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COM2005-00023 FINAL PASS - COM Inspections - 1/3/2006
n r CONCRETE MECHANICAL. MANUFACTURED HOME Fos tlnox l 111tawks Dace By Rfrbans o Date By Gas Piping o Date By w l ounci ion waI� babe By sell up Deft By INSULATION Date By ........ ..... BG 1 Sim binsulktbn Floors FINAL.INSPECTION Late By Ch" By Date By FRAMING WWI& FIRE DEPARTMENT Date By Dam By Date By PLUMBING AWc OTHER Groundwork Data By Fi Dote By WALLBOARD NAILING re M airs 1-�a. ,A roved DW Date By P P Date ByIN 7 WOW Line FlNAL PE ION su Gate �y 0- 0 O, U3 4v By LS P�' By � - I Type of Insp. Pass/Fail Request Date Inspect. Data Done By Comments c LP , o Z u i S - (M _DrF= 0" o 0 CD z w bod led.? b O(o —cni 0 i f AL I� 7- 0 r• C7 K CONCRETE Mt1aECHANICAL MANUFACTURED HOME oFa*lf W I iethecks Date Sy tans o Date By Got Mping o Data By w Fotbn Wails Date By Set-up Date By INSULATION Dote By 80{SlabInsuiesian Floors FINAL INSPECTION Date By Data By Date By FRAMING; Wake FIRE DEPARTMENT Date By Date f)l , By Date By PLUMBING attic OTHER Groundwork Date 1)< 3 C By L,- Dole By WALLBOARD NAILING D.w:v Date By Date By Wwater Line FINAL INSPECTION Data ey Dow By Date By Type of Insp. Paa"IFail Request Date Inspect. gate Done By Comments -rip/M l►�►y �,s-- tt � "6 GCS -�i ' z� e � Z . i� �e o�� n 3 AD 0 S&c 0IJ _ Corr-44iTe�. �"F P 'Fa, l z'v _ _ --F Z1151D 12 it I CA ME ECH l-OWcF0 w �� �coM �155E0 IfleF 0 comb l L Z� 1 I'Z-I�'��O S 1Z G IV Y 0 N( Zu A S ea, Cc rl -A e-k t-4a Ry W 444-[r5 1)03 K LIS 0- 4�-.cam✓? � � � � � � � �� N �f CONCRETE MECHANICAL MANUFACTURED HOME FocRtr s e ka Date Sy oc» r SY S aac FNpin� Date By a ro rttonwalls +1 `u)oS y ¢�aG- s9t Dar By INSULATION Date By SG 1 a yraulation Floors FINALINSPECTION cwSa7IM i3y By Dwe By FRAMING waft FIDE DEPARTMENT I m" By offie By DaW By PLUMBING AWc OTHER ,�J— Gro k Dada y G'h-1 k'b�• /�f lrrr^p son d/7 Deft �D�@y (�(� WALLBOARD NAPI N4� Sfrv�tit✓� ��✓ D.W.V iBy ram} ,L S�zc f o r Date Le toFBY ........... Wow u FINAL INSPECTION N. h IAv-y Date Sy Bata By Typal taf klsp. Pa 1FalI Requesti3de inlspeet. Gate Dwe►'I3y t`+Ci1'hirt@1118 N s FAT71fo 12 bS- Lq 1A a o o z n b o Nwt Z w 56 m v y S��A2wd Aid C F' 5j i�G-' fSF d► l ++n� 4e(aerA r'c ttJr"d� k 1Hclo O Al L t�p�r3 t C D �j Fa�1 t+ - 1t le jos Arc u® ioea -1, 0 cn 'F Ito low 1 i$ d fro 5ie c'�l Plu'V\8 pfts'�r� 4 Nt-r aW ,Co h:pc 13 07 10: 55a The Mahugh 's 360 275 8135 P. 2 l � 160 a1 . MASON COUNTY oo Department of Co;;imunity Development . INSPECTION CARD and CERTIFICATE OF OCCUPANCY* —T PO BOX 1 u6, 426 W Cedar ST, Shelton WA 98584 General Questions: (360) 427-9670 ext 352 Inspection Requests: (360) 427-7262 Permit Number �Ap®/„��1 Date 02/11/2005 Issued By Project Demolish Fire hose drying and storage. ,® up Q&( y,4rrw j4 Site Address 4350 E GRAPEVIEW LOOP RD GRAPE EW Applicant MASON COUNTY FIRE DIST#3 Contractor License Number Con. Phone Expiration Date Primary Code Occupancy Division Use Type of Construction Occ• Load Public Works Access/Driveway Other Health Dept Septic Well Planning Dept Site Inspection Fire Marshal Fire Apparatus Access Fire Sprinkler Auto Fire Alarm Hood and Duct Other Final X Pvt- j Building Dept Building Official: Larry Waters r c. Concrete Setbacks lab �SE,0( Footin Perimeter % - Ret.Wall /Bulkhead ?jlil� -FootingInterior ZZ FootingDecks/Porches V Foundation Stem Other Rough-In Groundwork Plumbing L, _ Plumbing Groundwork Mechanical Other 117- Groundwork Gas Pipe r _.-GasPiping -Fr�miri_•_.`�• - .5 •.r.� enc.I r �C •z � T` �%+;s:�rii_ �!G- X L,,�r � c-v �n-• r -c �• 4C_ --'Mechanical Insulation Slab ___ '= C ) Ceiling �\ •; ''/� 1����k loot Vaulted Ceiling CLl:LI" _ . i,��.Sb�f D3��-Walls Vapor Barrier Other Wallboard Nailing Interior Wall Brace Panels Fire walls OthergLww ,,J%4,ms1KmV ISM I9V tPOW1 n Final Buildin OrIA0p t f�q Mtct►e�� ,;i-r�, Manuf.Home Setbacks Setu Si67" ,epFF t Concrete Foot/Runners Final Other APPROVED LA MUST E ONSITE FOR ALL INSPECTIONS -`THIS STRUCTURE MAY NOT BE USED FOR OCCUPANCY UNITL ALL APPLICABLE FINAL INSPECTIONS ARE COMPLETED DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVALS ARE GIVEN. POST THIS CARD IN A CONSPICUOUS PLACE ON THE FRONT OF THE PREMISES CONVENIENT FOR MAFpNG REQUIRED ENTRIES. ALL PERMITS EXPIRE 180 DAYS AFTER PERMIT ISSUANCE OR 180 DAYS AFTER LAST INSPECTION ACTIVITY IS PERFORMED, OWNERI AGENT IS RESPONSIBLE FOR CALLING FOR ALL INSPECTIONS PRIOR TO CALLING FOR FINAL INSPECTION,ALL CONDITIONS OF THE PERMIT MUST BE MET. ' _ Pagel of 1 Debbera Coker- Fire Marshal approval of Grapeview Community Hall permit COM2005-00023 From: Debbera Coker To: local@wavecable.com Subject: Fire Marshal approval of Grapeview Community Hall permit COM2005-00023 Hello Mr. Mahugh, The inspection card faxed to our office has been received and posted to the case. Based upon the information received all inspections are approved and the permit has received approved final occupancy approval. Thank you for supplying the information. i i i I i 4 i f about:blank 12/13/2007 0 N -CONCRETE MECHANICAL ? 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DTI N Q " O � 0 7 o my v o cS a = m CD 0. cr mw v cr CD 0Or CD CD a m � m fA y. � O CD 0 �_ � N �- cr m m ca o o CD CD v v CD m -6 CD CD �. o = v0m a 0:3 0 o m as s 8 cn 0 m n CD , o 0 CD � CD 0 Q �, v 0 n � v� m CD O - c c� CD co CL O 0. � o oa CD m � m � � D{ � nfli � CD Q '� m 5 CD n o m 3 o CD. = r CCDD O �' N O �, n r« � „ a D o °0 0 m a) v °= 47 o C1 r CD cn o °v a 8 � m m CD cr Cn :3 no CD° Q (n o CD_ o m mv — = O N O � > a D n > r- n Cl)Q 3 s go C.) r 00 CC (D CD O < z c O Pi Q O m O :3 CA $ o 3� CD -i o =r y CD y < v co CC r: 2 c m rt CD CD CD 8 Cl) C 'D 7 Z 7 y 7 @ o CD O (n CD Q -I cD Q CD CL C 0. n CD C o O r CD iU 7� LL N r- 7 = � � m m < CD CD CD °1 ° ` m p �_ -i CD 3 CD n O m v O aoo ,* � � m _0CD o v a -», 0 �i w- �, 3 m 0 v X z N o cn 8 = 0 m o D Q 0 0o3 -� m > M CD W o m 0) CD � o x FORM MUST BE COMPLETED IN INK MASON GUUN I Y PERMIT NO.� 1� PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 t JW1 3 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner m e F P n vt'-- _ Company Name Mailin ddres p.6 Mailing Address City - State��Zip Code S City State Zip Code Phone 1 . 75-q4e S3 Other Ph. I'M C;>_l /a Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address /Ca F,J1 E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to Z=�� sta Sept' Connect to Water System _�X—Name of Water System .ar 51�5 'e i-%- Well-,'g—Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. o Fire District 47 Legal Description L `-t- O Site Address (Please include street nam , street number aLnd city 4 a Directions to site L 0 a �' 9r Will timber be cut and sold in parcel preparation?Yes/ o Is property within 200'of Saltwater t Lake River/Creek rl--'s Pond Wetland V1m Seasonal Runoff r-L-_,� Stream i'L-gr Slopes or Bluffs > 15% Irur Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add X Alt__Repair Other PMARY RESIDENCE ❑ SEASONAL ❑ Use of Building ee Sl-ifdii ' t" e e �n tiI 1 o a w. No.of Bedrooms— *A7 No. of Bathrooms IV A_Square Footage- 1 st Floor �, 5-00 2nd Floor 3rd Floor��Basement� Deck Covered Deck-61 Other Sq.ft. Garage /�� Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price $ Replacement Unit? Yes / No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and 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 required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. 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 prope7 and structure for review and inspection. PROOF OF INUATION OF WOR IS BY EA OF A ROGRESS INSPECTION. X Date Owner/ wner sentative Cont ctor indicate which one FOR OFFICIAL US9 BEYOND THIS POINT Accepte by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Departmen Pk ` Public Works Department ✓1 G Fire Marshal S L1 ;t< 1( (n_ FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal aluation $ TOTAL FEES MASON UOUN I Y PERMIT BUILDING PERMIT APPLICATION C� 3 426 W. Cedar • P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner '' ' 2 Company Name Mailing Address f. Mailing Address �City �. ,* -- city State Zip Code y State Zip Code Phone "* Other Ph. Phone Other Ph. Lien/Title Holder~ Contractor Reg.# Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System ,;:_Name of Water System ; Well-_Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel preparation?Yes Ao; Is property within 200'of Saltwater Lake River/Creek 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 action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building` Describe Work " No.of Bedrooms y, No.of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage ; ;.— Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price $ Replacement Unit? Yes/ No Installer Name Certification No. OVVNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and 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 required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accur to and grants employees of Mason County access to the above described property.and structure for review and inspection. PROOF O_FPOYINUATION OF WORK IS B MEA OF A PROGRESS INSPECTION. X Date, —57 Owner/Owners Re esentative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accept d by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Departmen 0 Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection i Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. 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 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner. M C , i"* j -X Company Name Mailing,Address -' A ' Mailing Address City State Zip Code I R City State Zip Code Phone 75" V Other Ph. ".'A' Phone Other Ph. Lien/Title Holder ? '+4 Contractor Reg.# Exp. E mail address ' 7„r -5 X T E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic — Existing Septic Connect to Water System -- -Name of Water System Well-,&—Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street nam , street number and city) Directions to site ' �° '� r 4 � .A Will timber be cut and sold in parcel preparation?Yes/ o Is property within 200'of Saltwater i a. Lake jeZ. . River/Creek :'M.,.1 Pond- Wetland i,, Seasonal Runoff r f Stream Slopes or Bluffs > 15% - Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add-2L Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building L", i. .�:IA icy,t ®ascribe Workp ..,4 w /�:. � s n No.of Bedrooms A No.of Bathrooms Square Footage- 1 st Floor f 01) 2nd Floor 3rd Floor ;v Basement Aii'f Deck Covered Deck "4i' 4 Other Sq.ft. Garage AV a Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/ No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and 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 required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. 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 structure for review and inspection. PROOF OF CO,PMNUATION OF WORD IS BY MEANS OF AYROGRESS INSPECTION. X Date Owner 06 wne entat' Cont ctor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepte by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department o I Environmental Health Departmen Public Works Department Fire Marshal FEES Building Permit Fee Site Ins action Plan Review Fee EH Review Fee Plumbing & Base Fee Plannin Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. 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 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION `r� Company Name Owner AfA e &-, ak Mailing Address ''' ' r Mailing Address City State Lt)e� Zip Code City State Zip Code Phone Other Ph. _".� ' r Phone Other Ph. Lien/Title Holder Vr Contractor Reg.# Exp. E mail address 4 fi 5 ' E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic existing Septic Connect to Water System —',X Name of Water SystemWell Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. � ' �° +' ' V 0 o �. Fire District �r 54 StgeaAddress (Please include street nam,, street number and city) '; 'p d Directions to site 77 Will timber be cut and sold in parcel preparation?Yes/ o ' Is property within 200'of Saltwater .v, Lake River/Creek Pond Wetland ''1 Seasonal Runoff "': � Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add X Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ "-- v.Q ^-t j c y1 cribe,Wrl ©�srsr' Use of Building.,-• No.of Bedrooms. A ' No.of Bathrooms j Square Footage- 1st Floorr a =?t 2nd Floor 3rd Floor /' ,:4 Basement , .Y Deck Covered Deck 4 °1 Other Sq.ft. Garage 4 Q Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price $ Replacement Unit? Yes/No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and 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 required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. 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 structure for review and inspection. PROOF OF C4)Isf TINUATION OF WORD IS BY MEANS OF A PROGRESS INSPECTION. =� - rw Date { Owner nersjj4sentatiye Cont ctor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepte by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department o �� •� Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Inspection Plan Review Fee �• �` _ EH Review Fee Plumbing & Base Fee T �� -PlanningflevrwFee - ��_1 Mechanical & Base fee ` ,Sa 3 Other 0-3 Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ �` , �'� TOTAL FEES FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD 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 On the web www.co.mason.wa.us APPLICANT INFORMATION l 3 CONTRACTOR INFORMATION Owner � C C-P/7 �1� Company Name Mailing Address -43 24 X 1.2 V Mailing Address City Lis R%jj State Zip Code ' City State Zip Code Phone -2 2'5 '514 k& O er Ph. Phone Other Ph. Lien/Title Holder N R Contractor Reg.# Exp. E mail address A-3 -2 7.5 - k.5 E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic— Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. e Fire District Legal Description L- S ndzldr Site Address (Please include street na street number and cityL- Directions to site --� % � 1 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 UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric= LPC Natural Gas_ Heat Pump_ Toilets r Type of Unit No. of UnitsG yt � Fees Bathroom Sink Furnace f Bath Tubs , Heatpumps Showers —" - Spot Vent Fan Water Heater I Propane Tank Clothes Washer .— Gas Outlets Kithen Sinks Wood/Gas/PelletStove_T_ Dishwasher Kitchen Exhaust Hood ' Dryer Vent Hosebibs Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL CAMBER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that 1 am entitled to receive this permit and 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 required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is acc and grants employees of Mason County access to the above described prop and sit cture for review and inspection. PROOF INUATION OF WOR IS B MEANS F A PROGRESS INSPECTION X Z Date: Owner/Owners presentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND TH S POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group—Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Ins ection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES PERMIT NO. 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 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner r. ' f.- "'`'." .' Company Name Mailing Address ,L'cf; oL < - Mailing Address ' ' City State Zip Code City -��'=' �« �� � �-•� State .Zip Code y' - ��� y P Phone Uther Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. ' E mail address E Mail Address G.� `° ' ° ' Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic 4 Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. ,r Y` 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 Slopes or Bluffs > 15% TYPE OF JOB - New Adder=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 UNITS Type of Fixture No. of Fixtures Fees Fuel Type-.Electric : LPQ_ Natural Gas— Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater ! � Propane Tank c Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and 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 required from any easement holder or any other parry in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. 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 structure for review and inspection. PROOF cXF CQNTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTIONS Date: X y Owner/Owners presentative/Contractor (indicate which one) -, FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Ins ection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES Mason County Permit Assistance Center Planning Intake Checklist Owners Name: i c s o, co.. 6:sl. 3 _ Date: d - //- C'_— Project: ('A' nS cJ Reviewed By: Commercial De:�elopment: (ES NO Comments: Planner: BM, TSC CMM KJM SG Site Plan: P L""A' k, ,, North Arrow Property Dimensions: -3o 4 X Streets and Driveways Shown. Road name: C,yk v,e i Ic,.o,9 'd All Existing Structures shown with setbacks ,,6('Well Location, Septic and Drain-field Shown with setbacks ED C !-- 1 u Identify all surface water(streams,ponds, shoreline,wetlands, etc.) Topography(slopes) - I' (' Proposed Structure Setbacks (Direction/Setback): F: A/ R: SS / -3 0� S 1: L / , �1 . S2: Q „ Utility and Drainage Easements: Yes J oP(if yes enter condition#5022) Other Easements ❑ Accessory Appurtenances ❑ County Access Permit Needed(add condition#0010) ❑ State Access Permit Needed(add condition#0020) Standard Conditions to be added to all Building permits that planning reviews: #5019 and#0700 Are there any impediments that may restrict access to your site? (dogs/gates) Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zonin Not Applicable ❑ Agricultural Jg RR 2.5 5 ,10 20 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy X Rural ❑ RI ❑ Natural 0 RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR ❑ Unknown ❑ Unknown Water Body(type of water if unnamed): SEPA: Yes LNo' Unknown Flood Plain: YES NO nknown, Map# Aquifer Recharge: YES NO unT' own Map# Tags/Cases: _ , RLC/SPI Case: 6-Year Dev. Moratorium: YES ,:NO Eagle Nest Tag: YES NO Other YES 'NO Addressing: Check box if needed ❑ Reviewed by: Revised:02-04-2005 I:\PLANNING\CHARELL&RENEE\PLANNING INTAKE FORM MUST BE COMPLETED IN INK PERMIT NO. .'t. PLEASE PRESS HARD MASON COONTY 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 On the web www.co.mason.wa.us APPLI NTINFORMATION 4 CONTRACTOR INFORMATION Owner l' =, , Company Name Mailing Address i Mailing Address City State Zip Code City State Zip Code Pho Other Ph. _ Phone Other Ph. Lien/Title Holder `' 'l:> '`f - Contractor Reg. 4 Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System _ PARCEL INFORYATIO - 12 Di it Parcel No. 12,111 ' ' ' _C Fire District Legal Description Site Address (Please include street name, street number nd city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff stream Slopes or Bluffs > 15% TYPE OF JOB - New Adder_Alt v1 Repair Other Use of Building Location of Fixtures/Units- 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:ElectriQ LPG— Natural Gas`_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and 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 required from any easement holder or any other parry in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. 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 structure for review and inspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department J Occ Group—Type Constr. �O— GU'Y\GL � f>S Planning Department Environmental Health Department 1 U Iv— cc— FEES Plumbing & Base Fee Site Ins ection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee O.tber-1 C Violation Fee TOTAL FEES MASONo COUNTY PERMIT BUILD eNG9Po RMI 6APPo IwAA ssGsN OW2-3 helton (360) 427-9670- Belfair (360) 275-4467- Elma (360) +482-5269 r )/j On the web www.co.mason.wa,us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Marlin ddress Mailing Address City` .State. IAZip Code City State dip Code Phone 1 1 ?1_IfJAR Other Ph. .27.5 2 ( Phone Other Ph. ` Lien/Title Holder Contractor Reg.# Exp. E mail address max 2 k-r &'"..�'�''ep E Mail Address Drivers tic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION Connect to New Sepflc txistin`.Sept Connect to Water System y_Name of Water System A .,rs.�, -&�4 ,, y Well Water system Name of Water System PARCEL INFORMATION- 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street namg, street number nd city) Directions to site Will timber be cut and sdW in parcel preparation?Yes/ o is property within 200'of Saltwater"_Lake ja2j= River/Creek YI-4 Pond ... Wetland Seasonal Runoff_117.4 Streamer Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction:Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other P MARY RESIDENCE ❑ SEASONAL ❑ Use.of BuildingA"w, 5`/�#�� `f" 1? 1 2 ir_Pto..a M No.of Bedrooms &A2 No.of Bathrooms N A_Square Footage- 1 st Floor4 500 2nd Floor 3rd Floor Na Basement�Deck Covered Deck Other. Sq.ft. Gara e--4lifa- Attached Detached- Carport - Attach Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms - No,of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No 'Installer Name Certification No. CIWNER/BULDER Admowledges submission of inaccurate infom'la' may result in a stopmo*order or permit revocation.Aclax wledgement of such is by signature below.I declare that I am the owner,owners legal ,or the contractor,I further declare that I am entitled to receive this permit and to do the work as proposed in the application.,I declare that ihave obtained the permission from all the necesp"parties.N permission is required from any easement holder or any other j%hy,in interest regiiAg this application or the work proposed in the applieatim?n,i have obtained permission from them to apply for this permit and conduct the work proposed. 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 prope and structure for review and inspection. PROOF NUAnON OF WOR 1S BY OF A ROGRESS INSPECTION. X Date Q Owner/ e entative Cont ctor indicate which one FOR OFFICI L USd BEYOND THIS POINT Accepte by: Dalte DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department M,Ke- c - 915 - O 117 Environmental Health Department Public Works Department /V Fire Marshal _05 ,S t,J( ZJw q - f?&0 6 FEES Building Permit Fee Site Inspection Plan Review Fee t3.4,q C0 EH Review Fee Plumbing&Base Fee ; o-kb Fee ,5c . Dd Mechanical&Base fee /`,! T 4 3-4�' Other 'I' Wood/Gas/Pellet Stove Fee State Fee zv- Violation Fee Pre-Paid at Submittal S Valuation$ !80?, 93 Lk TOTAL FEES