Loading...
HomeMy WebLinkAboutBLD2009-00421 Final Addition - BLD Permit / Conditions - 2/6/2015 o c o o � O cn = � N m m ic C � 0 r 0 g cu o Z% -� G) AC n cu .0) -gy m D D m iU m � mmm0 r 0 CD ID� 3 o Zz nz c N A o Er �. 2 sm'9 CO) .0X. rm'9 m y O - { NN C- -� 0 O OD > U�to0 Or- z p Ovmr � D •< 0 K) O TO � 0 -6 O W O �I N Z PO D � 00a)) Z `O z r Comm — � Z -< C N �N dN D m< Cl) cn 0° o ° O m m a � m p m o o c ?o- W 0 n y N � o Nm � d (D ? ZO C C r O OD mo � N z oo o T ? Ny (AO O vCO) .i O cn o Q N -� N m m 030 m — -Ti r Z x ic -n 0 m � d z OO � o � -g0cno C`o O to m 3 � � O �, m Z - � r v° o o y o v p0 � 0 �? y nv T y0w A Z m g Wp C00N rn o• 3 �'' ' � Wco -a m r z mo O o MTMEKW w m m m n -n XDm CO) -U s 3 s n n v _ D m ip f0 t0 2 2 *u � ; N < dNNW -o N < < �� CO) o -� - ; N `° -n f m w m- Z m n `D -n � �, w r r cn m m m fD 0 3 a cn pz ca o N r co m m ul CA)� o N O0 N CO) � n Z m ; zmx ;u;u c) c) m `° m " ' zm � .c v v eo co * 0 OOOOMEM m (CD 0) N -Do -1m -I CO) co > o m A 2 e c N rn rn rn m2 0 N N N f� N N � � � m N O O O O O O N N N O S = 0 0 0 0 0 0 0 0 0 0 f0 f0 l0 <O. �0 �0 t00 t00 ' 0 D O ch �+ D ? o m --I m �c 0 69 69 69 69 (A v N 69 A O O O �,, 40 N N W OND N N A N � t(D C � (n cn m W " ' �4 00 <T O -I (7+ O O N .. O O � -� m m m v N 7 to 00000cn000 - O n r � f1) 00 N -h U)'fn'UP UP UP UP UP W U)'U) 7 O D O N'N'N'-�' ' O N'N'N'N'N'N Z G) O'O'c'O'O'O'o'O'O'O = NNN oK0 o'o'o:O'o'o'o'o'o'o 'O'O'O'O'O'O'O'O'O'O N Q N N O x 71 •O.O'O'0.0.O.O'O'O'o .�. N O O N o•o•o•o•o•o•o•o•o•o N q (0 co N N W 00 -1 CY) CJl 11 W N N O O CO o Xco� 3 -1 o D $ D X (p Oo � XO Xvo D X ;' -j0 o -a CD m < -a N 3 -, � .� 00 0 3 O !U Tt 3. o m < 0 n -0 N w N OCCDD � n<ic O to ? y w - off 3� 0 v O Z X O tmn � v0i cD CQ j j CD ;1.m o d m 0 ;� 6 � v m � - 3 Q �CCOO � Q D :3 -o Q ., p.v 00 CD o. 3 N n O p O N N .�► .N. CD m O < ? m < 3 °� 0 N � � w Z .+ CD = QSp CD N CL (SD N• O (n (D CT O Q o O X 0 7 Q CD �_ O 3 N n Q O :3 �< .. m Cn w -' m FA* -I X O Q C CD Sa N = 3 _0 @ w O Ill CD -O O N "O O CD ? w 3 CL w w CD to = O a !. l0 caa D c mv, �.o `n � O moo � � o ? ,_, r om -, a, On cn mvm CC (D 13 GO co O v v0, n O 3 5. n O _r`Z 7 33'- CD m n Co m c CD CD � 3 — ca CL w O .. .. 0 3 N XN s' o (D cn a �. �_ 3 OL n 0 o m n R :3 0) CD m:3CD — 0 a CD m bi CL vi m o 0 0 LL � '� ca v N :CD -3 � �. O O o o0 � - Q m .. rn �. 3cn z w � om � ° o � �D = � CD n u:lZ �• N w N m N 3 N 0 CL CD p CD :3 CD(n c CL 3 CD CDQ- O CL O O 0)6-0 -i — 3 cr < w -h0 S7 0. n n o (D C S.-D , a N cn O CD W O W Q °o a) a� -5-a c om �' (Do0 Gz 6m 5' o 0 - o Q CD 9 Q w c w Q m Z eo y � -% D N N v (D � 3 (ND N �• �(O � � f/1 bQm o CL < m 3 < Q - 0 -, 3 _ � 3a m 3 � .ANa g vi w � m m CA 3 � m v n �. CD :3 OC ?,o � N N w`< r+ o CD CD O c CnN (u — = 3 Co. j � F ov3 -a 3 - sU � m (D 0)0 a� 3 X o D. o Now � w ornm :3 ,Y 7. CD O ° CD, CT CD Q :30 ? oCD o mo 3c CD ? mom Cl) � o o c m 0 3 = 0 CL o d 0 Q CLQ CL m n r o w -0 rn may m 0 � � � ,. = o m o ° (D o w (o co (D n (DCD _ m 0) psc CL Q O Cn - . D CD .� 0 0) CDM 0' N S. 3n3 m o = 8 0m c C O Cw.3n-a n:=r Q m c < . w 3 �. 63 m m n. m 0 2` .� O = cn m w m Crw o w � w -lcs om � O � CL CL 0) CD Cl) o 3 $ w -0 SCD N ((DD N COO m0 m = n Q- CT F. 0 'o n O N C = O 0 m CD > > > �< N o ° n M. 3 � 3 mm -o 0 03 a m a ° O 3 3 _� CDw U) 0i -„ >3 CD CL O 3 O CD = iv oOD v 2- _ (D CD = 0 W v V m cn O V N " ... O O co o D X � ca0 Xo D X-0 a) D Xcn a)i -i X m n Xa) CD'0 XW3 -0 Xr- X m jX A 0 s m r Z 70 58 0 p' 0 0 0 m 7 vD CD i m 0 C �« (col CD mo v CO o ° � -I > > CO)� �, O ( non Co ao oC N CCD (a O C '� p C \� WCL U) _ (p 7 O (D O CD (� .Z�7cn O — N O Q_I O ;� C - n O W O -n ED .. cn r- = 0=, 00 N � � O N m O -I �O m p m 0 cn � O 111Z O .. N0 Q Nm O. m Rc) oQ rnZ mN0 ova, ° om p_ 0 � ° < � vm jai v � O'v � cnC o � m CD m av O 3 m O3 s � m m co wm O =r iv °co 0 m m 3 - 0 CD N a CD w o Z j O m`c cn m C v C 0 m C O �'i �. � O -+ n N N (n N. C (D N " .Z1 n pC 3 ° O o -� Qn ° m C@ 0 C. � m m On. o �_ � m m m CD c : CD z cn cn < cc N - 0 � m 0-0 3 = <.m a v 3 C cCo0 � CS CL C ,� v vo oZ m0 Cn c 0 v fl v, W °: r. � a � v o � � s0 D m C n C. m ° ° m c C � fA m m roc d = CD = C m O v m � Q C 3 y � � cn -n �, N W :3 � � d0 m o 0 N 3 N 0 CL ca — 0) m o NO N O N. N. n � o 'a0 o to Nm o � -a � � �' o � aC cr 0. 3 om w3cn < CO m �, � � cn w o -0 m cr m �' omo vm. vO QC C.� �c c mom p .< M C_ o 0n) v C -n CL ,� Om � o O 0 m 0 7 � N a O C '-^ � O cn p_ ^: CA =� D 0 N C. O O 3 K o O � m " 0 < 4 Q1 > > > W °' m C =r mCo _5 � � O n� 0 o tn0 yob ° m o' ocD 3 �, mm McnM N 0,� O > > ? gyms � �_ omo c < `- m cn co co C c ° m - cD � `�? 0 0 �, z n � `n -0 ( o a � m CL (D 3 � � � °c ° W < � � m O ac m D d v m n 0 m — -0 CD C O m W — o c. 3 v v v m � m Q � o o ;< X n° C m ° = N 0 y O C• " N 0 v (o Q. N G �ccn OD CL Cl) Cl) 9 O o (C o n O ,r- O at O 7 (n 7 (n(C V! N -9 0 < 7 Q p (� j O O 6 O = .nr n N ^ m y W Z CD S. m a -� Co N O m m m C s ` = Q n 0-► m 3 m m Q O O � �_ `m N o N_ x 05 3 O m 3 O N O W m0 7 m m o O m o C 0 CD _ m ° 0 m = C T m y z 3 ? a ° o CD C (Q o n .•� � v cn m m m & 2r T _I o X O N cn a m to W W m y n cr m 0 cn (D N N < p 3 C O O CLC. = m p• a C m N O Q C CL M CD CD N 7 n O O co @ o Z v � CL M o f(a CY-1 S %< -- m N Cl) � D G) o°' 0) 0) aaS Cr CD ON C, C .c p v co Q Cl) 0 d m * O m co' � � m m y 0— ? a � v o CD o � CL .« � C ^ 3 s cn C• -, 3 N A 0 n 00 c m 0 cn O N m < fl. m .��7 C n N N C N m )- 0 m X ,< ° m ,� om ° 03 N C' c s C CL 0 Cv D CD c C U' f« (D:3 v C m oan O 0 M o m m 3 -m O 0 v ca CD cn Cl) -0 q cn w w O > n C- m 3 N a cn 0 O _co � ° m 0 oc r 'oM vai C � m C o = `� p I2 =, Dp o c C crS2. o v (D � C- =' (no ° O a� �. C 0 C C. m .. cC O A W3 ° :E C :3 � m � cn Q v (n Q 0 p C. T O v � � a- N M m CO � co m �. (D m Co r0 54; 00y b 00 v o X g cr (a o X 3 ac X3-a X fl. a3 XDori 0 Xo o Xa X � $ D P D (D (D N a Q Q m 'a •+ 7 (D p N m a- N G) - O m 8 N CA O _: =_0 a Q � N m 7 O_ -0 c aR N a Q a N C (O O z (Dm < " N 0CA � oM Cc O � m � � � �zc_L " � � m a m -� N Q O •N 11) m X m N 8 a m -a p1 O � Q O (p 3 N. o m O O'� m N * a O 7 N N C CA > > < N m cn O p (D O CL O N a N 3 (D Q .+ S 0 CD 3j CD enN m m a c0 3 °' X Nm c cn m c a 7* O fu _► m N N 7 N O a V -' ` C 3 C a C 7 (D G1 N < o � oo CL O < n (D (O 'O .N. � a � aOm O N (D (D -► "o N a m .-r 0) CD � � O � � O - � O (a C O (D O to (D (D O- 'yf c a' C ,r N (D c N 3 -� 3 00 (D Q a N n+ j n Q S O N ^" Q (D O O (0 7 O N m =w �, 3 X c N � Q ; t0 a• N. O. S ch N - 0 a paj C m � m O N fA (D N D :3N co S a (D n (/! 7 N (/� m 07 'a N j' CD , D (mD CCD :3 L x c C Cn C N(D a .•. m 0) (D � a 7 cn 7 (DC D n 0 O NM Q < CO) om 0 m _ cr" 0) ma c- (n7R rj 0 @ 7 CD m 3 O O .� < co m m O Q m CL 0. o � v O C S� n�= am =r 3 O N m O flU 3 Q O DO m NS a MA �• oai a. COn 3 M O AO m m CD � > > a SCD Q �' ((DD � m a N (D ...� 3. N C m 3 (n 3 pj .+ Q w cr co CD m N y TI S „�� S S a m �' Ma, CL .. p c' m -o N N O N O 3 N•� CO m < -a 04 �' a) CD 8 �► � yo (D m -Ism � c > > 1< = 0 o a m 3 OA a -a (° (nD a � O (Oi► t1 ? ; C O .ar 7 O 7 ! 0 0 8 �' a W a (D .2 (Q (D p� C� No (�� m 3 c N O N O m O 'A-" O � � m Qo v, Q N o o as oz omO (US' 'nO 3 (n N 300 a n mo Q � No c*m a' c N O o 0 oo a — Ca (� � j CD CD M 0 S U' 3 m c0 o O v m = Sm sr > O> oM m c j �CL 3 a 3 m N c y (no. (A 0 W O m 'p °' CL m 0Co v � c � n ter' a -ti _ 0 CD 0 (cn D O (Do O c (n(a c 00 '— 3 .a o m CAO NCL 0 m a 'a N co � O (p -1 a n. N m my C 0 .-► � a Q Qv a' 3 N o- p S m m S 3 �. r•« N5D CD CD 3 AA (O N O X (OD ^� m O� as N pp .r a' S.�. 07 0 m N a m O @' O -Ow - S :3n 7 O N m O (D CL '* m h o 0 = X N X N p p AO -h 3 p > > (D m �< r. ? a �, w O c p Sm — S dim m .z < m (D svm o v m 3 -a m fin ' m 3 c So N o' � � Q o CONCRETE MECHANICAL MANUFACTURED HOME Date � By - IF,o Footings ISetbacks Gas Pipin� � Ribbons -n o Interior Date By Interior-Date By Date By Z N Exterior Date 1�- ©'OrfBy-r/y Exterior-Date By L Set-up INSULATION Point Load I Isolated Footings Date By '< BG I SLAB INSULATION - --.------- Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date By Date By Data By DECKS FRAMING Walls Date By Date /,17 2!9 By Data / 'e-7,4 By / 2 PROPANE TANKS PLUMBING vault . l Date By Date By w OTHER Groundwork Attic Type_ Date _� By Date By Date By DRYWALL O.W.V 2''L� Type: Date z� BY J Int Brace Wall Date By 100 ' V / y -0 Date a FINAL INSPECTION 0 Water Line Fire Separation N �O O Date By Dale By Datu By p m co Pass or Request Inspect. b ° Type of Insp. Fail Date Date Dane By Comments � T N 6 s G- v cc C7 Cn Air 8 -s'II a _ En I rr � G FAX WY 46-19U— w s de-?-Of /j, Z,oY 77/ / .�L` �, � �► ,� ry li sr � I,IpiL �� i✓� �� SS I Zq b' Z �i 1'� AIL 0 o CONCRETE MECHANICAL MANUFACTURED HOME o Footings /Setbacks Date By Ribbons -n co Gas Piping o Interior Date Qn By � Interior•Date By Date By Z 0 N Exterior Date 6-3�2�9' B f Exterior- Date By Set-up D Point Load 1 isolated Footings INSULATION Date By -< BG 1 SLAB INSULATION Date By Data By FIRE DEPARTMENT Foundation Walls Floors Date By Date By Data By DECKS FRAMING Walls Date By Date By Data By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Type. Date By Date By Date By D.w.v DRYWALL Type- Date Brace Wall pate By W DatQ By Date By FINAL INSPECTION y Water Line Fire Separation NC Date By Date By Date By O m � Pass or Request Inspect. c Type of Insp. Fail Date Date Done By Comments v a 8 a CD 0 CD m 9 0 h FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION - S 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 A I L4 n 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- Z-9 V a-&6 Z Company Name Mailin Add es � Mailing Address City '� tate_fsa=Zip Code City a Zip Code Phone o -, 9 . G122 Other Ph • o o i Phone Other Ph. Lien/Title Holder Z/ Wed Contractor Reg. Exp. E mail address ar 6 T Aid-< <� E Mail Address Drivers Lic. DOB a 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. o Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site 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 > 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 [a-SEASONAL ❑ Use of Building Describe Work No. of Bedrooms 2—No. of Bathrooms Footage- 1st Floor .33� 2nd Floor J3� 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. 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 permitlapplication 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 OFA PROGRESS INSP CTI N.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: Owner/Owners Repr ent ve/Contractor (indicate which one) OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department �IG200B-dO105-T�V 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 PERMIT NO. 'I� ��^0044Z, 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 APPLICANT INFORMATION CONTRACTOR INFORMATION . Owner 724 Company Name Mailing Addrecc 7D zyE 7-124l11EAGL_ H?7K ea- - Mailing Address City iAffh-41k State AAI--Zip Code d4-Z-e City State Zip Code- Phone.ILO Other Ph.36 0 00/ 722 Phone Other Ph. Lien/Title Holder elc5 i-=4'q4!ro Contractor Reg.#_ Exp. E mail address 1",'"6 a�ijL / Rer,-n4.'4. .Lo A- E Mail Address Drivers Lic. r 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. 022.3 yaZ 75`— oS-� 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- 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:ElectriG_ LPC 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 GINNER/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 NTINUATI W RK BY MEANS OF A PROGRESS INSPECTION. X Date: wner/efwners Repre enta ive/Contractor (indicate which one) FOR OFFICIAL USE BEYON THI P INT Accepted b Planning Pd Ck# Dat 2—to 101BId Pd Receipt No. DEPARTME&ITAL 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 FORM MUST BE COMPLETED IN INK MASON COUNTY PER NO/ / •���� PLEASE PRESS HARD BUILDING PERMIT APPLICATION �`l �i- r 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, 41 /F�-/f r Company Name Unifinn Add es /De GC 07X/ Rr Mailing Address City �� StateZip Code s"Z City Sta Zip Code- Aa�an Phone lea 372 1G�i2. Other Ph o o/ 7Z.Lj"'� Phone ` Other Ph. Lien/Title Holder 0—- o Contractor Reg.4C Exp. E mail address Q`' o A/ f T ) E Mail Address �'� �'`� � Drivers Lic. DOB -5/ 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. - `7 - Fire District Legal Description Site Address(Please include street name, street number and city) N,45F. T/ZL/%a=20- r, 7/Y 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 Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement, Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDEl E"FAISEASONAL ❑ Use of Building Describe Work . }. No. of Bedrooms —No. of Bathroom —Square Footage- 1st Floor 33A Qnd Floor 3� �c s 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Year Length Width Serial No. No. of Bed No. of Bathrooms Type of Heat Purchase Price$ Replace .,Unit? Yes/No Installer Name CertificatieFi, lo. 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 OFA PROGRESS INSPECTIQN.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X �,._- Date: -5111t wner/ wners Repre enta e/Contractor (indicate which one) FCI�OFFICIAL USE BEYOND THIS POINT Accepted by:,rdyxu✓ Date Mtn 101 DEPARTMENTAL REVIEW APPRAOX&D DENIED NOT Building Department `da LC Planning Department TV7 T Z60-1 Environmental Health Department Opl�•dOlUS•Tny Fire Marshal FEES Building Permit Fee . 7 Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee J q. Sa • Planning Review Fee Mechanical & Base fee Ito . S Other Wood/Gas/Pellet Stove Fee State Fee •' � Violation Fee Pre-Paid at Submittal Valuation $ 65, 0 tD . 6- TOTAL FEES PERMIT NO.��� 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 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner; 2)� Company Name Mailing ddregs-2 41,,F. Ti2W464L P/ZW ic-'i - Mailing Address City c&�'Mlk State Zip Code 12�ti ? City state Zip Code Phone 160 372-2412 Other Phone Other Ph. Lien/Title Holder we,,ee-S CE Contractor Reg.4 Exp. E mail add res L211"01-'!�--i i iY0 • E Mail Address Drivers Lic. Gr F DOB :Zc 'Y 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. ;:?,Z-30eZ Fire District Legal Description Site Address (Pleake include street name, street number and city) IQ ,4� 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 Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electriq_ LPC Natural Gas— Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink -- Furnace Bath Tubs Heatpumps Showers _ Spot Vent Fan Water Heater : . 115 opani�•Zank Clothes Washer Gas Outlet_ Kithen Sinks ` /Gasff3LE Stove / Dishwasher - ' then Exhaust Flood Hosebibs _ Dryer VeL�t Other �-- .S�thr �.. Base Fee Base Fee TOTAL PLUI1/IBI ! TOTAL MECHANICAL O VNER/BUILDER Acknowledges submission of inaccurate information may result ha st p work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or 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 NTINUA W RK, BY MEANS OF A PROGRESS INSPECTION. X Date: wner/ wners Repr enta ive/Contractor (indicate which one) �- FOR OFFICIAL USE BE ONPTHiq PPINT Accepted b4- LPlanning Pd Ck# Dat 2 O Bid Pd Receipt No. DEPARTME TAL REVIEW APPROVED DENIED NOTES Building Department Occ Grou T e Constr.- Planning Constr.— Planning Department Environmental Health Department FEES Plumbinq &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 MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION # r 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 A iW / 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- �f�r cy.G ;1 ri �`'�� ` Company Name Mailin Add es =%'7'�' ���� << 'r/L��o > � �J'�! Mailing Address City r 1— State I-Cy�Zip Code ( s? �' City Sta Zip Code Phone © j�- -1 y - Other Ph_.'k0 1 G� 'j'Z Zj Phone Other Ph. Lien/Title Holder Wit"//} i'�J� o Contractor Reg. Exp. E mail address ' ` r� Tir,+N�C . - E Mail Address Drivers Lic. v DOB -YC Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well A-` Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. _ 2-4 _ 7-Z _ '77 - eXF S Fire District Legal Description Site Address (Please include street name, street number and city) ry,E • 7;c t�ik=.1c �ii?/`r . 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 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 tr Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building Describe Work No. of Bedrooms 2— No. of Bathrooms___J Square Footage- 1 st Floor " L_> 2nd Floor �3 0 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make nneY Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certificatior '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 parry 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 OFAPROGRESS INS ECTIQN.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X / '�.�----- Date: Owner/Owners Repr ent ve/Contractor (indicate which one) R OFFICIAL USE BEYOND THIS POINT Accepted by: < c c t . Date �& 'NARTMENTAL REVIEW APPROVED DENIED NOTES i Department Oe artment L i ,-� "�• c'at:'�:� - '�eIHealthDepartment FEES Site Ins ection EH Review Fee Planninq Review Fee Other e State Fee Pre-Paid at Submittal TOTAL FEES FQ .YLMUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION t ° 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 5 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Mailing Address. -"` r/�'c, `i r �'- °"r .=' Mailing Address Ci r r rl t State i r,� - ZipCode 'f ' i.' -� City S a Zip Code Phone i ! - , �� - Other Ph e 4 ; .; r Phone Other Ph. Lien/Title Holder .. j Contractor Reg. Exp. 7" IC . `' c,c-., E Mail Address E mail address Drivers Lic.1.1 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. - = "' "%'`> "" t_: Fire District Legal Description Site Address(Please include street name, street number and city) ` �' 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 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 e— Alt Repair Other PRIMARY RESIDENCE 0 SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms j Square Footage- 1 st Floor 2nd Floor 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. 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 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 appl'�ca_ti n. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any otfie 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 OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: " �' "� �a t Owner/ wners Representa ve/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: ' - c... Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department / '> J Planning Department A 416 Environmental Health Departm nt Fire Marshal FEES Buildinq 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 L on Fee Pre-Paid at Submittal ion $ TOTAL FEES ZON COUNTY PROJECT SITE INFORMATION • Case No. PARCEL NUMBER SHOW THE FOLLOWING ON SITE PLAN Show Direction by Indicatfong N, S, E, W in relation to the site plan Lot Dimensions Fences r1 �sUng Structures Driveways Structure Setbacks Shorelines Water Lines Topography �- Well Location (including adjacent) Drainage Plan Names of streets Easements Names of Fronting Streets Septic System !� DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of ad scent ro ert line. adjacent property line-) Z yy L4 4-adjacent property tine Q � NVIRONWRTAL HEALTH RECErAD a,► ` �� ','AY 2 6 20M MASON C:OUNTI adjacent property line-> ].Ho � w+ ' E-adjacent provertv line I( I r MASON COUNTY DEPARTMENT OF HEALTH SERVICES May 28, 2009 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 JAY B GRIFFIN Elma (360)482-5269 270 NE TRUDEAU MTN RD BELFAIR WA 98528 Belfair (360)275 4467 Case No.: BLD2009-00421 Parcel No.:223027500050 Dear Applicant: Your building permit will not be approved by Mason County Public Health until the following items are completed and received in our office. Approved septic records. We did not locate a septic record drawing for you parcel. You { need to contact a licensed designer or engineer to create a record drawing of your septic system. Please call me at(360)427-9670, ext. 279 if you have any questions. Sincerely, f fy f l Amanda Reynolds Environmental Health Mason County Health Services Comments: 5/28/2009 1 of 1 BLD2009-00421