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C C IWA "k qm No aw IV in - • - — - - - - - - Ob a* -M GO is 's I sk M sk Is m Is a, z z M 0 0 m > m I a 0 < r o > W C#3 m tl7QZJ lQskCA (A 0 r, 0 w d r Sn W + 1 1 1 I m sic c (JI CO (a :0 PO 4 CM Isis cm 0 r- z m d0=1 1 Im 40 on ux m 19 z z CO) 40 sass ® -4 > 0 m 1010 V V V a w 0 CA — — w . . . . . . Cb -4 .ss Ms MZZ . 03 - - - - - 4w 4w X Is % % 0 top 40&V as dW as ra M mw b in max >m is 0 -4 a) X M -4 m m r r vz 4 co flo -00 -IV so-W Am z .-.cp art I. CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date by Fodndation Walls date by Set up date by INSULATION date by BG/SLAB Insulation Floors Final dew by date by date by dde by Walls FIRE DEPT. date by date by PLUMBM Gmundwork Attic OTHER date by date by D.W.V. 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Lu 410 4-0 CL # Y f Q =u a c© c +0 o '� .I.H• �� #� ,mow � — C / y y� /qwry� q/� rr UZ" 3 4J �c 41 > a a , ds ' to ZCL +^> a C -` ¢fix; <—X W jxx a +" • ih n f M4SOU COUNTY ' BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 r f Job Location �J In This structure has been inspected by Mason County Building Department and the following VIOLA11ON of County Laws and Ordinances has been found: Items lister below myst be corrected to gain code compliance V4- rA ejvk\MAee:rk PAR �- Y � I You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK O Call for re-inspection when corrections are made before continuing ake corrections, items will be checked on next inspection r]0K to Department - t> Lb Date Z-z Inspector N' 0, Tr "Mmo- ,Y , Pr1 Gj'ct,rr'•U�''" MASON COUNTY BUI�DING PERMIT APPLICAT 7 • 426 W.Ce&r/P.O. Box 186,Shelton,WA 98584 427-9670/1-800-562-5628-" PLEASE PRINT � � # Phone# �� #1 e Address Fir® District# City St zip 2 Directions to Job Site u- - >> W W ' Owner Mails Ad (ress •o?.S�lS S a T City L ti► St Zip Lienlritle Holder Address City St Zip #2 Contractor Name 12s���1 t^s 1 Contractor Reg# Address Expiration Date / / City St Zip Phone# #3 If septic is located on project site, include records. Connect to Septic? �/ Public Water Supply Well Connect to Sewer System? Name of System residents , proof of potable water is required) #4j(IfgalDeription No. a o� D-_ - i� sc ,,, 9�► #5 Building Square Footage: (existing/proposed) 1 st FI�20/ 2nd FI / 3rd FI Basement / DeckC) / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq.h• --- #6 Use of building Describe work 0 #7 Type of Job: New Add Alt_Repair Other Kv #8 MOBILE/MANUFACTURED HOM Nf- TION Model Year Make Model idth Se No. #Bedrooms #Bathrooms Type of Heat Purchase Price$ #9 Indicate by cir a applicable source if any water is on or adj"nt to subject property: River Po ree Stream Wetland Lake Marsh Saltwater! Seasonal Runoff Other 611 n A Lot Dime" f �' Af`l'Ibod Zones Existing 9trt)ctuies Fences Structure Setbacks' y Drive Water Lines �� .:3G Drainage Alan �..,..v� � opography Septic Systems Wells Proposed Improvements Easements_ Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE-PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures(S3 each) Fgg Mechanical-Fixtures ($6 each) r t No. CIRCLE FUEL TYPE: Gas, Electric, Toilets Bath Basins Heatpump, Other `Bath Tubs _ Units Fees Showers _ Furn BTU Hot Water Htr _ _ Heatpumps _Laundry Washer « - , _ Vent Systems Sinks Spot Vent Fans Floor _ Drains, JyQ Boilers/Compressors _Laundry Basins _ HP _ Dishwasher jam,, Air Handling Units _Disposal cfm# _Urinals N,, Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50•00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys. 2500 TOTAL PLUMBING $ Other Gas Outlets Wood,Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES'NULL AND-VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MIENCED WITHIN 180 DAY$OR 1F CONSTRUCTION OR Permit Basic Fee 18•0 WORK IS SUSPENDED OR.ABANDONED FOR A PERIOD TOTAL MECHANICAL 7 OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED.PRAOF OF COk1*6*6 01FAVORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE I CERTIFY THAT I AM A-CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, 04D AM AWARE OF THE MASON COUNTY AM AWARE OFTHEORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORKFOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK .GONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH.NO CHANGES SHALL:BE THEREWITH.NOCHANGES-SHALL BE MADE-WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDIN DEPART ENT. DEPARTMENT. X OWNER X BY DATE oC' DATE DEPARTMENTAL REVIEW F. -- FOR OFFICE USE ONLY Approved Coed. Hold Approval Planning: Environmental Health: Building Plan Review is a Occupancy Group: Type of Const:- -- Fire Marshal: Other: Special Conditions: FEES Building Permit —� Plan Check Plumbing Fee i Mechanical Fee 2� Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee 7 Other Other ` iding Valuation: TOTAL FEE ��.46 FT Pik A � a � a C rn C � ld 00.� 3 1360HS -` �� Lam.► �� Lam'-_ �..., . . t� NEW it►:f. a gi a� �.� I HUMWarm- _ aT.► '_� � I mil _/ IF A pill // _ g" W.�QWit ,►G!� i r V ,!I / M 1/ _ 4� / Date Checklist Prepared_ MASON COUNTY BUILDING DEPARTMENT PLAN REVI ENVER A,NL? tN§P TOR CHECKLIST ° 1991 WSEC AND V&IAQ C(S WCOMPLIANCE Permit Number qc' Address ' 1 S 64 Lao-CA 1� _ Sq.Ft.. N On Vermit .� � �ContractorlPfione# 1 U Cto : ri tav+e --(Option) ( Gomp.onent OSystems Analysis Date FOUNDATION ' Insp. Rev. ( ) ( ) slab:R- (ExL(=Wdim down to =/"boaoM or i"w 24-top cU&Ub&badmakt Radwt under emm) ( ) B +Pau exactor or wall ca:uiaciotx'� ( ver+l lation: (t sq.(4 UW50 sq.tt flow s=.anss vcss4 FRAMING ( J ( ) O Stat dwd O Intumediate ( ) Advanced ( ) ( ) W00dS(0r"AW10r t ept (6 sq.=ate.Ito.sk; are WM amt ez awe m favbw.) ( ) ( ) Stitttdard air yak ouw. • ..ri. o wY..�tra•�•e.P UNWA&.e=add=so 00*4004itiao { } ( ) Attic Ventilation(1 Jt-e.0e4su aq.t, 4*4 { ) O SpM [ans: (4-a t-adMoaftSodm,*M wG; urod.a ss wcL veot4 owwi*awpao t ) )Mesh air vilauoe. Qrl�eble *�ai aM'- ,. ._. *oonwr. I�aa�Nid �pedMioeaL t«oee.iG doea, t+w*,1 b as iai6b�ia Whole hom edhaast fora: din(1*a K srkm mwd&a"ammishow ka/w w e do Ls at.t wo INSULATION ( ) ( ) Attic"battles installed to deflect hwoming air tr Am looeefiN ar 6- t ) t ) Watt amt Obove*rade) R__►___.. t.a+ R I f ug -A-1��poS' ecLc�i-4 i e�'% O ) Watt n tbtitctt► Aka ha"4 wq �J ( ) ( ) Vapor l [s ca WX*#%*W aM,er,i4 p*w p.n.. .ia.,*&o r { ) ( ) Rita JOJK owMatd. «rear mstd c•eipia tomn and a vUW-w 4 w rdra ( ) ( ) Vatted cMft WmIation R• m in , FINAL ( `�' PtOdra� �� (Sob.arMit.aM�ouw+«doaauppatriesM�..«sa94-vc,wotbto�3� t ) V 10�u � 16 oPoc 1� .M,iM ilcds�l/>Mbib6aiwe.r`1t�+M��� l�ie ( ) L ,*dWft. " tkao+fa+t4#iMira► wr.•aNMae�saw+i�aa..'i>AMs3 . W464000410 ( 3 t? 11adnmp« �. ( ) (14 R416011 MOO*cia AC Wth bftU0aot&:No. t' ) ( 1W&MO tlty 0W"mpS5,7* "+i3:6 **41&Bub*bedwa eot.@e OOSOF a p i!I�r.. iM► ap�kaJ (. � Sad fad**., wa s ft000t&*.owos,ff4rd%1, ( � a � tlt� d 16.i w.l��pol�A�a».« •4� �'at joi�k, ate.�i.P�r b�ioa a.q ( ) { ) ggaiur WA and cope peal adow sedw to&70,4-pbal6 h,,spwa bws,Pratt wo�pholeR,w4 + J ( ) ( ) CetTntg balafio R- Qomkfte&W*W W *86.ee..brick to piewr<apilo�ir y+1s ( ( ) Vapor mtat'da paint if a vapor retarder was not installed when insulation was installe& i GLAZING , Pbn Reviewer-Fill out glaring�dtyiloa 'a�sd1e�1 1p #-+ e# t. 7 tQt- V fYwiwow infwnadon dwing field inspections. Include skylights,glass doors and all other glazing on this form. Use rough opening area far cakulaims. Date S'tae Ac+dt U-V Rev. Y-A EAvIlICS EG VIA i t 1, Todit glazing area: Percentage gia:dags Verified:---- DOORS El� �°a'bg� sf �oetiA�.Mea► U►.�*trtl ', YrdtlAt�► Serra et Sint Inspmctors Doft a Find Lmpection: ASON COUNTY DEPARTMENT OF HEALTH SEKVIC ES POST '' OFFICE BOX•1666 SHELTON, WA 98584 (206) 427-9670 APPLICATION FOR DETERMINATION OF ADEQUACY FAX 427-8425 Revised 09/01/92 INSTRUCTIONS 1. Complete Part 1. No determination can be made until Part 1 is fully completed. 2. complete only the portion of Part 2 applying to the type of water .s¢stem utilized. 3. Submit completed application, with attachments to the health department for review. - PART 1: APPLICANT/PARCEL IDENTIFICATION !1!plltlttlfltilttifflllilllilflttllftlrl111l111ittliill!!f!l111llllfllltltlNlf!lUftt18ti1lliflllflll!!lfill!ilflillllttllltitlltillllilltUltltlflllllllilllllililililltl NAME OF APPLICANT I OV y DATE MAILING ADDRESS . 2 g4 �h TELEPHONE oz - citsy attar lip ASSESSOR'S PARCEL NUMBER I QL 3 (�.k I'» t M .SUBDIVISION (If Applicable) LOT . • yya+Y.t;� TYPE OF WATER SYSTEM (Check One) REASON FOR APPLICATION (Check One) j 1__1 Public/community Water System Oa-Building Permit, Single Family Res:. Individual System, Drilled Well Building Permit, Commercial Individual System', Dug Well Building Permit, Replace/Remodel individual System, Spring _ Land Use Application r <r:. k f 0 individual N Sy Stem, Surface •- �� � j' ttJ+�i ue,:[,�u-'w+yy,',E<a,.•m9w;:. .k. .y1 .#�`',y„*•• r',``'1 t� 'T+§F' .7 .k%a irh' 1.Rh •'. ` �• 1 -.PART 4-A: PUB= WATER: SYSTZK =sue .. ... .i.w' --mnmrrrmfuruirrrf�uneaafrfrurr�uuuruuErr�fral�furruuauruuuuftfruu�umfr�uflururnruulffuaauaunnfuunwimrunufnnrnnu NAM OF WMMR SYSTEM WFI ID the waterPuTIM for this system has pwavlonazy ailed s oartificats of water adequacy with. .the health district. I as manager of the above relecenced water system. .as water system. has DGH approval for ""ice aowwatl=w, with connection pressau u ens: MG applicant has approval to connect to this water system. Service of eater to the applicant for domestic purposes is 0-0041etent with both the water system Plan and the water zSgbt permit Pertly is effeat. 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