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'- z" -sz tt 0 � 40. yyrr •'"i,' c m 0 V wo+ Acs i 00 C)— O Q D Q6 - o D a � oDv, - �� x r- i a•+ J O a a ? z me co 670 � m o 00Q A t E 111"MrAlPermit No. BUILDING M APPLICATION nC� 426,W.Eedar/P.O. Box 186, S ": PLEASE PRINT Win,WA 98584 427-9670/1$00-562-5628 1p #1 r y.4t-fe-�V 44i/C.L/ArlS Phone SiteAddresa_�,E. 90 .c.gliCB:fLiD�E City L eQ F/ire District.# 'C s St �1•sue.. Directions to_,19b Sit# gsT' t�7E of -- `Y A Eki CK.So�! E A SCE QEE MAW Owner Mailing Address�SOSL /C/TS�4 t�Rl✓E City $R.E'HER 7-6 Af St WA _,ZiP 2 LierUTitle Holder S�l�-tE L/4 oNE� Address City St �p e #2 Contractor Name O[,vw E R Contractor Reg# Address City St Expiration Date / / P.Phone# #3 If septic is located on project site, include records. Connect to Septic? O P .�_Public Water Supply Well Connect to Sewer System? NO Name of System �uN S (If residential, proof of potable water is required) ' i�Anmel No. ZZ3o - �_- ,o/8 O H (Legal Description rt 7Ac F _ #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / 73G (Circle:Attached o tache Other sq.ft. / #6 U Describe works f #7 Type of Job: New )C Add Alt Repair Other #8 MOBILE/MA NUFACTURED HOME INFORM Model Year I LengthSerial No. #Bedroomthrooms Type of Heat Purc Bed: P #9 Indicate by circling the applicable source if an water is on or adjacent to s River Pond Creek Stream Wetland( Lake Marsh Saltwater Seasor Runoff Other Show following on tihs sits ph ;r. Lot Dimensions Existing Structures Fetes. r Structure Setbacks Drivewgys Water Lines - Shonslines Drainage Plan Topography„ Septic systems <: Wellrf ' Proposed ImpmVernetns Ea me Indicate Directional by S,. E, Name of Flanking Strut in relation to pert p Name of Fronting Street APPLICANT TO DRAW SITE-PLAN-BELOW - - SE-E ,4�A cll-E� SIf�T s - t : y APPLICANT TO DRAW-TOPOGRAPHY PROFU B �o sr Z So Plumbing Fixtures(S3.35 each) i Mechanical Fixtures 0.75 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins - Heatpump, Other _Bath Tubs 11pjS;i Em _Showers fum BTU _Hot Water Htr Heatpumps _Laundry Washer _ Vent Systems_ _Sinks Spot Vent Fans _Floor Drains Ng, Boilers/Compressors _Laundry Basins _ HP _Dishwasher No. Handling Units _Disposal cfm# TUrinals NO, __.: Fire Protection Symms _Other Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 16.75 _ Auto Fire Sprifik Sys' 35.00 TOTAL PLUMBING $4—of No. Other Gas Outlets Wood, Gas,-Pellet-Stove _ N0710E: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CC*MT"UCnON AUTiNARI EDIS NATGOM- MENCED WITHIN 180 DAYS ORJF ONSMUCTION_OR Permit Basic Fee 16.75 WORK IS SUSPE D OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $� OF 180 DAYS AT ANY T1MI~ ASTER A WORK IS'WM- tY .. -- _'OF FORK"Y MEANS OFA PROGi iES8 Mog "LION. OWNE S ' I_ VIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY T AT-I AM A CURRENTLY REGISTERED MENTS OFa THE CONTRACTORS REGISTRATION,LANK_ CONTRACTOR IN THE-STATE.OF_WASHINGTON AND 1 RCW 18.27,AND AM AWARE OF THE MASON COUNTY AMAWAREOFTHEORDIINANCEREQtJIREMENTSREGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER; LATINGTHEWORKFORWHICH'THEPERMITISlSSUED MIT IS . _.__ . TALL WORK D MILL B>=`IN AND ALL"'WORK-DONE'WU BE X iC'OWORMANCE CONFORMANCE TRH ITH.NO CHANGES SHALL BE. THEREWITH.NO CHANGES q*kLt_-BEWM WITHOUT MADE WITHOUT-FIRSTt113TAINING APPROVAL FROM FIRST OBTAINING APPROVAL.FROM-THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER X BY _ DATE 4-.L 9? DATE DEPARTMENTAL REVIEW ' 'OFFICE USE ONLY` Apaovad ' - Haa Planning: -.. /'rye Environmental Health: Building Plan Review a- 1 Occupancy.Group: U—.1 Type of Const:_J( AJ _ Fire Marshal: Other. _ Special Conditions: FEES Building Permit s,-- Plan Check Plumbing Fee Mechanical Fee Wood/Gastpellet Stove Radon:Monitor 7. Violation Fee Site Inspection Building State Fee Y. J'D t ,,J �� Other &1�L Ut`lC.�l &4. l/i o.� ✓ Other Building V TOTAL FEE GARY YAWn OIRpC'= +X »,:: Mill I SI`I .'hC V,WA • (M)4V-M ;OF� by 1+ Awcowi" #fa p ► 1 r flit eo dr t"aanq►f 4 p "do k4w m"do Comrty'� �rcMoar n►aiid. 0 (Aav l No.or too Dow"* (at a Cater ow+ Ibe$*Mwo of die owm W's NOW&W.4ted UP=proper proof of■uftfbw* A CX*TM'1'CA-M DUAL) STATE OF COUNTY OF • On of .in qa yeor .before un Nagry . P bma to me to be tips pmm wbm ammo b onb"eibed to d6 bft m m4 to scb"WSW do 6%6e mc oW it. -For CA" ltowesw by OP& pt t'�MiM) �� Stt�Rltatiei.�� MR/MRS JAMES WILLIAMS' r 1504 KITSAP DRIVE BREMERTON, WA 98312 Et_EVl tZ0A:� cA-SE ME/`/T" � t AKERi 6-rE -7 A s\ EL E ELEV S�ASoA"AL 2vvvFF C`'-o`'►c. _ l•��o� aEw CAQPoar �' as 2.Nx 7-6 �0 Nar': lZ'NiN. SE?ARATiod 0�� 89TWF.feA1 6TRJCTVRES A0 S A. Y,42 C b S vRFgE /Zc�n/oFF T c.o Sof�E AWAY t=,2nrt ST �cTu,2F arr� 118So►2gEt� \� 49� �e��\� /^tom Solt_, 2) %A/ATSit SOPPL_y $'j CaH/"J CIA,/ry, � vF �yL►fj��... e. S 7v' 1 /00 i f j i tt1 i USt'iNRsr..�..«._,.:�$►�_ .�.__... -DATE SH1'fUi= � / CI.IENY .A —.. __..___-- �___.JOI3 . ------------- __-- -- sr h. Ex . t B / C ) WIND . P ► � Type _`'{ SOIL. ICNC(:UIZIiCf: ( 'rA& f)GRCLTIZL ( Y II SITE°'SPECIFICS: < uac ./ u rllc.r ) pst SLAB ( Y / 0 > - VERY LOADS 1 /2" Alv„,, ( Yl ) ' SNOW _.Tr_?_ SHCAR MLLS M DEAD ( 5 )_5_ w ? POST TOP COMM' S 2 r_QUFlL LMYS Y I ?. CC z 4 a •.., op^0� I OL P.";! 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