 .00 per hour (minimum 1 hout• ) will he charged and .must be collected bV this department prior, to any further inspections being performed or.. approva I granted . i 12 ) RF..QU I RED INSPECTIONS (Foot I nq I nspec t i can- pr i or to pour , ;,eat--up 1 nspe-ct I on--pr I or t c) skirtin F i na I Inspection-prior to occupancy ) . I have received a coppy of the General I nformeg Ion and Gtr l de l i nes- Mob i 1 e/M.4nuf actttred Housing Installations Handout for detailed descriptions. of all required inspections on my mobile/manufactured home I nsta l I at 1 on . I hereby assume all re spons i bi l i tV for 't tie s otiodu I i rig of these: requ I red MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 1nspoi; tions , If tl.i ,e required Iit;si,. n0i yted' Off ( 8pproved> by the inspentor in the' order I ►jnder Larld Iliat I Itioitt: t a:,t: fees and an hourly Investigation fee pursuant to the 1994 UBC, Table 3A will be assessed in addition to my original permit fees to resolve any ql►est i onab 1 e praot i ne or problems that have been discovered . I further understand that this investigation will be schedu i ed as •t !me a i i nws . Utit I i r esr, I tit I on of any/ a I I prob I ems no ocoupanoy ( F i na I Inspection ) will be granted for the residence . OWNER!C:ONTRA(IOP ( IndI vat e which ) signature X ._.. ._._ __ ___.__.__._. __._..._.._._. _...___ 13 ) All mobile/manufactured honte landings or decks must ba4 freestanding ( self supporting ) . The largest landing or deck IJerm i t t crd without drawings. or a tau I I d i ng permit Is 120 q f t or less AND MUST be under 30 In height from surrounding grade . NO second story decks, or decks above 30" nan be built wit hots t a permit . Any l and i nq or deck that Is 30 or more in height f rout walking surface to finish grade requires a Permit . Any landing or deck that has 4 or acre r i Ner s recto i res a handra i I . X 14 ) Owner Ibui ider as,;umes a I respon 47, 1 b i I ity 1f dr,ainfI Irt Ores i encumttered .� Case No . : BLD99 0004 f iffy Gam` �, F.uturp Homes a - - MAST�M BEDROOM 10'-1 . J r� A-.v9 DINING FAMILY RETREAT ROOM f.. ROOM rz K ry , LIVING •�,. THIRD SECOND ROOM 1 `; BEDROOM BEDROOM t7_- � q .may. m..5. , v-s ,2'-7' Y.. ,r-r ,r_r A-O9 ,owe479�4663� • P( 0 100 200 400 —� cn1,3I. DRAINFIELD EXTENDED A3 PER PLAT o ZoF OUTH LINE OF PUT FND. PLAT MON. "MISSION CREEK' n' BRASS/GONG. 37.02' C EE - -I1311I JO' - S89'02'56-E - - I 1 30.8�5�..�� V 16 -1274.68' - 5 89'JJ'51" W -- — `I CORNER NW COR. OF SE 1/4, SE 1/4 1/16 LINE �'d + (EXISTING ROAD) NOTE: A f0O' SETBACK FROM MISSION 20' EASEMENT CREEK SHALL BE MAINTAINED PER AUD, FOR ALL BUILDING CONSTRUCTION. NO. 511612 (tor 2 ONLY) �J (PRIVATE) +o t I I I E It I/ m m NORTH LINE OF S 1/2, +" th. N e fl SE 1/4. S£ 1/4 0 � `I,,t -I I N M. 10" E-- T 1 _ 010 1rl -660.00'_ 277.64' '7' 167.75' I FND. IRWIN 0 1 S fQ 41 B� REEMR/CAP 0 Wry 210.21' ESTABUSTI 20' PRIVATE ''-N8853'f 0" Acc£ss & unU1Y ��O ,t. "' 20' PRIVATE —S— �,*/FASEMENT I EASEMENT r= a EXISTING 20' EASEMENT ROADf NG 1 EXISTING MOBILE _ N (PRIVATE) AS PER AUO. HOME NO. J9487 f do J8741 J ► N I �+ LOT 2 7� } a � 0 '� '1 � 14'ELL o.. 1_ 326,027 SO.FT.)Z Pp. I �.� 64'-- -?76 93 1 9.J5' -17t!oti 1280 59' - 8 12'4►'E 4 - �y0 IRW1N REBAR CAP - 36 1280.66, - P A J6 31 FOUND 199J PLACED WHITE STAKE/ FOUND 1981 1 (n IDNR ONR CONC/ V I LA nlf CONC. MON. MON. BRASS MON. tl �JO' PRIVATE EASEMENT W/BRASS DISC r1 TO MISSION CREEK V15/TED 19 J 1260.60' - N88"11'13"E (M)j YARNING ! OAD A110. NO. J94871(f1+S1 i 1280.86' - N88'l1'5rE (P) MASON COUNTY 1{AS NO R SPUNSIBILITY TO rrUILD, IMPR MAINTAIN, �1. OR OTHER141SE SERVICE Y PRIVATE RCKDS CONTAINED W/ N OR PROVIDING .SERVICE TO E PROPERTY DESCRIBED IN THIS SI T PLAT ,SHEET 1 OF 2 i r �W • F, •' ,yir'✓�iN,f✓:u',M+SiNY riS17�p41�kY1lWfraa...,. , ,w,,wuvJa.w'raw.... .,aid.+dNvu✓vw• , `.MlbillBinJct..•_•..<nlNw+'�.Y.Nd,,..t.s:N:{rtl•L.4ka6MwiK»rw.:uu�:�.a-...v..+W�w., _ _._.. LEGAL DESCRIPTION SS NO. 2 4'0.5 - PARCEL 2. F DAT P OVED '�>'•�'s�'� THE S 112 OF THE SE 1/ o�� sg 9,R J 3 q 4 SEC. 25, T23N, R2W, W.M., EXCEPTING THEREFROM, THOSE TWO PORTIONS THEREOF DESCRIBED AS FOLLOWS: 1) BEGINNING AT THE NE CORNER OF SAID S. 1/2 OF DIRECT F GENERAL SERVICES 0p THE SE 1/4 OF THE SE 1/4; THENCE WEST, ALONG THE NORTH LINE OF SAID S. 1/2 OF THE SE 1/4 OF THE OWNER: WELDON MATLOCK & SE 1/4, 660 FEET; THENCE DUE SOUTH 198 FEET,• THENCE ANNA KEITH EAST 660 FEET TO THE EAST LINE OF SAID S. 1/2 OF THE 90409 TROY ROAD SE 1/4 OF THE SE 1/4; THENCE NORTH, ALONG SAID ENTERPRISE, OREGON 97828 II EAST LINE, 198 FEET, MORE OR LESS, TO THE POINT OF m N BEGINNING. (503)828-7785 2 2) BEGINNING AT A POINT ON THE EAST LINE OF 5,4/D TAX ACCOUNT NO.: 22325-44-02000 ; SE 1/4 OF THE SE 1/4 198 FEET SOUTH OF THE o- ti NORTHEAST CORNER THEREOF,• THENCE SOUTH, ALONG THE LEGEND �- q EAST LINE THEREOF, TO THE SOUTHEAST CORNER OF S410 ••• SET NO. 5 REBAR/ d' 4]W SE 1/4 OF THE SE 1/4, THENCE WEST, ALONG THE SOUTH CAP & 2" X 2" UNE THEREOF, 450 FEET,• THENCE NORTH, PARALLEL WITH THE STAKE EAST LINE THEREOF, TO A POINT WHICH IS 198 FEET SOUTH ��: ;,•! OR THE NORTH LINE OF THE S 1/2 OF SAID SE 1/4 OF O FOUND REBAR AS ,;,,,•..;. THE SE 1/4; THENCE EAST, PARALLEL WITH SAID NORTH LINE NOTED t 450 FEET, MORE OR LESS, TO THE POINT OF BEGINNING. —B 75' WILDLIFE CORRIDOR & Q, EXCEPTING THEREFROM ROAD RIGHT-OF-WAY NATURAL FOUND 1993 0 VEGETATION DNR CONC/ BUFFER BRASS MON. SCALE.• 1" = 200' ■ N SET 2"x2" HUB -S-N EXIST. SEPTIC 0 100 200 400 DRAINFIELD 0 I 60' STEELHEAD DRIVE P v1o� EXTENDED AS PER PLAT SOUTH LINE OF PLAT FND. PLAT MON. OF "MISSION CREEK" BRASS/CONC. 37.02' 1311.JO' - S89'02 56'E - I C `<< Aa, 30.8�5'� 1/f 6 ?' / r /✓' --1274.68' - S 89'335 I" W -- - I CORNER NW COR. OF 1/16 LINE SE 1/4, SE 1/4 1 „ 3 (EXISTING ROAD) NOTE.- A 100' SETBACK FROM MISSION 20' EASEMENT CREEK SHALL BE MAINTAINED PER AUD. FOR ALL BUILDING CONSTRUCTION. NO. 511612 (LOT 2 ONLY) 9 o? (PRIVATE) i 0 SER/4USE 114 OF S 1/2, o - _ O 6lZ55' - N 88 '10" E-- _ _ 5�� _-660.D0'— ; ,- 277.64' - 7f 187.75' 3 G 1 I 5 4 � o C6 FND. IRWIN cj? O �o REBAR/CAP o h 41 B a to w a f 210.21' ESTABLISH 20' PRIVATE 4! r V B N88'S3'10"E` ACCESS & UTILITY 5- o 20' PRIVATE —S EASEMENT df2 d o i EASEMENT B ,o © EXISTING 20' EASEMENT of (EXISTING " EXISTING MOBILE (PRIVATE) AS PER AUD. ROAD) , HOME _ NO. 394871 & 387413 N 1 to B 3 1 LOT 2 O �e WELL � co (326,027 SQ.FT)z {e B �' B� LOT 1 �� (185,842 SQ.FT.) OF CREEK IS �- 4 s T O 250 BOUNDARY LINE 25 _ --276.95'- 179.35'-- 270.65' _ --553.64'-- - _--1 280.59' - N88'12'41"E (M)-- ( FND IRWIN REBAR/CAP 36 31 36 FOUND 1993 1280.86, - N88 1 1'57"E (P) PLACED WH17E STAKE/ FOUND 1982 DNR DNR CONC/ OV j�Jol LATHE CONC. MON. MON. BRASS MON. 0�\0 PRIVATE EASEMENT W/8R.4SS DISC VISITED 1993 TO MISSION CREEK WARNING ! ROAD AUD. NO. 394871 1280.80' - N88'11'13"E (M (0Iq i280.86' - N88'11'57"E (P�� MASON COUNTY HAS NO RESPONSIBILITY TO BUILD, IMPROVE, MAINTAIN, p. OR OTHERWISE SERVICE ANY PRIVATE ROADS CONTAINED WITHIN OR PROVIDING SERVICE TO THE PROPERTY DESCRIBED IN THIS SHORT PLAT. DRAW. ON.: 93525-2 SHEET 1 OF 2 7 �srs fro" MASON COUNTY PROJECT SITE INFORMATION Case No. Name PARCEL NUMBER 2 23 2 SS-1'S1- 90 LCIO/Date 12,17/ 9 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 Includ adjacent properties if on shoreline or ithin 100 fee of adjacent property line. adjacent property line- , I E-adjacent property line I ` I I I I ,zoo I I I I / / k3— 1 y �C) 1 / I 1 I I 1 I 4r ,Pro I � I � � I I I I �I adjacent property line- I <—adjacent property line SAMPLE SITE PLAN adjacent property lined _ � 1 aio Fadjacent property line D 30' ra�SCRve 3o--�I .gE -J AL. I' H fi C2EEK \ I � I Mons t i Gnaen� ]I I £ �• I Hot.x_sQ R\\ I PRO POSGD S¢Pti C tI \ 1 � I R I VAGrvT 1 T c nrt�c.cs \ I I � P0.oPn3CD � A&RzCLLLh&RAL so 80' I 1 \ I I I 1 L—e-LL I I I I Xt /00• "� I I L..a�LL I 1 ! I I adjacent property lined Fad'acent 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 . dts+�n.ca. to ShruLtL�Y� d;S'farLG to ---------- �� s 1 e p Z t e � � dis�ana2 'VO S) 4 e t r I Signatu a Date I Ictures in the zones where elevations or depths have been estab- ed. determine if flood insurance is available in this community, ,tact your insurance agent,or call the National Flood Insurance ;gram,at (800) 638-6620. { APPROXIMATE SCALE IN FEET 1000 0 1000 NATIONAL FLOOD INSURANCE PROGRAM FIRM FLOOD INSURANCE RATE MAP MASON COUNTY, WASHINGTON I (UNINCORPORATED AREAS) PANEL 135 OF 300 (SEE MAP INDEX FOR PANELS NOT PRINTED) COMMUNITY-PANEL NUMBER 530115 0135 C Y MA EFFECTIVE DATE: MAY 17, 1988 W ,g z o, o r12 Federal Emergency Management Agency PERMIT NO. BLD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner JTFvF �47��%.�?j0.�/ /�9Ti ��T/i Contractor Name /j�0�►-ilj_ Mailing Address Q, * 9 Mailing Address City State—/ -Zip Code J'J- City / �4'��/�`'i U�State 1-(/ •Zip Code &.1/L Phone( eO 7J-)36ZOther Ph.(2_.�.7)1 0- 9 S Ph. 60 7`� -s�6�ther Ph.( , Lien/Title Holder Contractor Reg. # f vTv,flyl e 76Z tag Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existin�ySptic Connect to Sewer System Name of Sewer System ,.P Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. J2 S / }� / 2. V0 Fire District Legal Description 2 S`2J -1 2.7 Z2 T �. G_ � f.� Z -7e,9 eri /a A Site Address(Please include street name, street number and city) 7 7 "e ^7111/&Z, ef* — Directions to site d0 Will timber be cut and sold in parcel preparation? (Yes/ o Is your property withi 00' of the following: Body of Water(Name) Af/'.1 Saltwater Lake River/ reeD Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB Nevy Add Alt Repair Other Use of Building Describe Work ^'sO Q/{ r'a "'yoA4 :, No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make e-O DI;fT- Model "'I 0"4,001,&'1.I?006e' Model Year Length 6 6 Width Serial No.a J-J O_,X&;T No. of Bedrooms 3 No athrooms aZ Type of Heat Purchase Price $ 7 4,9 7C—>0Replacement Unit? ee o) li Installer Name /-117 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 therewit dfch�nges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approv ry t< t;_-r,,;: first obtaining approval. X Date SI �, X Date FOR OFFICIAL USE BEYOND THIS POINT- Accepted Accepted by Q. Date�Submittal Amount Due / Receipt No. .. URPARTMEfuTAl..RlwVI W -13 D NII»Q CONDITION C0DE5. Building Department /Do Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ : : ...........................::::.:. .. ...:.;:..:: .. ... Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES