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Date By Date By FINAL INSPECTION Water Line Date "5- .; -c' t By ! '� Date By Date B y Cn .................. C CD 0 /�-3�-a y— �� -2Y-o y ,��� ..•-�- pgr�r- i ca m CD co 0 0 0 o, 0 o Z E r t� r St N O c 3 0 o � � d $L Request To Revise An Approved Plan Permit Number: BLD200_,;�_- ()I L441 Name n, Parcel Number Phone Number daytime (__) Project Address Mailing Address Please provide a complete, detailed description of the proposed revisions to the approved PttEIVED Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No Are the approved site plans included? ❑ Yes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? ❑ Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No If Yes,Has the engineer or architect approved this revision? ❑ Yes ❑ No Is a stamped and signed approval included with this request? ❑ Yes ❑ No Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record.) Does the proposed revision modify the footprint or location of the structure? ❑ Yes ❑ No If Yes, Is a revised site plan,with all new setback dimensions included with this request? ❑ Yes ❑ No Additional Information: Applicant's signature Date: Office Use Only ,f Received by: Forward to departments indicated below: ArIK6yal Date Building 0,3'6'0`1 Original Valuation: $ Additional Valuation: $ Q' Planning 4 Sq.Ft. �)olcZ _x$ `i 3v $ Sq.Ft. t Co x$ y $ 1 Total New Valuation $ �a •. ; `3 C�7' EnvironmentalHealtlkS�-- ���`� o ❑ Public Works Additional Fees: Additional Planning Dept. $ New Setbacks: Front / Rear / Additional Plan Review $^ 3-3 Additional Building Permit $ El 4Z ?P Sidel / Side2 / Additional Plumbing $ Additional Mechanical $ Additional Conditions/Comments: Additional E.H.Dept. $ Other $ Total Amount Due: $ Amount To Be Paid Up-Front$ Tad F PERMIT NO.: BLD 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 INFORMATION CONTRACTOR INFORMATION Owner b/, ,., fir^, -f--- Contractor Name Mailing Address Mailing Address City State - Zip Code ' f City State Zip Code Phone( K?fr ­,VtiV . Other Ph.( 7,57-.7 Ph.( _� Other Ph.( Lien/Title Holder .f)f'o- Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic r"a Connect to Sewer System Name of Sewer System Well r' Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. .� " / ;:'-r / t"? Fire District Legal Description r Site Address Please Include street name, street number and city) Directions to site Ed' r f �tf Will timber be cut Rd sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water (Name) "$ur + E'' Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE 3 TYPE OF JOB New ,�K Add Alt Repair Other Use of Building Describe Work 3`1 k 2.F 3 <. 1 TA j• :4 fZu, � No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor g 1.v 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached x 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 changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X ".'�a t" ( s Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group La"I Type Constr. Planning Department Environmental Health Department RECEIVED Public Works Department Fire Marshal art EAIR OFFICE Valuation $ 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 ( ) TOTAL FEES THIS PARCEL INCLUDES PLANS, BLUEPRINTS OR OVERSIZE IMAGES LARGE FORMAT IMAGES HAVE BEEN STORED IN FILE CABINETS) UNDER PARCEL NUMBER PARCEL # kz 3 jc - s° - � ' 2`3 CASE # 8�� �? - � i � 4 SiT£ Pc.ryrJ (60 rw�r f a...+..tnu i.r,..«,.,_.p.,a.a .,•,wr ....w�.lxw.w-rx nn�,,,xyro�r.rt'Stw 4x arR.•zfnnniisci5A4%e+rv+vwy.•.%i.s.v.Y+46•.F'r+'w+++«„N+�F:.s...:n'Wti:,..wriv...w»m�rv.vM pvw.a e..✓.Kr.+.. w.�::w..xs.+e«,rt.w-.:.ue+:'.nwY+�._.wn,.,..;:+.Y. W-_-•. -��.,ur.,.r„e, `U yI, s i� IF E ! (b 47 all a co Ao f I C/) -,j J C (I G G r�..� W '...... ~ v y d O V O _ Mason County Permit Assistance Center RECEIVED Planning Intake Checklist WOV 13 2003 �2 2BEl.F�:IFc OFFICE Owners Name: yI Date: Project: f Reviewed By: Commercial velop YES Comments: Planner: SAL GBM DMJ RD V Sit Plan: -" North Arrow v l Property Dimensions: -` X , .0 6 Streets and Driveways Shown. Road name: �4u)tn �Ajki 1 U er'-All Existing Structures shown with setbacks } *''Well Location, Septic and Drain-field Shown with setbacks a-'Identify all surface water(streams,ponds, shoreline, wetlands, etc.) a"Topography(slopes) q,--Proposed Structure Setbacks (Direction/Setback): F: l l a�I2�R: I�L_l 17 e51: UJ / (,; S2: / �� tility and Drainage Easeme ts: Yes yes enter condition#5022) ther Easements °Us Z Shoreline and Planning Info Setbacks: Shoreline: O lope: / Shoreline Designation: Comprehensive Pl Rural Zonin El Not Applicable a-RR 2.5/5 ! 10 20 Urban ❑ In-holding ❑ RMF �/ ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy er'Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR ❑ Unkn own L , ❑ Unknown Water Body(type of water if unnamed): en 1 4� SEPA: Yes N Unknown Flood Plain: YES N Unknon Map# Aquifer Recharge: YES NO nkno Map# Tags/Cases: RLC/SPI Case: / L 6-Year Dev. Moratorium: YES Eagle Nest Tag: YES NO Other YES Addressing: Check box if needed Reviewed by: ❑ County Access Permit Needed(add condition#0010) ❑ State Access Permit Needed(add condition#0020) Standard Conditions to be added to all Building permits that planning reviews: #0046,#4999, and#5019 Re iud:7nt2007 MASON COUNTY PERMIT ASSISTANCE CENTER PLANS SUBMITTAL CHECKLIST Owners name: L V . Date P Reviewed by: Project: U Documents V Accurate site plan attached to each set of plans (road setback sideyards < 101 V 1 p--' Topography attached to each set of plans ) 6ReFgy-Code application(heat fuel type {41ediealiPlumbing application cpmplete(water heater fuel type&location: ) Gentractor-mgistration#OR ncovide written notice "Hiring a Contractor or Remodeler Engineering/design criteria,, snow load,80 mph wind/exp,seismic zone 3 (Scope? ) Construction tans: (3 sets)Plans legible ✓ Recognized scale Cross Section fevation Roof framing Deck framing� oundation plan Floor framing,all levels Floor plan(use of rooms) DEVIL: (Include wood species and grade,i.e. DF#2, HF#2, PT�etc-) S Roof framing detail (species,size, &spacing) � NOV t 3 2003 Wall framing detail(size,species, &spacing) '—� �p BeafiRg-wall ht exceeding 10 ft requires engineering �iELFAIR OFFICE 4ee,F beams(size,species, &spacing) Fkxwjoists (size,spacing,species) /l Header and beam (size &species for openings over 4 ft) Foundation (size,steel,anchoring) Concrete walls (Reinforcement detail, >8 ft requires engineering) Non-conventional framing (steel structures, foam core, log, etc. requires full engineering) Fire separation walls shown on plans Point loads identified, calculations provided if needed. Slab insulation shown Stairs/Handrails on stairs with more than 3 risers Guardrails on landings greater than 30" above grade Location of furnace identified on plan, where? Propane appliances in basement (3" screened floor drain to o/s,2 combustion vents) / Fireplace/Stove information shown ✓ Window sizes marked Covered porch detail (Use ICBO Chapter detail? ) Braced wall li ies dearly marked on plans (Within 8 ft of corner, n.t.e. 25 ft o.c.,table 23-IV C-1) ✓" Interior braced wall lines required for boxes greater than 34 ft Do plans meet UBC prescriptive braced wall line requirements? UNUSUAL SHAPES: Roof or floor extend more than 6 feet beyond brace wall line or ICBO detail. (2320.5.4.2) Openings greater than 12 feet or 50% of the least floor area. (2320.5.4.4) Braced wall lines do not meet in a perpendicular direction. (2320.5.4.6) Braced wall lines offset the vertical plane from the foundation (2xl2 NTE 48", 2x10 NTE 40% no offset in 2x8 or smaller) (2320.5.4.1) Floor and roof is laterally supported by braced wall lines on all edges (2326.5.4.4) The end of a braced wall panel extends more than 1 ft over an opening in the floor below (BWP may extend over an opening 8 ft or less in width when the header is 4xl2 or more, U.B.C. section 2320.5.4.3) ) Engineered documents (Engineering required/include _ Design criteria-snow load , wind 80 mph,exposure C, seismic zone 3 _ Engineered data transferred onto the plans Structural general notes&calculations, 2 sets (Specify scope of work, project location, design criteria, etc) Washington State licensed engineers or architect signature and eng.expiration date COMMENTS: