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BY A Il" DECKS FRA Waft Date By Date lroln T:�.:.BYr/� Data 9 (V/tbr7 By "ET-4- PROPANETANKS PLU BI141_G Vault f Date Fay Date By - OTHER Groundwork Attic Date By Date A- 9 Type: - 0-? By,*,d& Date By D.W.1v DRYWALL Type: Int.Brac Wall Date By IOU Date L-Y7 By/_e, f 77-'7 '0 By f]4] FINAL INSPECTION Water Lin 13Y Fire Seperatl Date Date By Date CD CD -4 Type of Ins P_ Pass or Request Inspect. 6 Fail Date Date Done By Comments (D 0 Z3 (0 (D 7 - 17 �P 8 &07 F6t(J7 In 0 1,aJ�O'PA V/07 i> L 00e,'?-,Y7 0 VICINITY MAP NORTH N O M ■ • NAME: L4eq,3 LNDN SITE ADDRESS: I"LV N , flowe N PN CITY:5 .�p ZIP: q dSSK MAILING ADDRESS: No S- /4-A-' AoJ Se —70Zr7 3 CITY: L/ L� ZIP: a�31z PARCEL NUMBER: 2 ,33o5'0002S-/ PHONE NUMBERS H. aggj5 8qo-370(f W: C: z4!;3) In - N{s MILES FROM HILINE SALES OFFICE: /0 r� ,1 � 0 � s �P� N� h 13 Q a 3. t PLANNING: ALL SETBACKS ARE MEASURED FROM THE FURTHEST r.1p,p �; PROJECTION OF THE BUILDING R4� L.Of?E 1J L-4A MCN) 4oS- I`1`�t P"v S� PL-4 l vvL,(' W h . '�is 31Z a0 S I -ram A�7z ass s �p 4uYb v1/b g�5 8 �v /A�,¢cc� # Zz-33o Sao r � e� 5� V 1,I01 Niap Orawn 'ro Meet plea HiLine Homes Specifications. Any Revisions To Be Made BY The Home owner, \cP Y I�...��r-i�✓ N` P _ - N L !� r — � N i _Z W Z ~ J V '� Z z > OL D O- m a lam' Wpoa Op Iwo t3 o jr >- Lew IL z a� Q0ZN U Z a Z O m - i /oc. . li� ON.STA, MASON COUNTY MS �, DEPARTMENT OF COMMUNITY DEVELOPMENT N Planning Division 0 y � P O Box 279, Shelton,WA 98584 (360)427-9670 1864 NOTIFICATION OF INCOMPLETE APPLICATION March 09, 2007 LOREN LUNDY 9412 60TH AVE CT EAST PUYALLUP WA 98371 Parcel No.: 223305000251 Project Description: SFR, STOCK PLAN #2003-0006 Dear Applicant: You have submitted a permit application (case no. BLD2007-00312)for proposed construction or development in the county. Upon review of your application, I have determined that the contents of the application are incomplete or do not provide enough detail for review. Therefore, review of your application will not proceed until the necessary information is provided (see the comment section of this letter for details.) Once the information is submitted and the application is complete, I will continue to process your application accordingly. If the additional information is not provided to the County within 180 days of this request, the application shall expire and no further action on the proposed development shall take place. Please contact me at (360) 427-9670, ext. 294 if you have questions. Sinc rely, I Charles ead McCoy III Land Use Planner Mason County Planning Department Comments: A building permit is required to build surcharge-bearing retaining walls separately from the building permit needed for the construction of a single-family residence. 3/9/2007 Page 1 of 1 BLD2007-00312 Window Schedule fF4iL M for 1768 plan M E ' S Hiline Homes of Centralia Manufacturer: Milgard Windows Inc. Model: Classic Series Type: Vinyl U-Value = .36 Windows Quantity Size/Handing Glazing area Total S . Ft. Location width x height 2 1'0 x 5'0 5 10 Entry 1 6'0 x 5'0 30 30 Living Room 1 6'0 x 5'0 30 30 Family Room 1 4'0 x T6 14 14 Kitchen 1 6'0 x 5'0 30 30 Dining Room *1 6'0 x 4'0 24 24 Master Bedroom 1 6'0 x 4'0 24 24 Bedroom 2 1 4'0 x 4'0 16 16 Bedroom 3 1 TO x TO 9 9 Master Bath Slid.Glass Doors 1 6'0 x 6'10"s d 41 41 Nook Total glazing area 228 sq. ft. 228 - 1768 = .128 X 100 = 13% Glazing Area + Conditioned floor Area Glazing Percentage *If a sliding glass door option was chosen, switch the appropriate window w/the sliding glass door and use the calculation below. 3 1 6'0 x 6'10"sgd 41 41 Appropriate Room 245 - 1768 = .138 X 100 = 14% Glazing Area + Conditioned floor Area Glazing Percentage All other doors,windows&skylights do not need to be calculated do to the fact they meet all minimum requirements. i I EiM;M - Building Permit Information Form - 1768 Plan This form contains the information you'll need to complete your building permit packet. We've included information for all counties, some of it may not apply to yours. If you have any questions, please give us a call at 360-807-1849 Applicant/Owner/Contact Information: Your name, address. phone number Contractor Information: Name: HiLine Homes Address: 1213 Long Rd Centralia WA 98531 Phone: (360)807-1849 License# HILINH*981 BT Expiration: 02/10/08 Tax Parcel#/Assessor's Acct.#: This will be with your property information. Job Site Address: Your new home address(example:xxx Filmore St.) Legal Description: This will be with your property information. (example: Lot xx Large Lot Sub Division xxx in Lewis County etc.) This will be a New Single Family Residence Describe work/Type of Job: New Home construction Home Information: Floor Area:(sq.footage) Main/1st: 884 #of stories: 2 Carports: 0 Second: 884 Bedrooms: 3 Decks: 0 Basement: 0 Bathrooms: 2 Porches: 201 Total: 1768 Garage: 528 (Attached) Construction Method: Wood frame Heating System: Be sure to choose the information below that correlates with the heat system you have ordered. HVAC/Me our heat Cadet/Wall Mount/Zone Heaters: Standard heats stem Installer: North Pacific Electric Contact: Bernie/Kim License#: NORTHPE957JA Phone: 360-943-6020 Expiration: 04/01/07 Location: Olympia Manuf: Marley Brand: Module#: KW: 7 WHF: AMPS: 20 On permits,for the#of wall heaters,put 1,or you'll be charged extra for every one. ----------------------- Heat Pump w/furnace w/HWH: Installer: Chehalis Sheet Metal Contact: Dave Pyles License#: CHEHASM252MH Phone: 360-748-9921 Expiration: 09/21/07 Location: Chehalis Manuf: Trane Module: 2TWB0030A1000A KW: 10 Tonnage: 2 HSPF: 7.75 Seer: 10 LRA: 60 Efficiency: 100% Natural Gas or Propane furnace w/HWH Installer: Chehalis Sheet Metal Contact: Dave Pyles License#: CHEHASM252MH Phone: 360-748-9921 Expiration: 09/21/07 Location: Chehalis Manuf: Trane Module: TDE060A936 Watts: 977 BTU: 60,000 Efficiency: 80% Spot Vent Fan: 1 Kitchen Exhaust Fan: 1 Dryer Vent: 1 Wood/Gas/Pellet Stoves: 0 Gas Outlets: 0 Plumbing System: Installer: Dee Dubs Plumbing Contact: Darren License#: DEEDUBP1990KQ Phone: 360-456-7469 Expiration: 05/19/08 Location: Olympia Toilets: 2 Bathroom Sinks: 2 Bath Tubs: 2 Showers: 1 Kitchen Sinks: 1 Water Heater: 1 Clothes Washer: 1 Dishwasher: 1 Hose Bibs: 1 (first 4 enter quantity of 1, every home has 2) Energy Compliance Information: Compliance Method/Path: Always#3 (Per Washington State Energy Code) Total sq. ft of glazing(glass): Standard home: 228. w/sliding glass door option: 245 divided by total sq.ft. of heated area: 1768 equals a glazing percentage of 13% standard or 14% w/sliding glass door option. Swinging doors and skylights are not counted in this configuration because they meet all requirement minimums. Window Schedule: See attached form. Ventilation System: Intermittently operating Whole House Ventilation System using exhaust fans&window fresh air vents. (VIAQ 303.4.1) House Fan Specifications: Whole house fan: Qty: 1 Manuf: Solitaire Ultra Silent Module#: S110U CFM: 110 Bathroom One-Bulb Heater/Fans: Qty 2 Manuf:Solitaire Ultra Silent Model#: 162 CFM:70 Copyright 2003 HiLine Homes of Centralia MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Assistance Center SHELTON (360)427-9670 13ELFAIR(360)275-4467 SEATTLE(206)464-6968 ELMA(360)482-5269 FA►x: (360) 427-7798 WES SITE: www-co.mason.wa.us P.O. Box 186, SHELTON 98684 2001 Washington State Energy Code (WSEC) effective July 1, 2002 2000 Ventilation and Indoor Air Quality Code (VIAQ) Code Compliance Application Form The following Information will be required for the WSEC and VIAQ plan review: 1. Complete the Washington State Energy Code/Ventilation and Indoor Air Quality Code (WSEC/VIAQ)application located on the reverse side. 2. Complete the window and door schedule on the reverse side. Include all windows, skylights, sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening dimensions of the windows and doors. Information about the U-factor of the window will also held to expedite the energy code review. If you are complying with the WSEC by prescriptive path an are using the area weighted average method you must include your calculations. 3. On your building plans note the location and fuel type of water heater, location of exhaust fans (bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings an slabs, 4. Questions? Call Mason County Community Development at (360)427-9670 ext. 284. Additional WSEC and VIAQ compliance information is available on the internet at: www.energy.wsu.edulbuildingsl Prescriptive Requirements 0-1for Group R Occupancy Climate Zone 1, Table 6.1 Glazing Glazing U-factor Door Wall Wall Wall Option Area%of U- Coiling Vaulted Above interior` exterior Slab' Floor Vm,,�, o1 ftod" Factor° Ceiling Grade below 'Below Floors on grade Grade Grade 1 12% .35 .58 .20 R-36 R-30 R-15 R-15 R-10 R-30 R-10 li* 15%' .40 .58 .20 R-38 R-30 R 21 R-21 R-10 R-30 R-10 III Unlimited Single Family Res .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10 (R-3)Ony *Reference Case/Call(360)427.8670 ext 284 for footnote information. Log&solid timber wall with a min.avg.thickness of 3.5-are exempt from the above grade wall insulation requirements. DEEPARTMM OF I.A60R AND I DUSTPM REGISTERED AS PROVIDED BY LAW AS CONS T CONT GENERAL --:c• T:;�##rR• ..• ,;DATE :: EFFECTIVE"DATE `''''"•--pl/ 0/100'2-' HILINE HOMES 11306 62ND• AVE E PWALLUP. WA; 90373 rays-o:-ouu��n� 00.4 And WpW Certireaoe . REGISTERED AS PROVIDED BY LAW AS 1 CONST CONT • WNERAL Please Remove CCOl HILINH*9818T Oa/10%200g Arid Sign EFFECTIVE:DATE. o,1r30/2002 Identification . .. . . _ .. Card Before HILINE HOMES•V ' - :'. Placing In 11306 62ND AVE E Billfold PUYALLUP WA 98373 . Siwr.tu�t I leuuiJ by J &AXTA'!ENT OF WOR .,Wo 1NDUSTRIES 1 h7?5.fl5_�IIY l I Stu? MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton,WA 98584 Shelton (360) 427-6 the web irr((f36)275-467 9.usma (360) 482-5269 APPLICANT INFORMATION CONTRACTOR IN�QF�M�T ON Owner f-6 fZr' LU lei Company Name v� Mallin dd dims V� Mailin Ad Tess 11306 Z'" Ci State. Zip Code City a� State 0 Zip Code in 70 _Oth Ph. z53-2.73-bt? Phone 4 Other Ph. zexi Phone I� Contractor Reg.# t 6ITExp.ei Lien/Title Holder ert-Ru L o,g *' d-r E Mail Address DOB E mail address�� Drivers Lic.# Drivers Lic.# [L4�i1�� DOB j 2.- SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic_— Se Ile- Connect to Water System _ Name of Water System ell Water System Name of Water System RCEL INFORMATION -14 Digit earcel N Fire District Legal Description._ Z Site Address(Please includestreet n me,street number and city) , Directi s to site a S I Wiil timber be cut d sold in parcel pr paration?Ye N Is property ithin 200'of Saltwater Lake River/Creek ►�4 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 actio ?Y o TYPE OF JOB- ew R' Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building s�cw= Describe Wor No.of Bedrooms T-No.of Bathrooms quare Footage-1st FI or 2nd Floor 3rd Floor —'Base ment Deck Covered Deck Other Sq.ft. G arage A; ached ached Carport Attached Detached EACTUR A1E INFORMATION-Make Model ar Width _ o.of Bathrooms Heat _ urc ase n Warne Certification No. /BOLDER Admowledges submission of inaccurate information may result in a stop work order or permit revocation.ant of y signature below.I declare that I am the owner,ownerslegal representative,or the contractor.I further declare that I am entitled to receive this d 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 rPROOF red from any easement hdier or any other party in interest regarding this application or the work proposed in the application,I have obtained ission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information Provided rate employees of Mason County access to the above described property and structure for review and inspection. NTI F WORK IS BY MEANS OF A PROGRESS INSPECTION. i Date `.2 4:L_,2— Own /Owners Re q nta Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTALREVIEW EVIEW APPROVED DENIED NOTES Building Department Planning Department --� Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee �y EH Review Fee Plumbin Ftao------ -Planning Review Fee Mechanical&Base fee Other � Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ L TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT NO. �.-- PLEASE PRESS HARD MASON COUNTY PLUMBING/M1111 ► PIIA ' ASP84PLICATION 426 C ar• .O. 86, eRon,&A4- Shelton(360)427-gg�tp eBe air(3 . )275- n.7•Elma(360)482-5269 O h wJwv APPLICA INFQRMATION CONTRACTOR INFORMATION Owner L Company Name Maili Ad res Mailing Address City tate ih�&_Zip Code City State Zip Code ��S 3 7-7-COPS Phone Other Ph. Lion/Title Holder Contractor Reg.# Exp. E mail address E Mail Address Dove Lic,# DOB- S Drivers Lic.# DOB 811"C INPQRM TION Connect to New Septa Existing Septic Connect to Sewer System Name of$ er S stem 1, A ON- 12 Digit Parcel Ni . Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland,.,,,...—.Seasonal Runoff Stream lopes or Bluffs > 15% TY L©0 JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1st Floor 2nd Floor ment Garage-Closet ow Number of each) ' . , NICAL UN I)=9f Fixture No. of Fixtures Fees Fuel Type:Electric LPG_ Natural Gas_ Heat Pump_ Tollets '_ Type of Unit No.of Units Fees Bathroom Sink Z Furnace Bath Tubs 'Z Heatpumps Showers Spot Vent Fan Z Water Heater Propane Tank Clothes Washer �— Gas Outlets Kithen Sinks —� Wood/Gas/PelletStDve Kitchen Dishwasher —� hen Exhaust Hood Hosebibs —� Dryer Vent Other Other Base Fee t1 91 �`@ Base Fee TOTAL L I G TOTAL MEC A ICA OV*jffjjBLjrffi Admowled"won of burn uate information may result in a stop work order or permit revocegon.A016PNledgement of such is by sivv*w helm I declare the l am the owim,owners legal representative,or the contractor.I further declare OW I au!+ermpped 6R receive this permit and tD do the work as in time appli�on.I declare that I have obtained the pemtission from all the r4�es,if pe is . orient any ggtsrp in regarding this application or the work proposed in the I tte a fn4fn n tqm ply blrthi�peertit ar>r!l et the work proposed. Time bMrt�er or agent on owners behalf,mp�e w*t�#re Wormation 10 acaNaittt and, e�QI AAWn access to the a Ws described property and structure for review and inspection. OF N IPl"1f MEAI+ISC+B O A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (indicate which one) (`�� FOR OFFICIAL USE BEYOND THIS POINT Accepted W,—i�Plannino PO Ck# Date Bld Pd - Receipt No. I� RIEVIEW APPROVED DENIED NtYrES' OW&O Dopartment G&2WA,=,__TyDe Constr. Plannina Department i vironmental Health Department FEES Plunibleg Fee Site InIg2gon !Re FC Ian Review Fee /Gas/Pellet Stove Fee Mer Violation Fee TOTAL FEES ` 00"� "3! PERMIT NO. MASON COUNTY NTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 Shelton (360)427- 670Belfaw60)275-4467•Elma(360)482-5269 w coOn thee mason.wa.us APPLICAIET INF R ATION CONTRACTOR INFORMATION Owner L U Company Name Maili Ad res S Ue Mailing Address City ttv tateZip Code City Mate Zip Code Phone 3 04 Tel..ZS 3 Z7<0175 Phone Other Ph. Lien/Title Holder vel avA Contractor Reg. p. E mail address E Mail Address Drivers Lic.#L V'P I& U't DOB 1 5 Drivers Lic.# SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No, Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site { I, Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1 st Floor 2nd Floor. Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNI lype of Fixture No. of Fixtures Fees Fuel Type:Electric LPG Natural Gas_ Heat Pump_ Toilets Type of Unit No.of Units Fees Bathroom Sink '7- Furnace Bath Tubs Heatpumps Showers -` - Spot Vent Fan �— Water eate --r Propane Tank Clothe asher �- Gas Outlets �— Wood/Gas/Pellet Stove Dishww Siasher Kith F Kitchen Exhaust Hood Hosebibs �- Dryer Vent Other Other Ba e.lAee ('Wl �Qt c� ► Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Aclatowledges submission of inaccurate information may result in a stop work grder or-permit revocation.Acknowledgement of such is by signature below.I declare that 1 am the owner,owners legal representative,or the cont or.I r declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I h:this obtain pe v ' AM the necessary parties.If permission is required from any easement holier or arty,otherrpatty in interest regardin tion or the proposed in the application,I have obtained permission from them to apply for this pomdtand conduct t)e'work propo . owner or agent on owners behalf,represents that the information provided is accurate and grants ems of Mason access to the above described property and stricture for review and inspection. PROOF OF CONTINUATION OFWORK IS BY M OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted b Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department c Grou T e Constr.- Planning Constr.— Planning Department Environmental Health Department FEES Plumbing &Bass Fee Site Inspection Mechanical&Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other { Violation Fee TOTAL FEES PERMIT NO. �`t MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O. Box 186, Shelton,WA 98584 Shelton (360) 427-9670•Belfair(360)275-4467•Elma (360) 482-5269 r On the web www.co.mason.wa.us APPLICAf�T F R,MATION CONTRACTOR INFORMATION Owner iL�.. Company Name Maili Adel es t r Mailing Address City ` e ` ! State i Zip Code ` City State Zip Code Phone ` �'��—Other `- � ''i Phone Other Ph. Lien/Title Holder V ti ' ' ` ti Contractor Reg. E rnaf address `' E Mail Address Drivers Lic. Lt `' ' DOB f -. ` Drivers Lic.# Dt i SEPTIC INFORMATION Connect to New Septic Existing Septic Connect to Sewer System I Name of Sewer System ` PARCEL-INFORMATION- 12 Digit Parcel No. Fire District F Legal Description F Site Address(Please include street name,street number and city) i Directions to site Is property within 200'of Saltwater Lake River 1'Creek Pond F Wetland—.—Seasonal Runoff Stream Slopes or Bluffs > 15% & TYPE OF JOB - New Add _ Alt Repair Other Use of Building Location of Fixtures/Units-1 st Floor:^._. 2nd.Floor Basement tiara a Closet PLU ING FIXTURES Show Number of each) MECHANICAL UN !Bathr pe of Fixture No. of Fixtures Fees Fuel Type:Electric LPC�_ Natural Gas Heat Pump_ I ilets TM of Unit No.of Units Fees oom'Sink Furnace Bath Tubs Heatpumps Showers.. Spot Vent Fan Water Heatet, — — Propane Tank Clothess,Msher � Gas Outlets € Kithen S rifts-.., , -- -- Wood/GaslPelletStave Dishwasher Kitchen Exhaust Hood I Hosebibs — Dryer Vent E Other Other ` BawFee ' ; Base Fee ' T TAL.PLUMBING TOTAL MECHANICAL 0VVIVEl 16U113Ef i.Ackrtowedges a on of inaccurate information may result in a stop work order qr permit revoc on.pv�howledgement of such is hY sigrtatkire below,I declare that I am the owner,owners legal representative,or the or I ither declare thg 1 am erhtt®d lo receive this permit and to do the.work as proposed in the appke0on•I declare that I have obtai pe m an the necessary parties..N permission is requiredrarn ary easement holder or any o .party in interest regarding this or the proposed in the application,l have obtained a perrr�ssiorr trorn themt. ply for this and conduct the work proposed. owner or agent on owners behalf,represents that the information provided is aWjMto and:grarhis a of Mason trrdy access to the above described property and structure for review and inspection. Plaf)OF;OF`CONTMfUATION OF , K N BY M OF A PROGRESS INSPECTION.' s X Date: F owner/Owners Representative/Contractor (indicate which one) i FOR OFFICIAL USE BEYOND THIS POINT Accepted b Planning Pd_Ck# Date Bid Pd Receipt Na DEPAN fAL REVIEW APPROVED DENIED NOTES Building Department Ow GL%w===__TVye Constr. Planning Department Environmental Health Department FEES Plumbiri &Base Fee Site Inspection hank t i a fee UFC Plan Review Fee Wood'/Gas'/`Pellet Stove Fee Other Nip latiain Fee TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT No. W7—063I)— PLEASE PRESS HARD MASON COUNTY P LUMBING/IIA�, CH%I AL PERMIT APPLICATION 426 Cedar• x I W,Shelton, A 98584 Shelton(360)427- v • lr 360)275-4467«Elma(360)482-5269 n the w .co. us APPLICANT INF MATION INFORMATION Owner Company Name Mails A ress`. t1s Mailing Address City State A _Zip Code City ate Zip Code Phon er P . 'S 3 27,C017S Phone Other Ph. Lien/Title Holder_,.V. Contractor Reg.# Exp. E rdail addres E Mail Address LIB:.0, DOB S Drivers Ltd.# DOB IPARCEL S1PtIC. TION - Connect to New Septic Existing Sep Connect to Sewer System Name,Of Seem oystern MA1rION- 12 Digit Parcel No. Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wets md_ .-. Seasonal Runoff_._._Stream-------Slopes or Bluffs > 15% TYPE OF JOB- New Add Aft Repair Other Use of Building Loc tion of Fixtures/Units- 1 at Floor_ 2nd Fl= Basement Gara Closet OWN# lumber of each MECHANICAL UN 7Bath xture Lo. of Fixtures Fees Fuel Type:Electrk;___ LPCa_ Natural Gaii._ Heat Purnp_ __�_ Ty of Unit No.of Units Fees Sink — 2 Furnace 7- [Heatpumps Showers �— Spot Vent Fan Water Heater —�— Propane Tank Clothes Washer _�— Gas Outlets Kithen Sinks �— WoodJGaslPdet Stove Dishwasher �— Kitchen Exhaust Hood Hosebibs _T_ Dryer Vent Other — O#her Base Fee LkA[I k&Af t3 Base Fee TOTAL PLUMBING TOTAL MECHANICAL O1M%F1/BUILDER Adaamdedges submission d irmoaxate ftmiation may result in a stop work orderor pem t mvoca#ort.f%AVFA bdp nwd d such is by signs m below.I dedwe that I am the owner,owners legal repmeentathre,orthe conbacim.I further dedamihd I sm enlMedb rNO"this pemtit and to do the work as proposed h ihal iyapNcatlon.I declare that I haws obtained the perm l th permission from all neossary parMst if psrrrtlseiort is tfom ary eaiterrrerrt%oki t rariy wvtsrpa V in kilsrest regarding this application orthe work proposed in the ap{ftoafi^f have obfahed pemri,elo I from pwww apply iortltis psnrVtarrd odrdCugct ft work proposed. The owner or agent on owners belvA rrpn>isriM l oft h*mw ton OF CONT M�JAT10h1 t�Fe VMO K� MEANS OF A PROGRESS NSI PECTION. and stnxture for re�bw avid Irmpeclbn. X Date: owner/Owners Representative/Contractor (Indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted Planning Pd Ck# Date BId Pd_Recelpt No. DEPARMEI�TAL REMEW APPROVED DENIED NOTES Bui Department Planning Department Environmental Health Department FEES Plumblina&.Base Fee Sitelnepection fee UFC Plan Review Fee Wood/Gas/Pabst Stovo Fee Other Violation Fee TOTAL FEES