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CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location 1-425-5" n This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed below must be corrected to gain code compliance 6 d !�S ,`,., ,° 75 / 1 - l 6 D << 61/OP-'�z X, You are hereby notified that the above corrections shall We made BEFORE PROCEEDING WITH ANY FURTHER WORK e,x ,4v-' J -,/a!, Call for re-inspection when corrections are made before continuing sA� e ._ 0 da-Z-7;,, ❑ Make corrections, items will be checked on next inspection ❑OK to DepartmentT/� Date Inspector DO NOT REMOVE THIS TAG Permit No. MASON COUNTY BUILDING PERMIT APPLICATION �n'�n 426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670/1-800-562-5628 � PLEASE PRINT #1 O er /4k J--M(�S , )13 �l�)'7— Phone 0 Site Address tJ ,�� �7-5S /�d IE?THzSi R /�� Fire District# City St WA, - Zip Directions to Job Site N r E S &J A) Owner Mailing Address S�stit E- city St Zip Lien/Title Holder Address City St Zip #2 Contractor Name SD uwD Contractor Reg#,5)YJU1E*-A I 1� Address 7 5— e:- E - Expiration Date City )o St. 14* Zip 37 t Phone v -o4q #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well Connect to Sewer System? Name of System (If residential, proof of potable water is required) = aD N # Parcel No -�_- � Legal Description }- gory UJ #5 Building Square Footage: (existing/proposed) m 1st FI / 2nd FI / 3rd FI / Loft�T_ Basement / Deck / #bedrooms / #bathrooms / Garaged 7.- / Carport / (Circle:Attached or Detached?) Other sq.ft. / Use of building t-,U, A&0-- Describe work Ell. x 2 E?'- .AAZ-rbkH0A4F-- &ARdrr- - #7 Type of Job: New Ll Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Ste- AI,H, A�,k/Vt (T Model Year Make Model Length Width Serial No. #Bedrooms #Bathrooms Type of Heat Purchase Price$ #9 Indicate by circling the applicable source if any water is on nt to subject property: River Pond Creek Stream Wetland Lake Marsh altwater Seasonal Runoff Other Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Indicate Directional by (N, S, E, W) Name of Flanking Street Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other _Bath Tubs No Unk Fees _Showers _ Furn BTU _Hot Water Htr _ Heatpumps _Laundry Washer _ Vent Systems Sinks _ Spot Vent Fans Floor Drains No. Boilers/Compressors _Laundry Basins _ HP _Dishwasher No. Air Handling Units _Disposal _ cfm# _Urinals No. Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 16.75 _ Auto Fire Sprink Sys 35.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75 WORK IS SUSPENDED OR ABANDONED FORA PERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEP MENT. X OWNER X BY a DATE DATE 2-2-1 7 �z DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review Occupancy Group:U- Type of ConsfT77�;;- Fire Marshal: Other: Special Conditions: to'? cJ vs.(; FEES Building Permit ,5 Plan Check V56 Plumbing Fee Mechanical Fee i Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee LA,ri Other � - n Other Building Valuation: 7 TOTAL FEE lI 1 S - - ��� �.• - - �� '. - ����� 'Y "* -. ;y. ? _ , LJ' _.; ■ *_ _ t-,,,�:. .��a — ��— i ���::r .�) �� 4�� ti qp ti' I ' APPLICANT NAME: DATE: O/�L SITE ADDRESS I BUILDING PERMIT CHECKLIST If site address has not been issued refer the customer to Community Dev. ext 291. FIRE DISTRICTS Please make sure the fire district is included in the application information. Refer to map located at counter. DIRECTIONS TO JOB SITE Needs to be as complete as possible (i.e. major roads, is house on left or right side of road, etc.). Be sure to read for clarity (Landmarks, signage, owners name on mailbox, etc.?). LIEN/TITLE HOLDER Who holds the mortgage (Bank or name of private owner holding contract)? CONTRACTOR REGISTRATION #AND EXPIRATION DATE This information needs to be provided. The Building Department may be able to research expiration information if customer does not know it. We must have a signature in 1 of the 2 boxes, either the applicant or the contractor. SEPTIC RECORDS New systems must have test holes dug prior to submission and Septic Application must be filed and paid in full. 1l A B 1', WATER COMMUNITY PRIVATE SEPTIC EXISTING DESIGN APP. DEV REMODEL NEW STATUS IS THIS A REPLACEMENT UNIT? YES NO__I!;r IF SO: MASON COUNTY BUILDING PERMIT APPLICATION SECTION #5, BUILDING SQUARE FOOTAGE, MUST BE FILLED OUT COMPLETELY. AND: SECTION #6 MUST CLEARLY STATE, "REPLACEMENT UNIT" PARCEL#/LEGAL DESCRIPTION Parcel #must be included. If number is n available contact Addressing at Ext. 291 of b e g BUILDING SQUARE FOOTAGE Clearly show existing square footage and that of which is proposed. If there is a garage, verify whether it is attached III, or detached. Include square footage information for mobile homes.lie. 1 OX20 Z00 square t.) P USE OF BUILDING Residence, garage, greenhouse, designate if it is commercial. DESCRIBE WORK (i.e. mobile home addition, addition to a house, etc. . .) y TYPE OF JOB T Verify appropriate boxes are marked. v m Gir w ❑ MOBILE HOME Fres 71ON Verify appropriatere marked. If factory order, please put factory order#in mobile home serial#. If unit was assembled prior, t June 15, 1976, refer to procedures handout for "Obtaining Installation Permits for Mobiles Assembled Prior o June 15, 1976." (y� SHORELINES/CREEK/WETLAND If property is within 200 feet(including adiacent properties) of Shorelines/Creek/Wetlands, #9 must be complete. If none of the conditions are present please enter "na" or "none". SITE PLAN DRAWING MUST SHOW THE FOLLOWING: ' LOT DIMENSIONS * DRIVEWAYS ' EXISTING STRUCTURES * SHORELINES • STRUCTURE SETBACKS * WELLS * WATER LINES * SEPTIC SYSTEMS * PROPOSED IMPROVEMENTS * EASEMENTS ' NAME OF FLANKING STREET * NAME OF FRONTING STREET ALSO PLEASE MAKE SURE DIRECTIONAL IS FILLED IN ON APPLICATION ((7� TOPOGRAPHY DRAWING If property is flat write "flat" on the topography section. If house or structure is near a slope or hill, drawing must reflect this. This should show an accurate side view of the property. ❑ PLUMBINGM, NICAL This form mustbe completed for any structure with plumbing and mechanical excluding mobiles/modulars. OWNER OR CONTRACTOR AFFIDAVIT Owner or contractor must sign affidavit statement and date it. ACCEPTED BY Whoever is accepting permit information must sign your initials and date form on the bottom of page 3 or use date stamp and initial on back of permit. I PRINTS Need two sets of prints unless it is a stock plan. For stock plans, we only require one copy. Commercial prolects reaulre four sets of plans. ❑ WATER A a Y For new rest and mobiles. PRIVATE WELLS MUST HAVE WELL LOGS OR CAPACITY TEST AND BACTERIAL TEST. If y are on a public water system, check for signature to verify that the system is not on the State's "out of compliance list" ❑ WSEC & IA ODE Required for residential, additions and commercial buildings. Energy Code compliance form needs to be COMPLETE . fy heat source(no wood or pellet stoves are permitted as primary system). Window schedule must be filled out and reflect what appears on submitted building plans. If applicant has decided to go with the PUD in a Long Term Super Good Cents program, we require a copy of the signed agreement with the utility. ❑ ROAD AC S MIT If you will be ssing your driveway from a County road, contact the Public Works Department in Mason County Building I,4 -9 0 extension 450. Access from State Highways requires Department of Transportation approval. Contact office (206)895-4753 (Port Orchard). "Notarized statement for GMA" i i Checklist.2 2-5-97 Trish 2 GARY YANDO,DIRECTOR ON..STATFO sO _ DEPARTMENT OF COMMUNITY DEVELOPMENT •p T = PLANNING-SOLID WASTE-UTILITIES N Y y BLDG. I • 411 N. 5711 ST. 9 P.O. BOX 578 O J 1864. a SHELTON,WA 98584 • (360)427-9670 DISCLALMER/WAIVER OF COUNTY LIABILITY:PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS,SHORELINE PERMITS,VARIANCES,AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by that Order,the undersigned property owner hereby agrees to waive any lawsuit,action,or claim for damages against Mason County which may arise out of Mason County's actions in acceptance,processing and/or issuance of such permits or approvals(hereinafter"permitting actions'),which damages are attributable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid. t /3- �� ZZ— Di 31 as 080 Date (Parcel No. or Legal Description) r6wlb E2 fr;k,JDP,s Property owner's signature otarzed) (or the County may accepy the signature of the owner's authorized.agent upon proper proof of authorization) t ACKNOWLEDGEMENT CERTIFICATE(INDIVIDUAL) STATE OF 9 COUNTY OF On this day of ,in the year ,before me Notary Public, i personally appeared personally known to me to be the person whose name is i subscribed to this instrument,and acknowledged that he/she executed it. i i j WITNESS my hand and official seal. j -For Couarty use only- Reviewed Nqppfi—d'on j i Notary's signature Staff Initial: My Commission Expires: E Nc cy%It:d GARY YANDO,DIRECTOR �pN.STgrFO sU DEPARTMENT OF COMMUNITY DEVELOPMENT Le 0 T z PLANNING-SOLID WASTE-UTILITIES N Y �°► BLDG. I • 411 N.5TH ST. a P.O. BOX 578 of 1864. �o SHELTON,WA 98584 • (360)427-9670 DISCLAIMER/WAIVER OF COUNTY LIABILITY:PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS,SHORELINE PERNIITS,VARIANCES,AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by that Order,the undersigned property owner hereby agrees to waive any lawsuit, action,or claim for damages against Mason County which may arise out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals(hereinafter"permitting actions'),which damages are attnbutable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid. Zi Date (Parcel No:or Legal Description) i +the:VCoouZntyr�ma1y1 e ignature accept signature of the owner's authorized.agent upon proper proof of authorization) P. Av s•�r ACKNOWLEDGEMENT CERTIFICATE(INDIVIDUAL) STATE OF ` ogPUB COUNTY OF OF WP`� On this l day ofp� , ' , in the yea -t_- ,before me Judo w Notary Public, personally appeared tM6N personally known to me to be the person whose name is subscribed to this instrument,and acknow edged that he/she executed it. WITNESS my hand and official seal. -For County use only- Rev' �d by ap film u on 1 ate) Notary's signature Staff Initial:My Commission Expires: I i I jonan JIc Re PROJ CT: SHEET NO. � CONSULTING ENGINEER BY: DATE: ]JOB NO. / Z 12202 PACIFIC AVE. S.•TACOMA.WA 98444•(253)537-8128•FAX 531-1285 J !/03 Z, l����`_��� Z �J " �►ti`�. �� Igo L�i� ,5P4--e-'£- d Gay 40 7r/-,E S t-c.) 4e-7 fjcoC-4r- >. 3. -7/(, " O sm> t -I I t s NP, G! a N 4126199 jonon PROJECT: SHEET NO. o c Dc CONSULTING ENGINEER BY: DATE- JOB NO. 12202 PACIFIC AVE.S. •TACOMA,WA 98444•(253)537-8128•FAX 531-1285 l 1 t\ i� Ow V c4 �L TO �'�``