HomeMy WebLinkAboutBLD2006-00608 Cancelled SFR - BLD Permit / Conditions - 4/6/2006 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton,WA 98584
solo
RESIDENTIAL BUILDING PERMIT BLD2006-00608
OWNER: BRIAN NELSON
CONTRACTOR: LICENSE: EXP: RECEIVED: 4/14/20060 19/206
SITE ADDRESS: 102 NE LAKE DR TAHUYA EXPIRES: 1 ISSUED: 5// 9/200
PARCEL NUMBER: 223305000167
LEGAL DESCRIPTION: HAVEN LAKE TR 167
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR FROM BELFAIR OUT TH SHORE RD TO BELFAIR TAHUYA RD TO
TAHUYA BLACKSMIT R TO LAKE DR TO ADDRESS
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General Information Construction &Occupanc In r atio Square Footage Information
No.o Bedrooms: 2 Type o o tr. V
Type of Use: SF Insp.Area: No.of Bathrooms: 4 Occ. r up: Lot Size: Deck: 199
Type of Work: NEW Fire Dist.: 2 No.of Stories: 2 Occ. d: Building:1,936 Garage-Attached 392
Valuation: Building Height: St s: P Basement:885 cov porch 70
Manufactured Home Information §@tbacq Inf r ion Shoreline&Planning Information
Make: Length: Ft. nt: W 1 9 Ft. ine: 50.0 Ft. Water Body: HAVEN LAKE
Re 0. Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. (Side
ide 1 5.0 Shoreline Desig.: Urban
Year: Serial No.: 5.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures I'limechanical Fixtures FEES
Type Type Qty, Type By Date Amount Receipt
Hosebibs 3 Exhaust Hood 1 Plan Check Fee KS 4/17/2006 $1,009.94 S12006000
Kitchen Sink Fireplace 1 Planning Review Fee KS 4/17/2006 $155.00 512006000
Lavatories 5 Furnace<100K 1 Building Permit Fee TCS 4/17/2006 $1,553.75 S12006000
Showers 1 Gas Outlets 2 Building Permit Fee TCS 4/17/2006 $1,553.75 S120b6000
Water Closets (Toilets) 4 Ventilation Fan 6 EH Plan Review CEW 4/24/2006 $75.00 S12006000
Water Heaters 1 Propane Stove 1 Building State Fee DLC 4/26/2006 $4.50 S12bb6bbb
Bath Tubs 3 Dryer Vent 1 Plumbing Fee DLC 4/26/2006 $117.00 S12006000
Clothes Washer 1 Plumbing Base Fee DLC 4/26/2006 $20.00 512006000
Mechanical Fee DLC 4/26/2006 $191.45 S bb6b00
Mechanical Base Fee DLC 4/26/2006 $23.50 S12bb6000
ADJUST--Plan Check Fee DLC 4/26/2006 $3.64 S12006000
ADJUST--Building Permit Fee DLC 4/26/2006 $5.60 S12006000
Total $4,713.13
BLD2006-00608 Please referto the following pages for conditions of this permit. 1 of 5
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Bulding permit # b b p8' MASON COUNTY
- BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION
NOTICE
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This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliance
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You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection D
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❑ This is not a complete inspection Department Q
Date -Z t Z-!� I 6 -7 2 '4 3 Inspector A(2-c—
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Building Permit # 1Y (�D9� MASON COUNTY
• BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRE TION NOTICE
Job Location /D �-�
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliance
!N
q/ /�7 3
ri
� -4 1T�C�I�IGS �dt llr
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing
-flake corrections, items will be checked on next inspection
�?OK to y�, ,,r
❑ This is not a complete inspection Department
Date ,-'0 -7' 0-7 Inspector
moos NovT MO *V T 1, TAL
Case Activity Listings/1
8:56:4/2008 6AM6AM
Case#: BLD2006-00608
Assigned Done
Activity Description Date I Date 2 Date 3 Hold Disp To By Updated Updated By
131-DA010 Application Received 4/14/2006 4/14/2006 None DONE KS 4/14/2006 KS
BLDB200 Environmental Health Review 4/14/2006 4/24/2006 None DONE CEW 4/24/2006 CEW
br and plot maps match
BLDB210 Water Adequacy 4/14/2006 4/24/2006 None DONE CEW 4/24/2006 CEW
water adequacy waiver approved,see condition
BLDB120 WSEC Compliance Review 4/25/2006 None DONE DLC 4/25/2006 DLC
electric forced air option 4
BLDB130 Planning Review 4/14/2006 5/1/2006 None DONE CMM CMM 5/1/2006 CMM
Site visit 4/28/06. No issues.
BLDB110 Building Plan Review 4/14/2006 5/12/2006 None DONE DLC DLC 5/12/2006 DLC
I)Shear wall 4 references note 7. Did not locate note 7.
2)Bm 1 calcs 5-1/8x12,plans 3 I/8x 12
3)Bm 5 calcs 5-1/8x10-1/2,plans 3-1/8x10.5
4)Beam 8,3-2x10's. Requested info concerning lamination spec.
5)Nook/Master Bdrm area supported by 6x6 posts w24x12 ftg. requested that proposed posts and footings be be evaluated by archt. Called Zach on 427 to request.-do
Zach Adams,project manager for Archt will follow-up with addendum letter. do 425/2006
5/1 12006: Contacted Zach to inquires about requested information. He stated that he get to it right away.
Received addendum from Archt. Attached to plans
BLDA100 Approved for Issuance 5/12/2006 None DONE CMH 5/15/2006 CMH
05-15-2006-left message on recorder.
BLDB009 Fire Marshal Review 5/12/2006 None DONE CMH 5/12/2006 CMH
PER FIRE MARSHAL DENNY SKINNER: DRIVEWAY ACCESS LENGTH: 75 FEET. WIDTH: 12 FEET,SURFACE: H/P. NEEDS POST AT TEND OF DRIVEWAY WITH REFLECTIVE
ADDRESS NUMBERS. GRADE OF DRIVEWAY 12%. LOT INSIDE SMOKE MANAGEMENT ZONE,4 X 4 FIRES ONLY. NO ISSUES FOR FIRE/EMS.
Page 1 of 3 CawActivity.."
Case Activity Listing 8/1/2008
8:56:46AM
Case#: BI D2006-00608
Assigned Done
Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By
BLDA500 Issue Building Permit 5/19/2006 None DONE KS 5/19/2006 KS
BLDA540 Print Inspection Card 5/19/2006 None DONE KS 5/19/2006 KS
BLDB007 Plan Revisions Submitted 5/23/2006 None DLC 5/23/2006 PJO
Revised site plan-do
BLDB420 EH Review Revision 5/23/2006 5/23/2006 None DONE ADR 5/23/2006 ADR
Plot plans match
BLDB410 Planning Review Revision 5/23/2006 5/23/2006 None DONE CMH 5/23/2006 CMH
Revisions meet current regulations-applicant is moving structure back 20 feet further from shoreline.
BLDC110 Footing Inspection 6/6/2006 6/7/2006 None COND RLS 6/15/2006 KLW
EXT FOOTING COND PASS,OK TO PHOTO AND PROCEED FOR#6 GRADE 60 HOOK BAR 24"O.C.FOR 9'WALL AREA TO MEET PERSCRIPTIVE REQ BECAUSE OF SOIL
CLASSIFICATION
BLDC100 Inspection 6/6/2006 6/7/2006 None PASS RLS 6/15/2006 KLW
SETBACKS PASS
BLDC115 Foundation Wall Inspection 6/19/2006 6/21/2006 None PASS LAW 6/27/2006 KLW
BLDC120 Underground Plumbing 7/14/2006 7/17/2006 None PASS TFR 7/18/2006 KLW
BELOW GRADE DWV PASS,LEFT NOTE BE SURE TO CALL FOR B.G.INSULATION
BLDC110 Footing Inspection 7/25/2006 7/27/2006 None PASS LDK 8/1/2006 KLW
STEMWALL FOOTING(GARAGE EXT),HOLES FOR EPDXY AT INT FOOTING REBAR OK'D
Page 2 of 3 CaseActivity..rpt
8/1/2008
Case Activity Listing 8:56:46AM
Case #: BLD2006-00608
1�
Assigned Done
Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By
BLDC140 Framing/Plumbing/Mechanical 2/20/2007 2/26/2007 None DONE ARC KKK 2/26/2007 KKK
1. Inspection called for Re-Inspection for F.P.M. nothing is ready. No electrical,plumbing, mechanical. Not sure why inspection called for. Call office if you have questions on what needs to be done for
F.P.M.inspection.
BLDC100 Inspection 6/29/2007 7/2/2007 None PASS ARC 7/5/2007 MRB
NEW CONTRACTOR HE JUST WANTED TO MEET ON SITE TO GO OVER ITEMS HE HAD CONCERNS ABOUT
BLDC140 Framing/Plumbing/Mechanical 10/5/2007 10/9/2007 None FAIL MAU 10/11/2007 KDM
1)INSTALL SOLIC BLOCKING BETWEEN TRUSSES AT BEARING WALL IN FRONT WALL LIVING RM
2)EGRESS WINDOWS IN ALL BED RMS DO NOT MEET EGRESS VERTICAL SLIDERS THAT SIZE DO NOT OPEN HIGH ENOUGH MIN 24"AND MIN 20"WIDTH TO MEET CODE
3)FINISH STOVE PIPE ON GAS STOVE
**MAKE CORRECTIONS,ITEMS WILL BE CHECKED ON NEXT INSPECTION. **OKTO INSULATE**
BLDC100 Inspection 10/5/2007 10/9/2007 None PASS MAU 10/11/2007 KDM
BLDC145 Insulation Inspection 10/16/2007 10/18/2007 None PASS MAU 10/19/2007 KDM
BLDA540 Print Inspection Card 8/1/2008 None DONE KS 8/1/2008 KS
DUPLICATE CARD.8/01/08 KS
Page 3 of 3 Casewctivity..rpt
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT N —N CKJP ,(J�
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
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner C Company Name
Mailina Address Mailing Address
City State _Zip Code City State Zip Code
Phone-Agg- 7131c1 Other Ph. Vqo-?Qg-1 Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address —X c ell- 5r6 001 r.' E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic X Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORTo ION - 12 Digit Parcel No. a2 33 r�C''�197 Fire District Q
Legal Description �- 161' 1AQ1)rn WY- :rQNnyr, LrjA gSTRf
Site Address(Please include street name, street number and city)
Directions to site -F 2
�. Az>
Will timber be cut and sold in parcel preparatiorVIs property within 200'of Saltwater LRiver/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs>15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New _Add Alt Repair Other PRIMARY RESIDENCE J4 SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms—Square Footage- 1st Floor q33 2nd Floor y1
3rd Floor Basement q3_Deck 330 Covered Deck Other Sq. ft.
Garage 39 2 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 Certific
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a st r cation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representa iv , ctor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declar�►tt I obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in irStt rist e i his application or the work
proposed in the application, I have obtained permission from them to apply for this permit duct the work roposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants e#Au ;a�,��y t access to the above
described property and structure for review and inspection. This permit/application becomes null & voidVbdFlrlFldl-�rrfhorized 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 OFAPROG ESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION.
X Date: '41�,-,()lo
caner Owners Representative ontractor (indicate which one)
FOR OFFICIAL USE B THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
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
I
MASON COUNTY PERMIT N Al(
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 c/ ti , "Cl;3 Company Name
Mailing Address " " 'I " Mailing Address
City tate L)h Zip Code`s E� City State Zip Code
Phone 921' -73 I(A Other Ph. y4o-a-Ig t Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
Email address -T LlcteK yb q' goo Cory^ E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic X Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFOR TION - 12 Digit Parcel No. V2 Fire District—Q
Legal Description c y4A9195-99
Site Address(Please include street name street number and city) 0 _n1 r t,f
Directions to site -) r t2,_\'k'O\ < c :_1
Will timber be cut and sold in parcel preparation?Yes N
Is property within 200'of Saltwater Lake X -River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
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 J4 SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms_ No. of Bathrooms_VSquare Footage- 1st Floor 9 33 2nd Floor
3rd Floor Basement (72 3 Deck 330 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 permi
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal represent�tie, r,the�o a I rther declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that 1 have ob`�ained t fission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regardin tJp�iss,g��lication or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work�rdp6t►9tlJ 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 &1%, ( qn Vonstruction is
not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF TIIaO�I DP WORK IS BY
MEANS OFAPRO/GRE(SS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATIOP.
X ' .L: \, ^l try. 0 _____ , Date:
wn�Owners Representative/,Contractor (indicate which one)
FOR OFFICIAL US BE EYONDTHIS POII'T Accepted by: Date
DEPARTMENTAL REVIEW APPROVEb DENIED NOTES
Building Department S- 2 C,o
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee 'T re55 .35 Site Inspection
Plan Review Fee fc3 C--- /O 3.58 EH Review Fee
Plumbing & Base Fee ° *,90 Planning Review Fee
Mechanical & Base fee Ste? '-�' Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee /` (f—. Pre-Paid at Submittal
Valuation $ S. S� TOTAL FEES
rORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO�J
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
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner14 Company Name
Mailin,IA_ddress Mailing Address
City J X i nv-\ State.11 it Code City State Zip Code
Phone- Other Ph. 5/Qo- qgI Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address clotele- 5rb 001 w. E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic X Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORN�ATION - 12 Digit Parcel No. Fire District Q
Legal Description
Site Address(Please include street name, street number and cit ('
Directions to site -4
Will timber be cut and sold in parcel preparation?Ye o
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or BIuff�15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New,%�C_Add Alt Repair Other PRIMARY RESIDENCE J4 SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms- a? No. of Bathrooms—,_Square Footage- 1st Floor q33 2nd Floor
3rd Floor Basement-33—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 Certific
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a st tion.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal represen ctor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declar�}�t I obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in Xlr tt e� is application or the work
proposed in the application, I have obtained permission from them to apply for this permit duct the woposed. The owner or
agent on owners behalf, represents that the information provided is accurate and grants a l�� gjj access to the above
described property and structure for review and inspection.This permit/application becomes null&void onzed 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 OFAPROG SS INSPECTION.INACTIVITY OF THIS PERMITAPPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X9 Date: '�/ ��(a
caner Owners epresentative ontractor (indicate which one)
FOR OFFICIAL USE B THIS POINT Accepted by: Date
F
RTMENTAL REVIEW APPROVED DENIED NOTES
De artment
n Department
Environmental Health 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 I State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES
MASON COUNTY PERMIT NO:
BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner ,Nc'lS,C.?D �t :F 4r. -i y 6 L I, Company Name
Mailing Address Mailing Address
City State Zip Code City State Zip Code
Phone fLf S- -1=t`t Other Ph. J ^ I Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address �- ic, rt 'h "f +._?� °''` E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. . Fire District
Legal Description L o V 16'7
Site Address(Please include street name, street number and city) /0 1 tli ' L.nKC, t `tc u:lCi ��► `�:r S- �-
Directions to site
Will timber be cut and sold in parcel preparation?Yes,fNo_
Is property within 200'of Saltwater Lake 'je River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New_y,__Add Alt Repair Other PRIMARY RESIDENCE J4 SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms_ Square Footage- 1 st Floor 2.33 2nd Floor. /<//
3rd Floor Basement Deck _ 0 Covered Deck Other Sq. ft.
Garage a 1 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.. /No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revoca io
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or �oritr�ct�,�r1 L irther declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have t�allneeHH 1 ission from all
the necessary parties. If permission is required from any easement holder or any other party in interest y�g��iipg phis application the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct t Nd er or
agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access t 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 THEAPPLICATION.
X Date:
y
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department 7t l fl8
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
TOTAL FEES
Valuation $
ORIGINALDMUMENT MASON COUNTY PERMIT NO.'
NOTLZGIBLE 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 Company Name
Mailing Address Mailing Address
City State Zip Code City State Zip Code
Phone Other Ph. a Phone Other Ph.
Lien/Title Holder Contractor Reg.# Exp.
E mail address s E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. /4 7 Fire District
Legal Description t t -7
Site Address (Please include street name, street number and city) '" /I L I
Directions to site
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluff—sr%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New-,�L_Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor + 2nd Floor
3rd Floor Basement - Deck Covered Deck Other Sq. ft.
j 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,
re
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the =the'�Deli.4&'
mist/
Clare that I have obtainemissimall
' he a lication. I de
h work as proposed m t
permit and to dote PP
I� that I am entitled to receive this pe p P
the necessaryparties. If permission is required from any easement holder or any other party in interest regarding the ap�,,c�ti he work
proposed in te application, I have obtained permission from them to apply for this permit and conduct the work proposed. TtiIQ er or
above
agent on owners behalf, represents that the information provided is accurate and grants employees of Masor�CquQtyaccess to the
described property and structure for review and inspection.This permit/application becomes null&void if w i0€VrG/ n is
not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION O BY
MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
III X
Date:
Owner/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 Department U�
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee ?3
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
j TOTAL FEES
Valuation $
FORM MUST BE COMPLETED IN INK PERMIT NO.Zld 0100to - C"R
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
APPLICA T INFORMATION CONTRACTOR INFORMATION
Owner r ,`�r��G�n��1Z V��rQ� Company Name
Mailing Address zj�u Mailing Address
City Llnic n State Wf�_Zip Code 9S'is City State Zip Code
Phone'SqR- 93Ia Other Ph. a n.%qs 1 Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail add ress�0-rk3k �,�in E Mail Address
Drivers Lie.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic_ Existing Septic. Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. c-0; 27'k0S00n i to r7 Fire District
Legal Description
Site Address (Please include street name, street number and city
fictions to site
r
11s propert in 200'of Saltwater Lake .River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New X Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1 st Floor _ 2nd Floor Basement Gara a Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric-4 LPCo?,- Natural Gas_ Heat Pump_
Toilets T Type of Unit No. of Units Fees
Bathroom Sink S Furnace I
Bath Tubs 3 Heatpumps Pl
Showers = Spot Vent Fan 5
Water Heater Propane Tank I
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/PelletStove I
Dishwasher Kitchen Exhaust Hood
Hosebibs _ Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BULDER 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 WORK IS BY MEANS OF A PROGRESS INSPECTION.
X r sentativ Date: el-G jQP
O er/ ne wrs R Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Grour)-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
MASON COUNTY PERMIT NO.
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar-P.O.Box 186, Shelton,WA 98584
Shelton (360) 427-�670-Belfair(360)275-4467- Elma(360) 482-5269
n the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner `A\2At-n -'_4r- %,-% �n 1`Z 1.��(�� Company Name
Mailing Address`12" -F,-V �7,r) Mailing Address
City k t\k«.\ State'. .)f) Zip Code`�k„;`i� City State Zip Code
Phone cl ZA'3 Other Ph. !SG^,_24 .t Phone Other Ph.
Lien/Title Holder Contractor Reg.# Exp.
E mail address _ '\c, c\k r-\c3\ E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic— Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. J.� �D� own i r� r7 Fire District
Legal Description
Site Address (Please include street name, street number and city
rections to site'property in 200'of Saltwater Lake River/Creek Pond J
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New )< Add lol Alt Repair Other Use of Building
Location of Fixtures/Units- 1st For 2nd Floor--k—A— Basement_ 6 Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric 4 LPG-,2- Natural Gas— Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink —' -5 Furnace I
Bath Tubs v 3 Heatpumps Of
Showers I Spot Vent Fan vs, e..7
Water Heater Propane Tank
Clothes Washer Gas Outlets a
Kithen Sinks Wood/Gas/PelletStove I
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
i Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OVIINER/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
1 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 tOF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date:�n(o
( Owper L Owners Repreisentativ Contractor (indicate which one)
� FGR�OP�F`ICIALOSE BEYONDTHIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
j DEPARTMENTAL REVIEW APPROVED DENIED NOTES
I Building Department
fOcc Grou T e Constr.
I 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
MASON COUNTY PERMIT NO.
PLUM BING/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 'i, r Company Name
Mailing Address" = Mailing Address
City state Zip Code City Mate Zip Code
Phone ,`t Other Ph. i Phone Other Ph.
Lien/Title Holder Contractor Reg.ft Exp.
E mail address + c E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic--3(, Existing Septic. Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No ^ : .' Fire District
Legal Description /
Site Address (Please include street name, street number and city)'
Directions to site
Is property within 200'of Saltwater Lake �' River/Creek Pond
Wetland Seasonal Runoff-Stream-Slopes or Bluffs > 15%
TYPE OF JOB - New X Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1st Floors 2nd Floor 1� Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric,, LPG- Natural Gas_ Heat Pump_
Toilets 41 Type of Unit No.of Units Fees
Bathroom Sink n Furnace I
Bath Tubs .�', Heatpumps
Showers t Spot Vent Fan
Water Heater Propane Tank If
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/PelletStove I
Dishwasher Kitchen Exhaust Hood I
Hosebibs Dryer Vent 1
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 1 am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X a' Date: <f 4� n o
Owner/Owners 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 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 Company Name
Mailing Address Mailing Address
City State Zip Code City State Zip Code
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg.4 Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic. Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description -Site Address (Please include street name, street number and city)
Directions to site -
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New < Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1st Floors 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric, LPG Natural Gas Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/PelletStove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BULDER 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 WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: 01121GINtAL DOMMENT
Owner/Owners Representative/Contractor (indicate which one) NOT LEGIBLE
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group-Type Constr.
Planning Department
Environmental Health Department
FEES.
Plumbing & Base Fee Site Inspection
Mechanical &Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
Request To Revise An Approved Plan
Permit Number: BLD200 6 - on Name N on lyr/SQn
J
Parcel Number 2 Z 30 - s o _ M 16? Phone Number daytime(3jLO )
Project Address 1 og &,.c La kr Dr- Mailing Address?o k„c Sr,2_� )n ;on w/9
-ram -//90 a6s9
Please provide a complete,detailed description of the proposed revisions to the approved plans:
�1 1nl '�l�� odcZ..,S�,ti,c►, �'
' w r S
Are two sets of the revised plans or addendum indicating the changes included?C ❑ No
Are the approved site plans included? 4 :x z - ❑ No
Are the revisions clearly and accurately identified on the plans or addendum? ❑ 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 shuctural chances to a"designed"pan will be at roved without the written consent of the awfi w 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"QtMy Received
Date Sent Assigned To Approved By Date.
B. S Z Ongmal Valuation: s
Ptional Valuation: $
i P. 5 Sq.Ft. x$ $
Sq.Ft. x$ $
c5 otal New Valuation $
P.W. Additional Fees:
Additional Planning Dept.. $
Additional Plan Review $
New Setbacks: Front / Rear / Additional Building Permit $
Side1. / Side2 / Additional Plumbing $
Additional Conditions/Comments: Additional Mechanical $
Additional E.H.Dept. $ t�
Other $
Total Amount Due: $
Amount To Be Paid Up-Front$
ra rwr
PmbW srao 62MM
ACCESS & GRADE WORKSHEET DATE: 25 D(ry
ADDRESS
INSPECTOR Dleoov
DRIVEWAY CCESS
Length: r Width: 2 T Surface:
Size of turn-around:
Condition of shoulders:
Vertical clearance:
need 12ost at end of driveway with reflective address numbers.
GRADE,rOF DRIVEWAY_�� % OF ROAD
ROAD ACCESS
Length: Width: Surface:
Condition:
Vertical clearance:
( ) BURN PERMIT REQUIRED FOR LAND CLEARING FIRE.
LOT INSIDE SMZ, 4X4 FIRES ONLY.
( ) LOT INSIDE UGA, NO OUTDOOR BURNING PERMITTED.
LOT TOO SMALL FOR: BURN PERMITS _4X4 FIRES.
REMARKS L,
01
(continue remarks on back)
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Mason County Permit Assistance Center
Planning Intake Checklist
Owners Name: —i% �-�.C � Date: —6
Project: Reviewed By:
Commercial Developmen S NO Comments:
Planner: GBM TSC C PBC RDH
Sit Plan:
North Arrow
41-lProperty Dimensions: X_ 02 L
Streets and Driveways Shown.Road name: AuLe
❑ Adl-E - ng Structures shown with setbacks
e-'Well Location, Septic and Drain-field Shown with setbacks
identify all surface water(streams,ponds, shoreline,wetlands, etc.)
er- Topography(slopes)
Proposed Structurp Set (Dir tion/S tb4
F: �/ R: _/ 1: / S2:
Utility I Drainage Easements: Yes- N (if yes enter condition#5022)
Other Easements no Y&-
"KAccessory Appurtenances 040
County Access Permit Needed(add condition#0010)
A P ed(add condition#0020)
Stan nsdeadded to all Building permits that planning reviews:#5019 and#0700
Are there any impedipients that may restrict access to your site? (dogs/gates)
Shoreline and Planning Info
Setbacks: Shoreline: Slope:
Shoreline Designation: Comprehensive Plan: Rural Zonln
❑ Not Applicable 0 Agricultural 'V,RR 2.5& 10 20
-X Urban ❑ In-holding ❑ RMF
❑ Rural ❑ LTCFL 0 RC 1 2 3
❑ Conservancy Rural 0 RI
❑ Natural 9—RAC ❑ RNR
❑ Unknown ❑ RCC-Hamlet ❑ RT
❑ Urban.Growth Area ❑ MPR
❑ Unkn ❑ Unknown
Water Body(tM of water if unnamed):
SEPA: Yes Unknown
Flood Plain: YES O Unknown
Aquifer Recharge: YES NO nkno Map#
Tags/Cases: S-0J 0 05—0000�RLC/SPI Case: 6-Year Dev. Moratorium: YES NO
Eagle Nest Tag: YES NO Other YES NO
Addressing: Check box if needed ❑ Reviewed by:
Revised:11-01-2005 MPLANNINOPAOPLANNING INTAKE
lk
MASON COUNTY
JI
DEPARTMENT OF HEALTH SERVICES
Environmental Health . Personal Health
��l 7 •� PO BOX 1666 SHELTON,WA 9858
LOCAL(360)427-967
BELFAIR(360)275-446
Application for Determination of Adequacy FAX(360)427-779
Instructions
1. Colete Part 1: No d�te�tn as be made ttn !Piart 1Is ford ,
2. O'dimplete"only the portlm of P Ing tea of+ ttlitred.f
ttbmit�m leted
PART 1: A nt/Parcel Identification
Name of Applicant rl� r/ o h Date y`l` -0 6
Mailing Address U►)iovl wA Telephone 360 - Fr9 W-1319
g$S��
Assessor's Parcel Number a�o� 3 Q Yo6D /K`7
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 ❑ 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) Number:
(write "none"for two party)
❑ I am the manager of this water system. The water system has been approved for services.
There are presently connections)in use. This will be the connection.
❑ I 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
H.- WELDWEBPAGEIWEB SITEIWATERAD4.D0C Update:April 2006