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HomeMy WebLinkAboutBLD2000-00208 Replace Mobile Home - BLD Permit / Conditions - 4/24/2000 Inspection Line (360)427-7262 MASON COUNTY PERMIT ASSISTANCE CENTER Phone: (360)427-9670, ext. 352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 i RESIDENTIAL BUILDING PERMIT BLD2000-00208 OWNER: BEVERLY CONRAD 426-7418 pER EXPIA RECEIVED: 03/02/2000 CONTRACTOR: 10 B SITE ADDRESS: 151 E CLONAKILTY DR SHELTON V� ISSUED: /24/2000 PARCEL NUMBER: 321275400005 ��LL �Y EXPIRES: 10/24/2000 LEGAL DESCRIPTION: LAKE LIMERICK 5 TR 5 (QATF— PROJECT DESCRIPTION: DIRECTIONS TO SITE: MOBILE HOME REPLACEMENT HWY 3 NORTH OUT OF SHELTON TO FIRST MASON LAEK RD U TURN LEFT WEST GO PAST MINI GROCERY STORE UNDER RAILROAD TAKE FIRST RIGHT THEN LEFT LOT ON LEFT 5TH LOT FROM CORNER General Information Construction & Occupancy Information Square Footage Information No. of Bedrooms: 2 Type of Constr.: Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: Lot Size: Deck: Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building: Valuation: Building Height: Occ. Status: Basement: Manufactured Home Information Setback Information Shoreline & Planning Information Make FLEETWO Length: 44 Ft. Front: N 37.0 Ft. Shoreline: Ft. Water Body: Rear: S 88.0 Ft. Slope: Ft, SEPA?: Model:BROOKFIE Width: 25 Ft. Side 1: E 14.0 Ft. Shoreline Desig.: Year:2000 Serial No.: Side 2: W 27.0 Ft. I Com . Plan Desi .: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Mobile Home Submittal KLW 03/02/200 $175.00 52788 §§ding State Fee TLG 03/15/200 $4.50 53260 Mobile Home Issuance TLG 03/15/200 $175.00 53260 Eftron. Health Plan PSD 04/17/200 $50.00 53260 �+e Total $404.50 BLD2000-00208 Please refer to the following pages for conditions of this permit. 1 of 3 CASE NOTES FOR BLD2000-00208 CONDITIONS FOR BLD2000-00208 1) Owner uilder assumes all responsibility if drainfield/reserve area is encumbered. X,/� 2) This applica ubject to Buffer and Landscaping requirements as established under Mason County Ordinance 1.03.036. 3) Proposed structure or any portion thereof greater than 30" in height fro�e line, must maintain a minimum of 5' setback from all property lines, easements and 10' from all County and State Road right of ways. � 4) Structure must be setback 5' from all utility and drainage easements, a total of 10' from each property line, or a variance must be obtained from the Building Department. X 5) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be located within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work whicL may affect your project. x- 6) All upland areas disturbed or newl created by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 7) Approved per dimensions and setbacks on submitted site plan. X � 8) PURSUANT TO 1997 UNIFORM BUILDING CODE, 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 AS ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS. X,_ , 9) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X BLD2000-00208 Please refer to the following pages for conditions of this permit. 2 of 3 10), The approved plot plan is required to be on-site for inspection purposes. If inspection is called for and plot plan is not on site, Approval WILL NOT be granted. In addition, a Re-Inspection fee in the amount of$42.00 per hour( 'nimum 1 hour) will be charged and must be collected by this department prior to any further inspections being performed or approval granted. X, 11) 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 1997 UBC, 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 C.tE 12) 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 120 sq ft or less AND MUST be under 30" in height from surrounding grade. NO second story decks, or decks above 30" can be built without a permit. Any landing or deck that i.saO" or more in height from walki g surface to finish grade requires a Permit. Any landing or deck that has 4 or more risers requires a handrail. X ( �� ,� 7'� QM6�_' 13) The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including installation instructions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be clearly marked in the installation instructions. 14) An existing deck has been identified on the approved plot plan. This office did not review the deck for life/safety requirements however, the building inspector-may require corrections to the existing deck if it does not meet egress or life/safety standards. X ( �2c1011Z 70 2— � This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. OWNER OR AGENT DATE: BLD2000-00208 Please refer to the following pages for conditions of this permit. 3 of 3 I CONCRETE MECHANICAL MOBILE HOME I Footings-Setback�'`�' J date by Ribbons date by Gas Piping date 5! ZDOO b - ' Foundation Walls date by Set Up date by date — 7-��O by INSULATION 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 by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by 1 L CUSTOMER SERIAL# INSTALLER TAG WASHINGTON STATE (ORR nTY, TRADE AND INSTALLER l� CERTIFICATION EmoMlc DEVELOPMENT 51!GNATURE Budding Foundations for the Fur= J FOOTINGS 1 " _ SUPPORT PIERS ANCHORS EARTHQUAKE BRACING (if applicable) PLUMBING CONNECTIONS SKIRTING DATE OF FINAL INSPECTION 11STAi.LER5: PLACE NEAR SLTLDING PERMIT. FILL N CERTIFICATION NUMBERS FOR WORK PERFORMED AND SIGN. 115SPECLOR; NUMBERS AND SIGNATURES MUST BE ON TAG BEFORE FINAL APPROVAL. DATE AND SIGN. HOMEOWNER: STORE TAG iN HOME AFTER FNAL INSPECTION. OHim of Manufactured Housing.800-964-0852 INSPECTOR'S COPY July 1998 CUSTOMER SERIAL# .`� INSTALLER TAG WI S. T H..I'N G T O HSTATE 1I�tA mTy, TRADE AND [INSTALLER CERTIFICATION EmNomic DEVELOPMENT Y E, B SIGNATURE ure haft Foudndations for the Fut C FOOTINGS SLTPORT PIERS ANCHORS EARTHQUAKE BRACING (if applicable) PLUMBING CONNECTIONS S®[TING DIE OF FINAL INSPECTION E MMALLF.RS: PLACE NEAR BUILDING PERMIT. FILL N CERTIFICATION NL-.NIBERS FOR WORK PERFORMED AND SIGN. LECTOR: NUMBERS AND SIGNATURES MUST BE ON TAG BEFORE FINAL APPROVAL. DATE AND SIGN. 11�►IF.OWNER: STORE TAG RNI HOME AFTER FINAL INSPECTION. 01111ireof Manufactured HousinY,800-964-0852 HOMEOWNER'S COPY July 1998 CUSTOMER SERIAL# INSTALLER TA WASHINGTON STATE ConumiTY, TRADE AND INSTALLER CERTIFICATION EcoNomic DEVELOPMENT v U M OU SjGYATCRE Br d&g Foundauonr for the Futon FOOTINGS SUPPORT PIERS ANCHORS EARTHQUAKE BRACING (if applicable) PLUMBING CONNECTIONS SKIRTTING DATE OF FINAL INSPECTION i INST-aI.1-ERs: PLACE NEAR HLILDING PER`iIT. FILL IN CERTIFICATION NUMBERS FOR WORK PERFORMED AND SIGN. TNSPFCTOR: NUMBERS AJND SIGNATURES MUST BE ON TAG BEFORE FINAL APPROVAL. DATE AND SIGN. HOMEONI'NER: STORE TAG IN HOME AFTER FINAL INSPECTION. OT=of Manufactured Housing.800-964-0852 INSPECTOR'S COPY July 1998 CUSTOMER SERIAL# /,�'\\ /�►. INSTALLER TA WAS� T HIINGTONSTATE CDMMt mn 1 RARE AND INSTALLER CERTIFICATION Emomic DEVELOPMENT v Bps &G-N ATURE Bml&g Fomulraions for the Future FOOTINGS SUPPORT PIERS ANCHORS EARTHQUAKE BRACING (if applicable) PLUVBING CONNECTIONS SKST NG DATE OF FINAL INSPECTION I I?ySrAL FRS: PLACE NEAR BUILDING PERMIT. FILL IN CERTIFICATION NIL-NIBERS FOR WORK PERFORMED AND SIGN. INSPECTOR: NUMBERS AND SIGNATURES MUST BE ON TAG BEFORE FINAL APPROVAL, DATE AND SIGN. HCWOWNER: STORE TAG IN HOME AFTER FINAL INSPECTION. OPlimof Manufactured Housinz.$00-964-0852 HOMEOWNER'S COPY July 1998 • r s Q I�lr� INSTALIER TAG WASHINGTON STATE COMMUNITY, TRADE AND INSTALLER ECONOMIC DE�LOPMENT CERTIFICATION % NU BE SIGNATURE &dl&g Foundations.for the Future FOOTINGS SUPPORT PIERS ANCHORS EARTHQUAKE BRACING (if applicable) PLUMBING CONNECTIONS SKIRTING DATE OF FINAL INSPECTION INSTALLERS: PLACE NEAR BUILDING PERMIT. FILL IN CERTIFICATION NUMBERS FOR WORK PERFORMED AND SIGN. INSPECTOR: NUMBERS AND SIGNATURES MUST BE ON TAG BEFORE FINAL APPROVAL. DATE AND SIGN. HOMEOWNER: STORE TAG IN HOME AFTER FINAL INSPECTION. Office of Manufactured Housing, 800-964-0852 July 1998 c- to YAC,M I � �r�v e_ DATE: PLOT PLAN I �' 5 0 SCALE N I r� Gl 1 I I I 1 �? �• I 1 G � z I O - - - - 1 w I - I i ,Z 0 Z 10 0 L ' li Sti c_/r�� ��� NOTES: /SI ,t. l�on/��C� (� O2 - T�z�vE'/ z S �1!jmPi1q -1-A - yw� ion oe si�czrz i o�� iza.�,v TR,ayvz a.�3T oFF 2arup LAw /ol n/orn-+ htuf�/ 3 �� /znnip ro .Shc 1 �� Sf y_aw ICU-3 772ayz-:71A ' u.�,�zv3 My,/ T,n/ti'- -- �¢,nJ TI.r2*►1 Oni Z) i%9�;Or� C� GO cJn/D�z �/L 2t0 GJ.et s/h/fs ��� F/ilJr Or�_ '7 - IDENTIFY LOCATION OF HOME,DISTANCE FROM BOUNDARIES,UTILITIES,PORCHES,AWNINGS, CARPORTS, GARAGES AND ALL OTHER STRUCTURES OR OBSTICALS. MARK ALL BUSHES AND TREES TO BE SAVED,AND SPECIAL LANDSCAPING REQUIREMENTS. SYMBOLS: W = WATER, E = ELECTRICAL, G = GAs, S = SEWER/SEPTIC, P = PHONE,T = TV 4[Lo y Brookfield FLEEMMD. Limited Series a • Model 3442M 2 Bedrooms • 2 Baths • 1 ,034 Square Feet W ". ° ` o [� - °°�-- ------- n -- 'soo DESK r UTILITY 1 L 1K1TCFIEN O �.- MASTER I r ��[1-DOOR 10 -t DINING i' _}�-_'_��_}_:_ ; OPT. "A„I BEDROOM orr. �4-- - I `I.HALF IN 11'•6"X It'-5" I i o ISLAND— _ W JJ PORCH�l 14- OPT. FULL {f _ _ PORCH - ov7.—r CLASS ° R — ID_ ( �� � �I 6'O"X23'•6"' CLOSE �D\_M. BEDROOM DEN LIVING ROOM (HALF 10'-2"X 9'-3" 10'-4"X t 1'-3" OF 16'•10"X 11'-5" - PORCH BATH DOORS 6'°"x 1t's~ OPT.GARDEN vTU9 —ENTRANCE �yi;,y ♦�. /Oa/DEC97 PLOT PLAN I DATE: SCALE P=g'O N I ruCY4 IT I ry I ' I N /70 I Z w I I I � I - a i I� N I 0 _ L y L _ J b NOTES: ©l TIZ�a I/E'/ Zr S 7Z� <lM vilq -I-AldetE Nwy /O( -,e S/��ZTL�t/ yF� /Zl��,v TRHvG;Z /�•�3 - Or/ 77> SltLrL7an/ f � /D/ OFF P ?i9C- //tack ZZ) htwy 3 /Z4me 7- �h.= 1!4y�7/n��/ w�v:s �N TLr1n/ on/ �1.4Sort/ G�� i2D LJ Go yiy0�2 !�A/L 2vv4O Gl�y�S/wG 7 >C`� FI/lJT D►Y Z led IDENTIFY LOCATION OF HOME,DISTANCE FROM BOUNDARIES,UTILITIES,PORCHES,AWNINGS, CARPORTS, GARAGES AND ALL OTHER STRUCTURES OR OBSTICALS. MARK ALL BUSHES AND TREES TO BE SAVED,AND SPECIAL LANDSCAPING REQUIREMENTS. SYMBOLS: W = WATER, E = ELECTRICAL, G = GAS, S = SEWER/SEPTIC, P = PHONE,T = TV �111� Se)t by :RVRNS & 1ST HOME TRK Nov-17-99 11 :36 from 1 509 886 0869-)2535884930 Page 1 � 1 Received NOV-12-99 08:56 from 13602255069 -� RYANS 8 1ST HOME TRK 11/12/08 09;55 1&10802255069 F=NOOD WA Page I Q1001ioo1 Pierce Works anCounty P�,nitc Works and Utlllttes SPECIAL.MOTOR YEHtCC>t PERMlT Tranapo►tsUan 9arv(C4s 7y An�1 1 1 1 2401 South 35to sheet,Roam 100 1O 71r i [ 0 1 Tacoma,Waehington 94409-7485 ;,, i (253)798.72W FAX(253)790-2740 DATE IssUED: August 11, 1999 REPORTNUMSER: NAME: RYANS TRUCIQNG ADDRESS: P.O. BOX 2236 WENATC:RE WA, 98807 POWER UNIT TRAWNO UNfr(8) NO,AXLES: 2 NO,AXLES; LICENSE OR V1N NO: A 79208 LIOEN$E OR VIN NO: TRANSPORTING(ITEM): 1 ANU�RACTUUD:IOIJ►SING UNIT NO- OATES(FROM): August 11, 1999 (Tra•u): uKu�L ill 2000 FROM: POINT b; POINT ON PIERCE C04UNTY ROAD&: AS POSTED GROSS WEIGHT. Ilr'GAL 1,(AXIMUM WIDTH: F1', 0 IN. l£oAL CAPACITY: I'AXIMVM HEIGHT; 1� FT. 0 IN. FRONT OVERHAND: IT, IN. EXCESS ORM WEIGHT: d 4XIIAUM LENGTH: 95 FT, 0 IN, REAR OVERHMO: FT. IN, AXLE WEIGHTS IF OVERWEI0HT AND AXLE 8PACINI 111 _ #5 09 DIST DIST DIST 92 MB fK10 DIST owr� 018T CICT DIST DIST DIST 018T e Rl t)G6 A"TRIcT I ONS: lYOT TO EXCEED,4A Y Jv OSTED BRIDGE LIIKITS SPECIAL CONDMONS: SEE AfTACHEQ FORM Of FOR-AsS / NS PERMIT FEE: '$20.00 . P rvrV 1N tiLUE 0R R¢D lN1C 0, YJ , SIGNED X �Y. AL'l�UNL I ll N fAhtl IblT•"Net, AI 0 G R 6 T TATIQH pQ t a t9 t 0Ya><OR A61N1 VAL OATIU rrR P 1Y AND�CKelowt fi96 ROC&i OF FIN P)JO VIOLATION OF SPECIAL.PSRMITS.PENALTY For toilwa to ODIC?,mimprreentatlon,or v191e0on of 10(:411 7erRUts'state Lew provid43 for a fine,CWfilogtjon.and suapenslon 9(p4rm+t without refund. NO rafunCs after the start of the fff4etftra dates, ORIGINAL PERMIT MUST BE CARRIED ON VEHICLE DESCRIBED l'hOMNIf OFNM16NMNMT.pRNq Rw.OL2tl0i Q Y O Of .a 1 100 ' 149 ' " ~ ex is t i ng 1200 go 1 2 compartment o sept is tank hang pump in 2nd comportment modify tank per deta i I draw ing N No ro slop o 2'' c 1 200 transport I i ne f I ow sp I i tter see deta i I 6� 1'' c1 200 laterals 1/8'' or if icE ° 3 ' on center I eave or i f ices up �Y a►k use she i I ds 154 100 ' ' ';'". y w m o w �� w� I in e --------'- Goo ,� north Q w cn Q z c U J 0 V=30� � z a J J o Mp � PLOT-PLAN I SCALE 1"= � � A ga(M HV1S HOANIHSVM N lN3ddW IW i33w 1SIM �ti I )180M JNIVY80?81d-01 80INd 'N01103 SNI N04 7vn08dde 60.A S30) WO 11Wens 311s eo 3HI NO S3DN HO ' Be 1sniN s Vld 39AHA- ��'fvl��r� I � GZ Z _ 3 7'p I c ..r �• N 0 - - o - - - Y - uz n2ts�S?� L 1 b NOTES: /5l ,t l�on//4�C/ //�-� �?5��� ^/ 7lZr9 V6-1 Z S 7Z) /O/ o e 5/&Z 7ZM/ Qom/ 5W TLTahI �w 7<neTa u lol F r, / / l al w�� r W/i aa411 ?7Z4//L7ih��i %wcyev3 M/ ZA/ `7-614_ /1_4_5' h/ L J C= EX/T .,6rr Mq r") 7ZX-?Al on/ :z> r�.�So�Y G� ,Q o id. Go umgn z /Zc�y OW TJ l'JOnrRiClln/ '�i9,rcr �tcX r /��=r .3 2d frly*��' cy.c ,Cc �r IDENTIFY LOCATION OF HOME, DISTANCE FROM BOUNDARIES,UTILITIES,PORCHES,AWNINGS, CARPORTS, GARAGES AND ALL OTHER STRUCTURES OR OBSTICALS. MARK ALL BUSHES AND TREES TO BE SAVED,AND SPECIAL LANDSCAPING REQUIREMENTS. SYMBOLS: W = WATER, E = ELECTRICAL, G = GAS, S = SEWER/SEPTIC, P = PHONE,T = TV 3I11(p ti I 10 Q Y > a O p • � oa.. 7i Wac, ¢ z a � a N o w Z 2 100 , 149 , ex i st i ng 1200 ga 1 2 compartment (� Sao sept is tank hang pump in 2nd comportment m 0- mod ify tank per deto i I draw ing fj, _ No to J \ ' slop 2" c 1200 transport I ine flow sp l i t ter see deta i I ass, 1'' c1 200 1ateroIs 1/8'' or if icE 3 ' on center I eave or i f ices up Y' a use she i Ids 154 w A j M �`aT 4y C W V CC CC W SOU � za w= QC 'O,I ine ------------ Gin north Q = z0OW W n 0 1"=30�' I- -UJ (if r� w0L Z 2 Q o cm o m �, /�Q�PERMIT NO.: BL�Vw-11D20g a M S6 N 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 T c�►�Ii�AIZ Contractor Name Mailing Address �-1 , Ir— A�.IhIAk� -h P— � Mailing Address 1�I I!}Q fj City_5 ht✓I+Uh( State 1,44 Zip Code gRSA- City MARL& YAL- State 1,14N_ Zip Code QSf Phone(3)U21--7A Icy Other Ph.(_-12 q&-- !7q Jg Ph.(26(,, Other Ph.(� Lien/Title Holder Contractor Reg. #T Qom* 6 -, ark-a Address Expiration / /-C1CD_ SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. `32 J Q "7 914 / an4-vn 5 Fire District_�� Legal Description LCI,2 L,m 42,41 CH * 5 TICS Site Address(Please include street name, street tuber and city) IS J F�?Iawj a)< j 1 ru 1')RRT,�hg� tag I (,JA Directions to site N t�Y � nlcnPrN nc�nic SHC=21TNn1 -rN GI r13T A S�yll f q tcF (�'9 -f3 1121y) r Will timber be cut and sold in parcel preparation? (Yes/No)_Q,y L Ir Orl L.trT $TN Lo7-1­-11CM e U?AJO7 Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or duffs TYPE OF JOB New Add Alt Repair Other Use of Building fL,14 Describe Work .D21ptcc i Y� n►.�c�m�f:' J{.n _1 1 i� hlc= /Y1�1nIc 1LT�!L�» I't[r1L z�� No. of Bedrooms__.7__No. of Bathrooms_SQUARE FOOTAGE-1st Floor �r�2nd Floor__ 3rd Floor_ Loft�_ Basement_ Decki--X5ao4Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make F4�-���L Model n, c-Ic(� �?mModel Year 71-y-y- Length 4_Width��Serial No._S&n No. of Bedrooms No. of Bathrooms_ Type of Heat ElEcT rn 1 o Purchase Price $ qrj� Replacement Unit ? No) -�(4 % Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X FOR OFFICIAL USE BEYOND THIS POINT Accepted by cc Date / Submittal Amount Due 66 Receipt No.� DEPARTMENTAL:_REVIEW ROV ENIED CONDITIO CODE$ Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ FEES 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 '-1 PERMITNO.: MASON COUNTY ) Z 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 Contractor Name Mailing Address Mailing Address City State Zip Code City State_ Zip Code Phone( ) Other Ph.(_ Ph.( ) Other Ph.0 Lien/Title Holder Contractor Reg. # Address Expiration / SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic--,--.,—Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. % / / Fire District Legal DescriptionL_..! _ C t Site Address(Please include street name, street number and city) Directions to site i 1 Will timber be cut and sold in parcel preparation? (Yes/No)�p,i Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other_' Use of Building Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck, t Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make, Model Model Year Length -f� J Width Serial No. No. of Bedrooms No. of Bathrooms_ Type of Heat Purchase Price $ _: Replacement Unit ? No) T Installer Name Certification No. ��--------'' NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X Dat FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEFARTMENTAL'REVIEW APPROVED DENIED'' CONDITION CODE$ Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ F1.EES _ ... .... . ..... ...... Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee blic Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO.: 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 Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone( Other Ph.( ) Ph.(_ Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Fire Distri Legal Description Site dress(Please include street name, street number and _ 4Nmettions to site n s � i , Will timber be cut and sold in parcel preparation? (Yes/No) _ Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Describe Work 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 t, ake. Model Model Y IIJ Length Width ~ Serial No. No. of Bedrooms No. of B Type of Heat Purchase Price $ Installer Name Certification o. 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-]certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED< CONDITION CODES Building Department { Occ Group Type Constr. Planning Department �(D Environmental Health Department Public Works Department I Fire Marshal Valuation $ PIES .: .. 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