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BLD2007-00709 - BLD Permit / Conditions - 3/26/2007
)RM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.��<a 7 0 LEASE PRESS HARD 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 X/,t- OeqA,'flkl T 1#c/o Company Name ff4" d'ox Mailinn Address 097 zVC- 9 /1 llt_ Mailing Address Cityil� -�� State it Zip Code fy/W City_ _!!Zj iL1 ,mate Zip Code Phone] 0 Other Ph 206��� 7f�'9 Phone Other Ph. Lien/Title HolderC`fG _vp_- Contractor Reg. # Exp. E mail addres "—P c 0,0 E Mail Address Drivers Lic.# dC DOEO8--,;49—j� Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septie l' Existing Septic Connect to Water System �/ �:Name of Water System,P�C. �X>J F Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 0067167 Fire District Legal Description Site Address (Please include street name, street number and city) C/iC57- Directions to site Will timber be cut and sold in parcel preparation?Yes Is property within 200' of Saltwater �' Lake River/Creek Pond Wetland Seasonal Runof{ Stream Slopes or Bluff 5% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yesle> TYPE OF JOB - NewXAdd Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL Use of Building Describe Work -� No. of Bedrooms No. of Bathrooms -%Z Square Footage- 1st Floor 2nd Floor �a 3rd Floor Basement,-�A- Deck ACovered 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. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a s�op work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners lega©�gsgptative,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 Arc h obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in rnteres } a application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the v8or p sed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employe"of N'ra�on Cour access to the above 9 described property and structure for review and inspection. This permit/application be mes null & void�'i�ryry R}t or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 18 OOF OF C9NTINUATION OF WORK IS BY MEANS OFAP OGRESS INSPECT ON.INACTIVITY OF THIS PERMIT APPLICATION OF 180§Uj ",VALIDATE THE APPLICATION. X %�/fC� Date�Y--.ZI—O y�NrY, ' Owner/Owners r entative Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date .?5-C. :Z DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department a S- " f��' 14- Planning Department Environmental Health Department - Fire Marshal FEES Building Permit Fee Site Ins ecti 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 Valuation $ TOTAL FEES FORM UST VE COMPLETED IN INK MASON COUNTY PERMIT NO PLEASE PRESS HARD BUILDING PERMIT APPLICATION K ►I 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Beifair(360) 275-4467 • Elma (360) 482-5269 U On the web www.co.mason.wa.us l APPLICANT INFORMATION CONTRACTOR INFORMATION Owner�` f 1f LD� il�r' �dG Company NameL� Mailing Address 7 Mailing Address City %2-�W % 1 State Zip Code ✓��~ City ,!!rAM Mate Zip Code Phone �'f 1 / ' Other Ph. /� _ Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail addres Ad E Mail Address Drivers Lic. # d C� Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic... Existing Septic Connect to Water System 'z_Name of Water System&C_A-&-''oak Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. �' O }0 e- Fire District Legal Description Site Address (Please include street name, street number and city)2_`�z E_:�;7` Directions to site Will timber be cut and sold in parcel preparation?Yes Is property within 200'of Saltwater k�Lake River/Creel: Pond Wetland Seasonal Runof �. Stream Slopes or Bluff— s > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes TYPE OF JOB - New,Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL Use of Building Describe Work ^ No. of Bedrooms --';2-- No. of Bathrooms Square Footage- 1st Floor h 0, 2nd Floor 3rd Floor Basement f 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. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a s op work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners lega r qq��ss�ee t�ative,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 c-'. h� obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party inirfiterest r r application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the voo rsed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employ e"of N4apon Cou access to the above described property and structure for review and inspection. This permit/application bec mes null & voidf'yy'yy jjtt or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 18 �2OOF OF C9NTINUATION OF WORK IS BY MEANS OFA P OGRESS INSPE ON.INACTIVITY OF THIS PERMIT APPLICATION OF 1$ �A�(�IVkL`tnVALIDATE THE APPLICATION. X �,. l�,��� ,.r�,�t�', re:,� N Da . Owner/Owners entative Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by:�' '•:,, Date-' ' z ' DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department ,L. ` +` Planning Department Environmental Health Department Fire Marshal r 'f - LA ` FEES Building Permit Fee Site Ins ectiof 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 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 r On the web www.co.mason.wa.us �% APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 'Y, r r, �'' ' . Company Name Mailing Address g "<' d Mailin Address ,��-' � - '�' �� - '" City .`� f State `' Zip Code` City State Zip Code Phone � ;;r€ t` ' Other Ph.> ' °F Phone Other Ph. Lien/Title Holder,` Contractor Reg. # Exp. E mail address LI' = " E Mail Address Drivers Lic.# Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System 'L' `'" Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. /,• / OS 4'tK'="- '''' Fire District Legal Description Site Address (Please include street name, street number and cit Y) Directions to site Will timber be cut and sold in parcel preparation?Yes Nq' Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff"Stream Slopes or Bluffer 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes oy TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONALF Use of Building Describe Work No. of Bedrooms p- No. of Bathrooms Square Footage- 1 st Floors `.. 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. 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. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: a Owner/'Owners Releent ative;a'Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW M107L VED DENIED NOTES BuildingDepartment Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee 0 Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee ( d 1 • ;!_ Plannin Review Fee Mechanical & Base fee o Other Wood /Gas/ Pellet Stove Fee State Fee ' Violation Fee ® MF. Pre-Paid at Submittal valuatinn S ,�� _�_ 4��_ 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 rk" Company Name �'"' ;a' .��' .�,s �` p'9� � :._. Mailing Address 7 �� Mailing Address City- '� State. Zip Code' `'�� City "..:4J, Mate Zip Code Phone.20AX XA"¢U62 Other Ph.!26,6 �e k',l Phone Other Ph. Lien/Title Holder/ 4f,- f'1 4G��'� ' Contractor Reg. # Exp. E mail addres��-& %�' "� l/ra fir ', �'`''ti,4.1 E Mail Address Drivers Lic.# � l zez,1199 Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System -:,'` Name of Water System 8' ' e Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. G� Fire District — Legal Description Site Address (Please include street name, street number and city);22/ _*I:e' Z,4jW ShkAlAW Directions to site Will timber be cut and sold in parcel preparation?Yes Is property within 200' of Saltwater -Lake River/Creek Pond Wetland Seasonal RunoffStream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes CD TYPE OF JOB,- NewX_Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL Use of Building Describe Work No. of Bedrooms -s2. No. of Bathrooms ;:2. Square Footage- 1 st Floor �i1®.. 2nii Floor 21 3rd Floor Basement-6 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. 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. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X f.�✓ X Dated Owner/ wn e r naive Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by:!� Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department �1�1 I oil610"1 Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection' 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 FORM MUST BE COMPLETED IN INK PERMIT NO. PLEASE PRESS HARD 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 OwnerCe"ILr k �IW C� ' L� Company Nam &///Zf Mailing Address 4 Z ZLIW -f7- Mailing Address Cit /E State / Zip Code _ City ZdOO State Zip Code Phone"z� y/2 Other Ph,,'-"/ Phone Other Ph. Lien/Title Holder 2411 luo Contractor Reg.4 Exp. E mail address!5 oo of VAdoo.0 e-WIL E Mail Address Drivers Lic.#�" DOBar-.Z - / Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic X Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. U Fire District Legal Description Site Address (Please include street name, street number and city).2` ,e% T WL5 ---4 � Directions to site Is property within 200'of Saltwate Lake River/Creek Pond Wetland Seasonal Runo f - Stream Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units - 1 st Floors 2nd Floor /oi Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:ElectriG_ LPC A' 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 T— Wood/Gas/Pellet Stove-�- Dishwasher 7— Kitchen Exhaust Hood Hosebibs Dryer Vent / Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL O\MVER/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 INUATION OF_WORK I BY MEANS OF A PROGRESS INSPECTION. X G`� _te- 7_774 .rz Date: owner,,,*Owners Representative Contractor (indicate which one) FOR OFFICIAL USE BEY DTHIS DINT Accepted by Planning Pd Ck# Date - Bld Pd Receipt No. DEPARTME TAL REVIEW APPROVED DENIED NOTES Building Department Occ Group—Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PERMIT NO. 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 If FORMATION Owner� f�f ` �, Company Name Mailing Address % 2 / ✓ Mailing Address City-5 State lv'%t Zip Code,I mo%% City 49,.4Q!4- tate Zip Code Phone, IE' "'l' Other Ph sr ✓'�T / Phone Other Ph. Lien/Title Holder C-;-r Contractor Reg..4 Exp. E mail addresses- ,, ef Yw�rao G'©fit E Mail Address Drivers Lic.#�" C-4A DOBOp'=2 - / Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System `4 , PARCEL INFORMATION- 12 Digit Parcel No..Az `"r '= �' �`' Fire District Legal Description Site Address (Please include street name, street number and Directions to site Is property within 200'of Saltwater ' - Lake River/Creek Pond Wetland Seasonal Runoff `� Stream Slopes or Bluffs > 15% TYPE OF JOB - Newer Add Alt Repair Other Use of Building Location of Fixtures/Units - 1st Floor a 2nd Floor z- 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 152- Type of Unit No. of Units Fees Bathroom Sinkj Furnace Bath Tubs =� Heatpumps Showers Spot Vent Fan I Water Heater Propane Tank Clothes Washer Gas Outlets �— Kithen Sinks �— Wood/Gas/Pellet Stove T— Dishwasher T 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 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 INUAT�ON OF_WORK I BY MEANS OF A PROGRESS INSPECTION. .> ____ ����> Date: Owner wners Representative)Contractor (indicate which one) FOR OFFICIAL USE BEY D THIS OINT Accepted by Y' Planning Pd Ck# Date - Bld Pd. Receipt No. DEPARTME TAL REVIEW APPROVED DENIED NOTES Building Department Occ Group—Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection 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 till Company Name" ? Y Mailing Address `v' Mailing Address — City_'': -State Zip Code r City State Zip Code— Phone Other Phone Other Ph. Lien/Title Holder 4,"" Contractor Reg.4 Exp. E mail address E Mail Address Drivers Lic. P' 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 Fire District Legal Description ;�-7"� Site Address (Please include street name, street number and city) Z'LILL Directions to site Is property within 200'of Saltwater PLJ Lake River/Creek Pond Wetland SeasonalRu noff-4�Stream—S lopes or Bluffs > 15% TYPE OF JOB - New_�°� Add Alt—Repair Other Use of Building Location of Fixtures/Units - 1st Floor - 2nd Floor Basement— Garage Closet PLUMBING FIXTURES (Show Numberlof each) MECHANICAL UNITS Typeof Fixture No. of Fixtures Fees Fuel Type:Electric LPG ' Natural Gas— Heat Pump— Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace 1 7 Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater z-P em Propane Tank Clothes Washer Gas Outlets Kithen Sinks -� Wood/Gas/Pellet Stovei Dishwasher Kitchen Exhaust Hood Hosebibs 7- 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 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 CONTINUATION OF XNORK IDS BY MEANS OF A PROGRESS INSPECTION. Date: X - Owner�16Wr�;ri--R-eip-res-e-n-tati-iveij-Contractor (indicate which one) FOR OFFICIAL USE BEYONDTHIS POINT Accepted by: Planning Pd—Ck# Date" —Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grouo—Type Constr.— Planning Department Environmental Health Departmenti F FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES MASON COUNTY PERMIT NO. 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 CA ` ' . -, ",.:ss> s. , z .fig:. Company Nama Mailing Address 0-2` 12. � ;� $"% � Mailing Address City Zr47"� State Zip Code 's= `` City � State Zip Code Phone-k,FS 4:7'1 mil'#1 Other Ph,,; !Ae„ "s' ° Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. Email address 'Ar'7 ,,�. r< u" E Mail Address Drivers Lic.#f- . ' DOBa% - r" 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 < <!�lf� 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 Run s Stream Slopes or Bluffs > 15% TYPE OF JOB - New_)(—Add Alt Repair Other Use of Building Location of Fixtures/Units- 1 st Floors 2nd Floor O—�— Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:ElectriG_ LPG Natural Gas Heat Pump_ Toilets .. Type of Unit No. of Units Fees Bathroom Sink — Furnace Bath Tubs _ Heatpumps Showers a Spot Vent Fan 1 Water Heater Propane Tank / Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/PelletStove� 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 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 OFWNTINUATION OF WORK I BY MEANS OF A PROGRESS INSPECTION. -.. X r ttn.lr,,�x` Date:_',:z� Owner wners Representative Contractor (indicate which one) FOR OFFICIAL USE BEYONDTHIS,POINT Accepted by: Planning Pd Ck# Date' Bid 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 C�v 131lS � t-n r 4 W 1v O O O Cl Q 35f10i 0950dM aILG � J e 'VAC'dddd Ol 103f8 S S35 YVH:D 31lS NO 30 01. oivv 38 NVId _�11S ,9NINNVIcl Loci ;,i nog Njosm �J 3 Odc] V M313N1`d a 9NI151X3 c . b, cly 9NINNVld IL :00'SL .�ulr- r_ V 3 �. E. CJRE6T LANE WATER 1041 — — — — _ __ — — — ADJACENT — _ - - - _ — _ - - - STRUCTURE 100, _ _ _DRAIWIELD - c" . 1 . 1 3�' 30 'x 16' GARAGE W/ uWINISHED/ HEATED SPACE ' - - - - - - - - - - - - - �I' NORTH ,P 291 EAST CAST LANE A39AMVIEW, WA. SM46 PARCEL • 121182400010 cv TRACT 1 OF CsOVt LOT 3 4 TAX 1345 EXA-D — — — — — — LOT AREA : 034 ACRES Sb' - 94, / 821 ADJACENT STRUCTURE 80 40' Q Q -+00' ot%-STA MASON COUNTY o P� A o N DEPARTMENT OF COMMUNITY DEVELOPMENT s N Planning Division N y ti P O Box 279, Shelton,WA 98584 (360)427-9670 1864 REQUEST FOR ADDITIONAL INFORMATION August 17, 2007 CONRADO TOPACIO 4909 GREEN LAKE WAY N SEATTLE WA 98103-6734 Parcel No.: 121182400010 Project Description: NEW SFR Dear Applicant: You have submitted a permit application (case no. BLD2007-00709) for proposed construction or development in the county. Upon review of your application, I require additional information to complete the permit review process. 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. 363 if you have questions. Sincerely, �2 Kell McAboy Land Use Planner Mason County Planning Department 8/17/2007 Page 1 of 2 BLD2007-00709 REQUEST FOR ADDITIONAL INFORMATION 8/17/2007 Case No.: BLD2007-00709 Comments: Your geotechnical report has been sent to and reviewed by Kenneth Neal, Kenneth Neal & Associates. According to the enclosed memorandum from Mr. Neal, your geotechnical report cannot be approved. The report does not meet the standard of practice for geotechnical reports for the reasons Mr. Neal outlined in his memorandum. These issues must be addressed before a building permit can be approved. 8/17/2007 Page 2 of 2 BLD2007-00709 KENNETH NEAL& ASSOCIATES CONSULTING ENGINEERING GEOLOGISTS 3314 Gibraltar Ct. S.E.,Olympia,WA 98501-3968 Telephone: 360 352-5125 Fax: 360 236-0201 aj W 5�` e-mail: kengneal@aolcom �0 August 16,2007 MEMORANDUM r TO: Mason County Department of Community Development Engineering Geolo ATTENTION: Robert D.Fink,AICP,Planning Manager f; 100 FROM: Kenneth G.Neal,L.G.,L.E.G.,Principal Engineering Geologist KENNETH G. NEA SUBJECT: Review Comments—BLD 2007-00709 —- "Geotechnical Report, 291 East Crest Lane, Grapeview, Washington," prepared for Conrad Topacio by Geotechnical Testing Laboratory, dated January 23,2006. The document predates and does not meet the current regulatory requirements of the Mason County Resource Ordinance(MCRO) for a geotechnical report, as outlined under 17.01.100E5. There are several issues with this report, not necessarily pertaining to format,that must be addressed: 1. Site-specific information must be provided regarding on-site soils. The use of USDA Soil Survey mapping terminology is inappropriate for this application (MCRO 17.01.100E4). The Unified Soil Classification System and associated terminology for strength characteristics (compactness and consistency) is best used for this application. "Glacial till" is a geologic interpretation of the origin of the soil material,not a description of physical strength characteristics. 2. The building site is shown on the site plan, as required by MCRO 17.01.100E5(13).for geotechnical reports, but the relative location of the building site to the top of the marine bluff, and the location of the proposed setback line are not shown. There is no bar scale on the map. 3. There is no cross-section, as required by MCRO 17.01.100E5(5). The cross-section must be drawn at a readable scale, and must display soil layers (units), including fills and landslide deposits, if present. The section must also show earthwork (cuts and fills) associated with site development. 4. The analyses required under current regulations are more stringent that those required in 2006. A factor of safety.greater than .1.1 under seismic loading is now required. The actual factors of safety used as a basis for setback recommendation are not described in the text. 5. It is uncertain from the site plan whether there is 30 feet of separation between the proposed house(and footing drains)and the septic drain field,as required by regulation. While this is not a geotechnical requirement, it would be useful to inforin the client if the relative locations of the building footprint and drain field are out of compliance with regulation. For purposes of efficiency and reduced paperwork, it would make sense to include BLD 2005-02090(for the proposed garage)as part of this report. If you have any questions,please call. I can most easily be reached on my cell phone at 360-280-6180. 2 copies submitted MA. ON COUNTY I)EPARTMENT OF HEALTH SERVICES May 01, 2007 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 CONRADO TOPACIO Elma (360)482-5269 4909 GREEN LAKE WAY N SEATTLE WA 981 C3-6734 Belfair (360)275-4467 Case No.: BLD2007-00709 Parcel No.: �1182400010 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Application for Water Adequacy Please see comments at the end of this IettPr. Please call me at (3(330)427-9670, ext. 554 if you have any questions. Sincerely, Trish Woolett tw@co.mason.wa.u:; Environmental Health Mason County Health Services Comments: PLOT PLANS DO NOT MATCH. ACCORDING TO THE INSTPLLATION RECORDS THE SYSTEM WAS INSTALLED AS PER THE E;ESIGN. THESE RECORDS Dr) NOT MATCH. NEED TO MEET 85FT SETBACK. NEED SIGNED WATER ADEQAU`'Y FORM. 5/1/2007 1 of 1 BLD2007-00709 Mason County Planning Intake Checklist Owners Name: a Can r,ac) Date:_ Project: Reviewed By: Commercial Development: YES Comments: _ PLANNER: GBM TSC CMM K7M PBC RDH Site Plan: North Arrow Property Dimensions: '-15 X 2.15 Streets and Driveways Shown. Road name: _reS�' I_A n E — r"r�v6-b All SN:eptic!a Ct e UAx;_4 e1L,SCgtAx-rV1 C.ornmu nc� Well Loc n !nd!Drain-feel hown with setbacks �a en fly all surface water (streams, pon s, s ore me, wetlands, natural or historic drainage, defined drainage ditches) n C) tee( Topography (slopes) 54 o p.e_. 4D w&A cl 4- A-_ Sp u-fLA - Proposed Structure Setbacks (Direction/Setback): F: LOS / R; / S1: �5 1= S2: / l� ,e"'Utility and Drainage Easements: Yes No (if yes enter condition #5022) ❑ Other Easements ❑ Accessory Appurtenances: ro ane 1/ Heatpump ❑ Variance applied for: Yes / parking spaces allotted? Ye )/ No ❑ County Access Permit Needed (a d condition #001 ❑ State Access Permit Needed (add condition #0020))n OC`�- Standard Conditions to be added to all Building permits that planning reviews: #5019 and #0700 Site Access: Are there any impediments (dogs/gates) that my restrict access to your site? h� Is the site clearly marked? How? Address moidad a+-b rt u>2_Lj) ,_/ Critical Areas: ❑ Name ❑ Other: Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: ❑ Not Applicable ❑ Agricultural 0--RR 2.i 5 10 20 Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy teRural El RI El Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR ❑ Un Unknown Water Body (typ unnamed): SEPA: Yes/ N Unknown —� Flood Plain: YE /N Unkno n Map# Aquifer Recharge: S/N Unknown ap# Tags/Cases: RCC/SPI Case: r)o 6-Year Dev. Moratorium: YES Eagle Nest Tag: YES 0 Other YE NO Revised: 09-29-2006 MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health - —'u Personal Health PO BOX 1666 SHELTON,WA 98584 LOCAL(360)427-9670 BELFAIR(360) 275-4467 Application for Determination of Adequacy FAX(360)427-7798 Instructions 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water system utilized. 3. Submit completed application,with attachments to the health department for review. PART 1: Applicant/Parcel Identification Name of Applicant �-On t"a.D6 I 0 Die Mailing Address ATqeleph,� Assessor's Parcel Number, oZ 1 1c� aq clu o Type of Water System Check One): Reason for Application Check One): ■ Public/Community Water System (2 or more ❑ Building permit connections)* ❑ Land use application, if so.. ❑ Individual water source(one connection), ❑ Division of land: if so.. Well #of Parcels? SPL Spring/surface water ---dju ---- ----------- ❑ Boundary line adjustment ❑ Other(explain)-------------- ❑ Other(explain) **If you have more than one residence ❑ Replacement(please indicate name of water system connected to this well, check the Public box. below if applicable—no signature required) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated: Public Water System Name of Water System— Water Facility Inventory (WFI) Nu er: 6 7296pz (write"none"fnr twn na.r+u) lib I am the manager c)f th water system. The water system has been appraved for _ services. There are presently J connection(s)in use.This will be the connection. ❑ 1 am the manager of this system. This connection will be to upgrade or change the use of an existing connection on this system(ie:recreational to full time). Please indicate on the following line the nature of this change: This water system is able and willing to provide water to this(these)connection(s)without exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager _ Date a-( I CC Update:April 2006 MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health Personal Health PO BOX 1666 SHELTON,WA 98584 LOCAL(360)427-9670 BELFAIR(360) 275-4467 Application for Determination of Adequacy FAX(360)427--kiF% Instructions �; � 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water system utilized. 3. Submit completed application,with attachments to the health department for review. PART 1: Applicant/Parcel Identification Name of Applicant/2iy1/E'd-6&W 7154 `le% Date Mailing Address5z.22' jig Telephone.;?45;- Assessor's Parcel Number Type of Water System Check One): Reason for Application Check One): Public/Community Water System (2 or more Building permit connections)— ❑ Land use application, if so.. ❑ Individual water source(one connection), ❑ Division of land: if so.. Well #of Parcels?__L___ SPL____- _ Spring/surface water — ❑ Boundary line adjustment �j ❑ Other(explain)-------_----_ ❑ Other(explain)—___ _ _ If you have more than one residence ❑ Replacement(please indicate name of water system connected to this well, check the Public box. below if applicable—no signature required) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated: Public Water System Name of Water System Water Facility Inventory(WFI) Nu er: (write "none"for two party) ❑ I am the manager of this water system. 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