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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 INFORM ION CONTRACTOR INFORMATION Owner �'f� A w-N H PAN$0#4 Company Name Mailing Addres Mailing Address City V 1V ►0-"\ StateWKJ Zip CodeFfNe City State Zip Code Phone yQ'D' d V C Other Ph. !jQp -706 Phone Other Ph. Lien/Title Holder I I AI C—A l Contractor Reg.# Exp. E mail address • COWN E Mail Address Drivers Lic.# V q DOB MAr 3 S Drivers Lic. # DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well - Water System Name of Water System PARCEL INFORMATION - 12 Digi�P rcelrNo. Fire District Legal Description ' -r ` y2Ca 011- Site Address (Please include street name, s .eet n b r an city) u V W t 2 Directions to site '" Will timber be cut and sold in parcel pp--rep�ration?Yes No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff _, Stream i':; Slopes or Bluffs > 15% C �, 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 PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building "ylvu.zwC n� Describe Work No. of Bedrooms—No. of Bathrooms - Square Footage- 1 st Floo 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 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 permis- sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion or the work proposed in the app lion, I have obtained permission from them to pply for this permit and conduct the work proposed. X f / Date: Own FGoresentative/Conttacfor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld P Receipt No- DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department �. J E S_, Planning Department Environmental Health Department RECEIVED- Public Works Department Fire Marshal R 0 1 FEES Building Permit Fee — p® Site Inspection Plan Review Fee 'Jt- OCR EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other n At�7 C .��.�'J Wood /Gas /Pellet Stove Fee State Fee Violation Fee Pm_ I Pre-Paid at Submittal Valuation $ 4 TOTAL FEES MA 12004ro I Q' , - ;. lz FF-20 04 It Lo .t i.'� •4jt.� 1 /0 360 f PLANTERS noo .f i i{:.i� •���75.y+� a.''. -yp�''� •i. ♦ •�'r�"�'.:� ,j. :y1�:�S1.�'l�`f�',�11• •ii' f..tt�l�''j�' .'!� �. �j.riIS+f4 '�'.. t Ii ..5• r �,.s}7••� r 't�•�.` i 2L�y�. , y ,/. �• ;•� �r• .�. :�}y r . •.. .xv t'l s ,,2.:�., S` ':: .r• r.�� rr� �� - •:'�5; }• '�tflra'}•(•�:• ;3' ^•� �• f •+ti•'.,.a "lJ.?}•/ ti•„`• wr,,�'ri�,J.�r �c' ,y r�y�01 j,�.,,.5'....• '?�il��,�„� ''• ��`;l•t J' $Y��:+••' ,r C't. u %Y:V ,�F{",'t'{#j';�. fr7�,'?S� r F�lsf �".� 'M"' �.i:�,r,+1• ,'"2�: ti r'' rY ,��.� d .h4ftJ,:<< r ui ,. 'i f 1 'r :rxo, .M►�' rt't A�; :�• , t ,. 7� f. 3t�� 1•��'L �!. w �v {rr �'R�'! •t'••}: •f�{ t {J,�Lr+f, •`�• •� ':r�.. v',ir. kr r:r�t�'�.�t r; ,tj� � .,�^�: � � 4 '•� � '.�C i�l-y�•• •�«�i .��:��i?' r:� .�!r.4 •, .t'.: � t,�•:�r .�•.�•• 1a�•j3f1�.� �!�.r�' y r, r i,� , � �}'�Y �`�!!ti, •d:� .7 r {.7si. .t N � i r .r.., • i��'i�`j`.� �;�t`�,�1•f,�.y. Tj � i�' •�..ti�j�l' F•• '� `��!' jt�� .SQ.���..},'.�j:,t.• p;,���:����7.••tr4•�. •G��,� ��i'}. ••i�'�_ !'�r� "'� i S� ,p �T�4�t gin••• .40 .•�.'+l •%� .`c .Z' •1' ��JJ•,rt ''��.•Ir. -r' ;fir„ v M.%r'�{�fr�!'�21.�' ► •�yl��� � ��. •[•' it •►�••.•+'} t• �, a�• � j�1 �r�• [ ',•1. Ir H .1- VE() • ''i �'�. �)�ji. r 1. .f,�4. rf, T Illr1�Ni,•Jar"}; i+ K { ,�t ',♦ � x" t� .w'i' THIS PARCEL INCLUDES PLANS, BLUEPRINTS OfR OVERSIZE IMAGES LARGE FORMAT IMAGES HAVE BEEN. STORED IN FILE CABINETS) UNDER R- CEL NUMBERP A PARCEL # 3 a3 - 50 - 0 Q70 � CASE # Lorr) 2joo GPO �G`Tfl"II- �7uRvfY �P 2001 Washin ton State Nonresidential Eneray Code Compliance Form Lighting Summary LTG-SUM ' 2001 Washington State Nonresidential Energy Code Compliance Forms Revised June 2002-KJM Project Info Project Address Date For Building Department Use Applicant Name: 7jFWS5/1 Applicant Address: Applicant Phone: Project Description ❑ New Building ❑ Addition ( Alteration ❑Plans Included Refer to WSEC Section 1513 for controls and commissioning requirements. Compliance Option 0 Prescriptive 0 Lighting Power Allowance Q Systems Analysis (See Qualification Checklist(over).Indicate Prescriptive&LPA spaces clearly on plans.) Alteration Exceptions ❑ No changes are being made to the lighting (check appropriate box) ❑Less than 60%of the fixtures are new,and installed lighting wattage is not being increased Maximum Allowed Lighting Wattage(Interior) Location Allowed (floor/room no.) Occupancy Description Watts per ft2" Area in ft2 Allowed x Area "From Table 15-1 (over)-document all exceptions on form LTG-LPA Total Allowed Watts �a arm Notes: 1.Use manufacturer's listed maximum input wattage. For hard-wired ballasts only,the default table in the NREC Technical Reference Manual may also be used 2.Include exit lights unless less than 5 watts per fixture. Proposed Lighting Wattage (Interior)List all fixtures.For exempt lighting,not exception and leave Watts/Fixture blank. Location Number of Watts/ Watts (floor/room no.) Fixture Description Fixtures Fixture Proposed T - Total Proposed Watts may not exceed Total Allowed Watts for Interior Total Proposed Watts Maximum Allowed Lighting Wattage (Exterior) Allowed Watts Area in ft2 Allowed Watts Location Description per ft2 or per If (or If for perimeter) x ft2(or x If) Covered Parking (standard paint) 0.2 W/ftz Covered Parking (reflective paint) 0.3 W/ft2 Open Parking 0.2 W/ft2 Outdoor Areas 0.2 W/ft2 Bldg.(by facade) 0.25 W/ft2 Bldg.(by perim) 7.5 W/If Note:for building exterior,choose either the facade area or the perimeter method,but not both) Total Allowed Watts Use mfgr listed maximum input wattage.For fixtures with hard-wired ballasts only, Proposed Lighting Wattage (Exterior) the default table in the NREC Technical Reference Manual ma also be used. Number of Watts/ Watts Location Fixture Description Fixtures Fixture Proposed Total Proposed Watts may not exceed Total Allowed Watts for Exterior Total Proposed Watts THESE PLANS MUST B ON THE JOB SITE FOR INSPECTION. SCOPE OF PROJECT NOT MET 3/4/2004 DLC The scope of this project is includes 1)wall repair due to water damage, 2)insulation of exposed walls and 3)cover with gypsum wallboard. Other work performed in the structure must be approved by the Mason County Building Department and other applicable departments prior to performing work or installing components. X WSEC COMPLIANCE NOT MET 3/4/2004 DLC Washington State Energy Code compliance shall include as follows: 1)Insulate exposed walls. R-I 1 insulation in 2"x4" walls and R-19 insulation is required in 2"x6"walls. 2)Total light wattage shall not exceed 3,222 watts. Submit a lighting schedule to the Mason County Building Department prior to the final inspection. The lighting schedule shall include total wattage for lamps and fixtures and demonstrate that the installed wattage does not exceed 3,222 watts. X SITE SPECIFIC CONDITION NOT MET 3/4/2004 DLC This project is approved subject to the following conditions. Areas identified by Mason County Building Inspector, L. Waters during the February 27,2004 inspection shall be exposed, including: a)Areas where water damage was present and repaired b)Representative area(s)identifying wall insulation installed. Contact Mr.Waters at(306)427-9670 ext. 285 if you have questions about areas that need to be exposed. X THESE ON HE J FOR INSPECTION. SITE ECTION. .�. B IL'D �NG - � � - I VED • - •• GJ - p �F • • •,-• 1 l 6 :y�e' � S� �. •Y � f 91 BLDG FF-20.04 Zj CHANCE • Y... SUBMIT CHANGES FOR APP VAL I PRIOR TO PERFORMING RK . ` ; _ �j THESE PLANS 36" IF fi ON THE FOR INSPECTI N. 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L 'a' w lli • � •• ems .. � �e. a � � J _ lw s g z a K � ezo J ,?J v a r o c a. _- `� = CHANGES '4 SUBMIT rHAj\i _ PRIOR TO PERFORMING WORK r � \ 4 u t 9 THIESE PLANS F L..; ON T I-f E J IJ FOR INSPECTION. I WAL*MART ALWAYS LOW PRICES. 6�w- ' SUPERCENTER WE SELL FOR LESS MANAGER KEVIN JOHNSTON ( 360 ) 427 - 6226 STh 2121 OP# 00001670 TE# 73 TRX 09779 ROLLER COVER 007843590142 2.44 J BIT EXTENSIO 002887417219 3.82 J RBMD EXTPOLE 007004257341 7.86 J 1 GAL MIXER 007004252657 1 .84 J 3PC TRAYKIT 007843590143 1 .77 J 3PC TRAYKIT 007843590143 1 .77 J JOINT CEMENT 005286512400 7.97 J JOINT CEMENT 005286512400 7.97 J KILZ GP INT 005165257000 36.97 J SUBTOTAL 72.41 TAX 1 8.300 X 6.01 TOTAL 78.42 CASH TEND 100.00 CHANGE DUE 21 .58 # ITEMS SOLD 9 TC* 0445 1484 1043 7557 9523 II IIII II I I I I I I I I I II III IIIIII I IIIIIII(IIII IIIII)III)IIII II Join us for Baby Days! 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