Loading...
HomeMy WebLinkAboutCOM2000-00106 Restaurant - COM Permit / Conditions - 3/1/2000 0 0 F. cn Cl) a v m M No a CL co � ,� O CD CD (D o C- p0 m N a) N O CD C n m Cl a > � mcnz w * c o > y n -1 CD CD o OD rnU7 b� Z M 0rD —zl q� ,IN � „ CJ, 46ivoo � m � zp col CD 3 D CD 01 cn p Z)1 (7 Z 3 O CO 7C O d ZX (nXX 0 � Cl)cn<< (n a O 5 � � Nzz _ n O (D N 3 3 N N -4 .(1 .11 D ^Z J 3 � Ot � CD Ot D 00 `G " 00 C � = Zorn 3 = -n CA) 2 O O (n Op m .(1 .(1 Ol W C Q cD CD � N * ND00 Z z � mm w o fD m -v -V CD X 000 rn v °° c m m m � N O Zl � o � wm O m -0 cl) a CD c v O o °° m m 1'I 0 ° 4 y X 60 � 0 O z 0 m r ic m •< o m D C o `D CD W o o m -i r' Z m m Qo a . Z r 0 To N ppr F o 0 y Z _ CD o >� CD o � ? o y Z CE3 �-a n CD j 7 N CD 0 0 = O YI O cD CD ..O cD (Q CCD� tin 2. 4l M m _ .. N `� cn o 0 w m m m a m � N O o a� N D r = J Cl o O X O ql J _rt (n CD -CDCDO O (n -, m X r► O 0 Z O 0 �G O o ? CD CD a D n 0 3 - o G) o O CD CD CD cn cn Zll O o m p1 !n cQ cQ = c0 0 O o Co Ln N ccDD CD CC) M- 0 y o 0 0 m m 0 w o. 0)r a D ai CA) C��� XFnn 00 °' �-0 7� T � m o COvv O rn o o 0 CDO o 0 rn o -p co w co C) O O N0 CD J o0o wJ 1 O O O O N N � Z Z 10 � 06ed x SNOII03dSNi JNI1S3n30321 n - 01 UOINd 31IS NO SS3UOOV IS d O SIIVd 2lOI0V8IN00/a3NMO dl 03SS3SSV 38 IIIM WOO 0NIOl1f38 V4UO:lINn3 L66I 3H1 ONV NOIl010siun 3H1 A9 031dOOV SV S31VU NO 03SV8'33d N01103dSN13N V 'SNOII03dSNl 311S ANV NOd ONIIIVO Ol MORN (33131dW00 38 SIHI 1VHI S3 nt)32d 1N3WlaVd30.JNIOims AINn30O NOSVW'Alu3dONd 3Hl ONI1N08=1 OVOa NO 133NIS 3HI(N0N.A 3181031 ONV 3181SIA A1NIVld 38 Ol SV NOIIISOd V HOBS NI 0301AONd S3SS3Naav No S2138 m 03AONddV 3AVH 1Sn1W S3IIS 11V '3000 ON101ins INNOAINn3 1-66I Ol nsun3d WNS 100Zl60/l0 3aW ION 0 SS3 0 I Od ZOOL X •pa;uejB!enoadde to pawloped Bu!aq suo!;oadsu!jagpn;Aue o;joud;uawpedep s!y;Aq pa;oa!!oo aq jsn4 e40 aq ll!m(moy I wnw!u!w)ino4 jad 00•Zq$to;unowe ay;ui eel uo!;oadsu!-ad a'uo!yppe u! •pa;ueiB aq ION I11M IenaddV 'a;!s uo;ou aye sued pue jo;palled si uo!;oadsu!l! •sasodind uo!;oadsu!jo;ays-uo aq o;pajlnbei aie sued pa Ad !!V WNS IOOZ/60/l0. 3aW ION 0 311S NO 03um 3 SNVld Io0l X pa;uei6!enoidde jo pauLopad Bu!aq suo!;oadsu!�ayun}�(ue o}�o!ad;uaw}�edap s!y;Aq pa;oapoo aq;snw u yo aq!!!m(inoy I wnw!u!w)lnoy jad 0o•Zy$;o;unowe ay;ui eel uo!;oadsu!-eN a'uo!gppe u! 'pa;uejB aq ION 111M IenaddV a;!s uo;ou si ue!d;o!d pue jo;papeo si uo!;oadsu!;! sasocUnd uo!;oadsu!jo;a;!s-uo aq o;pannbai sl ue!d;o!d p dde ayl WNS IOOZ/6040 3aW ION 0 3115 NO 03uinO3U 101d ZLW X £'IOLIONVZIOLINIO 13I0 dSSV 38 IIVHS S3111I181SNOdS38 T S311n a SNOI03dSNl IVIOUS 3HI 'S'IOLI N01133S U30Nn1031SI1 AUOM d0 S3dAl 3H1 NO NOIIOn 8ISNOO 0NRIn30 SNO!103dSNl 301AOUd INNS OHM SU0103dSNI 1V103dS 3NOW NO 3NO AOldW3 INNS 1N30V 5.213NMO 3H1 SV ONIIOV 08003N d0.L03ilHO21V NO 833NION3 3HI NO UaNMO 3HI'SM NOII03S A8 03211n303U NOIIO3dSNl 3H1 Ol NOIIIOOV NI 40LI N01103S(�N1103dSNI ' 3IdVHO 08n1 L66I WNS IOOZ/60/I0 3aW ION 0 1V103dS IOOS X pa;ueaB!enadde jo pawjojjad Bu!aq suo!;oadsu!jayunl Aue o;joud;uawliedep s!y;Aq pa;oa!!oo aq;snw pue pa6�e !!!nn(�noy I wnw!u!w) ino4 jad 00-Zy$;o aal uo!;oadsu!-ei a'uo!yppe u! •pa;uej6 aq;ou ll!m Ienoidde'panowaJ aie s;uawnoop Buuaaufta 11 o;away; pa4oege ulewai;snw pue sue!d;o;as panoidde ay;;o lied a aie s;uawnoop Buuaeu!Bue IIV •uo!;onu;suoo o;joud;uawlieda0 6u!p!!ng fi4unoo uoseyV ay;o;6u!;unn ui pag!wgns pue pjooaa;o jaau!Bua Aq panna!naJ aq!!eys uo!;oru;suoo u!saB yo AuV WNS IOOZ/60/W IOVV ION 0 B u u!Bu3 ZOOS x '30NVH0 OI NOlUd 03AO8ddV 38 Ism 3Sn1 d0 30NVH0 'NO!1V3OA3N IIWU3d NI I1n1S13111�V%l M AONVdn3000 No 3sn3 d0 39NVH0 ANV 'NOI1VOIdISSV 10 03AOtlddV ONV a31llVYN3d 3HI OI SI AONVdnl000 ONV SIN3W3uin3o 08n3(INV S30001VOOI lIV 0330X3 NO 133W 1Sn VY NOIIOn m-LSNOO 11V WNS IOOZ/60/10 38W ION 0 NOIIOf3NISNOO 11V coos X of;oadsu!uo!;epuno;;o awg ay;;e pay!;uap!Apea!o aq lleys sau!!Apadad pV WAS IOOZ/60/IO 3aW ION seu!l Apadad OISS X•uo!;oefold;say}jn;;ey;pue sam;oni;s;uaoefpe usaNaq aoue;s!p uo!;eiedes,S a u!e;u!ew;snw'au!!apejB !ay u!„Oc nano ua!;oafad ue y;un loeia4;suo!}�od�o a�n;oru;s sodoad WNS WOZ/60/I0 3aW ION 0 Noeq;a ain otu;S 9Z09 X •uoyowlsuoo o;jo adde aq!!e4s suo!;e!nBaa f4uno0 uoseVq jo/pue sapo0 leolueyoaVy/Bu!gwn!d/Bu!p!!ng wjo;!u0(pVIA)apoO p!!en0 j!V joopul pue uo!;e!!;uan'(0321N)apoO ABaau3!e!;uep!saj-uou;uaima ay;o;eouelldwoo;oe;;e;ey;sued Bu!p!!nq panoidde o;se6uey0 WNS IOOZ/60/IO 3aW 3 N 0 sue!d panoiddV o;seBue4O ocos x'3000 0Ni(nn8 WNOdINn ONV IN3WIUVd3O 9NI011f38 A1Nn300 NOSVW aid 03uin303H 38NOO 0131d 38 01 SS300tld NOI UISN00 WNS IOOZ/60/I0 3aW 3oN 0 30 oO Pla!d SbOS • X 'AONVdn3000 Ol NOR1d IN3WIUVd3O JNIO nVan o NOSVW 3HI A8 IVAONddV ONV M31A3N NO-4 IlV4U3d ONI8Wn1ld/IVOINVH03W/JNIOIIn38 V 2lOd 11W8f3S NO NO!1V0!lddV M31A3U INVN31 V 313ldVYOO OI O321=3U 38 IIIM INVN3132in.Ln=l '31NI1 SIHI 1V A3NVdf3000 lNVN31 NO.y 03AOUddV ION SI ONV AINO ON1011f38 ll3HS V SV 03AOHddV SI 3union NiS 3HI VMS IOOZ/INTO WNS IOOZ/II/IO 3aW 3oN 0 ONIOlIn18l-13HS WOO AS pe4epdn 6el AS pa6uey3 sn4e4S P10H GRU OPOO Pa4updn pa6ueyo °fie;S °pu03 Wd 99:ZVZ 90400-000MOO :# aseo gjlm pejupossd suoilipuoO Woz/W/co Z 10 Z 96ed '3NOZ 31VNVd3S V SV Vy nv s 21 V 32lId JNlal 8 31-11 Ol 09103NNOO 38 Ol SI W31SAS NOISS38ddnS 3NIJ 3H1'SNOdVn NBOVl-3SV32IJ 11113 1VH1 S3ovJN 1S 0N1>1000 ANV 10310Nd Ol a32 mOEIN SI GOOH 3NO SSV10 aNV 11431SAS NOISS38ddflS gHi-A 43XId V'9 '30VdS 1NVN31 HOV3 NI a32i1 OEIN 1H011 AON3Jb31N3 dn>i0`d8 Aa311V8 V'NOOa 11X3 HOV3 1V CIE!Ni OEIN SNJIS lIX3 o31H011 dn>IOVB AN311V9'L 'NOOG lIX3 HOV3 Ol 1N30Vf aV 03wnDEIN S2i3HSIf1JNUX3 3NIJ IVOIIN3HO ANa#S a31VN 0801,VZ'9 'X08 AAONA 31-11 HEICINO Ol L LL9-SLZ 1V Z ad lOV1N00'a3NinD3H SI X08 A3A AON3DNEIVU X08 XONA V"S '1NV011ddV Ol 1N3S NVId 31lS NO C13iV0iaNI SNOUV001 3NV-1 3bld.b '1NVOIIddV 01103HIa 1N3S NVId 31lS NO a310N SNOUV001'a3 inD38 SN01103NN00 ZHO19'a32 m038 S1NVbaAH 3HId OMl'£ 'a3 inDEIN 11V4N3d aNV SNVId 31V8Vd3S,a3Nin03N V431SAS MVIV 3HI.-q 011VVVO1f1V'Z 'HOlOVHIN00 N31>INIHdS 3Nizi a3SN3011 31ViS NOIJNIHSVM V A8 a311V1SNl aNV a3NJIS30 38 Ol W31SAS,a3Hin03N ilVYN3d aNV SNVId 31V8Vd3S'a32 nOEIN W31SA\S 83-DININdS 3NIJ Cl,VddN'L SIG LOOZ20/LO SIC] OOOZ/LL/ZL IM ION 0 i s;uawannbaN U043a)Wd aJld 09Z0 X •palmbei s!6u!deospuel Aq sa!;Jadold lueoefpe wo1;6u!uaalos 1a;;ng -ssaooV;o IogwAS leuo!lewalul ay;yl!nn pays pue'AJlua 6u!pl!nq ayl of}sasolo paleool'Ailue of pedwel to(anal le aoe}jns yloows e;o aq lleys spels deolpu s ISIe 6uuannauew lua!og;ns t4p.m (laa;OZ Aq laa;S•Z L)spels 6uN1ed deo!puey Z pue(lea;OZ Aq laa;6)spels 6u!>I1ed Iewlou gy 1o;;ua!og;ns aq news 6u!NJed 8HV LOOZ/£0/LO PIN ION p 5uN1ed OlZO X -e91e 6u!N1ed algel!ene ylun'xaldwoo ysenn 1eo pue'(lueual+ nel) 8 6p18'(lueual+luelnelsal)V 6plg 6uunoys(00-L£-90 polep)ueld al!s pag!wgns uo sNoegles pue suo!suaw!p anolddV 8HV LOOZ/£0/LO 19VY 10N 0 Bid 91!S OOZO X •asodlnd ogpeds leyl 1o;paleo!pap luawasea. pue Alpgn 6u!ls!xa ue asn of paluel6 aq II!M Imidde loud 10 eoueu!p10 lalennwlols ayl;o sluawal!nbei laaw ll!m su!e1p pue sayol!p alenud 19y;!9'aoueu!p101alemwjolS AlunoO uoselly;o sluawal!nbal ay;aapua -slaoled lueoefpe joedw!Alaslanpe-LON ism PUB alp uo luawdolanap 10 uo!1owlsuoo mau yl!m poluawaldwi aq;snw laluoo 96eu!e1p ooepnsgns/ooejjns 1o;suo!s!Aad 8HV LOOZ/170/1,0 WIN 101I 0 sluawal!nbaH luawdolanao AMOVY 6LOS X-(6u!;lew melts 10 6u!oua;;l!s)uogoalold uo!sola ;o adAl luelenmba ue uaA!610 palela6aA'papeas eq lleys Sall!AI a 1lsuoo Aq palealo Almau 10 paglnisip seeie pueldn IIV 8HV LOOZ/£0/LO IGIN ION O 0113910d uo1s013 0900 X,9£0'£0,L aoueu!p10 AlunoO uoseyy lapun pa4s!Igelso se sluawal!nbal 6u!deospuel pue 1a;;ng of loaf eoildde s!yl 8HV LOOZ/£0/LO MY ION 0 sluawannbeH 6u!deospu l+ ayng 91700 X -loefold 1noA loelp Aew yo!ynn sp u o0 of sloedwi alg!ssod sl!pue)glom pauueld alnln;meiAa1 of eog;o leyl loeluoo of palseMns s!;!'Aenn;o ly6u peol AlunoO uoseyy e ;o,SZ ulyl!m paleool aq of pasodold s!4o!yen uo!lonilsuoo Aue 1od wilonl;suoo of loud(OSV-lxa le)luawpedaa s�I1o/A o!lgnd AlunoO uoseyy a41 loeluoo;snw noA'peoN AlunoO uoseyy a wo1;6u!loauuoo ssaooe 10 Aeananup e;o uo!1on11suoo/uo!lelle1su! ayl 1011II/YN3 300V ue ulelgo 011N3Vy3Nin03H ayl s!a1a41';!wlad ssaooe Aenny6!H 91e4S a 01 uo!;!ppe ul 8HV LOOZ/h0/LO 19VY ION 0 SS300V IVI02H3VVV400 L000 "Aean;o ly6u peob alelS pue AlunoO lie wo1;,O L pue sluawasea'sau!i A:padad Ile wo1; �loeglas,S;o wnw!ww. ua lsnw'awl ope16 wa;ly6!ay u!„O£ueyl laleal6;oalayl uo!}�od Aue 10 alnlonlnsp1s, dad 8HV LOOZ/b0/LO MY ION 0 )loeglAep!S SZOS X -Ieysleyy a1!d AlunoO uoseyy ayl;o Ieno1 0 ;!M pamolle lou s!suolle6 O L;o ssaoxa u!sp!nb!l alq!lsngwoo/algewweg 10 sleualew snoplezey;o a6elols pue'6u!lpue 'asn ayl 8HV LOOZ/b0/LO MY ION 0 SainDll 31 V VVVId L000 X Z'OL£L uo!loas apo0 A61au3 le!luap!saa-u0N alelS u016u!yseAA ayl ui pay!luep!se aoeds paleay-!was se panoldde si alnlonl;s si41 VYNS LOOZ/6O/LO PIN ION alnlon118 paleaH-!wag O L0 L As paIepdn Bel As peBueyO sn4LjS pIOH 81MI OP03 paIepdn pa6uey3 'WIS -PU03 Wd 99:z Vz 90W0-000ZWoo :# aseo t4j!m pejeioossv suoilipuoo Woz/Worn j CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date 3- 2/— '/ by Gas Piping date b Foundation Walls n date by Set Up date -G/ by INSULATION date by BG/SLAB Insulation FloFinal date S Z --e by 7`/Z dilaters by date by FRAMING Walls FIRE DEPT. date PLUMBING by date by date by ^ Attic OTHER Groundwork date S`- by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by fit'- y^ � � s'i�� �,�cc- �► �.r-�r T/1 -_. tiir�-� _ c h�'c� �yT /�✓T , ,/�c'c�i�/vG /,�vcr'�I T� 4o rr✓ /,el- lxl,es� -,>Oo/ y PERMIT NO.: BLD � 6 MASON COUNTY BUILDING PERMIT APPLICATION 426 W:CedatMP d.Box 186,Shelton,WA 98684 Shelton 360 427-9879 Beffair 360 64" tma 3�0 �6269 Seattle 246 64.6968 T 1 OR 7 N CONTRACTOR INFORMATION" Owner ' �.+G Contractor Name Mailin Add es Mailing Addrips City State Zip Code City State A7Zip Code Phone( ) 7 Other Ph.( ) Ph.0 �" Other Ph.( _ Lien/Title Holder Contractor Reg. # <ITW&Wif Lyy Address Expjration__jQ!2 Inj I SEPTIC/WATJER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Na a of S WerSystem Well Water System Name of 4 Water System j PARC tNtORMAT ON-12 digit Tax'F', reef No. "'" Fire Diatfaot escrlptlon I I e'Address('lease include street name; street number and cit ; 411 I41E ections to site M � a ill timber be.Cut and sold in parcel preparation? (Yes/No) Is your propertywithin 200' of the following: Body of Water(Name) Saltwater + Lake Ri Mek Pond' Wetland Seasonal Runoff Stream Slopes or Bluffs ItMIW♦?N •IILi14E Q NAL RESIDENCE Q TYPE OF JdB New Add Alt Repair Other Use of Buildin ' Describe Work,; • . droof ;s Ast Floor 2nd Floor ' '' d'Faoor Loft Basement Deck Other sq.ft. Garage ttached Detached Carport Attached Detached Y k MOBILE HOME MFORMATION-Make Model Model Year `. Length_Width,� Serial No. No. of Bedrooms No. of Qathrooms Type of Heat Purchase Price$. Replacement Unit?(Yes/No Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED 15 NOT COMMENCED WITHiN 1 +t 1"if, ff CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER THE WORK IS COblII?f�Cl PROOF OF CONTINUATION OF WORK IS BY,,MEANS OF A PROGRESS INSPECTION. The owner or agent on owner''s behalf,re�priasants ttlpt the information provided is accurate and grants employees of Mason County access'to the above described'propedy.and structur®s for rev ievt and inspection ptthis project. Acknowledgment of such,is by signature below: OWNER AFFFIDAy1T-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I fat 7 am currently registered as a d• Contractor C anon law RCW 18.27 aqd am aware of the ordinance contractor in the State of Wai 02 that 1 am.aware of the ordinance nequirements ifi which this permit,is issued and that all work will be done in requirements regulating the work for which this p"R is, tied' and all work ' conformancetlerewiMi.`t4o changes shalt be made without first obtaining shall be done in conformance therewith. No cha sljatl be made without approval. first obtaining approval. x bate Y Date FOR'.OFFICI USE BEYOND HIS p INT is Accepted b4 Date Submittal Amount Due Receipt No.�j �..... .. ,, ...... ...... f .... ...1.... L Building Department Occ Group, T e.Constr. Planning Department ' Olt Environmental Health Departmentkc �t0 ' Public Works Department Fire Marshal Valuation$ 4 `r 761dgSite Inspection ev1q*Fee EH 3eview Fee f. moo Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other r� 15.00 Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO.: BLD —WIC6 r MASON COUNTY .` BUILDING PERMIT APPLICATION 9� 426 W.CedariP.O.Box 126,Shelton,WA,98584 Shelton 360 27-9070%Betfair 60 275.4467.Elma 360 2-5269 Seattle 206 464-6968 IAPPLICANT I N.FO ,T ON CONTRACTOR INFORMATION Owners f f'' Contractor Name , Mail.inMvAdd s Mailing Addr s k City State WA Zip Code City A - State -Zip Code Phone( - ) ? °7_*Other Ph.( _- ) Ph. Other Ph.( ) Lien/Title Holder Contractor Address Expiration/j"�I / IS EPTIC/WAiTER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to.Sewer ystem Name of S wer System Well Water System Name of ater System 1 it PARCEL INFORMAT ON-12 digit Tax P rcel No. / 3 / Z Fire District Legal Description (€(-.t O Site Address(Please include street name., street number and city) Directions to site /If H W Will tknbe.r 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 PERMANENT RESIDENCE❑ SEASONAL RESIDENCE Q TYPE OF JOB NewX Add Alt Repair Other Use of Building tki-1a v c• Describe Work wt yr, 11 rt,, L",` 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 Mode Model Year Length Width Serial No. No, of Bedrooms No. of Bathrooms Type�Of Heat Purchase Price $ Replacement Unit ?(Yes/No) lns for Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID 10 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 WOOK 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 certifythat I am current) r Contractor Registration Law RCW 18.27 and am a Y registered as a 9 wee of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which;this permit,1p,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 fl Date FOR OFFICI L USE BEYOND tHIS P INT ccepted b f Date ' Submittal Amount Due Receipt No. Iding Departm .. • .:....::..::.:.::::..::::::;:.::.;:::. Group— Type Constr. nning Department ronmental Health Department Z � a1 Works Department rshal I $ Emma=mmmm it Fee Site Inspection ee EH Review Fee se Fee Planning ReviewTee ase Fee Other LO Q� t Stove Fee State Fee Pre-Paid at Submittal %EME=E=LTO:TA::L FEES "a PERMIT NO.: BLD 'w MASON COUNTY BUILDING PERMIT APPLICATION 446"W:CedarlP.O.Sox 186,Shelton,WA 98604 Shelton 360 4274670 $01fair S60 276.4467 Ehna 360 -$869 Seattle 20S -6968 APPLICANT I OR T N CONTRACTOR INFORMATION ` Owner / fl f ro C.Gt^,. Contractor Name i Mailin Add"es Mailing Addr ss l City ' State Zip Code State. Zip Code Phone 3 '7 Other Ph.( ) Ph.( Other Ph. a Lien/Title Holder Contractor Reg. # !GG LyV Address Expiation f�a / / � a I SYSTEM,,FORMATION-Connect to New Septic Existing Septirt Connect tp Sewer ystem "N4' t? ckf"5 or System Well.; Water SyStefn Name of ate stern �E i. ? PARCEL INFORMAT OM-12 tii lt Tax'P rcel No. F / / .` Tr District Legal;Description A '�". t, ta+1` " ; Site Addres�(Please include street name, street number and city) ' i Directions to site r Will timber be cut and sold in parcel preparation?'(Yes/No) r Is your prope y within 200'of the foilov frib: Body of Water(Name) Saltwater Lake; River/Creeks Pond Wetland Seasonal'Runoff Stream _; lopes or Bluffs �•, PERMANENTrRE�D>rNec SEA REST CEG] .. TYPE OF JOB,New, Add Alt_.'Repair Other Use of Building v flu Describe V11ork S +-p No. of Bedrooms No.'of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floors 3rd Floor Loft Basement � Deck��_©ther �$+np Sq. ft. Garage attached Detached Carport Attached Detasned , . MOBILE HOME 1'J"OfMATION-Make Mode Model Year L00, Width Serial No No.of`Bedrooms No. of Bathrooms 4 Typ ;of Heat Purchase Price $ Replacement Unit?(Yes/No) •: , Installer Certification No. NOTICE:%TWI$PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED,IS,NOT COMMENCE tltl i +¢I2IF CONS f•RUMbN WORK I,S SUSPENDED OR ABAN60NED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WOI�•1� PROOF OF CONTINUATION OF WORK,IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behrlll, s� taiat'1he information provided is accurate and grants-employees of Mason County access to the above described property and strucjirnes f$t'teltiiaw 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 AFF104VIT-1 certify that I am currently registered as a Contractor Regi3tration Law,RCW 1&27 and am aware of the ordinance contractor in the State of Washington and that I am ayiar of the ordinance requirements for which this pennft is issued and that work will be done in requirements regulating the work for which this permit J . ued and alt work ! ' conformance therewith.`No changes shall be made without first obtaining shall bo done'in conformance therewith. No changes st it t mao-vttithout approval. first obtaining approval. X Date J( pIr p ` FOk OFFICI USE 9�YO D HIS P INT Accepted b Date Submittal Amount Due F�eCeipt No.S / PRO Building ep me�nt l 1 Occ Grou Type Cogs N Planni merit Environmental Health Department s Public Works Department . :..Fire-Marshal Valuation $ Building.Per IA66 Site Inspection777-, Plan Revi"Fee EH Review Fee PIurfrtiing&Base Fee Planning Review Fee Mechanical&Base`Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee L Pre-Paid at Submittal ( ) TOTAL FEES PERMIT)NO+: MASON COUNTY PLUMBING/.MECMANtCAL PERMIT APPLICATION A� (S✓' 426 W,,C*daF/P;0.Box 186,Shelton,WA 98584 Shelton 360 27 670 Be it 360 275-4467 Elms 360 2 69 Seattle 206 6 4968 APPLI O TON CONTRACTOR I rRM�4T1 Omer �` taro rs 5 L-L4. Contractor Name M itin aAd ss Mafi Cy State Zip Code -. City I State ,Zip'Code Phone Other Ph:L; Ph. Otfi h. , Lien/Title Holder Contractor Red # Address s Expiration G l l SEPTIC INtF;Q TI©N-Co n to I w Septic cisting.Septic Connect to Sewer.System�lVame of T t Sewer S _k ,f PA I2, z5 Legal, f, . Bo of lNatr� 1 ellty homing: y e9 (Name} Seasortal Rtirtaff " Ak.' Rtiipa 'Other. USe of �5 w � �y p f � j f�71r �� �N r►bet of 600) CH` C x �Healpty}�:►s ent 9 ropaoe.' ank e Gas W©{rei#i lux" Often' ' ij y t ' r + � �' a . i r�'' a -.E¢q k j�. rs s e. , i,• r s I i g ks 'T P �� �'1 ferrl�Clte r�gtJlatln� mWdewfthd #Irat s16d1 be:dor{e irf conf ; ,g 3 k ��,��f �yA.tr �y1,w�'�� �p � I-j. ^t ,far,��,' h ..,•� �. h �, �4�y. K �+ OP P16h f4i� fi+..T.l I !� � ^sN - .,, 6 4 � d►!coe ' i' ©ate bMittal Arnounfoue f f H 1 :1 �'gLam L +I+ �• kk f �, , 'Piarming Other Other �.. { -S ;, :, � } •`�7dw d� ha•� a+.Ys f,rn� 5+•dx•'r Y. .S` +k.•.•y�.••off., .., ft::'k�?.... ,. u. d.::J:•.;..:•3•r.S:.;..t.. u:..y.dt�::. .\ -{pr d ::�; x ik. �y;;' .;s,;:i�y� � t,yi •�� ••Yi:::�;:�.i:.i�::A<.r.d:.+:n. �:t�•.�'+���"•..;c�:•; Lid,, :�:,f,}., :.:y'*..:�.:t y$f�2Y> m.''S k n�;.. +.?'�.,.�y '}::, ..;�:•tv;,•:•�, •. .{ .: + :•S•d� is i.:d''•;}..r.... .nn / •:., + .:: .:is •. Permit Fee Site,inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other WoodlGas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation fee TOTAL FEES