Loading...
HomeMy WebLinkAboutBLD2002-00555 Final SFR/Garage - BLD Permit / Conditions - 9/29/2003 IliC C ry 0 W < < N N A _ � 6 N (n_D N ,G co L N O a<i ? H ? d CD m n r C) CD � 0 d CD or C N O (� z -1 m Cr CD _ dy m ni ° nm D cn mwo0 N 00 c O CO) r y cn m @ c c 0 ic `�' 3 G) n 00 � n q� l y to CD `� a n D �CL mmmZ CD o `'c CD c m � G) � c0 O m =. r �• m O -0 K o * K 01 g o z a) -4 z 0Z CL (a 7 N o CA p ' r N N X 00 0 CA � m m Z > lJ m m 3 CD z Zr o N N N N W -► w0nv Co 0 S = cCA FD Znm `° Z `' Dmcn W r < N p2 < -p0 'nTm cncn oo O� vm •� cOi ai tD X n o � T �, z o Cn X m CD =v o m fD 0 0 0 o n 0 o W -p r CL CD CD CD 0 N cnzm � _ y D 0 �� - momo m ° oo fn 111 CD _� ; �' o o Z � (D 3 3 O 'T1 3 W O W O CL N •• y N m O _. 0 1 `I a boob a � � NW3 o m CD CD m m 90 m Z x m pr O (D c � a CA) S C y m r oo OooO < z2v 90 C Z `CD p GO � r G> > �, X * 55 rn < r y C N C y O � n n' v v CD O) y CLC3 � Z m X 0 0 ° � o m 0 O C ' D r y cn m O 0 �t o g o, W D o -n m z Co -i c c (D (D 5. G. n v Cu O z -i ic m 3 3 = � aac�� = ' Ovm D E _� m n v ; = m X = m M Z Cn (D 0 <_. -n D CD CD H m -n m * m oo m D V ou (D (D CDN m (D W o C O CD O CD - y — ry z CD mo ' (o (a D m o (A � C/) z 0000000 G) T. 07 Cl) CD _ d Cl) (� c- cr� cr� Cr� nnCr� Cr� CDr „ o (D oo `D v .�Cf � `2 m ti Cl) 0 90 m m c rn � rn rn rn rn rn rn rn j �. G W � — � NNNN � N � ood to p M � -n 0 0 0 0 0 0 0 0 0 0 (D O _ m _ m _ _ 0 0 0 0 0 0 0 0 0 0 N N N N N N N N N 0 O D 3 (� x GA W O < d Tori) m °' 0 v+ cnv, v, �' o d+ rn 0. 0) = � X C < r "tr O N -4 N N 0 to 6q W 0 � � (D 0 v o �_ m m m 0 N 0 -4W CO D7 W OD W N O i.D iD bin A cn to 0 (D > > � CD D (n p -;4 -* 0000CD00 00 CL Z -4rncn N Cr 0 0 (A 0 Cn 0 0cp 0 Cn N -+ r N N � -4 CD rnrnrnrnrnrnrnO> rn (Di A DO m � C) a (D N GO) P06 � ( (� ( (n C) NNN (D V � v W N N � N N v N O O N o X 0 D D -0a) 0 v Fn ° 5- WO -u 0 � X o �, n - CA O (3D 3 o c -0 M m e CD CDCDD -0 :3 0 C) 0 o N CD c) CD 3 w CA O CD 7 O m = aO. (=D f<_p' y C O CU v' Im 0 ca v < Z0,Z0 ,< 0 0O 0, y m ° (,wv A � 0 O = d fA � cn-0 C N = -0 = p v fD Q T --j =r 0 CD Ca o CD -0 CA = =' � ° X n "0 co ° m2 ° X-0 Qom = tU �, n ° co ° m o 0 CD CD c� mmQ o 0 0 CD ° ° o _ c _a cp Q3 v am c c — 3a 3 02 (Dp (DoQv �' �, co m � ° a - CD z � m cfDi 0 w 0 C0 -n ° O 0 O (aCD = N r CDp - 0 CD-, c y to Q. N O Z C = N .+ O' 0 .. N = X N Om � O � S (n O = ai O Cl. N ((0 CAD �-• 0 0 CD c cn Ca = Q. w CD y O tll 0 _ = 0) CD CD C 3co CCD 0 o � 3 � C CD v o c3 3cQ � _ (D O `� N D N m N O N CL X w = CCDD <O R N N CD CD co `� CD v c� X j v Q. 0 °� c(DD 7 a cyi va 3 Zug r � 0 � . yCD nc 3 Q Cr c mom ? o = cD C ° �' 3 = Q a Q N d y N n N = (� mcQ N •• N -« y 0 �—, 30 � 3 3 v 00C) B m 30X v 0 CA CD c (p = 0 � m � O ZIF tb •� '' N KO C Y DSO p CD c r O � O 0 N 3 Iv = ••0 CD a 3 Z y .Z CD -" N 3 N �. CD -! fll _ (D CD v CD ElFCD 3 _ (o o � ° � p 3 CD � 3 0 o m CDCD n n y O Z 3 3 CD CD X CD 3 " m ti 6* CD 0 6 o ° ° Cl) m � 3 � �' `� o o a y � Q � m gcc> = n � m = (QCD� ° a � cc� m C CD cn 0- pDo r; � 3 c Q 0 = m CD � N NM CDor _ � y — Q , (o a mch (D CD N N a1 � m -n cn v, o 0 Z = � c ° N � y cn M D TI CD C CD CD r- p (a y m = = O ch (=D C CD CD CD m CDv m � cn cn Q o � D Q � Xo --a -0d_ LD. 3 CD ° (a D a y ? � to CD CA) CD� o (n a Vim = =r c = m rn o N N (p = p 0 3 K(p N 2 0 CD CDa o m m g ° v w ! mz0 o � � Ov _ v, � Q0 y CD 0 CD 0 � _0 a. Dpmv� m� o o CD CD _ -0 _ v D = ° .. � � 3 °. a v ° o mar_ (a n � m � 0CD3xCD CD 0) 0r- 3 CD Cr CD my � —0 � Q = CD o Co 0 Q -Z Cc y' TI � � O (D3 N CD y p _a F. TO 0 (D 7 = < (1) CD n = 3 O (D 7 d m SQ CD mm = � C o O QCD (a (D � Q Q (� cnD � o » : m Q - m nc� n Q C. v < (D m 3 0 1 -- 3 3 0 = °- CD 3 �, C w mm3 < 3 CD 0 = w = o c v =_ __ m g m ° 3 EK 0 y .Z � mD c � 0 = 0 0 0W CD .. _ ,« v 3 0 CD � 0� � CA0 -0 (DQ v °1 3 0 3 m ° � � �' p 0 CD � o 0.CD � C ° 3 N acr3 0 = mc 3 0 ° acn CD CL 0 m0 -• m Q v (° v0 XC jw a3 M. m z0 cc Qn ° N o -a r n. 0 n N CD '� c ° N O N ymv 0 ZwO ic3 `< - cl > CCDD -0 o O Q �. mmm c o -nN CD v, not _ (n � ? c 0 0 (ten CD v _ p CD CD :3 -1 ai s = 0 � � m 0 CD (pD v = M3 33 � � CD o v N v O CT v w N O O O N ' X � -I Xo D Xcp m D X02 � X IOU m � Xa y m -I Xo m X03 o 3 - ca3 3- o O — CJl m �+ n (Q Q O y n a y m CD m a CD 0 01 a'O CA ° 0 3• o O CD 3 y -{ 7 < of 3 >� m 0 m 0 � m a a CD 3 7 m CA �< 7 cc Cy a O O m 0 - -„ O cc m y C m Ca (n � a ca O 3 0 O p O 3 m S � m o _ < m 3 7 .. .. Vmi Q ° 0j O 0) N O j 0 - y m n .. C .D - ^• 3 a y 3 ? O p p m m N CD 7 ° m CD < y 3 - n0 � o ^' (�D O CD m w C= .. 0 ,. m .-y. 3 O CD m o O ° m m �- v ° m ' � � a °' °_ � a c�n'on3 m a �< ° CD � m ° Ox � G� m nm �' O tom ° W y 3 - +, O m ° o m N a (a (7 m to -i� 0 c a n m 3' O N '-3"- -• a y CT 3 c O- p "pd a. ° 3 = a O - m 3 to 3 �. m a in CD 01 01 m n 3 -0 (D 0 % O - CA m t0 OL :3C) m N M a 0 a (3N n 0 CD 0 0 01 CD 01 3 m 0 0 p _. � n cQ m �' O O -. CD 3 7 M m y a 3 m C7 m Q OL O C d y O � m M '3 TI O m m 0 - ° m m CD �. S O-"0 CSm�'. 3 ° O m + 7 Na 7 -• ya m O �_ O Q `G A _d Q'0 y O 0) CD (a N O m 7 N 3 CT - K - n 3 0) CAD y m p m 0 N m y M a �, y CD m p° 5 7 0 p C30D 41 CDD 3 v', 0 O O S y 0 Cmn y D O n j y, CA N Vl p -p CD y - LU p -O ° 3 =a ? II c CCDD 0 CCDD 0 cc N v m (mp n 3p j p3j m Cc C ' m a O � 3 ma 1 ? CL o 3c°i c o ° a,� o `< mmm 5' � 03- p ° c CD 0 00 m O fl. m p m O N W �� W c C .►-0 o o y � y m 3 Oc 3 CL c o- ' mom m _m•ZCD v m N o ° .. � °. � n � � y m r. � a o ° n m a m m O O n 0 -0 3 0 O C Co a y w 3 c Omv rn nao v CD �, cc n n N 0 3 (D �; O O �, a0 0 y < 0 o 0 cn a (a c 0 CD o 0 W 0 3 0 o to p o y ~' °—' w ai rn � 3 o CD Cp m C 3 y X c 3 3 °° m 3 . ja 3 - 3 -6 � °c o o 0 �. � cc f0 � v -ap m c"i i� 3m 3 0 y 3 n m C1 ,..' m m CD -0 ,--' y m m y C 0 7 c� `Z ai � cn C� :3 < nm C3� 0 3 �; O 3 C_ m w O 3 n � .-.� O a O m i (Q n _ n n 3 lA' p o � S X c C c m { O• mS' 3 om o — CD carom 3CDW vn i a v' (° :3 0 n � 3 � 3 m ° 3 Wy y o N O n m ^ C c m C s CD - -' _ _ -00 CD d � �. 3 Cy 3 � y Cn -p n d Cr 3 CD a) 01 `< m (a x - CD y CCD n :' 0 m n 3 CD- ° CD MC om =•� O (7 nNm =r 3 0 fl a"i N 0 CD 0 CD �° d CCDD n Cc (3n y ° _° m "• ? y Q 3 p CD 0 3 m N mD m Oy � � m —(DCD gotn CL WCD C 0 � CCDD CL .� CT Cu 3 o a � CT"0 0 3 3 =. ° O Cl. ° Ca C) m e N 0 m CD m a } CL y 0 Q T - y O CD m -0 3 CD .. m 3- CD (n m ° cN � yn c < C 3 m o- < 7C < (p 7CD y a 0 m CD ° (a cam• CL CL °� 3. 3 m Cl) o o m Cr CD .-« N 3 O m N^ CD 7 0 M Op �� O' o m O p 33 c3 c � O•o c. 3CD �; 00 U CD 0) y n < .. m .-. n � o o C o C m a� a m Q CD O m CD 3 O O 3 -'n cr N Crc m0 0- - 5. 0 CAj `< 60 m Q Qa X ° 01 m w < G c c 3 O o 0 - 3 0 O y " m �' 3 3 Co 3 a v O «Z O < m m 3.c CD 0) A O- � O (3� O 3 .a :3i CD0n my cv 1 a `< 3 Oj a CD 0 y C ° m fl < 3 m CD 0 0 3 a m m W m co m N 3 C C Y CD p 0 .< 3 0 CD n lz CCDD 3 (•3n n co o O 2 k / co 00 . q q § 2 0 q i \ * 0a — * E0 $ � m § A ¢2 02c q CD ek 0 CD C /o$n� \= 2\ D k m �� CO . ��2 0 ( 0 CD �Adm � � 0 ° J OD CD kCTk 2 / g2k cc � 0 � JE amp f % XSA C: \ 2 ] o CD c 0) 2 R CD- § ¢ � m kE-a ± 0 / 2\ m % % 8 CD 0 2 CD CO m 3 a 5 § CD CD / 0. \ / § 0f § q 2 § 2k qmg M � m % m 'Q k \ / � � / CD BCD � a cr co � w BCD / CD o K 7 ] T.2 Cc 7 " R f k CD N 7� 0 k k 0 a c c 0) 0 j7 Bg & o k / 77 O Z § Eq § � &CU CD g CDCD \ ƒ § E � ] 7� Ek R % « v / CD k § - % k Cr & ] m m ] L � ou o CD 5 � c � - 0 � n� c � cc / 0 : / ƒ a \ � . 22 kk CLk ] EE � ] / . ca m CD0 � -0 m ax § � # _ — & / / Q \ p \ mCD EC CD i 3 kE E » a MECHANICAL MOBILE HOME Footings'�� date by Ribbons e — by Gas Piping date by Fdi ' Wallsdate b Set UP e V>— �^O 2 INSULATION date by Insulation 1. Floors Final elate by date by date by FRAMING Walls FIRE DEPT. y date date PLUMBING S Q 3 ba 1 A c _ �'�� by OTHER by Groundwork date by date by D.W.V. WALLBOARD NAILING date by date by i Water Line FINAL INSPfCTIqN date by date v' G� ZR 03 by date by ,¢ -- ram, 03 3` 03 - a i,.� Dylp2 O 3 D4 !S 03 - D i S 94S cl ' 0 03 - I�iE " - RC : s scoI`S PERMIT NO.. BLD MA�'ON COUNTY -3F-3 BUILDING PERMIT APPLICATION 426 W.Cedar/P.O:Box 186,Shelton,WA 98684 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT FORMATI( q� 4 CONTRACTOR INFORMATION Owner r e w ) u 1,e Contractor Name O w N f2 Mailing Ad ress , v /O 95 Mailing Address City /14 ki State w Zip Code ? 52N City State Zip Code Phone Go -75 f3 `/G Other Ph. 3co 7yZ. 9-73$ lPh.(____)_OtherPh.( Lien/Title Holder �� ��r-r a&lfr s0- Contractor Reg. # Address y()G &r.kLAWod N �•rrlc W 04 9 "/w Expiration S�PTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System_�Name of Sewer System /1t o -r4 ec4- Well Water System Name of, Water System e P e a, e, PARCEL INFORMATION-12 digit Tax Parcel No. 'L 7219 / 0/ v o Fire Distri Legal Description 7 0. d .. d t/oc £ %fc G ros St Site Address(Please include street name, tr et numger and city) Z- iV o a s1 Directions to site + �Q ,C[f!l/!�N/ c ✓1 �R S r t!/f � d /o •L r r 6.r �4 t'k7 v c7a o✓� h � �� �< <.� Will timber be cut and sold in parcel preparation? (Yes/No) Gav Saltwater_ Is your property within 200' of the following: Body of Water Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENHO SEASONAL RESIDENCE❑ TYPE OF JOB New X Add Alt Repair Other Use of Building Describe Work < fo .-e. �i�/a— -- 4 AO No. of Bedrooms_'&_�No. of Bathrooms -z SQUARE FOOTAGE-1st Floor 2nd Floor_9 ft. 3rd Floor __Lofty t Basemen _ Deck_�Other lGaraq,e ,J68S; ttached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No hanges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date BZ•- X Date FOR OFFICIAL USE BEYOND THIS POINT /d Accepted by t Date ubmittal Amount Due �" Receipt No. i3E~P#RT �V :::W A.PPRQVEp p:t"NIt~Dsi C .NDI.Ti+ N CC7:t7S :' O Building De artm �," a rm rxs Slat Occ Grou (' is Mr fO l2 -D Planning Department Qr -��r��� Environmental Health Department 1 public Works Department i Fire Marshal i 4 Valuat n $ I a � 055. `5L�" FEES t Building Permit Fee 0 5jf EPHRaview ection Plan Review Fee _ 3.(o�f &q 3„ Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee �a Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES eou 65 PERMIT NO.: BL FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY 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 Seattle 206 464-6968 APPLICANT,. FORMATI" CONTRACTOR INFORMATION Owner r w Contractor Name U w N IE (L Ad ress . O r /v'7 Mailing Address Mailing City / ��y h State Iv Zip Code S'2 City State Zip Code Phone L•c 275 `/G Other Ph. ao 7N2 9730 Ph.( _ ) Other Ph.( Lien/Title Holde Ll-lei , 506� Contractor Reg. # Address . 1lOt's cr rkwi>>:( l St-Yr►ft it,, q 4 r Expiration I l SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System_>!(_Name of Sewer System lV O r'74 L-L Well Water System Name of Water System - ,-r PARCEL INFORMATION-12 digit Tax Parcel/�'o. 22 Z O -soj 007 Fire Dist ct Legal Description ...•cf S r N •r'f/rc E X G ws 5 �jpj Site Address(Please include street name, t et num er and city) ' Z o `% Directions to site 4'u H 3 'Ta yn r vi! e''� c9✓IL C&s. r 5 ` G d ¢ /o .� �r f,r fit_ txT 'c,'N d,1 Ha vI/Lll�► Will timber be cut and sold in parcel preparation? (Yes/No) MY Is your property within 200' of the following: Body of Water(Name) i1/d f7G, G a Saltwater _ Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE❑ TYPE OF JOB New >e Add Alt Repair Other Use of Building Describe Work c �� ��+^ �"'` ti (1 w W/lo No. of Bedrooms_;No. of Bathrooms Z SQUARE FOOTAGE-1st Floor42nd Floor 3rd Floor�Loft__K Basement__ Deck_�Other sq. ft. Garage ic9SJGAttached Detached Carport Attached Detached [Installer ILE HOME INFORMATION-Make Model Model Year ih Width Serial No. No. of Bedrooms No. of Bathrooms of Heat Purchase Price $ Replacement Unit ?(Yes/No) Name Certification No. 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'ar t a described property and structures for review and inspection of this project. Acknowled ment of such is by signature below: r 1 p P 1 9 OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTC-- -- FFIDAQqllsifl11har,!J° R r r gistered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating 1RArly(or�vhich his perms ued and all work conformance therewith. No han es shall be made without first obtainingshall be done in conformanc th a th.td anges shall be made without approval first obtaining approval. A X .S`— d� X , ' : Date Date L. L (—� FOR OFFICIAL USE BEYOND THIS POINT Accepted byA6114 114 Date ubmittal Amount Due Receipt No. .APPRC}uEA !)ENID CCQNDIT�+ N QCp . :> X. ; t Building Departm Occ Groupe Co str. Planning Department Environmental Health Departme tb Public Works Department Fire Marshal i Valuation $ j i FBuilding Permit Fee Site Inspection l eview Fee EH Review Fee Plumbing&Base Fee Planning Review Fee I Other Mechanical&Base Fee Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES dna-� PERMIT NO.: BL MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.a.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT FORMATION CONTRACTOR INFORMATION Owner Aj e, e IJI r Contractor Name 0 w 015 /Z Mailing Address 1 `� Mailing Address City f7 �1'�w� State v,-,,4 Zip Code 911�5 2 4 City State Zip Code Phone 7.&,J 2 7A Other Ph. !t v 7,1'i2 9`7?6 Ph.( Other Ph.( , Lien/Title Holder,#", 4/411,a 9—L L' Contractor Reg. # Address A °fOL <, c­­t RZA *=r%le W_7 102 Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System�_Name of Sewer System A!o � ,i, G��t Well Water System Name of Water System Reel,, *.Az PARCEL INFORMATION-12 digit Tax Parcel No. 4-X 7 Z '0 / 4�0 / f v o Fire Distri " 'r iA Legal Description pit r �� :1kN > ar.� Llll ,� era✓or E %f G �sf ST a" Site Address(Please include street name, street numt�er and city) Z rt1 — /o r i> w Directions to site k. ., Y / H (r+yr Will timber be cut and sold in parcel preparation? (Yes/No) ,Al Is your property within 200' of the following: Body of Water (Name) Cy+ Y Saltwater_y___ Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RES17ENCEO SEASONAL RESIDENCE❑ TYPE OF JOB New >e Add A/lt��, Repair Other Use of Building Describe Work ,�t 4 .c o rd �tu.M t e`l �'►v ` �'"' No. of Bedrooms—_S No. of Bathrooms 2 SQUARE FOOTAGE-1st Floor 2nd Floor <:Y 3rd Floor Loft , Basements DeckOther rig` sq. ft. ge Gara i2Q85FAttached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-[certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval., f first obtaining approval. X •�--�- Date - aZ X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date ubmittal Amount Due f,,,� ,�: r Receipt No. . D P RT Ell. W APPROVED Df"N1.1»D> C NDITI?f CQ:p S Building Departm t Occ GroupT e Co str. Planning Department AA Environmental Health Department Public Works Department I Fire Marshal Valuat! n $ IFEES 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 ( ) TOTAL FEES PERMIT NO.: •r, ii�[ ; 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 Seattle 206 464-6968 APPLICAN NFORMAT CONTRACTOR INFORMATION Owner a.-�v Contractor Name O c.v A � r- Mailing �dress_ a. ox O Mailing Address City State(tlq Zip Code !?V S2 V City State Zip Code Phone(-4GU )275asHG Other Ph.(3&0 )71YI Q73 S Ph.( Other Ph.( Lien/Title HolderAl,,,/nr-r /.s- „�lso.� Contractor Reg. # Address5`/46 ?1/a/ Sf-rr/e k/A ?OLo3 Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System_�G Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. 7-7-7-D / 'S o / / d 4' Fire District Legal Description o �l . 5 `' o o u .. a .� VoLc Et r ./' Slte Address(Please include street name st eet numb r and city) Z Z F .o Directions to site �, o f -f v c w s o S i r a ,'o,n / P o 0 C 6 Acc 14 z ✓ I aif IA Is your property within 200'of the following: Body of Water(Name) A10 r 7 ge-4 Saltwater x Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New-,,V,' Add Alt Repair Other Use of B ilding Location of Fixtures/Units 1st Floor 2nd Floor_ 2 Basement "Garage Closet _j��l PLUMBING FIXTURE;?(Show Number of each) IMECHANICAL UNITS Fuel Type: Electric e. Type of Fixture No.of Fixtures Fees LPG_ Natural Gas Heatpump Toilets Z Type of Unit No.of Units Fees ` Bathroom Sink 'L Furnace _ Bath Tubs 2 Heatpumps / Showers Spot Vent Fan Water Heater Propane Tank f Clothes Washer / Gas Outlets Kitchen Sinks / Wood/Gas/Pellet Stove Dishwasher �_ Kitchen Exhaust Hood Hosebibs Z- Dryer Vent / Othe r,cr`rr c,`i;ak / Other �— Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL K 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: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No cha es shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date S at- X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. AIR�VIwD......< I±CIE#}................................................. It1Dt71Cf #.Gb19.::::::::::::::::::::::::::::::::::::::::::::::. Building Department Occ Group Type Constr. Planning Department Other Other �F �ra7<` »::»::>y>>:<:»::>::>::> :::::>::i::>::::_ >::i>::>:<;v:i::»::r;:>::>::>::»::>:«<z<:isz:::;i:<:>:<:»::::<:i>::i :::: ?'>: ::>:':>::>>:::: XX .Permit Fee ::::::::::.:.:.:...:::.Site Insction : :.:::::::::::::::::;;:::::•;:•::•;:;:;•;:;•;:.;:;•::•;:;;•;:;•::.;:.;:.;:.;:.;::.;;;:<;;;•:;.;:.;:.;:.:;•::•;:•;:.;:.:.;: Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee 6 re-Paid at Submittal Violation Fee TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name ice e S PARCEL NUMBER /2 �2 �—ry%/Oi�7 Date S 07- SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line-� , , , <—adjacent property line I I r I r-3!0e '. O 4 I J hoa �k �S�I 7l� ©�, �c 141,10 I n fU lgsc-e I I n r6'I I I I I � I I � I I J J I I wa-ree--Brat �k Q, I_ - Q('V ' _w._7tr A..t - - I i"-, rcr adjacent property e� �L I E-adjacent property line SAMPLE SITE PLAN adjar'�nt property lined 3ic� _ E-adjacent property line I D 30' rR.SCRv0- SEASG%J AL CREJF v I c fi Mona a I � I Gaslw Hc�as� I j PriaP03L septic -�I R i• 1 1 I I VACAwT GARAr.6 o I I(� 3 PA.oPmelD R 7 Ad4ZAU.LTWiAL. SO I I I , I � I i00' I I � c.+..eLL._ I I I I A /00' adjacent property lined ; / E-adjacent properfV line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) y < SAMPLE TOPOGRAPHY PROFILE j r �CJa vjC 7� S►opm fic¢ dis+ancC. J�k *o s Signature Date 1R"'w '<n'9Wa_ o(°'9- l Mason County Permit Assistance Center Planning Intake Checklis Owners Name: V i F5 Date: O.8 d2 Project:_ 45 E��_ Reviewed B Commercial Development: YES rPFB- Planner: GBM RAM Comments: Site lan: orth Arrow 59erty Dimensions: /$b X ?J(j ®. and Driveways Shown. Road name: — - 11 Existing Structures shown with setbacks dew��, 9,--Well Location, Septic and Drain-field Shown with setbacks identify all surface water(streams,ponds, shoreline,wetlands etc.),lJooA —'l 9_-*�Topography(slopes) ❑ Proposed Struclure Setbacks (Direction/Setback):F: / A10 R: f�' l S 1: / 52:--3 ❑ Utility and Drainage Easements: Yes No (if yes enter condition#5022) ❑ Other Easements Shoreline and Planning Info 7 Setbacks: Shoreline: I� Slope: Shoreline Designation: Comprehensive Plan Rural Zoning ❑ Not Applicable Designation: ❑ RR 2.5 5 10 20 Urban ❑ Agricultural ❑ RIAF ❑ Rural ❑ Inholding ❑ RC 1 2 3 ❑ Conservancy ❑ LTCFL ❑ RI ❑ Natural ❑ Rural ❑ RNR ❑ Unknown ❑ RAC ❑ RT ❑ RCC-Hamlet ❑ MPR Urban Growth Area ❑ Unknown ❑ Unknown Water Body(type of water if unnamed): ` o tj SEPA: Yes Nc Unknown Flood Plain: YES e Unknown Map# 0 G Aquifer Recharge: YES RT Unknown Map Tags/Cases: �p RLC/SPI Case: S(� I ZGG Z —G CGS I 6-Year Dev. Moratorium: YES T Eagle Nest Tag: YES 1�JO Other YES 10 Addressing: Check box if needed Reviewed by: onlo 5-8 62 ❑ County Access Permit Needed(add condition#0010) ;)a S h0014.., 8` J, P ❑ State Access Permit Needed (add condition#0020) L Standard Conditions to be added to all Building permits that planning reviews: #0046, #4999, and# 5019 Revised:04/11/02 �w 00. k. _ f � OA t � � �`^may f9, Pt ts ����►���r''`� � Mee �� OVA C Ire .s w. ff F I } 'r 1yK 1 M i shp2oft-00051 oil II �