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BLD2006-00481 Final SFR - BLD Permit / Conditions - 4/30/2008
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B y T- Data PROPANE TANKS PLUMBING Vault Dade By Date By OTHER Groundwork Attic Date B Date By Type: y Date By MWav DRYWALL Type_ Int Brace Wall Date By W Date 7 L a2 BY Dots By FINAL INSPECTION Water Line Fire Separation B 3 i Date�_ "Q B Date By Date y. (� ID Pass or Request Inspect. c Type of Insp. Fail Date Date Done By Comments 4h .SF./'-r�' J y CD 0 8 -07 a fil/r¢Gt AV a ,�sv �� Ir 3-z 3-Z/�3 Tf `` y�4� / � ✓ 0 . 0 ilk FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. o �I PLEASE PRESS HARD BUILDING PERMIT APPLICATIO 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 �� 2 Shelton (360) 427-9670 • Belfair(360) 275-4467 • Elma (360) kUl On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR IN ORMATION OwnerGou 5 o rLoQc-4 L. LC, Company Name d140.vtcs X- Mail' Address 2 , Mailing Address O l.Eac-4-JQ City �'�Z 0-,j tate _Zip Code %5t 0 City State WA Zip Code 2 14 Phone "1'llfl Other Ph.36o-)1S01c4 10 Phone_:)-S3-9Z 633 0 Other Ph. Lien/Title Holder r 'i' ov 1 GAT Contractor Reg. # LEA I1+110tAQU Exp. L21-5 � E mail address EAS&IC41Z S C VArfto. ce E Mail Address Drivers Lic.# 1L 4 SOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System X Name of Water System p L),tk A Well Sewer System K Name of Sewer Syste S S'ir-A Tv a/4P-1 v AdD PARCEL INFORMATION - 12 Digit Parcel No. IlKiM7_ 00 Iq Fire District ? - Legal Description LOT l q '-tTC�-L LA\c-E ,M,pc Site Address(Please include street name, street number and city) 0141 tv 17-1- & Direction to site C Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff�_Stream Slopes or Bluff 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? e TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ET SEASONAL ❑ Use of Building S F2 nescribe�LVork No. of Bedrooms—,3 No. of Bathrooms Z Square Footage- 1st FlooLJ627 2nd Floor. '�Q"-' 3rd Floor 'a'" Basement 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 Certification No. — 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 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.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 OF RO ESS INSPECT .II ACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. Date: caner/Owners treientative/Contractor (indicate which one) FOR OF ICIAL USE YOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Plannin '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 MASON COUNTY PERMIT NO.6�� BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 a-- -266 Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 48 (_ On the web www.co.mason.wa.us APPLICANT IN ORAOATION CONTRACTOR INAORMATION E Owner LCCompany Name Maili AAN E ddress O L A4 V 5 , Mailing Add City RC 0AGZ7v^J to W.A' Zip C de _ City F0 -i �E State Zip Code y ' Phone b" _ QQther Ph.§bb-7L75ci 3 Phone ZS31' 9- '3© Other Ph. Lien/Title Holder C ST S0v 0a. GA Contractor Reg.# ZA rrT'� '1c Exp. E mail addres F��/ZtL°' 1�t 100 C o�M E Mail Address Drivers Lic.# 1 b t•1 k�. "� $ OB $ a5 6 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMAT49N - Connect to Ne Sep c Existing Septic Connect to Water System Name of Water System— Well— J� �� j Well Sewer System X Name of Sewer System C t)M PAU rwl nn PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description `ON" I`t 'rj�`�- 1-1Z- c-- _rt�' Site Address(Please include street name, street number and city) 1.- LA&LA a-O Direction to site 4. N P- co T-I-o K Q A 7 Will timber be cut and sold in parcel preparation?Yes/ o Is property within 200'of Saltwater Lake 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? ei/P TYPE OF JOB - New Add Alt Repair Other � PRIMARY RESIDENCE ff SEASONAL ❑ Use of Building s nescribefork � No. of Bedroom No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Flo or— Basement Deck Covered Deck Other Sq. ft. Garage y ` t ' Attached Detached Carport - Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. o. of Bedrooms No. of Bathrooms "'" Type of Heat Purchase Price$ Replacement Unit? Yes/ No Installer Name Certification No. - OWNER/BUILDER Acknowledges submission of inaccurate'mformation 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 t4e application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or i 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 &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 j MEANS rOF; R SS INSP CT I ACTIVITYOF THIS PERMIT APPLICATION OF 180 D YS WI L INVALIDATE THEAPPLICATION. Date: 2 016 caner/Owners pre entative/Contractor (indicate which one) FOR OF CIAL USE 46OND THIS POINT Accepted,by: -Y`t -v Date 1 ' DEPARTMENTAL REVIEW APPROVED DENIED NOTES fBuildingDepartment I Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fees- Site Inspection i Plan Review Fee EH Review Fee Plumbing & Base Fee — Planning Review Fee Mechanical & Base fee a5 Other Wood/Gas/ Pellet Stove Fee State Fee L Violation Fee Pre-Paid at Submittal Valuation $ o ' TOTAL FEES MASON COUNTY PERMIT N0. 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 I On the web www.co.mason.wa.us I APPLICA T IN OR ATION CONTRACTOR INFORMATION Owner ta 5 tS O n a 0 G-IA L. LC Company Name 141--A,-.�-'-11, tir Maili Address �- . �^"1 'S i Mailing Address k `� =R. City Eun =?^�u^� t e t"o' Zip C de- Cit t'r4 State '^/ Zip Code� 4 j { Phone Sb 0~ 157 - `� Other Ph.560 a75-:A14 10 Phone - ',10 Other Ph. j Lien/Title Holder_ `�"``' �''� 6 G, Contractor Reg. # CAS. `c-'�I p. 1 E mail addres I., �'f' "mot` " "= S 6 e. YA000 . t o'm E Mail Address Drivers Lic.# Z ik k"tL L4 $ OB 9 a S b Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMAT49N - Connect to Ne Sep�c Existing Septic j Connect to Water System Name of Water System ��� �— I Well Sewer System X Name of Sewer SystemtM IN u�1� ° ^'" '� � PARCEL INFORMATION - 12 D"gut Par el No. Fire District Legal Description L. OT -` L,R - T-<- -C4 Site Address(Please include street name, street number and city) 90 Ne LA A 8-1J C?R Direction to site 11 N 0 -F-' 3e/ 2 C(Z OF c orrc, If 44 0 O 7 0 Will timber be cut and sold in parcel preparation?Yes/ o Is property within 200'of Saltwater Lake 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? es/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ff SEASONAL ❑ ' Use of Building 7;C-- escribe-9ork PAC'^"' =- �— No. of Bedroom No. of Bathrooms Square Footage- 1st Floor 2nd Floor i 3rd Floor Basement Deck Covered Deck " Other ..... Sq. ft. Garage Attached Detached "'� Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length-"""'"" Width "" Serial No. o. of Bedrooms �— No. of Bathrooms Type of Heat Purchase Price$ ""'""" Replacement Unit? Yes/No { Installer Name Certification No. OWNER/BUILDER Acknowtedges 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 worts 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 parry in interest regarding this application or the work { proposed in hip, 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.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 OF RQGRESS INSPECTOR.I ACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WI L INVALIDATE THEAPPLICATION. < r Date: wner/Owners R,epre entative/Contractor (indicate which one) FOR OF CIAL USE 66OND THIS POINT Accepted by: " Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department s r �> Planning Department S la 06 f' Environmental Health Department �' I 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 I Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES a>t> r ` j� FORM MWT BE COMPLETED IN INK MASON COUNTY PERMIT NO.j� PLEASE PRESS HARD BOIL NG PERMIT APPLICATIO 426 W. Cedar•P.O. Box 186, Shelton, WA 98584 �C( �0 Shelton (360)427-9670 • Belfair(360) 275-4467 • Elma (360) k- 214 On the web www.co.mason.wa.us APPLICA T INFORMATION CONTRACTOR INEOR ATION Owner L V(,4 L L-C, Company Name ( wuc Maili Address 2 . Mailing Address l-E)c4V4 City 0"J Rtate WA.Zip Cod 95tO City State WA Zip Code 2 Phone t Other Ph. ba-a7Sg4 10 Phone 2S3-9Z -633 0 Other Ph. Lien/Title Holder T ou MAOXI' Contractor Reg.# IZ AL I Exp. E mail address 1_4 _q G e_ __ YAfto. cov4,LE Mail Address Drivers Lic.# 1L 44VJ6013 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic— Existing Septic Connect to Water System f Name of Water System p V Well Sewer SystertL�L_ Name of Sewer System S S'fV-A Tv 00st n PARCEL INFORMATION - 12 Digit Parcel Ni . Z Ono 1 GiFire District Z Legal Description LOT (q `M�-A_ LA,\Gt � Site Address(Please include street name, street number and city) Direction to site Z2 , Z& 120cyty goo/ avy xy!x�� Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater Lake 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? TYPE OF JOB- New Add Alt Repair Other PRIMARY RESIDENCE 0 SEASONAL ❑ UseofBuilding escribe�LVork No.of Bedrooms, ,-3 No. of Bathrooms Z. Square Footage- 1st Floor 2 2nd Floor 3rd Floor Basements^ Deck Covered Deck Other Sq. ft. Qarage� 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 revocation. Acknowledgement of such is by signature below. 1 declare that 1 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.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 g i'vwner F R ESS INSPECT .It ACTIVITY OF THIS PERMITAPPLICATION OF 180 DAlYS WILL INVALIDATE THEAPPLICATION. Date: /Owners treientative/Contractor (indicate which one) FOR OF ICIAL USE b&OND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Plannin De artment Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee 7 .C)CO Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES I i FORM MUST BE COMPLETED IN INK PERMIT NOQ �1 PLEASE PRESS HARD MASON COUNTY 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 I RMATION Owner. S AA DU" L C_ Company Name rrLLR.Aram=!r 40:!� Mailin ddress 3 0_7 IOL(A MPJS Q/l. 11 .1E Mailing Address 130 6 AL' rRk F--R- N City a1 tate t4A Zip Code e7aa t O - City tate Zip Code°I y��y Phone - 3 Other Ph360.L)S- qy 1 C Phone 3- 3 O Other Ph. Lien/Title Holder MA Contractor Reg. a L TTI a p. 4&S&A Email address Eio 12, L14,11400-c_" E Mail Address Drivers Lic.# L cJ- DOB Drivers Lic.# DOB SEPTIC INFORMATION - C ngct to New Septic Existing Septic Connect to Sewer System Name of Sewer System rid POS�A 006%144 y�1 c;.4c> -AA_ , PARCEL INFORMATION- 12 Digit Parcel No. m7ns7z 000111 Fire District Legal Description t -LO f-k VZ&-ee-Z V-'=- 2 Site Address (Please include street name, street number and city)— nl r L.A-.1X_ Directions to site �-�� ova 3a 2 2 e- V&C-0TTO 2- v- 0&/ cJAAR_M Ouu/V 400.1 U,-J rL.T-6-H- i Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff---,_Stream Slopes or Bluffs > 15% TYPE OF JOB - New_K 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 Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPC, Natural Gas_ Heat Pump_ Toilets Z Type of Unit No. of Units Fees Bathroom Sink 7- Furnace t Bath Tubs Z Heatpumps Showers Spot Vent Fan Water Heater = Propane Tank Clothes Washer I Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove -- Dishwasher Kitchen Exhaust Hood \ Hosebibs Dryer Vent t Other *— Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUL.DER 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 apcurate&nd grants employees of Mason County access to the above described property and structure for review and inspection. PROOF O ��Ohl OF W R Y MEANS OF A PROGRESS INSPECTION. Date: 'e ner/Owners Repr sent five/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grour)_Type Constr.- Planning 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 APPLICATWk,-"'-` - 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 IN ORMATION Owner U U L-�--0- Company Name ����--�`� ''��-t -- -"� Mailing ddress 3 0-7 C?L4 W1 P�JS 0/l - .k; Mailing Address �1 D g A«XA�+� � N j city��f�� tate 1AA Zip Code "f k—k 10 City 1 '"�'' tate W 4 Zip Code 02442 Phone 3 Lu 3-2 Other Ph360-;0S- 9y 1 0 Phone 3-- 2 63 O Other Ph. Lien/Title Holder_ a Mo A Contractor Reg. E mail address a S 4 (-to0. C"—M E Mail Address Drivers Lic.# SU C c1. /t DOB Drivers Lic.# DOB SEPTIC INFORMATION - C n Pc to New Septic Existing Septic Connect to Sewer System _ NamR of Sewer System fO R4S�=� 6 0 +� c)^�1 S`-kST� . PARCEL INFORMATION- 12 Digit Parcel No. Fire District Legal Description 1-- 1�t T Lr�= �A �L o.c Q Site Address (Please include street name, street number and city) !q O IV r L,*UAe f I 0 Directions to site i-r\) _ . C-'C n V -- 0 O LA cJ mt e-�1 0 LA�w U/ O N 111-1-6 4+ 1 Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 1 15% TYPE OF JOB - New-A Add Alt Repair Other Use of Building Location of Fixtures/Units - 1 st Floor _ 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 2. Type of Unit No.of Units Fees Bathroom Sink 2 Furnace Bath Tubs 2 Heatpumps �.. Showers Spot Vent Fan Water Heater = Propane Tank Clothes Washer I Gas Outlets _ Kithen Sinks � Wood/Gas/PelletStove Dishwasher Kitchen Exhaust Hood Hosebibs Z Dryer Vent t 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 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 O ONT ON OF WOR&SElY MEANS OF A PROGRESS INSPECTION. Date: Z !� wner/Owners Rep r sent five/Contractor (indicate which one) T7^ 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 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 I 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_ GnL_t, S �f n a UG- to L.--LC, Company Name"c. r l � .-.X..�J C. Mailing Address 3 6 G7 Mailing Address ( Q fl r= A ,' A.! City ► -vA r-r 4 tate LAVA Zip Code "t 10 City Mate WA Zip Code °t `4h�'U Phone 7,W 177- I !-::Other Phl 60 .1)S- 9y 10 Phone 3- 62 " 6330 Other Ph. Lien/Title Holder V4 L IT SJ U.4 ,Holz-�J A OIC Contractor Reg. tA L 1 2 ` 6bE� E mail address ! A- `c*"C.''` S7 qA d C'a C�1 E Mail Address Drivers Lic.# 'tZ G 9,41ALDOB Drivers Lic.# DOB SEPTIC INFORMATION - CTnpct to New Septic Existing Septic Connect to Sewer System"____'_&_ Name of Sewer System = 00V4 A" y�T ' ►`t S 7 PARCEL INFORMATION- 12 Digit Parcel No. Fire District Legal Description L-vi, I k-1 t-T z LA �C ; b'2 k r Site Address (Please include street name, street number and city) A\ f=_ L A,.4e_'1 0^_. Directions to site i2,' 04-' 13 --A 2 C 0i= t 0-rT QA 'S3► D^J c ft,2 g..11 410A,. fl LA,,"- 40u, U n1 (L--r(- F+ 'i Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% i TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1 st Floor_ 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Rumber of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:ElectriG_ LPG' Natural Gasp_ Heat Pump_ Toilets 71 Type of Unit No.of Units Fees Bathroom Sink Z Furnace Bath Tubs Z Heatpumps I Showers '^ Spot Vent Fan _ Water Heater = Propane Tank Clothes Washer I Gas Outlets Kithen Sinks Wood/Gas/PelletStove Dishwasher Kitchen Exhaust Hood Hosebibs 'L Dryer Vent I 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 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 ILLATION OF WOR Y MEANS OF A PROGRESS INSPECTION. Dater r� wner/Owners Reprasent tive/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 Grouo-Type Constr.- Planning 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 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-gs67 •Belfair((360)275-4467•Elma(360)482-5269 On the we www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR 1 ORMATION Owner t h S AA n 0 U" LL-L Company Name Pt -7^J e-. Mailin ddress '3 pS(7`7 d Lc4 wt P J S n Mailing Address V-6. City tote lily Zip Code �I I City �atae- - Zip Code gR�2y Phone - 3 Other PQ 60-;"c-- Ry 10 Phone �� O Other Ph. Lien/Title Holder Contractor Reg. . a �, E mail address S �O-cal E Mail Address Drivers Lic.# L cl- DOB Drivers'Lic.# DOB SEPTIC INFORMATION - Cq�n ct to New Septic Existing Septic Connect to Sewer System —< Name of Sewer System N�0 POSE 0004144 0",rI-n S`{S7_s" , PARCEL INFORMATION- 12 Digit Parcel No. 1774 n 5,5 2000144 Fire District Legal Description L-(9 T 41 V- ..-/t. e - Site Address(Please include street name, street number and city) �0 /V CC L IA.1.1 Directions to site c9V1=1 3 aA-2 —V&c0 A-elD, C9"70 c1KA_e_" 0tA.iw 4001 0n1 rLZ-6-"- t Is property within 200'of Saltwater Lake River/Creek Pond Wetland r Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New—K Add JAlt Repair Other Use of Building Location of Fixtures/Units- 1 st Floor 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 2 Type of Unit No.of Units Fees Bathroom Sink 'z Furnace I- Bath Tubs 2 Heatpumps %.. Showers Spot Vent Fan _ Water Heater = Propane Tank Clothes Washer 1 Gas Outlets v Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent t Other +-- Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUIDER Admowledges submission of inaccurate information may result in a stop work order or permit revocation.AdawMedgement 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 apeurate grants employees of Mason County access to the above described property and structure for review and inspection. PROOF O OF W R Y MEANS OF A PROGRESS INSPECTION. Date: ner/Owners Rep r sen tive/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department cc Grout)—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 Look Up a Contractor, Electrician or Plumber License Detail Pagel of 3 Topic Index Contact info Labor and Industries HOM S f t CWM a _.. �,� Tira km Me r Lic sing Find a Law or Rule= Get a Form or Publication Look Up a Contractor, Electrician or Plumber Printer.Friendly Version General/Specialty Contractor A business registered as a construction contractor with L&I to perform construction work within the scope Hof its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment Hof account and carry general liability insurance. i License Information License REALIH1984CN Licensee Name REALITY HOMES INC Licensee Type CONSTRUCTION CONTRACTOR UBI 602170782..V. re •fy W�cLk CQm.p- remium Status Ind. Ins. Account 0 Id Business Type CORPORATION Address 1 1308 ALEXANDER AVE E Address 2 City FIFE County PIERCE l State WA Zip 98424 Phone 2539266330 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 2/15/2002 Expiration Date 2/15/2008 Suspend Date Separation Date Parent Company Previous License SECURFn90L6 Next License 1 Associated I License https:Hfortress.wa.gov/lni/bbip/Detail.aspx?License=R EALIHI984CN 6/7/2006 ACCESS & GRADE WORKSHEET DATE:y d 6 ADDRESS INSPECTOR DRIVEWAY ACCESS , n Length: 5D' Width: Z Surface: Size of turn-around: Condition of shoulders: Vertica learance: f>r, need 12ost at end of driveway with reflective address numbers. GRADE,OF 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 (continue remarks on back) I __...�ilr ,. IWI r1Yf If VI WYIi .,..,. -_ .....■IIOlrll-II IYiI G _. FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATIQ 426 W. Cedar•P.O. Box 186, Shelton, WA 98584 �C( v Shelton (360)427-9670 • Belfair(360) 275-4467 • Elma (360I W- 2 On the web www.co.mason.wa.us APPLICA T INFORMATION CONTRACTOR INEOR ATION Owner 0 Fly t, L Company Name Maili Address 2 Mailing Address O l.Eacilr�JQ City V'`� tate�Zip Code %31 O City State WA Zip Code A- Phone Other Ph.3 60-77 S c4 41 O Phone 2S3-92 -b 33 0 Other Ph. Lien/Title Holder T 5ovA4 M 0XT _ Contractor Reg.# IILC-AL I IF 1°t&qCJJ Exp. E mail address Lw - o. Q E Mail Address Drivers Lic.# I 4 tj6OB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Water System _ X Name of Water System v Well Sewer System K Name of Sewer SystemS S7 Tv fv PARCEL INFORMATION -12 Di it Parcel Ni . Z 1 Fire District ? 9 P Legal Descri tion L o T 14 -1'Z&VWL L V P_ k Ac Site Address(Please include street name, street number and city) Direction§to site Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater Lake River/Creek and 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? e TYPE'OF JOB --New Add Alt Repair Other PRIMARY RESIDENCE Ey SEASONAL ❑ Use of Building SF DescribeZork No.of Bedroom No. of Bathrooms Z. Square Footage- 1st Flo 2 2nd Floor 3rd Floor '�'` Basement �—� Deck Covered Deck — Other Sq. ft. Oarage Attached Detached Carport Attached Detached MANUFACTURED �- D ME INFORMATION - Make Model Year _ H Len9 th 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 revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor.I further declare i and to do the work as proposed in the application. I declare that I have obtained the permission from all that I am entitled to receive this permit R, P PP 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.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 OFVROWESS INSPECT X I ACTIVITY OF THIS PERMIT APPLICATION OF 180 DRAYS WILL INVALIDATE THEAPPLICATION. Date: wner/Owners pre entative/Contractor (indicate which one) FOR OF ICIAL USE b1fYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning 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 State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES a I/1 OF AWLSON MIUCVTWV A -- , ca %w4cos , { - .,A P h -` II ' Z - • � � # R EVgoing -_ lbe----Mwuw Maio �c. auors� - - - h TAMA: "bW—W dh+•'a}:Sys 1' .. ._ •_ � � •��-'eyj� �-.,� '•":.F-.''-_fir y.} � K - �+.i=+.,#.,''�`+_-�if.�'�'�. 2 . .L'7 j I' b • I i �Now ATt-� (, 14 s sWf tt #4 � J -- �iJ iii{M a_� c a I toi u Im =a I J z f I' 1 t f MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT WSEC/VIAQ Compliance Application Owner: Telephone: Parcel#: o0 Type of project ( New Residence ( )Addition ( ) Remodel Total Sq. Ft. 1 Floor: 2" floor: Heated Basement: of heated area:: 2 - ---- Heating System Type: O Electric wall heater ectric Central Furnace O LPG Furnace O Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type: O Other:SDecifv Glazing O Prescriptive Option see reverse side circle one: 1 11 IV Percentage: Compliance Method O Component Performance , Chapter 5— Calculation worksheets required % Check one:: O Systems analysis, Chapter 4 Whole House Ventilation system O Whole House Ventilation using a Heat Ventilation using exhaust fans&window or wall fresh air Recovery Ventilation System (VIAQ 303.4.4) System vents (VIAQ 303.4.1) Check one O Whole House Ventilation Integrated O Whole House Ventilation using an inline with a Forced Air System (VIAQ 303.4.2) su I fan. VIAQ 303.4.3) Window & Door Schedule (If needed, attach an additional sheet) Total Manufacturer Room/location U-Factor Size Quantity Square Feet Windows: i 0( indows: Total Sq. ft. Doors: Doors: Total Sq. Ft Total window and door area Total window&door area /(divided by)total sq.ft of heated area = %of glazing TE ON i. S Cy d O,c'cG,Q �Fq TyFBU � o �9 c ;D � � N R F 2Z AAA. h I pow, tf n �a t a l cc CD ;par—Qr�pa lrwasig--^% CD .00 N ru CD ® i ` 0 �1 O - '"--`-...,.._....m... .._.._.......�,..�.. 3 1 o � , i i 1 I■ Mason County Permit Assistance Center Planning Intake Checklist Owners Name: �� fS bor,01Date: c�Z);Z4/0 Project: SIEEReviewed By: Commercial Develop ES Comments: Planner: GBM T CM SNG PBC Site Plan: &— North Arrow t"Property Dimensions: X 2- 0 Streets and Driveways Sho oad name: ° own with setbacks ° acks identify all surface water(streams,ponds, shoreline,wetlands, etc.) Q--fopography(slopes) /__- t6 (� B�roposed Structur Setbacks((Directioi et ack): F: /_� : , alS 1: W / S2: Ej u""'Utility and Drainage Easements: F No (if yes enter condition#5022) Other Easements e�Accessory Appurtenances r)6 i'\C,- 0--- r cc ss Permit Needed(add condition#0010) °--Sts**MT-ss Permit Needed(add condition#0020) Standard Conditions to be added to all Building permits that planning reviews:#5019 and#0700 Are there any iminiediment&that may restrict access to your site? (dogs/gates) Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: Not Applicable ❑ Agricultural 0 RR 2.5 5 10 20 0 Urban ❑ In-holding ❑ RW ❑ Rural ❑ LTCFL ❑ RC 1 2 3 . ❑ Conservancy 4 Rural ❑ RI ❑ Natural 0 RAC - ❑ RNR 0 Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR 0 Unknown 0 Unknown Water Body(type of water if unnamed): SEPA: Yes Unknown Flood Plain: YES NO nkno Map# Aquifer Recharge: YES NO nkno Map# i Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: YES ! Eagle Nest Tag: ' YES O Other YES NO �w 1 Addressing: Check box if needed ❑ Reviewed by: Revised: 11-01-2005 I:\PLANNING\PAC\PLANNING INTAKE p5! P' 02/27/2006 15:40 2 PAGE 03 MASON COUNTY A DEPARTMENT OF HEALTH SERVICES Eirubmw renter - �` p�,�,l�Nor PO BOX 18G8 SHELTON,WA W44 LOCAL.(380)427.070 BELFAIR(360)2754467 FAX(3ti0)427-7798 Application for Determination of Adequacy Instructions 1. Complete Part t. No determination can be made until Part 1 is A&-oompleied. z Complete only the portion of Part 2 applying to the type of water system utilised. 3. Submit completed applicallart,with attachments to the health degmrimient for revlaw. PART 1: ApplicantlParcel Identification Name of Applicant Date Mailing Address �1 Telephone Assessor's Parcel Number J 2,305 52. Cad TWe of Water Arsbw Check One): Reason for ApOicabon Check One): it PublidCommunity Water System C2 or am A Building permit cmnecdoesp- 0 Land use application,if so.. © Individual water source(one ca mcsm), o Division of land: if so.. Well #of Parcels? l3PH�� SpriVaurface water n Other(explain) o Boundary line adjustment **If you have more than one residence Ej Other(explain) connected to this well,cheek the Public bore PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated: Public Water arms of water systemi,5e r �r Water FacilitD,Inventory(NVFI) Number: Z?7 (write-none fior two party) The water purveyor has filed a letter granting blanket hookups to this water system. i>f I am the manegerofth' tersystem. The wow system has been a for services. There are pressn�yy connections in use. Thiswi corm n. iswater system is able arxlvm' ng�q� Phis(thes:it s) earoeeding the limits of the water system or any limas set by Signature of Water System Manager Date e2 0 via:txcenner 2W5