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BLD2005-01105 Final Remodel and Addition - BLD Permit / Conditions - 12/20/2005
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O CD = CD 3 3 o �$ y 3 CD nl< CC X w CD o O -O CA = 8`< v � COD n O O 0 — N p C1 O � O 3 _te — 3 .' g ' BCD CD ' N CD CD y CD 3 - N a' CD _ n 0 3 -., Xw O O MECHANICAL MOBILE HOME Fft* -Shcbadc date by Ribbons ' by Gas Pkft date by Fae dation Wang date by Set UP date by loon INSULATION date Flom Fkw by date by NO date FIRE DEPT. by date by date by PLUMBING OTHER Gruix�dworkby Attic date by D.W.V. WALLBOARD NAILING by date by star Line FINAL INSPECTION e by date by date by D�r-r l Z /�'�✓- Z- -os- TAW F(y�� � _ . to o CONCRETE MECHANICAL MANUFACTURED HOME 10'0„ Fw�kh s!9�r ka Oats Z`?'0'1-ey `��(L Ribbons o Data -/i?—T-'By Gawplpiry e-X - mate By CA Founaaatlo�nWalk � /�?" ,23� By ? ±gip Date . g-,C By �—l2 INSULATION C By SG 1 Slab las►epitlon Floor* FINAL I NSPECTION Date By i I( Z I 65, By ts,¢G. Daft By FRAMING Walls FIRE DEPARTMENT D*eg qe-as— BY Tom_ DOW tt t 16457By 4�,-V-XL Dole By PLUMBING AM Oats ' /,,1 / By OTHER 6r�atwarlr _. _ By WALLBOARD NAILING Date f/-e'ge— By 71 OWN Date t i'2,a5 By 4VZG r i s FINAL I I PECTION [�Mg ►a z7 OSBy BY Date By s Type of Insp. Pass Fail Request Date Inspect. Date Dime By Comments CD 0 ry�CA-- �✓�j �f�G oro r. 0 /zz-tidy r��✓ r �p 8 �G py `r/"/ l o ONO CL /r C7f b J-G ,�,C� v`—_ f Z� �S/JUi.: Cr . iT�� ©,r` T /% __ '�� CD i o cep R ZZ ram' 1pl;- DF,P L&* a Fxf Ur- A5ulallw F� �' -16 FMA t&-- k s� FA-1� �r JILo �+�tcl� -kkA 10 o3 b- 10 h3 ty- /9 C S &-r a2 1 h "V u log4r0 rt P4,55 e.4 16 12 8 �s f�l��b� '��'G CS C C R r7 '� FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. CS PLEASE PRESS HARD 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 On the web www.co.mason.wa.us APPLICA IN ORMATIO CONTRACTOR INFORMATION Owner +LIM Company Name � Mailin Ad ress Mailin Address City tate (1 Code C' r, �State�Zip CodeletPhone Other Ph.;22 3/TQ Phone Other Ph. Lien/Title Holder I/_ d(= 1s72J CA Contractor Reg. Exp. E mail address E Mail Address Drivers Lic.# OB -L Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic 'x Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORYAIIgONel 12 DiOit P cel No. 2 Fire District Legal Descriptio Q- •^'- Site Address (Plea a include street name, street number and city)2285 Directions to sag.HU4 5 rZ55 PAD it MJ lt. 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 1 150/0 Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y TYPE OF JOB- N Add-')(_Aft Repair Other PRIMARY RESIDENCE SEASONAL E]Use of Building to Describe ork No.of Bedrooms No.of Bathrooms-..I- Square Footage- 1st FI 2nd Floor 3rd Floor Basement Deck Covered Deck o Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make 4 4 Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ I lei Replacement Unit? Yes/No Installer Name Certification No. CVYT 6M/BUL.DER Admowledges submission of inaccurate information may result in a stop work order or permit revocation.Ackixmiedgement 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 aA 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,l 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 k*r mation 1�=�iate grants employees of Mason County access to the above described property and structure for review and iinspection. TION OFWORK IS M OF A PROD INSPECTION. VTZ Date: er/2Eers Re r tative/Contractor indicate wh' ne FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department t 4 S i(/a �/U Environmental Health Departmen Public Works Department Fire Marshal FEES i 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 Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. _ BUILDING PERMIT APPLICATION v ( o� 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 APPLICA T IN ORMATION CONTRACTOR INFORMATION ) , Owner � Company Name p C•V Mailin Ad ress Mailin Address City a TState f 1 - Code City IP State LV A Zip Code Phone Other Ph. �7--?� S"C> Phone - Other Ph. Lien/Title Holder �Z ©r-- AM �2f rA Contractor Reg. Exp. E mail address E Mail Address Drivers Lic.# OB 7711 Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic FAsting Septic�� Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFOR ATION 12 Di�it P cel No. 2 Fire District Legal Description .Q. Site Address (Plea a include street name, street number and city) =857 Directions to sit ►' 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 1 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o TYPE OF JOB - w Add Repair Other Y. PRIMARY RESIDENCE RSEASONAL ❑ Use of Building Describe ork No.of Bedrooms No.of Bathrooms Square Footage- 1 st Flo 2nd Floor 3rd Floor Basement Deck Covered Deck— Other Sq.ft. a:wex 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$ermission 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 provid urate and grants employees of Mason County access to the above described property and structure for review and inspection. PROO OF O INU TION OF WORK ISr MEANS OF A PROG S INSPECTION f �"' X44- Date 1� J C/ her/O ners Re r tative/Contractor indicate whi ne FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department "► Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection i Plan Review Fee g-q EH Review Fee iPlumbing & Base Fee — Planning Review Fee Mechanical & Base fee Other f Wood/Gas/Pellet Stove Fee State Fee f Violation Fee Pre-Paid at Submittal Valuation $ 13 TOTAL FEES MASON COUNTY PERMIT NO.�� 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 On the web www.co.mason.wa.us APPLICA TIN ORMATION CONTRACTOR INFORMATION Owner 7 + &V14 Company Name Mailin Ad ress Mailin !Address City tate�tll Code _ City YA /tW State Zip Code "2 " .. Phone Other Ph 3 Phone L" 6-- Other Ph. Lien/Title Holder 13ANK. Or— P tyI I R-1-t-A Contractor Reg.4.T ELWITA Exp. E mail address E Mail Address Drivers Lic.# OB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Fxisting Septic_, Connect to Water System Name of Water System Well Water System Name of Water System PARCEL IN FOR AT ON 12 Diait Parcel No. Fire District Legal Description CM Co Site Address (Plea a include street name, street number and city) 8 Dir ctions to sit G, r0 k-V ^^ 1.. Ze-e—z- Llf 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?Ye o TYPE OF JOB- Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑ Use of Building Describe ork No.of Bedrooms No.of Bathrooms , uare Footage- 1 st Flo 2nd Floor 3rd Floor Basement Deck Covered Deck Other Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. j No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ If Replacement Unit? Yes/No Installer Name Certification No. 4 O VNER/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 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 ' provid urate and grants employees of Mason County access to the above described property and structure for review and inspection. PROO OF O IN TION OF WORK IS MEAN OF A PROG S INSPECTION. X Date: ner/ ners Re r tative/Contractor indicate whic ne FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department 4 1 /t. C: /wc� Environmental Health Departmen Public Works Department 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 Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. 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 On the web www.co.mason.wa.us APPILICAKIT INFORMATION CONTRACTOR INFORMATION Owner L Company Name Mailin Ad ress � 1'" Mailing Address City -i tate `�A"' Code , 77... City V t-('W State Zip Code Phone Other Ph. 2 I'7 / ""0 Phone 7 5 /)/.Z 2 Other Ph. "" Lien/Title Holder ; :`s /�/Y f /� CA Contractor Reg.#S" � a �L 'kT;ZExp. E mail address E Mail Address Drivers Lic.# OB Drivers Lic.# DOB 2-1 SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Fxisting Septic_„, Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFOR AT[ON 12 Dioit Parcel N I z Ito Fire District Legal Description `"t- a o- --I Site Address (Plea a include street name, street number and city)Directions to sit A C r e,�� V L0 �- K � - Will timber be cut and sold in parcel preparation?Yes/ffo 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?Ye o TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE KSEASONAL ❑ Use of Building I „�_Describe ork No.of Bedrooms No.of Bathrooms Square Foo- 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make 4 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 apcurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF'OFJOR7/7,INU TION OF WORK IS Y MEAN OF A PROG S INSPECTION. -`1 car Date Ix f'�, er/O Hers Repre6Ktative/Contractor indicate which ne FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Departmen 5 Public Works Department 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 Violation Fee Pre-Paid at Submittal Valuation $ 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)i75-4467 Elma(360)482-5269 APPLICANT F RMATION CONTRACTOR INFOR ATION Owner 4' '( Contractor Name %U S`� Maili A dress LE ddress City State Zip Code S ate Zip Code Phone ther Ph,( � — her Ph. Lien/Title Holder eiYCA- r eg. # L Address n SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATIONdig' TV P rcel No. l S?�0 0 / . Fire District Legal Description Site Address(Pleas include street name,street numb; and city) Dire ionVo siteLDA Is our property within 200'of th o wing: Body f W ter(Name) Saltwater Lake River/CreekPond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st rloor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Jyoe of Fixture No.of Fixtures Fees LPG54-011c Natural Gas Heatpump 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 7— Kitchen Sinks Wood/ as ellet Stove Dishwasher �_ Kitchen haust Hood Hosebibs Dryer Vent Other 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-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 d in conformance therewith. No changes shall be made without approval. first obt nin ap r al. X Date X Date r� FOR OFFICIAL USE BEYO D THIS POINT Accepted by Date Submittal Amount Due Receipt No. ><>:;: :.;:.;:.;:.;;;:fJkPA#1`MEf111`At..RIwViElti(.:::::::::::::::::::::::.:..A##?Ft�?V�D.......CfENIEt}......................................... Q 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 PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton,WA 98584 Shelton(360)427-9670 Belfair(360)�176-4467 Elma(360)482-5269 APPLICANT F RMATION CONTRACTOR INFOR ATION � Owner 4e- �� Contractor Nam `/�.K... Mailina A dress Mail'"Address City L State Zip Code Cit 1' OSa' te Zip Cod Phone ther Ph.( Ph.(� 6 ) her Ph. Lien/Title Holder Contractor eg. # Address Expiration / SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION dig' Tex P rcel No. ! ,�Ziol� l7" Fire District . Legal Description �34- 5niffAmo Site Address(Pleas include street name,street numbe and city) Direction Vo site Is 91bur property within 200'of th ing: Body f W Saltwater ter( Lake River/Creek_Pond Wetland Seasonal Runoff Stream Slopes or Bluffs i TYPE OF J'OB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Ffloor= 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No.of Fixtures Fees LPG qc"` Natural Gas Heatpump 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 OW ets Z. Kitchen Sinks Wood/ as eeet Stove Dishwasher _ Kitchen aust Hood Hosebibs_; Dryer Vent Other 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-I 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 j conformance therewith. No changes shall be made without first obtaining shall be d in conformance therewith. No changes shall be made without approval. first obt nin ap r al. X Date X Date FOR OFFICIAL USE BEYO D THIS POINT 61 Accepted by Date Submittal Amount Due Receipt No. ..........:.....::.::.::...............:::::::::::::...::::::::::::.: ;;;;;;:.;;:.:::::.:..:.:........:..................... ;;;:.;:::.: p77<:>::»::i::6<: »»>::»«<:<:>::: -—---'IQN::GLIDES«:::<«;:<;>::>:<::>;::::>::>::>:::<:»:: >::>::>::><:::>: APPROVED:::<>;:::::C3ENIE#3............................. GO ........................... Building Department Occ Group Type Constr. Planning Department i I Other I Other In rmit Fee Site Inspection Pe Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) i Violation Fee TOTAL FEES ' r PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton,WA 98584 Shelton(360)427-9670 Belfair(360475-4467 Elma(360)482-5269 APPLICANT 1 F RMATION CON ACTOR INFORMATION Owner I Cdz, d` f3 Contrictor Nam AJ 0 P Maili A dress Maili Address City ' State Zip Code Cif Se Zip Cod Phone( x' they Ph.( Ph. Ph. Lien/Title HolderAlfC / tt-/C Contractor eg. M— tther Sri= Address Expiration / / SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 1 dlgi*l Tits Parcel No. / 'S 2)G 0 / Fire District Legal Description Site Address(Please include street name,street numbe and city) Direction o site Is our property within 200'of the ing: Body of W ter(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 1 st loor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No.of Fixtures Fees LPGI'�'. Natural Gas Heatpump 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 Z, Kitchen Sinks _� Wood/ as elet Stove 1 Dishwasher _ KitcherrMaust Hood Hosebibs,4, Dryer Vent Other 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-I certify that 1 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 bed a in conformance therewith. No changes shall be made without approval. first obt in ap r al. / )( Date X "'�✓GVt. Date FOR OFFICIAL USE BEYO D THI POINT Accepted by Date Submittal Amount Due Receipt No. MET «<:tE » DENIik. Building Department Occ Group Type Constr. Planning Department Other Other X. 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 ( ) lation Fee TOTAL FEES 4 j �o Q' le 2 o ' cr- D �- _j fn ff) — c� w Z 4 Lj D L:J ` Z Q W � a- L6 4vl%MCEDAR STi 51. RAG ��QQ�J 3v _ 26 ' zz Ci Za' 4 liCT- 1 Mason.County Permit Assistance Center Planning Intake Checklist Owners Name: ' - �AV �� )�� v Date: '7 r S� D� Project: AaocAt o� .—ro 5�dZT- Reviewed By: Commercial Developmen • YES Comments'. Planner. GBM TSC KJM SG Site.Plan: North Arrow Property Dimensions:=X 1 S 1 ' Streets-and Driveways Shown.Road name: k�w ti 3 �f All Bxisting Structures shown with setbacks Well Locatio DES . �' n,Septic and Drain-field Shown with sWacks C e--J,� Identify all Surf water(streams,ponds,shoreline wetlands,etc.) - Topography(slopes) tZ�E K o Proposed Structure Setbacks(Direction/Setback): F: C' / M 0 R: W tLor S1: / S2: / Utility and Drainage Easements: Yes (if yes enter condition#5022) Other Easements No!N e_ o Accessory Appurtenances o County Access Permit Nmdcd(add condition#oo 10) o State Access Permit Needed(add edition 0020) Standard Conditions to be added to all Building permits that planning nwiews:#5019 and#0700 Are there any impediments that may restrict access to your site? (dogs/gates) • Shoreline and Planning Info L Setbacks:Shoreline: �oLC Slope: (r4T Shoreline Designation: Comprehensive Plan: Rural Zoning: ❑ .Not Applicable 0 Agricultural RR 2.5 �10 20. ❑ Urban 0 In-holding O RMF 0. Rural 0 LTCFL ❑ RC -1 2 3 O conservancy .,,�� . � ❑ Natural. . O RAC � ❑ RNR D Unknown 0 RCC-hamlet ❑ RT ❑ Urban Growth Area ❑ MPR 0 Unknown ❑ Unknown Water Body(type of water if unnamed): p D t^,A► 'E V • e SEPA:Yes M>Unknown Flood Plain: YBS NO LT Map# Aquifer Recharge: YES NO utoh Map# Tags/Gases: RLC/SPI Case: 6-Year Dev.Moratorium:YES 00 Bagle Nest Tag: YES Other YES Addressing:' Check box if needed O Reviewed by: Ravisoa:02 oa-zoos LTLANNINaCHARBI.L&RENEMPLA NING INTAKE