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BLD03-01302 Final SFR and Garage - BLD Permit / Conditions - 9/11/2003
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L) ca O Q m m a� oU OE y c p aci E cc amiZ °, L p yOp > Oc 0 _�. V = p O D O •La) 3yyYca 0o � � oc co CSC XQ a) � of Ca0 oU Va ca � N y m ,O C U) >. rn Co O a) m m U) O C vmi ` Q !n O 'D y p)" y � C y 0 +y- U `- �' m O m Cp Q. E !A C a) c Co C O a) m U O C O m Q. y U m m a) . y O a) + O = E S L O O O 0 O O co O U - U O O C L (a O O N C O O N a) - 7 O' C C CL— O..- U 'O O 7 U a) L O. Cl .0 a) U)) O_.0 'pp 7'U E M a) N O y CV)y O L — L L y — — ` m "� — C y a) a) Q cca � X min Q oX F- 35X Q QS � X Q cOa � X Q Fo .S H -0 a cCD h 0 o N M O C14 ce) cl) tD 1� a0 0 m Y 0 O 3 aT m � a� O c m io c ca a O =3 V8 0 0 a) � .0 0. ca 0) ov v m D o O L c 3 ca) `a o_ �, w 'E o 0 C C O 0 8 5 C cu O �y N 0) CD C •C I OI C CL 3 3 > Wca o -o Q o ono a> E O E .- C w 8 � N c 3 C c� •- o a N O_ 0 U) L C f0 � C .Q Ula) Z; C O U`o0o>c(QN 85 U' CDW Q Q -6 a O O a) o s fl E LLl N 4 L 0 0 H 0 O m s g39f . � l f CONCRETE ' 1►IIECHNICAL_ MANUFACTURED HOME Footings/Setbacks Date Z4; Byl� Ribbons Date t 7.. 23 0 By gL..:o Gas Piping Date By Foundation Walls Date B y Set-up Date. I -(o-Dy By rt"F(Z INSULATION . Date By B G / Slab Insulation Floors Final Date By Date ©(aCOZ By Date By FRAMING COµ,C> Walls FIRE DEPT Date B Date t)(010710q By KL8 Date B PLUMBING Attie OTHER Groundwork Date e.?7 Oq B y UM, Date By WALLBOARD NAILING D.W.V. Date &-I5`�Y -try j? Date 5-1 Oq By TTP FINAL INSPECTION Water Line Date B Date !j�-- 13-0 Bq r. Date B y 3Nspec aar �F�r aF+�l mlftkFw� g� CoMMEu • s i Z/10 a3 'ZI 11 F 56E 5 L L s RE- Fao�i t� o �� � RL5 SSE � 5 y t a 8 t� RatCt2 P?. e� 2. oc�s oa. �c FA-*LED 'q31 03 0'102, 0Vf � � CA* S+r-Antm 11 % RA01C. t4�"UAPF 'r,F 0 me 03 0 03E m JCq gs . P PASS c& 5l ulD � � W 1W U" Ptl 51201oq blUfOV RLS N AA9GUAW&L ' S �p ���, lam, its � wA�1 � RE-Rc c� °c o 0 for 4111-11.0 4S r�u� alma .. Ara 7/1 qAte AY F--I KIAL P l6 E (t W IiKgt�d, �. IqKkOl" &111 *9-5, &c-r PFkj Por CaqUA00 "FCORCRETE MECHANICAL MANUFACTURED HOME 0 ca Foatinas Set acks Date By Ribbons 0 W Date 12 � 03 By 1� Gas Piping Date By 0 ati N Foundon Walls Date B y Set-up Date ._6- l7 By /R INSULATION Date By B G I Slab Insulation Floors Final Date By Date By Date By FRAMING Walls FIRE DEPT Date =/.3 -oy By -,7—j Date By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILING D.W.V. Date By Date By 7" FINAL INSPECTION Water Line Date By Date =/3-oy By Date By ID s 2 ict os - 2 ZZo3 CD " ER. a Z Z:3 10-3G- 12, 3t o3 - bt 02 lo qt, .' c T SLS 0 0v -0,5 03 oy c S---/_3 �'f` - J=/i-o� ' ��$�S- cr��-O cS� �-�7� /� ram-+ ►�" 0 d o � o y o w � 0 N 0 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. R, PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 1'86, 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 j5r)'0 0,- 7- PP Contractor Name Awl Mailing Address A930 Nara La Sf 4 810to Mailing Address City Po rfQr",d State W 4 Zip Code -ggS&(r City j7de_ Stated Zip Code Phone (3W ) 8 - Other Ph. ( ) 41q-23 /x 1J Phone (jq;�) -6 3 ther Ph. ( ) Lien/Title Holder eo !d Contractor Reg. #jWAZ ;h Wy�_5xp. 02/1£/ e Email Address tandeheirt 0 mP, c6ni Email AddressJim SEPTIC/WATER SYSTEM I ORMATION -Connect to fy,�w Septici't a ExistingSeptich a-- Connect to Sewer System Name of Sewer System (�� (,( ' �' Well Water System Name of Water System ` Ll PARCEL INFORMATION - 12 di it Tax Parcel No. 12171T t1 0QQ/ / Fire District Legal Description -r S 'OF 5 /S' Site Address (Please include street name, stre t riumbe and ci ) Dir ctions19 site to I dr Will ti ber be ut and sol in parcel preparation? (Yes/No) WO Is property located within 200' of saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB- New Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(Ye No) Describe Work No. of Bedrooms No. of Bathrooms SQ ARE FOOTAGE- 1 st Floor 2nd Floor tj 3rd Floor Loft A- Basement j4,ig, Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Model Year Length Width Serial No. No. of tedrooms No. of athrooms fl— Type of Heat L4T� 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT-I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT- I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be m without first btaining approval. with. No changes shall be made without first obtaining approval. Dated r 3 X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by t Planning Pd Vcn— Ck# Date Bld Pd. 6 Reciept No. - '5 Building Department Occ Group Type Constr. Planning Department J Environmental Health Department S F P Public Works Department Fire Marshal Valuation$ MOIR "�' '",t �3 a. 3 �,I•^: �" � '3 * '�a �•? '. Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning ReviewFee Mechanical&Base Fee Other Md a,55 Ho ov Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) F 2 TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT NO.: PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton,WA 98584 Shelton(360)427-9670 Belfair(360)t75-4467 Elma(360)482-5269 APPLICANT INFORMATI N CONTRACTOR INF RMAZION Owner Contractor Name Mailipg A dre s� S Mailing Address Cit State j&A Zip Code W1966 City File. State' Zip Code Phone151 )U — Other Ph. 0 x1l Ph. Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration__CL2_/ / SEPTIC INFOR ATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 di it Tax Parcel No. / Fire District Legal Description S Site Address(Please include street name,streetnu ber and city) Directions to site n (p us a Ar. Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland 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 T_vDe of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump_1,!!!f Toilets woe of Unit No of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater I Propane Tank Clothes Washer Gas Outlets _ 0 Kitchen Sinks 1 Wood/Gas/Pellet Stove Dishwasher I Kitchen Exhaust Hood Hosebibs �_ Dryer Vent 1 Other UIJs q[ f 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 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-1 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 Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. R €E DENIF�3:::::::::.:...................................... 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 MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Bob 1'$6, Shelton, WA 98584 Shelton (360)427-9670 • Belfair(360) 275-4467 • Elma (360)482-5269 On the Web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner t a i T Contractor Name Mailing Address ��/-ru c �->: - t' � Mailing Address ; r- City x State iv, Zip Other Ph. Code w +` `' ,. / Phone CityS` r , -Statethe Zip Code Phone ( r°('. ) (. ) ( = �) `,�� r Ph. ( ) Lien/Title Holder s a , ,: S `< Contractor Reg. # ,,j:.,t t r-tFxp. Email Address art+ ,i4t: )L Email Address ,z t��� i SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic 4- Connect to Sewer System Yr Name of Sewer System Well Water System v Name of Water System F PARCEL INFORMATION - 12 digit Tax Parcel No. ` �/� -' / Fire District Legal Description Site Address (Please include street name, street number and city) F` t ;- Directions to site ht;'1/ . .. .. Will timber be out and sold in parcel preparation? (Yes/No) 1�' Is property located within 200' of saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB - New V Add Alt Repair Other Use of Building 2' il_,,% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(Yes/No)': Describe Work No. of Bedrooms No. of Bathrooms " SQUARE FOOTAGE- 1 st Floor ' '' " 2nd Floor ;7! 3rd Floor i ,#- Loft F,l Basement �,L Deck Other sq. ft. Garage L Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make fry_. Model /;6 . Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms i Type of Heat Purchase Price$ ,r `_ 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT-I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be made without first gbtaining approval. with. No changes shall be made without first obtaining approval. X Date f X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd n Ck# Date Bld Pd. - Reciept No. Building Department Occ Group Type Constr. Planning Department Environmental Health Department U l45 03 Public Works Department Fire Marshal Valuation$ t 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 g TOTAL FEES MASON COUNTY PERMIT NO.C�,� 'O BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 1'86, 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 INF RMATION Owner 15(t01 Ct/7 7-heema dar, Contractor Name Maili g Address 99W kkr` L4 SF 10(v Mailing Ac1dress City jo ri 607ard State WA Zip Code 9 &4 City / State Zip Code Phone (3(00 ) 871-20'%Z-Other Ph. (3f U) r"O ( Phone (155) 24-6 3 ther Ph. ( ) Lien/Title Holder c1�k ta"Id t � 0 /d Contractor Reg. #�QFALI N19Lgckxp. 03-/ IT/O Email Address f - Orh Email Address / SEPTIC/WATER SYSTEM 15FORMATION -Connect to ,w Septicl'1 6- Existing Septich A— Connect to Sewer System Nf Name of Sewer System ! I tf .4 Well Water System Name of Water System Norffi I PARCEL INFORMATION - 12 di it Tax Parcel No. �� ? 04� / Fire District Legal Description '7' 5&P,V .21 a�- ,t 1 S" Site Address Please include street name, street,numbe and ci /-o A Directions site %a U fV �7 Yd 4e V 1 C40` ) Will ti ber be ut and sold in parcel preparation? (Yes/No) O Is property located within 200' of saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 10 PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt Repair Other Use of Building Is this permit submittal the r suit of a Stop Work Notice,Correctiop Notice or other enforcement action?(Ye No) Describe Work ys No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE - 1st Floor 2nd Floor 3rd Floor Loft K 0- Basement��Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Model Year Length Width -Serial No. No. of gedrooms No. of athrooms G— Type of Heat en A Purchase Price$ Replacement Unit? (Yes/No) _ Installer Name 1 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT- I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shag be done in conformance there- shalrbe mpO without first btaining approval. with. No changes shall be made without first obtaining approval. Date -> X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd ,` l_" Ck# a Date Bld Pd. Reciept No. - Building a ment Occ GrouDe a Constr.V Planning D a ment jr Environmental Health Department Public Works Department Fire Marshal Valuation$ E x Building Permit Fee Site Inspection Plan Review Fee 1 �j$ EH Review Fee Plumbing&Base Fee %9•00 00 Planning Review Fee Mechanical&Base Feelg-4N5 '$!5 Other v,F 9 Wood/Gas/Pellet Stove Fee State Fee L Violation Fee Pre-Paid at Submittal ) TOTAL FEES PERMIT NO.: MASON ,COUNTY PLUMBING/MECHANICAlL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton,WA 98684 Shelton(360)427-9670 Belfair(360►�75-4467 Elma(360)482-5269 APPLICANT INFORMATI N CONTRACTOR INF RMATION Owner( / 'l �,- Contractor Name Mail' g Add re s Mailing Address Citi State Jd/R Zip Code City State)d/A Zip Code Phone(1W )V4-102Z Other Ph. O 426-2591gil Ph. Other Ph.( ) - Lien/Title Holder , Contractor Reg. # Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic 'Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 di it Tax Parcel No. 60412 / Fire District Legal Description Site Address(Please include street name,stree nu her and city) Directions to site Z Jlf � �Jr S op �_ t/ �( Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland 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. f Fi r Fees LPG Natural Gas Heatpump Z Toilets �De of Unit No. f nit Fees Bathroom Sink Furnace Bath Tubs _ Heatpumps + Showers �_ Spot Vent Fan Water Heater I Propane Tank Clothes Washer ---I Gas Outlets 13 Kitchen Sinks— .., 1 Wood/Gas/Pellet Stove 0— Dishwasher '`/ Dtcehen Exhaust Hood Hosebibs Dryer OtherJ� „gI ) 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 WOW 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. first obtaining approval. )( Date X Date i FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. .:...........:.....:.:::::::.....,........::::.:::::::.::::::::::::::::::::::::::.::::::::::..:..:.:.............::..:... ::::«:>::>::>_::>::>:<:::>::>::>::::ii—A ROVIwD::'::>::>:CTENIE#k:.::::.:::::::::::::::::::::::::.................. OOfttDi# fJEIAti�MEfHTAi..#iI"Vf Building Department Occ Grout) TVpe 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 MASON COUNT PERMIT NO. . A) b,v. BUILDING PERMIT APPLICATION f, 426 W. Cedar• P.O. Bolt 1T6, 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 r( i LI) ci l id Contractor Name Mailing Address A936 4c.1`1 41) St -e, J310& Mailing Address !- 1=� E r ?I,� City d State WA Zip Code sSLc it City (_,6: State l44 Zip Code !�y4�J(,,,( Phone(3'PC) ) b'7/- ij-Other Ph. ( & ) ��y 13 1 x !( Phone ( ) ther Ph. ( ) Lien/Title Holder k 1,n it ! jk,1 11. Contractor Reg. #4CA 11:jjIg,c Fxp. Email Address tixr1del7ar 1 , .C G wl Email Address. �.�. SEPTIC/WATER SYSTEM I ORMATION -Connect to New Septic Existing SepticrN e—' Connect to Sewer System Name of Sewer System f Well Water System Name of Water System 4r'` 1 PARCEL INFORMATION - 12 di it Tax Parcel No. .212171 O-041 / Fire District Legal Description '7- � -5& „ U r''N �s- Site Address (Please include street n me, stre t number and ci ) 4k Directions jo site Y t t atf Will tirAber be 4eut and sold in parcel preparation? (Yes/No) U Is property located within 200' of saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB- New V Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(YesfWo) Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE- 1st Floor — 2nd Floor aI .,� � 3rd Floor� Atta Loft_ Basement�1y_Deck Other sq. ft. � Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make A Ac.�Model h��� Model Year a Length kL T Width Serial No. Tf�,.� No. of Bedrooms No. of athrooms Type of Heat ,��&— Purchase Price$ _ Replacement Unit? (Yes/No) Installer Name Certification No. I NOTICE:THIS P'f7W 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT- I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be m without first 7btaining approval. with. No changes shall be made without first obtaining approval. Date = X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by -1, Planning Pd V 'Y `Ck# � Date t" � < Bld Pd. \ -- Reciept No. Building Department Occ Group Type Constr. Planning Department x ` Environmental Health Department Public Works Department Fire Marshal Valuation$ ; ,a n u Building Permit Fee Site Inspection Plan Review Fee EH Review Fee - -- y-- w--- 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.: MASON COUNTY PLUMBING/MECHANtCA'L PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton,WA 98584 Shelton(360)427-9670 Belfair(3601�75-4467 Elma(360)482-5269 APPLICANT INFORMATION CONTRACTOR INF,9RMATION Owner /,i,. 4,4-J �r & tb v � Contractor Name Cd Mailjng Address �f 3 Mailing Address Cit ram I ��R+. State 1,a4it Zip Code ' r'�1: City e Stated Zip Cod "_x j Phone( �,7L ,ZC Other Ph x ZI Ph.( --� ;al�� `'3 Sr1 Other Ph.(_� Lien/Title Holder Contractor Reg.#ter - !�t-gcA,4 Address Expiration - / SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System s PARCEL INFORMATION- 12 di it Tax Parcel No. / Fire District Legal Description �,. r ` Site Address(Please include street name,stree nu ber and city) Directions to site , E 4,k Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland 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 Tvoe of Fixture No.of Fixtures Fees LPG Natural.Gas Heatpump Toilets Type of Unit No..of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers _ Spot Vent Fan Water Heater T_ Propane Tank Clothes Washer Gas Outlets "3 Kitchen Sinks Wood/Gas/Pellet Stove , I Dishwasher '`"_` Kitchen Exhaust Hood f � � Hosebibs _ Dryer Vent i � � Other Other t Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL IL_ J A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. L : THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF RUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the tion provided is accurate and grants employees of Mason County access to the above described property and structures for review and ion of this project. Acknowledgment of such is by signature below: R AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a tor 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 ments 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 ance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without l. first obtaining approval. Date X Date F OFFICIAL USE BEYOND THIS POINT Accepted by ate Submittal Amount Due Receipt No. a r R_ -- 1000 E1!1T ..............:...::.. 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 1 F v Violation Fee TOTAL FEES II ' srgr MASON COUNTY �pN Fps c P A U N DEPARTMENT OF COMMUNITY DEVELOPMENT Planning Division o T = P O Box 279,Shelton,WA 98584 y�0 N Y pY (360)427-9670 J � 1864 NOTIFICATION OF INCOMPLETE APPLICATION October 08, 2003 ERIC HART 2930 MERI LANE SE #13106 PORT ORCHARD WA 98366 Parcel No.: 122297890061 Project Description: New SFR and Garage I I Dear Applicant: You have submitted a permi t application case no. BLD2003-01302)for proposed � construction or development in the county. Upon review of your application, I have determined that the contents of the application are incomplete or do not provide enough detail for review. Therefore, review of your application will not proceed until the necessary information is provided (see the comment section of this letter for details.) Once the information is submitted and the application is complete, I will continue to process your application accordingly. If the additional information is not provided to the County within 180 days of this request, the application shall expire and no further action on the proposed development shall take place. Please contact me at (360)427-9670, ext. 363 if you have questions. Sincerely, Diane M-Jones Land Use Planner Mason County Planning Department 1002003 1 of 2 BLD2003-01302 r • NOTIFICATION OF INCOMPLETE APPLICATION 10/8/2003 Case No.: BLD2003-01302 Comments: An unnamed stream is located along the eastern boundary of the subject property. The stream has been identified as a fish bearing stream. Per the Mason County Resource Ordinance Fish and Wildlife Chapter Section 17.01.110, the stream requires a 150 ft. Fish and Wildlife Conservation Area buffer and additional 15' building setback for a total of 165'. Please submit a revised site plan showing location of stream on the subject property and adjacent properties and setbacks from the Ordinary High Water Mark (OHWM) of the stream to the proposed building site. If you need assistance identifying the OHWM, buffer setback or building setback, please call the planning dept. at 360-427-9670 ext. 363. New residential construction is not permitted within a FWHCA or its buffer except as approved through a variance process. A Habitat ti Management Plan (HMP), prepared by a qualified biologist, would be required to support the variance request. The HMP addresses impacts to the buffer and offers measures to preserve and protect the buffer or mitigate impacts. A copy of the Fish and Wildlife Habitat Conservation Areas chapter is enclosed. It includes details on the contents of an HMP. It also contains information about the variance procedure. Application of a variance does not guarantee approval. i a i I 10/8/2003 2 of 2 BLD2003-01302 l a YYil111W11 _.. 1 M T S D-i m p j n�c� C1' j lee bY� G j \ { %S4, < tA P I � L jIV '� �aL .� C.M C7 10 o• ua m f :g- o l fb , c� '4 ` - N ,•� � Cat _ t1� / \ \�\\ \\\ ,67� P SL r .... p O cr, LO ' o ; a 1 - \ . 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