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HomeMy WebLinkAboutBLD2001-00717 Cancelled ATF ADU - BLD Application - 3/7/2001 r FORM MUST BE COMPLETED IN INK �(}., 1 PLEASE PRESS HARD MASON COUNTY � UlJ PERMIT NO.: BLD BUILDING PERMIT APPLICATION t 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 l ty Shelton 360 427-9670 Belfair 360 275- 467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANkINFORiMATION Owner CONTRACTOR INFORMAT N ((�� $f i►� Contractor Name Mailinigg Ad r ss 3 t�r� ttSc:iL m, y Mailing Address City �� State Zip Code City ®1 State Zip Code Phone�� Other Ph. _ P (—� Ph.( (�d ) S 7'3 Other Ph.�,,� Lien/Title Holder Al�iv.o, Contractor Reg. #_ A D R&p� Pi 7Y (� Al Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name pf L Sew r$yster>a Well Water System _Name of Water System (.� K 1 �� G PARCEL INFORMATION-12 digit Tax PaScel No. `3 / 3 / 00 Legal Description 405 /- �1t/ / — a Fire District Site Address(Please include street name,s reet number and city) �O Directions t dc� , i� 5 Will timber be cut and sold in parcel preparation. (Yes/No)_ ! Is your property within 200' of the following: Body of Water(Name) C�^L44,6 r Cr•� Saltwater Lake River/Creek�C _Bluffs Pond Wetland Seasonal Runoff Stream Slopes or PERMANENT RESIDENCEA SEASONAL RESIDENCE❑ TYPE OF JOB IN Add Alt Repair OtherXUse of Building `hefQ6r Describe Work - A I Lie No. of Bedrooms�[_N0. of Bathrooms_SQUA E FOO AGE-1st Floor O 2nd Floor - 3rd Floor Loft Basement Deck Other Garage Attached Detached Carport sq. ft. P Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. Type of Heat No. of Bedrooms No. of Bathrooms Installer Name Purchase Price $ Replacement Unit ?(Yes/No) Certification No. 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-1 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 aconformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without a 1. first obtaining approval. X Date X Date 3' --0/ FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date_`--(1-p( Submittal Amount Due3 �40 Receipt No.S[�Rrs . .':: . :�I� f APPRQV _DNIER IVt31'ff :>CCt41wS Building Department - Occ Grou onstr. Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ 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 ( ...., ..;.: ... ,;:y .... : .. ,:.. TOTAL FEES PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION ?-11 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 1360 482-5269 Seattle 206 464-6968 APPLICANI INFO MATION CONTRACTOR INFOR,IVIATI N Owner Contractor Name (� if 1� Mailing Address Mailing Address / '�. Al City State&44 Zip Code City irt. State 40419'_ Zip Code Phone _) 1Ph.(31%0L)—%2J-?3'Other Ph. Lien/Title Holder A ��_ Contractor Reg. Address Expiration 3 /_,;* SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Se we System Well Water r System System OX_Name of ` L FORMATION-12 digit Tax Parcel No. / 3 ( Fire District ID iption ' e d e s(Please include street name, Street number and city) Direction to site W ./ OX Wi I timb be cut ands Id in parcel preparation. (Yes/No) Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE❑ 1TYPE OF JOB N#w_ A Add Alt Repair Other�Use of Building • Describe Work , _. /A No. of Bedrooms.1 No. of Bathrooms SQUA E FOO AGE-1st Floor 010 2nd Floor ' 3rd Floor Loft Basement Deck Other Garage Attached Detached Carport Attached Detached sq. ft. A w<, MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ ?. I ': ' �7' R601666 ent Unit ?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID W WORK OR CONSTRUC ION U HORIZWS'N T COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ATY 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 conformance therewith. No changes shall be made without first obtaining shall bQ done in conformance therewith. No changes shall be made without La I. first obtaining approval. a X Date X Date FOR OFFICIAL USE BE$ONb THIS POINT Accepted by }',, t , Date' Submittal Amount Due lr, Receipt No.5{ •(r; 1Vlf~NT V APPRQV D: DENIED, IVRITI cz Building Department - ` Occ Group_ a Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $_ Nft 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 ( � TOTAL FEES PERMIT NO.: BLD -L"" 1 ob-71 7 MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elrna 360 482-5269 Seattle 206 464-6968 APPLICAN INFO MATION CONTRACTOR INF I�MATI N Owner Contractor Name 11�� e. �, Mailing Address Mailing Address . City � State Zip Code City J by ta. State _ Zip Code Phone� �2Other Ph.(�� 1Ph.(� ,�) ,� .7 Other Ph. Lien/Title Holder ���y Contractor Reg. #_ A DR F�1. (III' Address Expiration ESEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer Name of Sewe S�rstem Well Water System of System PARCEL INFORMATION-12 digit Tax Parcel No. T� + Legal Description 6 3 Z Fire District „ Site Address(Please include street name, stre t num er and city) Directions to site Wi I tlmb . be cut and Id in parcel preparation. (Yes/No) Is your property within 200' of the following: Body of Water(Name) �t ��rA� �•� Saltwater Lake River/Creek#_ Pond Wetland Seasonal Runoff Bluffs Stream Slopes or PERMANENT RESIDENCE SEASONAL RESIDENCE❑ TYPE OF JOB w Add Alt Repair OthervUse of Building Describe Work !'A t✓► L7¢4e&V.4- No. of Bedrooms No. of Bathrooms_SQUA E FOO AGE-1st Floor. a 0 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carpo Attached Detache MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ f 4. -)5,3 lh4hient Unit ?(Yes/No) Installer Name Certification.Nib. NOTICE: THIS PERMIT BECOMES NULL$VOID W WORK OR CONSTRUC ION AUTHORIZED S N T COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT TINY 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-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in he 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 req�ir rrt nt regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining Shill ne in conformance therewith. No changes shall be made without apprawl. first obtaining approval.` r X Q e l 4� X T r Date -7-4' FOR OFFICIAL UShtfdVEYOND THIS POINT Accepted by Date Submittal Amount Duel (� �� (ra Receipt No.=5t.0h IJEP(#RTNlIT lt111Y A#'PR DE;NIEp UNDII'lI CL1l JES ;. Building Department Occ Grou 7 3 Constr(�,i✓ eF-ly Planning Department Environmental Health Department Public Works Department i Fire Marshal Valuation $_ Building Permit Fee L 60 X ����'� Site InspecEFee Plan Review Fee EH Review Plumbing$Base Fee pp Planning Review Fee Mechanical&Base Fee 3 a Other L p Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) F W, I NotF TOTAL FEES MA PERMIT NO.: BLD 26b SON COUNTY � ' �� 4' - BUILDING PERMIT APPLICATION 7-0 " 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANTINFORMATION CONTRACTOR INFORMATION Owner ." I. ' t`s 5 4!ns Contractor Name Mailing Address ;4 od 4;,A ji, 4 y9 � Mailing Address City- r State Zip Code• } -"'.,,7,7;r City o a>, r State Zi Phone ,vo 2�1 "J.,' Other Ph.( � ode — Ph. = „- ..: •. Other Ph.( p C Lien/Title Holder �; z � Contractor Reg. #_ a�1 f r0� YJ i- Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System _Name of Water System f PARCEL INFORMATION-12 digit Tax Parcel No. I / '�. / L�s � . " Fire District Legal Description Directions to site {tre t number and city) .P'F Site Address Please include name',, s Will timb .r be cut and '` Id in parcel preparation. (Yes/No) Is your property within 200' of the following: Body of Water(Name) '_ ,: �'A`,� ,Kt Saltwater Lake River/Creek_ Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE JJ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Other�Use of Building y Describe Work , ; ., • (1 ,Yi1 No. of Bedroomsj No. of Bathrooms_ —SQUA E FOOD j -1st Floor' . 0 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached ----------- MOBILE>HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of,Heat Purchase Price $ / Repkaoer�aent Unit ?(Yes/No) Installer Name Certification No. - NOTICE: THIS PERMIT B C MES NULL&VOID Ilk WORK OR CONSTRUC ON AU •HOI 1ZzED IS T COM ENCE WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANeIME AFTER THE WORK IS COMMENCED. information provided is accurate and grants employees of Mason County access PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without apprWal�' first obtaining approval. X �.w ,r.,X +,. Date ,, `.' . X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date k Submittal Amount Due Receipt No..' 3 I3EPf I R M TC .E 1/l�Vf APPROVE D.EN �D �DNpITlt7f� Building Department- --- - Occ Group­ Type Constr. Planning Department Environmental Health Department 2 Public Works Department Fire Marshal Valuation $ 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 ( ) �x, TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD 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 360 482-6269 Seattle 206 464-6968 FAPPLICANJrIN O MATION S. CONTRACTOR INFORMATION r a, $ Contractor Name A 0 R Address !' -C4a 11r Mailing Address 2 l !,z f-k 4v4E A- '� State Zip Code 9�/��/-7ayo city c State Zip Code Phone(2a ) I Other Ph.( Ph.(3 )_ Q 7391Other Ph.( Lien/Title Holder wo t _ Contractor Reg. # 14 O/?E < 9 9 y D M Address Expiration 2 /209.R [Sewer IC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of System G a ` � ��u6 FDifections ORMATION-12 digit Tax Parcel No. tion e-� ! -I / --�- — Fire District_ Please include street name, street number and city) 70 f f 'te /1'l N �. O 5 L aG Is your property within 200'of the following: Body of Water(Name) C 61.011` Saltwater Lake River/Creek,_ Pond Wetland Seasonal Runoff St earn Si- Bluffs Bluffs s or ELlocatio:nn F JOB New Add Alt Repair Other Use of Building (j •�d. of Fixtures/Units 1st Floor4_2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets Bath Basins Type of Unit No. of Units � Furnace Fees Bath Tubs — Heatpumps Showers Vent Fans Z Water Heater � PropanerTank Laundry Wsher Gas Outlets Sinks _ Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other Other 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. FNOTICE: PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IFN WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.NTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that thevided is accurate and grants employees of Mason County access to the above described property and structures for review andhis 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X Date L FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. :.;;;;:.;:.; : ;;: ;:.>::;>:<:;.;:«.:::.:.: FBBuilding Department Grou T e Constr. ning 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 MASON COUNTY PERMIT NO.: PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 Shelton 360 427-9670 Belfair 360 2754467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT IN O MATION S . Owne CONTRACTOR INFORMATION r Contractor Name /-) 0/� Mailing Address �� �,� (� � ; �u��� �J/_ .- Cit4 f f Mailing Address 2 t l,t t�, Fq�� Y State l Zip Code / - UDO City / r w State Zip Code 6 Phone(20 ) !� Other Ph.( ��s Lien/Title Holder_ U Ph.(3 0 ) ys6-7399 Other Ph.( Address Contractor Reg. #_k1 02 y4+ 9 9 y 1)r�1 Expiration _/ 4 SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System L a fc� �!,; �, i tro 1f,, (� I v PARCEL INFORMATION-12 digit Tax Parcel No. 32/� 7 , Legal Description ?� / / ; G -3-- — Fire District Site Address(Please include street name, street number and city) 7Q E twt Directions to site III t ti «. t Is your property within 200'of the following: Body of Water(Name) < (•} d/ Lake River/Creek Pond Wetland Seasonal Runoff St Slopes water Bluffs eam or =OFw Add Alt Repair Other Use of Building 4 0, s/Units 1st Floor 2nd Floor Basement Garage Closet,~ j PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No. of Units Bath Basins _ Furnace Fees Bath Tubs Heatpumps Showers Vent Fans Z Water Heater �_ Propane Tank Laundry Wsher Gas Outlets Sinks ___�__ Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other Other 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. FNOTICE: PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION, UTHORIZED]S NOT,COMMENCEDWITHIN 180 DAYS OR IF N WORK IS SUSPENDED OR ABANDONED FQR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. NTINUATION OF WORK IS BY MEANS OVA'PRO'GRESS INSPECTION. The owner or agent on owner's behalf,represents that the vided is accurate and gran ernployeds"of Mason County access to the above described property and structures for review and his project. Acknowledgmen ;oftsuch 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval first obtaining approval X Date_ X Date /� O FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. Building De m nt ..t�t�Clf'{"IQ}�#:Lei.�S:.;:.;;:.;;;;:.;:.;;;;:;z:::::»:::>:<;:»::>:>:: Occ Grou Type Constr. Planning Department Other Other :,. . ... Permit and F.�:...:. Site Inspection i ry Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other 11 Vechanical&Base Fee Other "Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal j 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 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner � 'r--i----=«---� Contractor Name Mailing Ad ress r . Mailing Address City_ State -Zi Code Phones 4 :, k• Other�Ph. p �}'+-S yr- =-' ti City State Zip Co ey Lien/Title Holder X -tether Ph.( � "�'" ( Ph.�C Address `"'"" r Contractor Rego Expiration l' u`�t --'� ` SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System • INFORMATION-12 digit Tax Parcel No. � T_ � L Legal Des 'ption T 1 _Fiore DistrictLLe Li e dress lease include street name, si reet num er and city) Dir s to 'te _ Is YOur4 rty within 200' of the following: Body of Water(Name) Lake River/Creek Pond Saltwater Bluffs Wetland Seasonal Runof 'IS tr am <: TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS F Type of Fixture No. of Fixtures 'r�Re: Electric Fees LPG Natural Gas -He.*ump Toilets �_ Tvpe of Unit -- Bath Basins No._of Units Fees Bath Tubs �— Furnace Showers Heatpumps Water Heater Vent Fans Laundry Wsher�— Propane Tank Sinks Gas Outlets Dishwasher �— Wood/Gas/Pellet Stove Other Direct Vent? Other Other Base Fee Other TOTAL PLUMBING Rase Fee _ TOTAL MIECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. FNOTICE: PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYSOR IF N WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. NTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the vided is accurate and grants employees of Mason County access to the above described property and structures for review and his 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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X ✓' e , Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. ::>::>::><::>: ::>:<:; ::»»>::»:::::::::: Building Department - -- Occ GroupType Constr. Planning Department Other Other PermitFee ......................:::::.:::.:::::::.;:;:.:;<.:.;:.: 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 1736092 Pass: 1 of 1 07/27/2001 11:00A MASON co PERMIT CTR CERT 8.00 Mason Cc, WA l U1 S Return To: I f 1 IA 4_� 4-vif_ P� 14.W. Oa CERTIFICATE OF RESIDENTIAL USE LIMITATION ON NUMBER OF BEDROOMS I(We)the undersigned,hereby place this notice on record that the following described real estate situated in Mason County,State of Washington;t0 Wit:(abbreviated legal description) 4m-J_5 lyl-141 Oiv N 4i4k_p tt„►.-e rrc`e and having the Tax Parcel Number of: 3 /275.3 ao l L_-2. is subject to the following understandings and conditions: I. The use of this parcel will be restricted to no more than bedrooms. 2. The on-site sewage system was designed for and the building permit was issued on the basis of no more than bedrooms, and a maximum residential occupancy of not more than ( persons. Z. use of the other rooms as bedrooms, in excess of the number identified herein, could result in hydraulic overload and premature failure of the on-site sewage system, and could result in Mason County taking steps to cause vacation of the premises. 4. In the event of any future residential remodeling, expansion, or replacement that results in additional bedrooms to the number specified herein, the property owner will obtain the appropriate permits for expansion of the on-site sewage system. WITNESS hand this S)�O day of 4 � ! ,,Itli:trr n� Signature �tie ��t1 LU(j P Signature �uat.1 State of Washingtonpr. County of Lamm ICi p'" ) (/ INA9 {!!111 I,the undersigned,a Notary Public in and for the above named County and State,do hereby certify that on this 15 day of Mcw ,; 2601 ,personally appeared before me_ RQIoh 5im5 to me known to be the individual described in and who executed the within instrument,and acknowledge that he(she) (they)signed and sealed the same as free and voluntary act and deed,for the uses and purposes herein mentioned. GIVEN under my hand and official seal the day and year last above written. �J Notary Public in and for the State of Washington,residing at ,6XpJtt A My Commission Expires: .7uly 27i 200+ t; i «� Q 93 w Ala A` Irtf Aft`-= f C7 w �. 1-se, 4F" T + © I ^ Li <<s