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BLD99-00085 Final Engine House and Carport - BLD Permit / Conditions - 8/13/2008
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Q me+ ffi O 9 E Zm IA. vm vZ -a r� a► tar -ow- ` rr -40m 0 0 v to rt#+ x 00 ++a-- -1 r+ 00 0 j mom* C 4? O M 'a LZ— N o � m "$Os -6 00a -� 10or+ 7 c a O Orr z<r` a* -s o CLS O �q O -s 7�►Mf- 0<lo— oma on X n O - evo rr o r ffio •ar+ OC O ! #+0 a-* v a MOO -�� a c► -�� � C 'A -7 2.0 O r-O r+6 Z r+rr Vl c 170 00 OA> $06 !iG s CIO t O 0 r+ J 1 z r+'0 0 cr t1) 2 t! x O-+ -i� <D m —c�c 0 0*0 C-C) f*< rt Om 40 Al so 9>(A -.40 V ro .__ { O aO ZC rr�i �C 'v � N r f+ rr 0to m � 0 � COOO ),. -i m M)w c CO -0 o o ao a3 oad cz- rtim -a .,,zr � 0 -4 a �s c zr be (a to c v# oo® °a rr rt-r C7�! 'r qr _c Q ' >00 0+4 ZOO �. rat 40 rnC� rffir m y e-- II "t I. i CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date by Foundation Wails date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by FRAMING date by date by dale by Wails FIRE DEPT. PLUMBING date by date by Groundwork Attic OTHER date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date+ by date by date by DAY ay- If u, , l 1 I I CONCRETE MECHANICAL MANUFACTURED HOME o footings I Setbacks GasePlping By Ribbons C) Interior Date By Interior-Date By pate By cn Exterior Date By Exterior-Date .a By Set-up Point Load I Isolated Footings INSULATION Date By n BG I SLAB INSULATION --I Date By Data By FIRE DEPARTMENT N Foundation Walls Floors Date By Date By Data By DECKS FRAMING Walls gate. By Date By Data By PROPANE TANKS PLUMBING vault Date By Data By OTHER Groundwork Attic Date� By Data By Type.Date By o.w.v DRYWALL Type- Vale Brace Wall Date B�y� [date By [?ate By FINAL INSPECTION 2 Water Line Fire Separation W r 2 pate By Date By Date •c= Eby / Pass or Request Inspect. Type of Insp. Fail Date Date Done By Comments Co 0 co cn 0 8 a 0 En 0 m 0 8/12/2008 Case Activity Listing 8:11:36AM Case #: BLD99-00085 Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By BLDA915 Existing Records-See Case Mgr. None 2/17/1999 KW BLDA700 FAX Received 2/18/1999 None DONE SKM 2/18/1999 SKM recived requested changes in the engineering and have attached to file. BLDB135 Addressing 2/17/1999 2/17/1999 None DONE GMM 2/17/1999 GMM BLDB138 Planning Pre-Review 2/17/1999 2/17/1999 None DONE MMS 2/17/1999 MMS 131-DA010 Application received 2/10/1999 2/17/1999 None DONE KW 2/17/1999 KW RECEIVED ON 2/16/99 f BLDB200 Environmental Health Review 2/17/1999 2/18/1999 None DONE CEB 2/18/1999 CEB it Plot map matches. BLDA900 Telephone call 2/26/1999 None PEND SKM 2/26/1999 SKM SPOKE WITH CHIEF GREEN AND HE WILL PROVIDE ME WITH EXHAUST INFORMATION AS PER 1206.2.6 UBC"97"FOR THIS ENGINE HOUSE,FILE HAS BEEN PLACED ON HOLD AND HAS BEEN FORWARDED TO MARSHAL DAVE. BLDB009 Fire Marshal Review 2/26/1999 3/10/1999 None DONE DLS 3/10/1999 DLS BACK TO STRUCTURAL WHEN DONE. BLDB007 Plans Revisions Submitted 3/12/1999 None RECD SKM 4/1/1999 SKM lighting lay-out(did not incl light wattage etc.),revised eng.trusss detail,and reply regarding ventilation system. BLDB007 Plans Revisions Submitted 4/1/1999 None RECV SKM 4/1/1999 SKM REICVED NEW SITE PLAN WILL SENT COPY PLANNING AND ATTACH TO MY FILE COPY OF THE PLANS,ALSO SHOWS BREEZE WAY ATTACHMENT,REQUIRED ADDITIONAL PLANS AND ENGINEERING TO PROCEED WITH THE REVIEW,SPOKE WITH MIKE GREENE. I Page 1 of 3 CaseActiviry..rpt 8/12/2008 Case Activity Listing 8:11:37AM Case#: BLD99-00085 . ir Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By BLD13007 Plans Revisions Submitted 4/13/1999 None RECV SKM 4/13/1999 SKM CONTRACTOR DROPPED OF PLAN SHOWING THE BREEZE WAY CONNECTION,REVIEW WILL CONTINUE.PLACED WITH FILE AND PUT IN MY BOX. BLDB134 RLC Review 4/15/1999 None N/A AHB 4/15/1999 AHB WETLANDS OFF PROPERTY NOT AFFECTED. BLDB 130 Planning Review 2/17/1999 4/15/1999 None DONE AHB 4/15/1999 AHB pre-submission meeting on 2-10-99;under comp plan review. ahb REVISED PLANS THAT CONNECT NEW BLDG TO EXISTING WILL MEET COMP PLAN REVIEW STANDARDS;BREEZEWAY IS ADDED TO PREVIOUS PLANS.NO NEED FOR ADDITIONAL PARKING PER PRE-SUB MEETING. BLDB120 WSEC Compliance Review 4/20/1999 4/20/1999 None COND SKM 4/20/1999 SKM DEB IS CONTACTING MR.GREEN AND WILL REQUEST ADDITIONAL NREC-FLOOR-PLAN"FOR lighting REVIEW PURPOSES.-----------------------------WILL CONDITION PERMIT TO REQUIRE NREC PRIOR TO PROCEEDING PASTF/P/M/P INSPECTION. BLDA200 (H)Hold 4/20/1999 4/20/1999 None DONE SKM 4/20/1999 SKM site map indicates structure is @ 19'from p/1.Mr Green has been contacted and has agreed to relocate the structure @ 20'from the property line. BLDA100 Approved For Issuance 4/20/1999 None DONE TMJ 4/20/1999 NJP i BLDA500 (F)Issue building permit 4/20/1999 None DONE TMJ 4/20/1999 NIP Sent to Belfair BLDC110 Footing inspection 4/30/1999 4/30/1999 4/30/1999 None FAIL TFR 5/3/1999 KW 1.FOOTING TO BE 18"DEEP OVER ALL MIN.2.ALL FOOTING REQ TO BE MIN 12"BELOW GRADE.3.ALL REBAR TO BE 3"ABOVE GRADE.4.HAVE SITE PLAN ON SITE NEXT INSPECTION 5.ENDS OF ALL REBAR TO HAVE 1 1/2"CLEARANCE TO EARTH.D BLDC100 Inspection 4/30/1999 4/30/1999 4/30/1999 None FAIL TFR 5/6/1999 KW 1.FOOTING TO BE 18"DEEP OVERALL MIN 2.ALL FOOTING REQ TO BE MIN 12"BELOW GRADE.3.ALL REBAR TO BE 3"ABOVE GRADE.4.HAVE SITE PLAN ON SITE NEXT INSPECTION 5.ENDS OF ALL REBAR TO HAVE 1 1/2"CLEARANCE TO EARTH. Page 2 of 3 CaseActivity..rpt 8/12/2008 Case Activity Listing 8:11:36AM Case #: BLD99-00085 • irp Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Cpdated By BLDA920 Miscellaneous action 6/22/1999 None PEND SKM 6/22/1999 SKM ------------BREEZE WAY IS NOT REQUIRED-----------------THE INSPECTOR CAME TO THE OFFICE AND VOICED CONCERNS THAT THE STRUCTURE IS NOW UNDER USE AND HAS NO C/O,THEY ALSO HAVE NOT CONSTRUCTED THE BREEZE WAY.I WILL CONTACT THE FIRE DISTRICT TODAY AND INFORM THEM THAT THEY WILL NEED TO COMPLETE THE INSPECTION PROCESS PRIOR TO OCCUPANCY.ALSO NEED TO ESTABILISH WEATHER THE BREEZE WAY IS STILL REQUIRED IN THIS AREA,THE ENGINEERING FOR THIS STRUCTURE WILL ALSO NEED TO BE REVISED BECAUSE THE FOOTING SUPPORT IS NOT AS PER PLAN. BLDC140 Fr/Pl/Mc/Pen Inspection 6/23/1999 6/23/1999 6/23/1999 None PART DWH 6/23/1999 KW PART STORAGE AREA ONLY OK BREEZEWAY IS NOT BUILT APPLICANT TO BUILD BREEZEWAY OR PROVIDE DOCUMENTATION THAT IT IS NOT REQUIRED 90 DAY TEMP OCCUPANCY BLDB110 Building Plan Review 2/17/1999 9/20/1999 None DONE SKM 4/20/1999 SKM NOW UNDER REVIEW.----REICVED PLANS BACK FROM FIRE,PLACED IN HOLD TILL THE EXHAUST SYSTEM HAS BEEN SUBMITTED.--------INFORMATION RECIVED REVIEW COMPLETE,WILL ADD CONDITION TO PERMIT REQUESTING NREC BE COMPLETED AND SIGNED OFF PRIOR TO F/P/M/P INSPECTION. BLDA560 Permit Cancelled 10/3/2001 None DONE KW 10/18/2001 KLW Page 3 of 3 CaseActivity..rpt 11/15/00 Activities for Case #: BLD99-00085 8:12:43 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes BLDA010 Application received 2/10/99 2/17/99 KW DONE KW 2/17/99 RECEIVED ON 2/16/99 BLDB134 RLC Review 4/15/99 AHB N/A AHB 4/15/99 WETLANDS OFF PROPERTY NOT AFFECTED. BLDB110 Building Plan Review 2/17/99 9/20/99 SKM DONE SKM 4/20/99 NOW UNDER REVIEW.---- REICVED PLANS BACK FROM FIRE,PLACED IN HOLD TILL THE EXHAUST SYSTEM HAS BEEN SUBMITTED.----- INFORMATION RECIVED REVIEW COMPLETE,WILL ADD CONDITION TO PERMIT REQUESTING NREC BE COMPLETED AND SIGNED OFF PRIOR TO F/P/M/P INSPECTION. BLDB130 Planning Review 2/17/99 4/15/99 AHB DONE AHB 4/15/99 pre-submission meeting on 2-10-99;under comp plan review. ahb REVISED PLANS THAT CONNECT NEW BLDG TO EXISTING WILL MEET COMP PLAN REVIEW STANDARDS; BREEZEWAY IS ADDED TO PREVIOUS PLANS.NO NEED FOR ADDITIONAL PARKING PER PRE-SUB MEETING. BLDB135 Addressing 2/17/99 2/17/99 GMM DONE GMM 2/17/99 BLDB138 Planning Pre-Review 2/17/99 2/17/99 MMS DONE MMS 2/17/99 BLDB200 Environmental Health Review 2/17/99 2/18/99 CEB DONE CEB 2/18/99 Plot map matches. BLDA915 Existing Records-See Case Mgr. KW 2/17/99 BLDA700 FAX Received 2/18/99 SKM DONE SKM 2/18/99 recived requested changes in the engineering and have attached to file. BLDB120 WSEC Compliance Review 4/20/99 4/20/99 SKM COND SKM 4/20/99 DEB IS CONTACTING MR. GREEN AND WILL REQUEST ADDITIONAL NREC -FLOOR-PLAN"FOR lighting REVIEW PURPOSES. ---------------------------WILL CONDITION PERMIT TO REQUIRE NREC PRIOR TO PROCEEDING PASTF/P/M/P INSPECTION. Page 1 of 3 `11/15/00 Activities for Case #: BLD99-00085 8:12:43 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes BLDA900 Telephone call 2/26/99 SKIM PEND SKIM 2/26/99 SPOKE WITH CHIEF GREEN AND HE WILL PROVIDE ME WITH EXHAUST INFORMATION AS PER 1206.2.6 UBC"97"FOR THIS ENGINE HOUSE, FILE HAS BEEN PLACED ON HOLD AND HAS BEEN FORWARDED TO MARSHAL DAVE. BLD13009 Fire Marshal Review 2/26/99 3/10/99 DLS DONE DLS 3/10/99 BACK TO STRUCTURAL WHEN DONE. BLDB007 Plans Revisions Submitted 3/12/99 DC RECD SKM 4/1/99 lighting lay-out(did not incl light wattage etc.),revised eng.trusss detail,and reply regarding ventilation system. BLDB007 Plans Revisions Submitted 4/1/99 SKM RECV SKM 4/1/99 REICVED NEW SITE PLAN WILL SENT COPY PLANNING AND ATTACH TO MY FILE COPY OF THE PLANS,ALSO SHOWS BREEZE WAY ATTACHMENT, REQUIRED ADDITIONAL PLANS AND ENGINEERING TO PROCEED WITH THE REVIEW,SPOKE WITH MIKE GREENE. BLDB007 Plans Revisions Submitted 4/13/99 SKM RECV SKM 4/13/99 CONTRACTOR DROPPED OF PLAN SHOWING THE BREEZE WAY CONNECTION, REVIEW WILL CONTINUE. PLACED WITH FILE AND PUT IN MY BOX. BLDA200 (H)Hold 4/20/99 4/20/99 SKM DONE SKM 4/20/99 site map indicates structure is @ 19'from p/I.Mr Green has been contacted and has agreed to relocate the structure @ 20'from the property line. BLDA100 Approved For Issuance 4/20/99 TMJ DONE NJP 4/20/99 BLDA500 (F)Issue building permit 4/20/99 TMJ DONE NJP 4/20/99 Sent to Belfair BLDC110 Footing inspection 4/30/99 4/30/99 4/30/99 TR FAIL KW 5/3/99 1. FOOTING TO BE 18"DEEP OVER ALL MIN.2.ALL FOOTING REQ TO BE MIN 12" BELOW GRADE.3.ALL REBAR TO BE 3"ABOVE GRADE.4. HAVE SITE PLAN ON SITE NEXT INSPECTION 5. ENDS OF ALL REBAR TO HAVE 1 1/2"CLEARANCE TO EARTH.D Page 2 of 3 K 11/15/00 Activities for Case #o BLD99-00085 8:12:43 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes BLDC100 Inspection 4/30/99 4/30/99 4/30/99 TR FAIL KW 5/6199 1.FOOTING TO BE 18"DEEP OVERALL MIN 2.ALL FOOTING REQ TO BE MIN 12 BELOW GRADE.3.ALL REBAR TO BE 3"ABOVE GRADE.4. HAVE SITE PLAN ON SITE NEXT INSPECTION 5.ENDS OF ALL REBAR TO HAVE 1 1/2"CLEARANCE TO EARTH. BLDA920 Miscellaneous action 6/22/99 SKM PEND SKM 6/22/99 -----------BREEZE WAY IS NOT REQUIRED-----------THE INSPECTOR CAME TO THE OFFICE AND VOICED CONCERNS THAT THE STRUCTURE IS NOW UNDER USE AND HAS NO C/O,THEY ALSO HAVE NOT CONSTRUCTED THE BREEZE WAY.I WILL CONTACT THE FIRE DISTRICT TODAY AND INFORM THEM THAT THEY WILL NEED TO COMPLETE THE INSPECTION PROCESS PRIOR TO OCCUPANCY. ALSO NEED TO ESTABILISH WEATHER THE BREEZE WAY IS STILL REQUIRED IN THIS AREA,THE ENGINEERING FOR THIS STRUCTURE WILL ALSO NEED TO BE REVISED BECAUSE THE FOOTING SUPPORT IS NOT AS PER PLAN. BLDC140 Fr/PI/Mc/Pen Inspection 6/23/99 6/23/99 6/23/99 DH PART KW 6/23/99 PART STORAGE AREA ONLY OK BREEZEWAY IS NOT BUILT APPLICANT TO BUILD BREEZEWAY OR PROVIDE DOCUMENTATION THAT IT IS NOT REQUIRED 90 DAY TEMP OCCUPANCY I Page 3 of 3 Building Permit# �C'U� �'G'� MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTI E Job Location 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 code compliance �-E fgUlGp//YG %E. /r7lcScS-/r'�'� ,C3�'F,•s'Z/ 1✓�4✓ 0 it/T7 You are hereby notified that the above corrections shall be made 1 :. BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection U ❑ This is not a complete inspectio Department Date d - 21 Inspector T-�EM THISDO NOT ROVE TAG Permit # MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location F/t21:-� D 6Z'221c7- -W-- z 94!!5'v (f:5C,0 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 qa n Bode compliance �S GC 2421 — •. C�,�' 7Z� You are hereby notified that the above corrections shall be made 'r BEFORE PROCEEDING WITH ANY FURTHER WORK i Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑ OK to ❑ This is not a complete inspection �p Department Date ' ? Inspector T l aL�. TA DO NOT REMOVE THIS G Q NV v� O _I PERMIT NO.: BLD c� OVB MASON COU TY � a n ILaO MIT APPLICATION 424 WAk iW' r/P.O.Box 186,Shelton,WA 98U4 Shelton 360 427-9670 BqI114k, 360 276 4467.1:1ma 360 2-5269 Seatt 206 64-6968 APKICANT INFORMATION , COi11TRACTOR INFORMATION Owner rf .L + isµ 1. Contractor Name 7Rt+C�kr�t +LGt MiAaj-0r4 Mailing Address Po :tux ..a17 N40ng Address f►yie =a If !%U A,k &J _ City 1,.1=Ailr. StateWA Zip Code ffXZaP-P' — C4Y'""rt in State sift Zip Code " Phone(-2kQ .27S7 &'71/ Other Ph.( ) Ph:( ) q Other Ph.(_� Lien/Title Holder Contractor Reg. # aitaI i2a,ie... Address Expiration / ,�:-P / F SEPTIC/WATER SYSTEM INFORMATIOWConnect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Wa r System PARCEL INFORMATION-12.d git Tax Parcel No. I _l "i eA+6?3"'& Fire District A. Legal Description ... f Site Address(Please include street name, street number and city) x Directions to site Will timber be cut and sold in parcel re es/No) _ 1 .Fafwii�g ody of Water(Name) a Saltwater E Lake River/Creek Pond Wetland -Seasonal Runoff Stream Slopes or Bluffs • i 1 # New Add `t. Alt_ Repair Other Ilse of Building i •escribl§.Work. No. of Bedrooms No. of Bathrooms SQUAB FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basements Deck Other sq. ft. Garage Attached ,%Detac ed. Car ort r ,Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No.of Bedrooms �No. of 13 .thr�ooms Type of Heat Purchase Price $ Repladeivi ftt Unit?(Y1WNJD Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL✓!i VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCEn WI'i'HIN 180 DAY$OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME 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'rdescribed 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 AF�IDAVIT-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 1Afashington 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 arork for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformanceherewith. No iHges shell be made without approval. first obtaining approval. X Date Date FOR OFFICIAL USE BEYOND THIS POI T Accepted by4 Date Submittal Amount Due Rece,i No. ' .4......Yv'.i::..:. .?. :.. •.:. ... .. :.:.. ......... .. .. ........n....,.......................��N� ��:::::•:i�.'i.v:::�:.i:.i:.:::i::�:� �::::�:.�:.- •' .•: .::..::.:;.:':+?•:::: Building Department Occ Group Type Constr.— Planning Department AW min 1 Environmental Health Department Public Works Department - Fire Marshal t . r Valuation $ a x ;•Y r•Y:tinY}•.; +. .....:• ..... ..n.... Y nt. .....r;:h.•Y. ,.;. Y ..,r•t .;.}....aYr,'?,:;:•:•:n�r:nvv...... '• r..,.:.,.s:i:Ybrji n..}•:r!J{?'r�Y}.I-J•f Y: 3• ! t 4: .v}.,. : �..+. �.: .{• n 4...n3 xrn'r ++� '•Y .✓.... ...:.. :tin}Yi: ':?.: 'n:r+a:p•.;n,,.:.. .L... •::�:w.�•: :;}}?•Y%+•i:•�:'?;:�..;i�•Y:+•i}+./•:'Y;... �;?•:,.+' :......:...•,.n•::;::•n..:•••::•:::`}..r..,....•:::::r :..n.:x:�.•:r.�::::..:••:::::::.::.... ....,.. �f ,.a...'4:•... ...... Y .; E ;?•:n}:•}};v::v.:vv::::.:...............:............. ..r.rn.r........,.....\......+if ...n......... .. .......................v....v....�. r.. ..f.n. : .................:.:-.v.v::v;•};::;?Y:i'�J:.?iTi'i}}Y:i4Y:ni:iii}::•.,.v:;?ni}Y:::::::::::::r::::::,vn:::::::. .;.,...:....::............. w.. Building Perrrat Fee Site Inspection Plan Review Fee.. UFC Plan Review Fee f Plumbing & Base-fee Public Works Review Fee Mechanical & Base Fee Oiler �. Wood/Gas/Pellet Stove Fee Other 1fI-ition Fee Pre-Paid at Submittal #; 7)TAL FEES .; r, .. _ , fir Z'�S' PERMIT NO.; BLD 1 3`a� ON.COUNTY, E U1 1�t IT AO ICATION a- •426 W Cedar/P.O,Qox 786,St►eltok%WA'UM L' i Gar' Es'(LCEtJ Shelton 360 74670 SaIllair 86 2 64467. 36i? .6Z8 Seattle 206 .6011 APP4.ICANT INFOi MATION CONTRACTOR INFORMATION Owner F-i P- �I S.T 2 Contractor Name CI 0 -c Mailing Address v TO%. -711 Mailing Address NC :��_� a.�C City re L; pr112. . State�_ Zip Code City" _q State y h Zip Code Phone(Zigo.).I-Is (e71 i Other Ph.(� Ph.(��f3 ) .��T�c7 Other Ph.( Lien/Title Holder Contractor Reg.# ¢ol Rnr�1cC* jot in A Address Expiration / rVS EPTICNVATER SYSTEM INFORMATION-Connect'to NewSepticExisting Septic Connect to Sewer ystem Name of Sewer System Well Water System Name of ater System PARCEL INFORMATION-12 digit Tax Parcel No. / // / 6 DQ Z00 Fire District Legal"Description I , Site Address(Please include street name;street number and citty) Directions to site ? Will timber be cut and sold in parcel preparaU es/No) _ Is your prbperty.�n►itthifhr t 'of the, irl o y of Water(Name) Saltwater Lake River/Creeks Pond Wetland Seasonal Runoff Stream-`- Slopes or Bluffs , TYPE OF JOB New A Alt Repair Other Use of Building ' Describe Work .t�r Gi' „�ir�s .�:t� �. f('s 1....,s .Tl..�,.=:Ti#�rsL, s t- •�:-�T. No. of Bedrooms No. of Bathrooms SQUARE!FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft -Bas�emgnt- Deck Other r�ENsct r+d,r� z-yan j sq. ft. Garage Attached tac ed• Car ort _Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width_ _Serial No. No. of Bedrooms No.of Bathrooms - Type - Type of Heat Purchase Price $ Replacement Unit .(Yesli\lo) Installer,Name Certification No. Al NONCE:.THIS H SP PERMIT ISOS NULL&SUSPENDED OR VOID IF WORK OR'C;731itl1CTION'AUTHORIZED IS NOT C ENCED WITHIN 1 QR IF ABANDONED Fbfi A PERIOt7 OF i86 DAYS,AT ANY TIME AFTER THE WORK IS CO " PROOF OFF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTON: The owner or agent on owner's behalf, Itthe. information provided is accurate and grants employees of Mason County access to.the above described property and structures for review and' inspection of;thus project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-]cerft 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 i�issued and d work `conformance therew8h. No changes shall be made without first obtaining shall be dome in confor6nce therewith. No gm shall be made wdW approval. fire obtaining approval. X r Data FOR OFFICIAL USE BEYOND THIS POINT;. ` Accepted by Date Submittal Amount;Due tP: Receipt No. '� ~ Building D.60artment Ote GroupT Constr. Planning Department Environmental Health Department z� Public Works Department Fire Marshal Valuation$ l: y Building Permit Fee Site Inspection . Plan Review Fee a` UFC plan Review Fee Plumbing,&Base tFee ` Public tlli'ofies.Revieia Fee Mechanical E�Base Fee Other ! W sc Wood/Gas/Pellet Stove Fee ` Other s-� roe— * Pre=Paid"at Submittal ( -�-�- Tl, FEES _ MASON COUNT' PROJECT SITE INFORMATION i *case No. Name 1+►, l`'. t+r �l Ott C, RRCEL NUMBER Date jr� SHbW n FIt'FOLLOWiNG ON SITE PLAN- Show Direction by indiaationg N, 6 E, W in relation to the ,. si#e plan , .,. L ot Diffmensions Fences \ Existing Structufes Driveways Structure Setbacks Shoretlnes s Well Locate+(Inciudlttg topogray ' Water Lin adjacent) 0 ainag, Names of Streets . ' . asernents N es of Fr641n e tre Sep#i0'...stem. DRAW SITE PLAN B LOW Include ad acent propertiesif on shoreline or within 100 feet of ad' cent ro ert line. adjacent property lihe , I E-adjace h t property line .. ""Ip ' I 1 f ; ♦ I -- IY+F a i I I v 1 ( t I I � t ( I 1 1 1 I t f I i I 1 adjacent \ ro perty line ' E-a went:pro ert time SAMPL15I4!TE PLAN � , adjant property litter 1 3io'1 property line " D 30' tSCRv@ Hong t VA C-A KIT ► i 1 tae4 AG6 i iv I \ {� to80 � i \ i /00 I � � I ( A'DO ro ' Y r"1 1 adjacent ert tine-3 E-adjacent ro erf"line'• , TOPOGRAPHY PRQFtLE(Snow aside view of property. Show slopes, cuts sin fills. if possible include height and the degree of slopes. See sam a topography profile.) i IY . SAMPLE;1'OPOGRAP P tr3F#LE -17 t; sr tom Sigttatwra ' +:' :. Date f- - Q PERMIT NO.: BLD ` MASON COUNTY BUILDING PERMIT APPLICATION a. 426 W.Cedar/P.O.Box 186,Shelton,WA`98584 Shelton 360 427-9670 Belfair 360 275-446T Elma 360 482.5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner I>t rt==Y; i~ Contractor Name Mailing Address Mailing Address "E =C f :"E City 'r.L.-`Atli State tit_ Zip Code -ram City 7"Ak 4 &40 State %j^_ Zip Code Jr Phone +tr( U ) .219 &1711 Other Ph.( ) Ph.(- "" .2 ) ..1.7 79 Other Ph.( ) Lien/Title Holder Contractor Reg. # Ce o 1 kcw_k�. 101 A Address Expiration 1 .1..x_l .� `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 A Legal Description ' f Ale We' Site Address(Please include street name, street number and city) . G t✓" Directions to site Will timber be cut and sold in parcel preparation? (Yes/No)t Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 1TYPE OF JOB New_X Add Alt Repair Other ` Use of Building Describe Work f No. of Bedrooms No. of Bathrooms SQUAR FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement - Deck Other sq. ft. Garage^ Attached ?etac e6 Carport *Attached Detached r MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms 4 Type of Heat Purchase Price$ Replacement Unit?(Yes/No) f fr�staller Name Certification No. i 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 owners 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 ihanges shall be made without approval first obtaining approval. X Date Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by" ,'. Date F Submittal Amount Due j Receipt No. ' t Building Department Occ Group Type Constr. Planning Department Environmental Health Department Ip 49 CEes .3au Public Works Department Fire Marshal Valuation$ - ........................................................:::::::::::::::::::•::::::.�:::::v::::.�::::.�.v:n n}w:::::::x:?'•}:4:^:?^}:•}:•}}:?•}:4:•}}:?•}::r:::>i'i::•:%:•iiil?:i:< '}Wt, ............:•w::::::.:::•...:.:.......................:...:;••:w:::::.•::.::...:r.......................:...::w::::::::::.....:..... ..........::.:::::._::::::...........................:::.:..:::::vn•.::........................:.....ti.::::::•:�v1::................... - ;ii:.i'::::?::.'::::.}•.}v.}•.:.iv.}:•pY::.i'{+?•}i}}i::::.......?......::::v:^:pY:.F•:::: k::::^i:;i<:ii::>�};`::::''.:ii}ii::%:i:�ii:�iiiiii'i':i�ijii'>::i�jiiiiY[:i�i::�iiii%�3i::i:`' Building Permit Fee Site Inspection - Plan Review Fee,, UFC Plan Review Fee Plumbing & BasW—Fee Public Works Review Fee Mechanical &Base Fee Other 1514 V 14eJ't- 6_0.Uv Wood/Gas/Pellet Stave Fee Other a; Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES THIS PA�!lCLL irNCLl�ES PUNS, KPR1�lrl E� �iS o'n tRSIZE IMAGES LARGE FORMAT IMAGES HAVE BEEN STORED IN FILE CABINETS) UNDER PARCEL NUMBER PARCEL # I t - 60o5D CASE # �'-D9q - Doss FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name PARCEL NUMBER //—( jS ate SHOW THE FOLLOWING ON SITE PLAN Show Direction by Indlcationg 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 adjacent property lined Include adjacent propertles if on shoreline or within 100 feet of adjacent property line. I Fadjacent property line I I 1 1 I I I � I I I A" 1 Oq I I � I I 1 I I I 1 I I 1 I I 1 I I I A4 I I adjacent property lined Fadjacent ro ert tine SAMPLE SITE PLAN v adjacent property line- FIVIAICAKiT NAL. 3o, �t�seaveFadjacent property line H I T CIAPLAvd k� I PgoPmea J A64LCLLLTLL0.AL 50,� r/ I � I I I I i I •, I I I /00' I I 1 I 4.aLL I I I I I * /00' 1 I I adjacent property Iine4 c 1 Fad acent pmnpri;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+a..cs +o nad't.a.lt't distar,c� to Stop& toe dtatan�a t e d, Signature Date