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Attie Date By Type: Date By Date By Ia wv DRYWALL Type- Int.Brace Wail Date By Date By Date By FINAL INSPECTION W water tine Firs Separation T r Doe By Date By Date �- —�� $y/ w IRD Pans or Request Inspect. c Type of Insp. Fail Date Date Done By Comments 00 a 8 0 i O -h I � ' i i i, i Permit No. MASON COUNTY 0 _ BUILDING PERMIT APPLICATION t�p 4? 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 v PLEASE PRINT �?'I Phone# 3 G - 3 7 7 6l 3 #1 Owner Ctn/F'f d t� Address HE 79I 7-, M,SIia, Fire District#( o;? 6� t M Q ov n St iv/4 Zip I Directions to Job Site 13 ar Cr-e,e k• Oe Wq7qo Jo T%y er /y1.ff%oi► 4/ to N. F. 741 Tier M!flion ew VOW,? XW a� le z`. over l�,'11 arovnc� / 9�° 7vrn F%rs - ZeFt orupedt or Le _ Owner Mailing Address 3071 ROCLy /0'1 X City fC"- St�Zip Lien/Title Holder SA rh E Address City Zip ✓G #2 Contractor Name Contr a0 eg Address piration Ld4 City St Zip �e# . #3 If septic is located on project site, include records. Connect to Septic?__X _Public Water Supply Well _ �•� Connect to Sewer System? Name of System ( (If residential, proof of potable water is required) # el No. 12 30S - S I - 0001 Legal Description Nowt Ns 7%fir,. �4Iti IZ�� p�'� Z , �ef 1 , ��C S , TUIdP ,UV w,?7 #5 Building Square Footage: (existing/proposed) 1st FI 7. SS 2nd FI / 11, 3rd FI / Loft / Basement / Deck / J68 #bedrooms / ,�. #bathrooms / 1 Garage /4 33/ Carport / (Circle:Attached or Detached?) Other sq.ft. / o/o rvfFree ke-Y&�fz, escribe work s #6 Use of building a s rU a� S f �G #7 Type of Job: New X Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION r Model Year Make Model Length Width Serial No. #Bedrooms # Bathrooms Type of Heat Purchase Price $ #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the site plan S Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways l/(/ Water Lines Shorelines Drainage Plan Topography Septic Systems Wells N Proposed Improvements Easements Indicate Directional b N, S, E, W Name of Flanking Street y ( ) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW propo.std Gara�P_ Fx;s�%J 1Jro;� ;e/� E,(; 1-t-L14go' S 72.93 79 , 2 100, zS- LAKE S 7 Mot, EMST 0 :.,.} ScQ le, : "_ 100' APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW -4zs. 64 �5 30' 40' 40 30, go J0' 72.93 122,66 FM sT 41q K� 403,s7 1s2 .0 i Fvlvre 2s Fv l vre Plumbing_Fixtures 6,8-etch) Fee Mechanical Fixtures 5� No. 2 Toilets 6 CIRCLE FUEL TYPE: Gas, lectric 10 Bath Basins Heatpump, Other S 'rel Coe Fans — zS Bath Tubs' 3 . Units Fees zs I Showers 3 — Furn BTU 2f Hot Water Htr 3 — Heatpumps z Laundry Washer _ S I000 'Al Vent Systems ,so 2- 2 500 W V� E s `l. Sinks 6 ~''_,_. Spot %Aa0_rtL � ZS T4,r-9oan w I Floor Drains 3 Boilers/Com rep ssors Laundry Basins 3 25 _ HP 3 - Dishwasher No.. Air Handling Units � , —Disposal — cfm# Urinals IQ. Fire Protection Systems F _Other _ _ Auto. Fire Alarm Sys 50.00 — Fixed Fire Supp. Sys 50.00 Permit Basic Fee Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $� Other 5Z,Zs — Gas Outlets l — Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- 14-915 MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 4*016 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY 36 MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT i 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, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDIN ARTjKNT. DEPARTMENT. X OWNER X BY DATE DATE IFICIa > aNL cey I�at rrrrrs�rr rr DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review Occupancy Group:_ Type of Const: �,' Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check 6(;. 7-6 Plumbing Fee Z Z S Mechanical Fee �a Wood/Gas/Pellet Stove �sf fits �S 1_�y7S Radon Monitor Sz-,,M+ ii20 t Sc)yckp Violation Fee �-ar /�/73 . 13 /s 62-9 cc Site Inspection y17CC� ��5r � L-Sa BUZZ n�r6 Building State Fee $b Other T,,,e _l,, ` qa7 Other Building Valuation: {S l( TOTAL FEE 933.�' i 08/18/2004 08:51 FAX 360 427 7798 MASON CO PERMIT CTR fa001 * s TX REPORT TRANSMISSION OK T%/RX NO 2030 CONNECTION TEL 9136027554153111991 CONNECTION ID ST. TIME 08%18 08:51 USAGE T ( 00'�4 PGS. SENT \ 2 RESULT OK MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Prooessing/Inspecdons/Addrewing Mason County Bldg.III 426 W.Cedar P.O.Box 188 Shelton,WAW504 (360) 427-9670 Belfair(360) 275-4467 Elma (360) 482-5269 Seattle (206)464-6968 Dear Mr.McGee Hcre is a list of the corrections from ycw last final inspection 5-5-01. When the corrections are made call Phyllis at 360-427-9670 ext.355 to schedule an inspection. The inspection fee will be$58 Thanks �✓ l Rich Balderston Permit Technition IL MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Processing/Inspections/Addressing Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shelton,WA 98584 (360) 427-9670 Belfair(360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 Dear Mr.McGee Here is a list of the corrections from your last final inspection 5-5-01. When the corrections are made call Phyllis at 360427-9670 ext.355 to schedule an inspection. The inspection fee will be$58 Thanks Rich Balderston Permit Technition MASON COUNTY DEPARTMENT OF HEALTH SERVICES Environmental Health Water Quality Pereona1 Health PO BOX 1666 SHELTON,WA 98584 LOCAL(360)427-9670 BELFAIR(360)275-4467&4468 Application for Determination of Adequacy . TOLL FREE 1-800-562-5628 SAX:%0)427-7798 Instructions a l uruplete P .1 ;Nv det xtunation� e mad.,uz1 l 1 f co pLted J 2 Complete anIy the parttor of Part; applmg ttz the type of water system .�cl. 3ibmit coppleted lvcati©n,w#h atlpp�epts to theheaitl�t1. etttft�Ptew.,�, f PART 1: Applicant/Parcel Identification Name of Applicant JA-IJ E� M C6 E-E Date 1 Mailing Address 3a-7 t' P+_ (�� . Telephone 37 7-G 13-7 Wo Assessor's Parcel Number / Z 3 0 S Tvpe of Water System Check One): Reason for Application Check One): ❑ Public/Community Water System(2 or more Building permit pl� onnections) ❑ Land use application,if so.. Individual water source(one connection),if so.. ❑ Division of land W Well #of Parcels? ❑ Spring/surface water SPH9 - ❑ Other(explain) ❑ Boundary line adjustment ❑ Other(explain) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated for adequacy: Public Water System Name of Water System Water Facility Inventory (WFI)Number: ❑ The water purveyor has filed a letter granting blanket hookups to this water system. ❑ 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. s water system is able and willing to pro;iZe water to this(these)connections without ex�cee 'ing the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date W_7 H.•IWDATAURCMIDWATERAD3.WP Update:October20,1995 / Individual Water Well Water well report(attach to application) Depths ft. t>r"' Well capacity test(attach to application) gpm gpd Well ca acity tests are often performed by the well driller at the time the well is constructed. Test results, rom these tests are noted on the water well report. Results from these tests will be accepted. If the water well report cannot be located by the applicant or if the water well report does not have a capacity test,a well capacity test,which provides stabilization of draw-down and recovery data, must be performed by a licensed contractor. Satisfactory bacteriological test(attach to application) Individual S rin /Sur ace Water ❑ WDOE permit(attach to application) ❑ Method of disinfection ❑ I have reason to believe that this water source can provide at least 800 gallons per day and/or provides water at a rate of 2 gallons per minute based on the following observations. AUTHOR OF STATEMENT DATE RELATIONSHIP TO APPLICANT In addition to providing the above statement, the applicant will need to arrange an on-site inspection by the health department prior to determination of adequacy. Departmental use only. Do not write below this line. `A 3: ea�th D*palrtx+ n valuafic► (Sta.. use Gl�' c ..:.SATISFACTORY:DETERffN�.TtC. Applicajnfi's water supply appears adequate to . nneet the needs of its:'an#ended use 7h1sde4ermirratran does nat address�clu�rc of the iftWhutaor ste z, guarantee an ade uate su o water nde nItei ante the tore, xr Qrant a co laance wrth ull atzplicable W1�aE water re.U."P regulations o U`NSATISFA.GTORY'DETER ANATION: Appltcan#'s wa#er supply dries no. appear adegui#e to z�;meet the needs of it.9...i.. ntended use for the fallowing reason(s . REVEWER'.S TONA`TUE DATE ' ` H.1WDATAIARCHIVEIWA7ERAD3.WP Update:October 20,1995 W s weir,-•co sue. a`�' �' M .: Z Oft..w I" � A C7 ttt tit r" rrt to tti W 7D -n -a T a 0 0-1 O -1 n O tv�) C _� wo s as r" _" '- > rtt > C Q s7 -rG t? •+t !" Z f¢ SW!! r > t� C9."a t'3 -rf > -•i >Ra op.. 4*4* c�a "'t "' � t�{ r i r m r aft tftr- O t!! 3C n W t �- •• . ••i 7c m r- 'v ff1 r > to r 1 '_: 0 > rrt -- i Z R? -+ W O 0 0 mot m .. 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I m tm I 1 O I IM .�.r ! oats I } CONCRETE MECHANICAL MOBILE HOME Foot'W-Seback date by Rbbons data 9— Z 7- C by 1`J Gas PON date by Fcrndadon Wags / date by Set Up dabs q— ;3-- / INSULATION date by BGaM Insulation Floors Final dab by date by date by FRAMING Wails FIRE DEPT. date by date by date by PLUMBING Attic OTHER GrounchNork date by date 9--5 -74, byL✓ D.W.V. 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(> v c � a v —brn CC fl fl C 0 -#O>"r 3 M)lb-4 CA A C •+ z =r©fie 0 aG ri cD c 20C m «t r, = m w a m > G M G M m a co a -�ca zib *� v e Building Permit# 3�� �-O8"?6 MAA COUNTY BUILDING 111 426 W. CEDAR SHELTOH, WASHINGTON 98584 (360) 427-9670 ,p � Job Location (Nr- Gar z5iAi 77C�- > This structure has been Inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been fo d: Items Listed below must be corrected to gain code compliance T� ' Of 46=22-�ac I 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 ;a OK to ❑ This is not a complete inspection Department Date Z i_ Inspector Building Permit# %Lb4j,Oftiv Q ,COUNTY' BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 Job Location 'i q I Ut -r i um Mi65i osl'7;,>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 z "T T T B L c r 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 --4-1-01(to ❑ This is not a complete inspection Depart... nt -btxuv►0 Date Inspector iA�7L] DO NOT VrE THIS TAG Building Permit# �'Z 6 MASON COUNTY BUILbING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 0 : -M, � ,wwTl N Job Location 87cG4C 7eYl 2'/G,ci3 This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been tnd: Items Listed below must be corrected to gain code compliance c /o f" " SEE ce- C d—cI- /�� T / DTI /nil' z + p Odc7`- r� 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 VOK to 0<--c �p7 ❑ This is not a complete inspection Department /3L,,O Date S'-cS -�/ Inspector 71/� DONOT III-TEWNFOCN&VE T',M&&P TAG ling Permit# 8'2-C MASON COUNTY i BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 0'ME, we""p-cm ,C b Location G 741/ 716M A' .49is91 r�,o is structure has been inspected by Mason County Building Department d the following VIOLATION of County Laws and Ordinances has been und'; Items Listed below must be corrected to gain code compliance Vol �- zlv7 I you are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH AN Y FURTHER WORK 0 Call for re-inspection when corrections are made before continuing Q Make corrections, items will be checked on next inspection OK to �`S (3 This is not a complete inspection Department 13CO-9 �ate Z_2 Z g-? Inspector -