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COM2009-00049 Final Add Dental Office - COM Permit / Conditions - 9/28/2009
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O N CL a v 3 `< 3 3 =4 O 3 3 CIDn 3 cn -i n' N c 0- 3 lD < (n' •-+ S (n FT '0 O : a. a fn 9 fD a� Qa O N O O CA CID N y CID — rn v w cn co (D 0 N < CA O O Al Sg n N 0ca N 3- X > > OL m 3 n °' o � N (ID :3L (D CID c0i N (D O O O O 77 O + N 0 0 0 C) CONCRETE MECHANICAL % MANUFACTURED HOME > z C) Footings/Setbacks Date V, By Ribbons 1P Gas Piping co interiorDate By interior-Date By bale By z mExte(*(Date By Exterior-Date By Set-up m Point Load I Isolated Footings INSULATION Date By BG I SLAB INSULATION Date By Date By FIRE DEPARTMENT Foundation Walls Floors Date By Date By 7-4 Data By DECKS FRAMING Walls Date By Date By Data 41 -clq BY PROPANE TANKS PLUMBING Vault Date By Date By OTHER Groundwork Attic Date By Date B Type: y Date By D.W.'V DRYWALL Type. 0 Int.Brace Wall Date By 0 Date 0Y Dat By r_j FINAL INSPECTION CD Water Line Fire Seperation (D Date By Date By Date(7, By T C) Pass or Request Inspect. Q Sh. Type of Insp. Fail Date Date Done By Comments J-3-0 S-1-07 I'� e s ->'�� /Y, 0 -J c-- — r 2 17 v OVY\ r\v C On -LL- tn e4lel-CAJ e-4 ca,-,- k v Z!5 r _j 0) 0 h 0) FORM MUST BE COMPLETED IN�1[�� MASON COUNTY PERMIT NO. 00 rn -� PLEASE PRESS HARD �UILDING PERMIT APPLICATION 6 W. Cedar- P.O. Box 186, Shelton, WA 98584 n` Shelton (360) 427-9670 - Belfair(360) 275-4467 - Elma (360) 482-5269'1�1 UiA On the web www.co.mason.wa.us APPLIOwner A T INF MATION CONTRACTOR IN RMATION Owner 0.h r CONTRACTOR Maili Add r ss W a Z ors C _ Cit Maili Ad ess p Y Phone Statels, Zip ode City State lw)q _ Zip Code Other Ph. Phone 6� Z7 Other Ph. Lien/Title Holder Contractor Reg. E mail address Exp. E Mail Address�TE� S J n • e7,�. Drivers Lic.# ppg Drivers Lic.# SEPTIC /WATER SYSTEM INFORMATION - Connect to New Se tic DOB Connect to Water System Name of Water System p Existing Septic X Well Sewer Systern— Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Legal Description .. O Fire District Site Address (Pleas inclu street nam street number And city) Op"Q n Directions to site 13 !AA la In Will timber be cut and sold in parcel preparation?Yes/N Is property within 200'of Saltwater Lake Wetland Seasonal Runoff River/Creek Pond 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 Alt Repair Other • Use of Building_ nescribe Work e r PRIMARY E IDENCE ❑ SEASONAL ❑ No. of Bedrooms No. of Bathrooms Square F tage- 1st Floo 3rd Floor Basement Deck 2nd Floor �Gara a Covered Deck Other Sq. ft. 9 Attached Detached Carport Attached MANUFACTURED HOME INFORMATION - Make Detached Model Length Width__Serial No. Year Type of Heat No. of Bedrooms No. of Bathrooms Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is LM;EA�ffNSGRES ommenced within 18 ys or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY IN EC ION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. Owner presentative Contract (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Acce ted b DEPARTMENTAL REVIEW APPROVED DENIED p y Date I I- Buildin Department NOTES Planninq De artment Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Plannin 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\ w'`` On the web www.co.mason.wa.us APPLIC6NT INFqlEkMATION CONTRACTOR I RMATION G _Owner r^ L Company Name h e , jp !1 HS ate, f Mailin Addr ss "" �,�y d� .�./VC . I Maili Adc�ess Ca Lea Xqp I City I StateL3 Zip ode City 1�kA r State Phone Holder Other Ph. Phone Ic C) Z..:) 7 Zip Code I Lien/Title Hold Other Ph. i E mail address Contractor Reg. 7 r i t4JExp . D / i Drivers Lic. # E Mail Address DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic X I Connect to Water System Name of Water System I Well Sewer Systern— Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No7 tb Legal Description O Fire District 2— Site Address (Pleas ginclud street namg CA?street number city) / C:/ p�-,0 �, � j Directions to site 'f-`" -}• �,yG �.e A Will timber be cut and sold in parcel preparation?Yes Is property within 200'of Saltwater Lake River/Creek Wetland Seasonal Runoff Pond j Stream Slopes or Bluff—To 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 Use of Building PRIMARY �DENCE ❑ SEASONAL i 9 Describe Work o o r l.r tG ❑ No. of Bedrooms No. of Bathrooms Square Footage- 1st Floo �� 3rd Floor Basement Deck 2nd Floor Gara e Covered Deck Other Sq. ft. 9 Attached Detached Carport Attached MANUFACTURED HOME INFORMATION - Make Detached Length Width . Serial No. Model Year Type of Heat No. of Bedrooms No. of Bathrooms 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 infonbation 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 i not commenced within 18 ys or if-corstruction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS RbGRESIS'INS EC ION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS ILL INVALIDATE THE APPLICATION. X Date: �� -`Owner/Owners presentative/ ontracto (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date `,- I i FBuilding RTMENTAL REVIEW APPROVED DENIED NOTES Departmentn De artment nmental Health Department Fire Marshal FEES Building Permit Fee Site In ection Plan Review Fee EH Review Fee Plumbing & Base Fee Plannin Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES AMR MASON COUNTY PERMIT NO. -„i I BUILDING PERMIT APPLICATION ; S I iA 1. 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 INF ATION CONTRACTOR I RMATION , _ Owner 1 Company Name 1�a �-, Mailin Addr ss �} p Q ��a,, ...L/V� . City Maili Ad ess • 0 L o X Phone I StateleL Zip ode City 1� r I State Zip Code Other Ph. Phone b® Z. S 7 3 Othe Ph. Lien/Title Holder 0 — Contractor Reg. 7-t - 1-, ( 9e[,J E mail address ZO Exp. E Mail Address -re .S r h e- . ��.• Drivers Lic.# DOB Drivers Lic. # SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic DOB Connect to Water System Name of Water System p Existing Septic X Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Legal Description Fire District Site Address (Pleas includ street nam street number d city) Z/ E O•r�Qp7 C Directions to site 6✓l7G Will timber be cut and sold in parcel preparation?Yes Is property within 200'of Saltwater Lake Wetland Seasonal Runoff River/Creek Pond Stream Slopes or BIuffT oho 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 • Use of Building Describe Work o ,-, NGIN(ARY /�E�N.CE ❑ SEASONAL ❑ No. of Bedrooms No. of Bathrooms Square Fo tage- 1st Floole 3rd Floor Basement Deck 2nd Flooi Garage Covered Deck Other Srq. ft. 9 Attached Detached. ' Carport Attached MANUFACTURED HOME INFORMATION'- Make Detached i Model Length Width = ` serial No Year . Type of Heat ' No. of Bedrooms No. of Bathrooms Purchase Price $ Replacement Unit? Yes/No Installer: ame Certification No. OWNER/BUILDER Acknowledges submission of inaccurate inforrpation 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 tYfis rmit.and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permiss n i from,required fro any,easement holder or any other party in interest regarding this application or the work proposed in the application, I have g6tained.permisgionfrom them to aeserIpply for this permit and conduct the work proposed. The owner or described property and'structure st ucture fo�,evieIt,tw,and inspeciontion,Thisd is permit/application and becomerants s(null & void if work or aees of Mason uthor zedtconstruction not commenced within 18 , ys or if"construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS B is Y MEANS Cf1,kYftGRES NS EC ION.INACTIVITY OF THIS PERMITAPPLICATION OF 180 DAYS ILL INVALIDATE THEAPPLICATION. X ul1 Date: 6 b 1 16— Owner/Owner presentative/ ontracto (indicate which one, FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date .> I)-rJ DEPARTMENTAL REVIEW PPROVED DENIED Building De artment _ NOTES Planning De artment i t Environmental Health Department i Fire Marshal FEES Bu,ildinq Permit Fee (1, $5— Site Ins ection Plan Review Fee —74-B-D 4o f EH Review Fee ' Plumbin & Base Fee / i Plannin Review Fee Mechanical & Base fee s'o Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ OTAL FEES MA$ON 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 APPLICANT INFQP,,MATION Owner CONTRACTOR INFORMATION Company Name ->' r , r i• , _< �,, �ti r . Mailin Addr ss C�Z. Mailing Ad �ess � C: �� y } City i / State�Zip ode City ' 1 14Z State Phone Other Ph. Phoneti, ; Zip Code - t Lien/Title Holder �, Other Ph. Contractor Reg. # %Ex ' / ft. E mail address E Mail Address >� r777 , r r P �- [Drivers Lic.# DOB Drivers Lic.# DOB EPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic X onnect to Water System Name of Water System ell Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No, ; Legal Description Fire District Site Address(Please includ street name,.street number and city) j w,^ rim Directions to site / a / -�- .. ,., , at a, ! . . F3rd er be cut and sold in parcel preparation?Yes N f y within 200'of Saltwater Lake River/Creek Seasonal Runoff Pond Stream Slopes or Bluff— sT5% permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No OF JOB - New Add Alt Repair Other .. Building Describe Work u },. PRIMARYSIDENCE ❑ SEASONAL ❑ / ,c' � edrooms No. of Bathrooms Square Fo tage- 1st Floo IL ` 2nd Floor or _ Basement Deck Covered Deck Other Garage Attached Detached Carport Attached Sq Detached MANUFACTURED HOME INFORMATION - Make Model Length Width Serial No. Year ______ Type of Heat Purchase Price $ No. of Bedrooms No. of Bathrooms Replacement Unit? Yes/No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null& void if work or authorized construction is not commenced within 180. ys or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS PROGRESS INS ECTION.INACTIVITY OF THIS PERMITAPPLICATION OF 180 DAYS YVILL INVALIDATE THE APPLICATION. X O O c ► + y-^--- Date: Owner/Owners Representative/ ontracto (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by:;,",'. Date,.` i i DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Buildinq Permit Fee Site Ins ection f Plan Review Fee EH Review Fee ©� Plumbing & Base Fee Plannin 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. C 6m.2 coa—' �I q 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 APPLICANT INFORMATION CONTRACTOR INJEORMATION -- Owner 0, ' ,.. . i t Company Name Mailing Address . ' L4)L_ 3 Mailing Address 4 r k City i L 1 A A. State Zip ode City �.;�"��? � _ State ` Zip Code Phone Other Ph. Phone 5 = --' / Other Ph. Lien/Title Holder Contractor Reg.# i - 7 . .��`l`Exp. E mail address E Mail Address -`>� Drivers Lic.# 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. l , ti ` ;/ Fire District » Legal Description Site Address(Please include street name, street number and city) Directions to site i tit"^. ;-� ., i f.� x....i "�" r y'2 f�tT ;' 1�•t..i �,..k". .".•'{ ' ` ( •'"'C,,,,. f '."`. / ^:. �- Will timber be cut and sold in parcel preparation?Yes N ,.- 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 Alt Repair Other, .J PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work—, No. of Bedrooms No. of Bathrooms Square Footage- 1st 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 f Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS QFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS ILL INVALIDATE THE APPLICATION. X � . . r{ .. - " .. Dater Owner/Owners Representative/ ontract9 ' (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Datd-- DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT NO.COO aWq '�`� I PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION AILA n 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 Shelton (360) 427-9670•Belfair(360)275-4467• Elma(360) 482-5269 � 1 n the web www.co.mason.wa.us APPLICANT INFORgATION CONTRACTOR IN RMATION Owner .0Q K a l7 CAS Company Name- ��'"P^ ,riti"d7re Sry c Mailing Address Mailing ddr s n City State Zip Code City tate Zip Code Z Phone Other Ph. Phone O er Ph. Lien/Title Holder Contractor Reg. Exp. E mail address E Mail Address • �'- Drivers Lic.# 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. Z — — Fire District 7— 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 - 1st Floor 2nd Floor Basement Garage Closef_��__j PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric— LPCz_ Natural Gas_ Heat Pump_ Toilets _ Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan 2- 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 OWNER/BULDER 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' u nts employees of Mason County access to the above described property and structure for review and inspection. PROO OF NUATI F WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: sI / Owner/Owirers Representat' Contractor (indicate which one) FOR OFFICIAL USE BEYONDTHIS POINT Accepted by Planning Pd Ck# Dater 1 1-Oq Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grour)-Type Constr.- Planning Constr.— Planning Department Environmental Health Department FEES Plumbing &Base Fee Site Inspection Mechanical& Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES PERMIT NO.(�_'I ; ; MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION �xli IA 0 426 W.Cedar-P.O. Box 186, Shelton,WA 98584 -- ' Shelton (360) 427-�670-Belfair(360)275-4467-Elma(360) 482-5269 n the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR IN ORMATION C- Owner ID h 1 �e n e 0 CIS Company Name —4tr Q A-f— '� r,S ti 'Trt►c Mailing Address Mailing,Qddre s f='0 i:'' r. r v City State Zip Code City.-- "/ State Zip Code Phone Other Ph. Phone ~�� 0 -� 6-7.3 Y Other Ph. Lien/Title Holder Contractor Reg. `^ r 4 �c ` Exp. i, E mail address E Mail Address r '�' � .d ij rac ® »e �— Drivers Lic.# 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. 3 3 Z. = -- y Fire District 7— 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 "461 Location of Fixtures/Units- 1 st Floor 2nd Floor Basement Garage Close'. LDMB N FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LPC Natural Gas_ Heat Pump_ Toilets _ Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Z.. 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 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' u rants employees of Mason County access to the above described property and structure for review and inspection. PROO OF INUATI F WORK IS BY MEANS OF A PROGRESS INSPECTION. X Dater D Owner/O . rs Representat' Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: VPlanning Pd Ck# Date- W U'I Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grou T e Constr. Planning Department Environmental Health Department FEES Plumbing& Base Fee Site Inspection Mechanical &Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES ; _- MASON COUNTY PERMIT NO.I-- 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 IN RMATION Owner DC- r, !t✓'h e D Q.S Company Name h f''"' S 6 San Mailing Address Mailin ddr City State Zip Cede City tate c" Zip Code Phone Other Ph 0 — Phone 4- 0 �.S`673`� Ot er Ph. , b Lien/Title Holder Contractor Reg. / L Exp. E mail address E Mail Address " 1W S v 1';W e a--- Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic X Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. "" 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 Fi ures/Units'- 1st Floor 2nd Floor. Basement Garage Closet-L--1 PLUM B N RES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:ElectriG_ LPQ _ Natural Gas_ Heat Pump_ Toilets ` Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers �r'ramie offi;�r Spot Vent FanWater Heater 65) Propane Tank Clothes Washer Gas Outlets Kithen Sinks I k ✓6d r, Wood/Gas/PelletStove Dishwasher -6. Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL 01MVER/BULDER 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 provid u n nts employees of Mason County access to the above described property and structure for review and inspection. PROD OF NUATI t�oF WORK IS BY MEANS OF A PROGRESS INSPECTION X 7, Jc_ Date: T)7 d Owner/O ers Representat' /Contractor (indicate which one) FOR OFFICIAL USE BEYrOt1D THIS OINT Accepted by: Planning Pd Ck# Datey Bld Pd Receipt No. DEPARTMENTAL 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 MASON COUNTY PERMIT NO. i PLUMBING/MECHANICAL PERMIT APPLICATION i 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 A c'. Company Name Mailing Addres— s Mailing Address City State Zip Code City .Y x State Zip Code Phone Other Ph. Phone i. ry ` _}-3 Y Other Ph. Lien/Title Holder Contractor Reg.#ty` �' ' .3, Exp. •Email address E Mail Address �. Drivers Lic.# 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. I Z 1 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- 1st Floor 2nd Floor Basement Garage Close PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPC Natural Gas_ Heat Pump_ Toilets 2 Type of Unit No. of Units Fees Bathroom Sink 1— 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 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 ip accurate lrir rants employees of Mason County access to the above described property and structure for review and inspection. PROD OF CON"NUATI F WORK IS BY MEANS OF A PROGRESS INSPECTION. X - r ��, .1-- _ Date: ' Owner/Owners Representati Co tractor (indicate which one) ,"A OPFI�ALUSE BEYOND PHIS POINT Accepted by: �'i Manning Pd Ck# -Date'`-" i r Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Depar ent FEES Plumbing& Base Fee Site Inspection Mechanical&Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES � M � � 1 r � j z dik Ilk Al OA AV i �1 MASON COUNTY DEPARTMENT OF HEALTH SERVICES May 19, 2009 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 DAN BYRNE DDS Elma (360)482-5269 3862 E STATE ROUTE 302 BELFAIR WA 98528 Belfair (360)275-4467 Case No.: COM2009-00049 Parcel No.:123325090040 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. mL Please see comments at the end of this letter. Please call me at(360)427-9670, ext. 279 if you have any questions. Sincerely, Amanda Reynolds Environmental Health Mason County Health Services Comments: Need a letter from licensed designer or engineer addressing the proposed flows and waste strength of the waste water. The septic system installation has never been approved. 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