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P § EE m (D:E \ § / 8 a � $ / § / OD k ƒ C m � i � 2 R \ Akk @ ® � C \ E 8 / \ G $ k \ . m � 7Eq � \ E\.% jgD CD CD SEE � � Ee @ w . a@ CD 30 ) k CL $ g7k a :3 o 0 / / a C: At n Cm « @ ƒ ■ � epi � E E FORM MUST BE COMPLETED IN INK MASON COUN-f Y PERMIT NO.(w PLEASE 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 APPLICA11T INFORMA ION I CONT CTOR INFORMATION Owner 1 /2Cb Compan me Mailing Addr ss P�o • Z 0 6 6 Mailing Address City StatelV44 Zip Code 9A-2 ZS City Sta ip Code Phon - Other Ph.3,9,o ZA40 -W_78 Phone ther Ph. Lien/Title Holder Contractor Reg. Exp. E mail address �X �✓I �- P. �4oL, G v r! E Mail Addr !u e Drivers Lic.# ?l KS 190 DOB I Z-7 o- Drivers L' DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic V-e& Existing Septic Connect to Water System Name of Water System --- Well-�j' Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Izt--7— 1137 700o a Fire District Legal Description L. - U.) � � Site Address (Please include street name, street number and city) « Directions to site FRo^4 6 eta c�-- �`✓�r 3 -7 Q<« t&w,Y /a C 710 L`" T�RA LS CA/D 90 ,(rs.C+. N 7-'2 14 iLf 67AZO o N E' 9.49 O ^ R b !! X, v 4; Roe,i f1rD.fe N f.0 Will timber be cut and sold in parcel preparation?Yes A67- c-V o N Is property within 200'of Saltwater Lake River/Creek Pond Wetland12Seasonal 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 - Newer_Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building Describe Work No.of Bedrooms No.of Bathrooms 7_Square Footage- 1st Floor Z/3 2nd Floor 3rd Floor Basement — Deck_I Z Covered Deck L1 TO Other Sq.ft. Garage 6 Z,6 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 rev ��grrI nt of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare L i2=eiive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the neces arties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the alb,(�ay�p�tafined permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that t i- rmation provided is accurate and g employ of Mason County access tolhe above described property and structure for, msnectQk PROOF CONTI AT OF W IS BY MEANS OF A PROGRESS INSPECTION. VfFIC. X Date: O r/Owne Re resentative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection 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 CUUN I Y PERMIT N0.67t"" / �l` 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 - `' LECLE I I Compan me /. Mailing Address P�n - p .� 6 Mailing Address City 11a-t- -9.4 State_uW Zip'Code !�R 8 City Sta ip Code Phone. /1-4 7_,_. j-<_1 7`� Other Ph. - ' Phone they Ph. Lien/Title Holder /u'C ! Contractor Reg. Exp. E mail address G a E Mail Addres Drivers Lic.# DOB Drivers L' DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New SepticT`f S Existing Septic Connect to W�tef System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. i Fire District Legal Description T �!;� L ol. =t�U ;Q7"M SW !, , _5 c,j 4e - Z> -Z Site Address (Please include street name, street numb4f and city) 1, .S n jA k' �C,/,-A�.•�-1_ n3 ,G2d B'�L��a rv- Directions to site ,e° �-+ 2_ e C-� �i�,7 3 r`4 is .��� Y �, 7� E ?'R.a c s 4/0 7_8 674//3 �'�4�' /...•� �% o N �'ft S +^ /Z t> Will timber be cut and sold in parcel preparation?Yes<M> R, Is property within 200'of Saltwater —Lake—River/Creek Pond Wetlan 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 ja SEASONAL ❑ Use of Building Describe Work No.of Bedrooms No.of Bathrooms---7.—Square Footage- 1 st Floor _2nd Floor 3rd Floor --^ Basement � Deck 4 4 Covered Deck //4f� Other Sq.ft. Garage 6 Z i6 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. f OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of I such is by signature below.I declare that I am the owner,owners legal representative,orthe contractor.I further decl ;T=tp receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all then i mission is required from any easement holder or any other party in interest regarding this application or the work proposed in the apalfication,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,KrFs#Vy information f provided is accurate and gra employe of Mason County access to the above described property and structure for review and ih ion. PROOF O CONTI ATI� OF WO IS BY MEANS OF A PROGRESS INSPECTION. $ELFAIR OFFICE x Date: Ow r/Owne Re resentative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED I NOTES Building Department k-slios n t nd Planning Department Environmental Health Department Public Works Department Fire Marshal , G FEES Building Permit Fee - Site Inspection Plan Review Fee d EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee °t-° Other Wood/Gas/Pellet Stove Fee State Fee L �G Violafi& Fee Pre-Paid at Submittal V luation$ TOTAL FEES MASON COUNTY PERMIT NO.✓` ` t E 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 CONT ACTOR INFORMATION Owner . , Compact me Mailing Address P, o - f e�..� Mailing'Address - City -/ i State_ts_ Zip Code %�� E— � City Sta Zip Code Phone..s / Z% v 7� Other Ph�r.,;'/ :t. Phone ther Ph. Lien/Title Holder t' Contractor Reg. Exp. E mail address_ r \4. a F 4 it of - C E Mail Addres Drivers Lic.# DOB Drivers'L' . 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. I -n--7— t A 7 7 e a t�c� ,? t� Fire District Legal Description_T"' .�1-„3_S.S _ .. L �f "' s f�L� ;LyL/ > 7- � Site Address Please include street name, street number-and city) n> 1c, 1 Win,? l�ta e4r�L4..z«.- I Directions to site r.' r...� !' c :"' y t t! f ? r: ti i:: r !. T c c 7-iF . i% f• . Will timber be cut and sold in parcel preparation?Yes AW Is property within 200'of Saltwater Lake River/Creek Pond Wetlan , Seasonal Runoff Stream Slopes,br Bluffs > 15% g 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 ja SEASONAL ❑ Use of Building Describe Work No.of Bedrooms No.of Bathrooms_ .m—Square Footage- 1 st Floor Z•1 3;9 _2nd Floor 3rd Floor Basement -- Deck 4 4 Covered Deck l/2t) Other Sq.ft. Garage 4 Z 4 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.Admowledgemenf of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare tha �e�re this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessa =cis 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,represW Uon provided is accurate and gra employ of Mason County access to the above described property and structure for review and 1AHMa PROOF-0 CONTI A[ OF W IS BY MEANS OF A PROGRESS INSPECTION. 8ELFAIR. OFFICE i X , — Date: Ow r/Owneis Re resentative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal t 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 MASON CUUN TY 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 �! 1 ,.- a Company-Mame Mailing Address `'*J Mailing Address'-_ City / State ii Zip Code City Sta Zip Code Phone „ r r' Other Ph. Phone ther Ph. Lien/Title Holder Contractor Reg. Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lie:# 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. j a--z 1 t-, 7 7 � :w Fire District - Z Legal Description_Tr� .�-�� Lt..� �<.=L.:�/�/�. ��w' .�tom' �..,� .5 � ��T/ Site Address (Please include street name, street number and city) ' "i , ,' C.j Directions to site '� f Will timber be cut and sold in parcel preparation?Yes 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 actiori?Yes/No TYPE OF JOB - Newer Add Alt Repair Other PRIMARY RESIDENCE ja SEASONAL ❑ Use of Building Describe Work No.of Bedrooms No.of Bathrooms 2- Square Footage- 1 st Floor L__2nd Floor 3rd Floor Basement Deck 4-Covered Deck 1L o Other Sq.ft. Garage t'. 7. 4 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 th l ' permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary,§aT6i 972ionive isthis required from any easement holder or any other party in interest regarding this application or the work proposed in the n I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,re,P 6�hcc�( a6on provided is accurate and grapCs employees of Mason County access to the above described property and structure for review and inspdfctl PROOF OF CONTINUATICiV OF W IS BY MEANS OF A PROGRESS INSPECTION. ,, f 13ELFAIR OFFI X ! .��` ,,... �- i/: Date: Ct T Ow r/Owners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Departmen t b Public Works Department Fire Marshal AA FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee `7 T� Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee r Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES ~Soo, FORM MUST BE COMPLETED IN INK PERMIT NO.: PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION Shelton(360)27-9670/Beellf ir(360),75467'Elma(360►482-6269 APPLICANT I(JFORMATION CONTRACTOR INFORMAT ON Owner o4L+;^e d FEeP_e-14C_ J"!L- Contractor Name Mailing Address P.o o Z-o X6 Mailing Address City Be-L-9.9t t., State O*9 Zip Code City V At ZipCode Phone( la ) !J79�Other Ph.(1r46 )�3ya-S7_A,6 Ph. Uther Ph.(_ Lien/Title Holder IJ o ry c` Contractor Reg.# Address cr,v+ Expiration R,C) • ,a L SEPTIC INFORMATION-Connect to New Septicjt�Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. 'LI _/ 7 7 / o 0 03 O Fire District Legal Description -rP, 3 -,3 G 93--oO1�, ^A1 g&O%/, S cd Xf t8- a z -- z— Site Address(Please include street name,street number and city) FRoef 3 74k67 04 y /0 6 7'0 Directions to site `` - dV/- X7 :5 tv - E T/Z#4,G.s &Z 5 rZD 7'p '7'7FZ4, t-. -"D ®Q. 7-o t ok,.4 r A-Z 7'o t= RICO ,4 dsaou ,4 I /,i' LoT O N A 14 W I Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland P,S Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Ye-.0 Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS F el Type: Electric Type of Fixture No.of Fixtures Fees LPG Natural Gas J0 Heatpump Toilets Z /4 ape of Unit No.of Units Fees Bathroom Sink „3 7 Furnace Bath Tubs z 7 Heatpumps ! Showers / 7 Spot Vent Fan 7- Water Heater / 7,o o Propane Tank .0 Clothes Washer / 7 Gas Outlets 4 Kitchen Sinks -Z- 91 Wood/Gas/Pellet Stove / Dishwasher / Kitchen Exhaust Hood Hosebibs - 3 -2-( Dryer Vent / Other As ypve, 'f Sr Other Base Fee I o Base Fee TOTAL PLUMBING !o 2._ TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: ��``W�i J� OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDF4FLN 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 t m aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the ►M p Torch rmit is issued and all work conformance therewith. No ang shall be made without first obtaining shall be done in conforman=with. No changes shall be made without approval. first obtaining approval. $��.F�O�R X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. r.. ... ......:........... :.....:.......::.: ;:::::.:::.:::.::.::.:: ........QN ...DIE JtlP? CfENIEtk::... ................ ........................... ttCi Building Department Occ Group Type Constr. Planning Department Other Other .................... Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION Shelton(360)27-9670 Beellf ir(360I754467'Elma1360)482-5269 APPLICANT INFORMATION R CONTRACTOR INFORMAT ON Owner — r > I fe.C- .i!Z - Contractor Name Mailing Address P.0, Jj O)L Z_o 1C,6 Mailing Address City_ge L PA (r• State 4,j o4 Zip Code City ta_ Zip Code PhoneC;V,4 ) !�-7�4. 4 i Other Ph.(34,c ) �y,;-;;�_�z� Ph.0 ()ther•Ph.( ) Lien/Title Holder r"•.,- � Contractor Reg. # t Address 4c.w CL 9 lC14 A.J Expiration D SEPTIC INFORMATION-Connect to New Septic ` 4 Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 digit Tax Parcel No. ( 2—7 , 6 / �J 7 0 v 0,3 D Fire District Legal Description 7"f ,a - 3 c c 5=s.. r 1. ,'7` Site Address(Please include street name,street number and city) /-`»,Y i u Tv Directions to site 7 f . �.` r/�r--t , L.; r�/.r L �.t �y; 7'" 13 T=' C h'r,7 .• .:. /�'!.:> 7'-� �' fS', - r, � :Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland 4_1�, Seasonal Runoff Stream ' Slopes or Bluffs 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 Number of each) MECHANICAL UNITS Fuel Type: Electric ✓ Type of Fixture No.of Fixtures Fees LPG Natural Gas `' Heatpump _ Toilets 2- ,a r` Type of Unit No.of Units Fees Bathroom Sink __T Furnace Bath Tubs , Heatpumps Showers j Spot Vent Fan 7— Water Heater / Propane Tank Ad Clothes Washer / Gas Outlets _gyp Kitchen Sinks Z. Wood/Gas/Pellet Stove i Dishwasher;,,, Kitchen Exhaust Hood i Hosebibs 3 z ( Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 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 described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: RECEIVED OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I cerI t I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of WashingtojaT a�avy f the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work forthi i ued and all work conformance therewith. No ange�sshall be made without first obtaining shall be done in conformance thereygtbLVo changes shall be made without approval. !' f first obtaining approval tt3att AIR OFFIC f . 1 Date X Date - c OFFICIAL USE BEYN THI POIN Accepted by Date Submittal Amount Due ece pf No. ......:.:... ..:. .: ::::: ...i;1i €iQ4... I'M�'Ai<c: #�1tiY::::i:::>::>::::>::>::>:<:;<:;>;>::::::::APPi�O�[i:>:..... . N ff>A5>:>:>:>:>::>:>:>:>:< <>:: Building Department —r Occ Group Type Constr. Planning Department Other Other Permit Fee Site Inspection Plan Review Fee. t1FC Plan Review Fee.,. p Plumbing&Base Fe.6" Other ! Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation"Fee a TOTAL FEES ,w PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION { Shelton(360)42 9670 Beellf ir(3606 $75467'Elma93601482-5269 APPLICANT IkFOR1111ATION CONTRACTOR INFORMAT ON Owner ,6 yr a d C- .7"!z Contractor Name It J Mailing Address P.o o 4 Z-O 6 Mailing Address City x3e.0-P.9i I,- State 0 A Zip Code City V bt Ziv Code Phone(. do ) q79-S/7�Other Ph.(U6 ) 3ya-gzAZ Ph.Uf lther�Ph.(� Lien/title Holder N o ry Contractor Reg. # Address Acr,r Expiration 12,D • L car z SEPTIC INFORMATION-Connect to New Septic_ t Existing Septic Connect to Sewer System Name of Sewer System ! PARCEL INFORMATION-12 digit Tax Parcel No. ( -Z.7.1 A 7 7 / CD o 03 O Fire District Legal Description 7'/Z J 3 << +'`9s- of/, /)tic./ sw%� s'w %�/ l�,- a z - �- Site Address(Please include street name,street number and city) 9'2 oe1 3e t�',u t- 3 -rak 6 f-/w i v 6 7- Directions to site - E 7- Zs4l EAU 7'� TK4, L., 0e, T, o A,0 To IC 4.- CIS a,v R n 4o ]- UN -.Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland e5 Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building " Location of Fixtures/Units 1st Floor `�S 2nd Floor Basement Garage 72S Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No.of Fixtures Fees LPG Natural Gas , Heatpump_V'_ Toilets 7- /H Type of Unit No.of Units Fees Bathroom Sink „3 7 Furnace / Bath Tubs Z 7 Heatpumps / Showers / 7 Spot Vent Fan Water Heater / -7,o o Propane Tank alb I Clothes Washer / 7 Gas Outlets Kitchen Sinks Z 7 W000(�Pellet Stove / C Dishwashers / Kitchen Exhaust Hood / Hosebibtir Dryer Vent / Other -has-, 3'�-- !' 5-01 Other Base Fee 2 ' Base Fee j TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 age qq�w represents that the information provided is accurate and grants employees of Mason County access to the above describe pbr E:= t res for review and inspection of this project. Acknowledgment of such is by signature below: Yh� 4 dW5 OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I e i t Itt 4 ntly registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of WashljQtpn 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 wo#U6 i1Rthi *p- issued and all work conformance therewith. No ang shall be made without first obtaining shall be done in conformance therewith. No changes'shall be made without j approval. first obtaining approval. X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. l s>?;::;::>::;:;:<::;; ::;»»»::>::»<:Alk"t?A�tME3!11`AE::�it�VllEVfG.;:::.;;:.;:::;:::::::::.:..:.APPR�7V�D.::::::.t1ENIE#3................................................ Building Department Occ Group Type Constr. Planning Department f { Other Other ::::::.:.:::::::::::::::.:::::::•:::::.;:.;:.;:.;:.;:.: FE ................................................................... Permit Fee Site Inspection I Plan Review Fee,, U.FC Plan Review Fee Plumbing&Base Feet; Other t d Mechanical&Base Fee -� b Other e; r, Wood/Gas/Pellet Stove Fee u Pre-Paid at Submittal ( ) TOTAL FEES Violation Fee THIS PARCEL INCLUDES PLANS, BLUEPRINTS OR OVERSIZE IMAGES LARGE FORMAT � IMAGES HAVE BEEN STORED IN FILE CABINETS) UNDER PARCEL NUMBER PARCEL # CASE # 5- 01 7SLI-- D4ASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST / G�- Owner's Name: Y�( ��' Date: l ` ' ' Reviewed By: H'�- Documents/: ry !; Buildiag Permit Application Completed c _Manning Intake Checklist Completed, � i 2- P OCr o Site plan includes:Allowable building area,r s,decks,etc. �P-Fv a Apparatus Access Road info required Yes 1 No �F�F,41� ergy Code Application Form-O Electric wall heater O Electric central furnace O LPG Furn9&i 't O Heat pump with eolpinc furnace O Heat pump with LPG furnace O Boiler(heat type ) #Other:Specify: n a- echanicaUPlumbing OplptQ-WkiER HEATER TYPE _ VGe ngineering? Yes No Snow load Used: mic Design Category: D1 or otechnical report or assessment? Yes D2 Construction Plans: COMPLETE SETS 00, V Plans Legible ✓cognized Scale 1,15evation Views --✓71 GYoss Section Foundation Plan _Lj1e ff Framing Plan V Floor Plan-Use of Rooms Noted 'Floor Framing Plan-all floor levels represented? Loft,crawlspace,etc. ✓Deck Framing Plan,including covered porch roof framingplan Plan Detai +rUS "' Roof framing details,truss lay out may be needed Wall Framing-Does bearing- 11 hei lit exceed 10'?(Engineering may be r uired) j /t Floor faming: Floor joists I v Floorbearns 6_ V Window headers. Typical header. ShQ 7Foundation:footing size,reinforcement -eu rete Walls-Does Concrete Wall Height Exc d Engineering may be required) Landings at all exit levels? -:30"above grade Y - eated By Furnace-Location of Furnace W, a �7 Fireplace/Stove Information Shown-Fuel Type? Window Sizes Marked on Plans l _2cSlvry Garage? (Engineering maybe required)R602.10.1, 1"story of a two story. D 1-45%,D2-55% —Braced wall panels(shear walls)marked on plans or lateral engineering?(Plans m not � be approved if not provided) C Oxbs� I 1 &S ^ v- t 111REGULAR BUILDINGS nusual Shape)R301.2.2.2.2 Irregular portions of structures shall be designed�n accordance with accepted engineering practice. A portion of a building shall be considered to be irregular when one or more of the following conditions occur: 1)Exterior braced wall line or BWP cantilevered or offset by more than 4' 'i 2)Roof or floor is not laterally supported on all edges 'i 2A)Portion of roof or floor extend more than 6 ft.beyond the braced wall line. 3)End of BWP extends more than 1 ft.over an opening more than 8 ft in width below. 4)Opening in a floor or roof exceed the lesser of 12 ft.or 50%of the least floor or roof dimension. 5)Portions of floor level are offset vertically 6)Shear wall lines do.not occur in two perpendicular directions. 7)When a story above grade includes masonry or concrete construction(exc: fireplaces,chimneys,and.veneer). When this condition applies the entire story shall be designed in accordance with accepted engineering practice. 2003 mC►I..submittal cheMid ri Vjjr&WKD i Mason County Permit Assistance Center Planning Intake Checklist Owners Name: d�� Date: 1 0 Project: Reviewed By: Commercial Developme S O Comments: Planner: GBM TSC CMM KJ SNG BJR Site Plan: V North Arrow 1VProperty Dimensions: , X Streets and Driveways Shown. Road name: L v ❑ dating Structures shown with setbacks q/Well Location, Septic and Drain-field Shown with setbacks qY Identify all surface wat r stre s,ponds, shoreline, wetlands, etc.) d (� g/fopography(slopes) 0 T r e"Proposed Structure Set cks (Dire tion/Setback): /,, U . + !i F �f1f1Gj F: �/ ���R: ! I: �l� / '`— S2: / (l� 8�:�, .>.:R 0rhtCE ta"Utility and Drainage Easem nts: Yes (if yes enter condition#5022) e11"Other Easements r C)a s JJ p' Accessory Appurtenances Uft kn of o hio,T pu vy\p o+4v_� -+-,rtry a--Geeftt-r-Access Permit Needed(add condition#0010) `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) I Shoreline and Planning Info L Setbacks: Shoreline: 0 u i'� Slope: rl Shoreline Designation: Com hensive Plan: Rural Zoning: � P g ❑ Not Applicable ❑ Agricultural -,W' RR 2.5 l./10 20 ❑ Urban 0 In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy g Rural ❑ RI 0 Natural 0 RAC 0 RNR ❑ Unknown 0 RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR ❑ Unknown // ElUnknown Water Body(type of water if unnamed): (I I Q 1r SEPA: Yes (g)Unknown Flood Plain: YES N Unknowns ap# Aquifer Recharge: YES N Unknown ap# Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: YES Eagle Nest Tag: YES O Other YES Addressing: Check box if needed ❑ Reviewed by: Revised:07-12-2005 L\PLANNING\CHARELL&RENEE\PLANNING INTAKE i MASON COUNTY DEPARTMENT OF HEALTH SERVICES t October 20, 2005 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 ALFRED FERREIRA Elma (360)482-5269 PO BOX 2066 BELFAIR WA 98528 Belfair (360)275-4467 Case No.: BLD2005-01754 Parcel No.: 122187700030 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: 11 Please see comments at the end of this letter. Please call me at (360)427-9670, ext. 353 if you have any questions. Sincerely, Cindy Waite Environmental Health Mason County Health Services Comments: You will need to apply for a water adequacy waiver. The fee is $100.00. Fill out the enclosed form, I will keep all of other information in your file. 10/20/2005 1 of 1 BLD2005-01754 MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health Personal Health PO BOX 1666 SHELTON,WA 98584 LOCAL(36Q)427-9670 BELFAIR 360)2754467 Application for Determination of Adequacy FAXJ360)4,27-7798 Instructions '{ 1. Complete Part 1 i p 000.eat tic made until Past 1 is fllyu Eompieted. O 2. Complete only the.parf 2:aing to Qie type of water system utilized.ete I �p� 3., Submit co let use tlt,d ��V nit.for review;, PART l: Applicant/Parcel Identification Name of Applicant A L -�y�a-a/ 1-erauyecc- 222. Date Mailing Address •O, O)C 2-D 6 6' 13e,�,+,4lr,AL Telephone 31 - yT9,5"j 79 g e szg Assessor's Parcel Number j Z Z l,R 7 7 o e o 0 Type of Water System (Check One): Reason for Application (Check One): ❑ Public/community water system(2 or '' g permit more connections) ew rPrivate Two-Party ❑ Replace Existing Structure ❑ Individual well(one connection) ❑ Land use application,if so... B 'Well ❑ Division of land ❑ Spring/surface water #of parcels? ❑. Other(explain) SPH2 o Boundary line adjustment ❑ Other(explain) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated for adequacy: Public Water System/Private Two-Part Name of Water System Water Facility Inventory(WFI)Number(enter"none"for Two Party): ,C/©Afe, l7 The water purveyor has filed a letter granting blanket hookups to this water system ❑ I am the manager of this water system The water system has been approved for services. There are presently connections m use. This will be the connection.-T water system is able and willing to provide water to this(these)connections witho—ut—e—miiMg the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date H.-IWELLIWATERADI WRDOC Update:March 22,1999