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HomeMy WebLinkAboutCOM2002-00038 Final Tenant Improvement - COM Inspections - 10/14/2002 MECHANICAL MOBILE HOME ack date by Ribbons by Gas Piping date b ,on Walls date by Set Up by INSULATION date by ,J/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEP . date Z by ��(,� date p b LJ� PLUMBING An,c by OTHE Groundwork date by date by D.W.V. WALLBOARD NAILING date / by �I date by Water Line FINAL INSPECTION date date 11,4 1 by date by �''� 1 �r/.ube i f- /�►SS— �JL L ; L;�>r "../`� 4,- 4, 1L/d!7 t' 7+ <f Ail1C)L4 Ob 4UAAS �� �9 n mmO m � CD a` aam z ON C Do c CD CD CD o o CD 'aZ m N -4rT o CD r 00 �! � mcnz v � � aQ � m c) -0 ow0 nc = CD co co O � > CnC) r CD ='! � N N W W 3 69 CD m -V cn cn (D O pp N O n Z D � c N ,i o000 � o om 0 � C � � O cn . 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CD Orm � 5' O c O- m to F- r Cta _-L o = v CD a- 8 CD o o S. 8 8 o a a� v su W = O 3 W CD N CD (D O 1"'S 1`� t v,' t_`+ !a 22 —7 FORM MUST Stlll�OM`P'LETED kINK PERMIT NO BLD n7� PLEASE PRESS HARD MASON COUNTY BP 426 W. d ILDINGPERMIgTSAIPPL ton,WA9CATION 8584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLIC NT INFORMATION eA4-KE CONTRACTOR INFORMATION Owner ' �-�ZQ_A_t&T- Contractor Name Mailing Address G. !YpfAHcJ� ( Mailing Address City State c�Q..Zip ode<z*R15�Z- City State Zip Code Phone() Other Ph.(-�,W) 27?- 3159 Ph.( Other Ph.( Lien/Title Holder JJsapA l CVr,94d L-t-G- Contractor Reg. # Address Expiration / n. SEPTICfWATER SYSTEM INFORMATION-Connect to New Septic Existing Septic C Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Fire District Legal Description L+ aL Site Address(Please include street name, street number and city) U K� Directions to site � t S e 9� Will timber be cut and sold in parcel preparation? (Yes7l� O 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 0 TYPE OF JOB New Add Alt_,X,,_Repair Other Use of Building Describe Work I t0i24;,Je MoF-7W "T&-,1(Lt�n,1'Tc No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 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 $ Replacement Unit ?(Yes/No) Installer Name 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-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 Pernut 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 ang shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval X ate 01 X Date FOR OF ICIAL �U11SE BEYOND THIS POINT Accepted by Datttbmittal Amount Due �L - Receipt No DEPARTMENTAL REV1 W APPROVED DENIED CONDITION CODES Building Department A-6,t 0� P t eonJ Occ Group Type Constr. Planning Department T Environmental Health Department 5 02. -� I, Public Works Department Fire Marshal i I i Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee ` ]�j,(-J C) Plumbing& Base Fee Planning Review Fee Mechanical& Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTALFEES j PERMIT NO.: BLD MASON COUNTY' 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 Seattle(206)464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION A Owner t­ T Contractor Name Mailing Address Mailing Address City State Zip Coclec: , City State Zip Code Phone( Other Ph.(, Ph.' Other Ph.( Lien/Title Holder Contractor Reg. # .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 PARCEL INFORMATION-12 digit Tax Parcel No. Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site timber be cut and sold in parcel preparation? (Yes/t46), Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland- Seasonal Runoff Stream ',-,-,.Slopes or Bluffs PERMANENTRESIDENCE Ll SEASONAL RESIDENCE C] TYPE OF JOB New Add—Alt---,-X Repair Other Use of Building Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor O 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached - - -- - I MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Typeof Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name 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-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 pernt 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. Nooang�s.slhall 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 FOR OFFICIAL USE BEYOND THIS POINT Accepted by ,. —Date—LL-� -=�'->submittal Amount Due Receipt No, :.:.,:.:.........:......: :DEPARTM.ENTALREV.IEW�. APPROVED DENIED CONDITION CODES Building DepWment Occ Grou Type Constr.\/N Planning Department Environmental Health Department Public Works Department Fire Marshal :V1— Valuation $ GL.0 FEES Building Permit Fee cao Site Inspection Plan Review Fee 0&2 z EH Review Fee Plumbing& Base Fee 10, Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee lViolation Fee Pre-Paid at Submittal TOTAL FEES PERMIT NO.: MASON COUNTY 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 Contractor Name Mailing Address ,. I : - Mailing Address City State Zip Code City State Zip Code Phone( ;. <` ) ,Other Ph.( s, Other Ph.( Lien/Title Holder Contractor Reg. # Address - Y. }_,_. Expiration i. E SEPTIC INFORMATION-Connect to New Septic Existing Septic_ Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 digit Tax Parcel No. Fire District Legal Description Site Address(Please include street name,street number and city) ;Ek Directions to site Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 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 Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs = Heatpumps Showers " Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent 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. 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: i 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 FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. i AFPRt7V1wD ''IJENIEt3:> CCG1NDf{I(lN;GUCfES. Building Department Occ Group Type Constr. Planning 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 �c L' FORM MUST BE t OMPl T1=4114INK PERMIT NO BLDw 3 PLEASE PRESS HARD MASON COUNTY k t ,B - [LDINGPERMITSAI �PPLICATION 426 W. d Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICgNT INFORMATION IE�A� CONTRACTOR INFORMATION Owner (LWr�9-11AJi, ��.Ill r- Contractor Name _ Mailing Address -Hfe�14L, �/ J'V& Mailing Address City L2NIoN State LLA-Zip ode<'9,8.gZ City State Zip Code Phone(?&i2 Other Ph.(�e0) 1 7?- 3159 Ph.(_ Other Ph.( ) Lien/Title Holder /JEy.1 I C5--44,th. L-t.('- Contractor Reg. # Address Expiration / ! A SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic_,X. Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. 3ZZ 32. / / /00 Fire District Legal Description " - aL Site Address(Please include street name, street number and city) U RAS Directions to site IOI Tn IC)( NufkXto� r.JTo (� M� �� era ��Tr`+�iCr Will timber be cut and sold in parcel preparation? (Yes9� O Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream_cSlopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt_ Repair Other Use of Building Describe Work j E�Jy. ►.ST 1►�I t�'12oJe M�` 1 �'v.�l(LA. T- No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 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 $ Replacement Unit ?(Yes/No) Installer Name 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-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 ang shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. , first obtaining approval. X ate ©.� X Date FOR 0 ICIAL USE BEYOND THIS POINT Accepted by Date - 1--�4tbinittal Amount Due Receipt No DEPARTMENTAL'REVIEW APPROVED DENIED CONDITION CODES Building Department II A-6,t of Pla's tvr-o n-&— Occ Group Type Constr. Planning Department Ltj ,WTI'$ Environmental Health Department Public Works Department i Fire Marshal f Valuation $ FEES 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 i Pre-Paid at Submittal ( ) TOTAL FEES ti J FORM MUST 9'E-6OMPL-1-6 [kINK PERMIT NO BLD / PLEASE PRESS HARD MASON COUNTY ok BYILDING PERMIT APPLICATION CO '1, 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 APPLIC NT INFORMATION 8L� <fA4-PioJ LA-.- CONTRACTOR INFORMATION Owner JK1R5iXR,,)g,ps t.-i r Contractor Name Mailing Address C.'�p fey!-fc) Mailing Address City L2NIpq State (, Zip ode<q,Q,�Z- City State Zip Code Phone() Other Ph.(,--z*O j 27?- 3159 Ph.( Other Ph.( Lien/Title Holder ►liav3 I C5-44&. L-LX— Contractor Reg. # Address Expiration p. 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 PARCEL INFORMATION-12 digit Tax Parcel No. 322: 32 / I /00 Fire District Legal Description L- — al Site Address(Please include street name, street number and city) URti Directions to site lCl Tc2 In(p S s �Z, Will timber be cut and sold in parcel preparation? (Ye O Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream_>c.,Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt__, _-Repair Other Use of Building Describe Work 1►✓1 r.-Az;Je mC' 4 No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 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 $ Replacement Unit ?(Yes/No) Installer Name 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: I 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 per 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 .ang shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X ate ©� X Date FOR OFIfICIAL USE BEYOND THIS POINT Accepted by S Dat(e" 3�c)�Lbmittal Amount Due L) -sb Receipt No DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department A- ,Belt 0� P tC-oYWA-- Occ Group Type Constr. Planning Department �taTa� i Environmental Health Department i Public Works Department Fire Marshal Valuation $ FEES 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 .try f 2� FORM MUST BIE`eOMPI:ETE11�11(tINK PERMIT NO. BLD PLEASE PRESS HARD MASON COUNTY L �. k°,BY[LDINGdPERMIBoxgTSAIPPLICATION Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICgNT INFORMATION V:,L� tf~"JE/- CONTRACTOR INFORMATION Owner k;TZ:;9.1A,rS Contractor Name Mailing Address 4r,,1JQ {d(e?Hc2-41L /)960 Mailing Address City L2NInU State t�ZL4 Zip ode4:::ZT9-, �2�'V'- City State Zip Code Phone(?*0) Other Ph.(----*;e0) 2'7?- 5159 Ph.( Other Ph.( Lien/Title Holder t CVta4&. L.L--- Contractor Reg. # Address Expiration A 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 PARCEL INFORMATION-12 digit Tax Parcel No. 32Z 32 / / /00 Fire District Legal Description I.+ —� c aL Site Address(Please include street name, street number and city) V R�1 Directions to site p t S e N ��. Will timber be cut and sold in parcel preparation? (Yes�n � 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❑ TYPE OF JOB New Add Alt­,&_Repair Other Use of Building Describe Work j ErJA-►Sj 1►✓I I�i2oJe t��"i�-(� '��-aJ(LatiCT' '"'"� No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 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 $ Replacement Unit ?(Yes/No) Installer Name 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-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 per 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 .ang shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X ate - ^' ©� X Date FOR O``F ICIAL USE BEYOND THIS POINT _ Accepted by Date��ibmittal Amount Due 04-�� Receipt No DEPARTiVI;ENTAL>REVIEW APPROVED DENIED, CONDITION CODES' Building Department j PIt-,5 tvoolr+A Occ Group Type Constr. Planning Department /W Environmental Health Department Public Works Department Fire Marshal I i Valuation $ FEES 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 FORM MUST BE COMPLETED IN INK PERMIT NO.: PLEASE PRESS HARD MASON COUNTY 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 $La.1 G.uP&-JW1-L. CONTRACTOR INFORMATION tear 70 Owner V 1 c-fo4iA n r Contractor Name Mailing Address Mailing Address City U ht 1 DrJ State Zip Co !EJ City State Zip Code Phone() 3176-440&ther Ph.(,e)2T?-3159 Ph.( Other Ph.(� Lien/Title Holder NeJ Jtc r&-,qA o• LL.C.. Contractor Reg. # Address 4zz Expiration / / Lus�%/LAF- SEPTIC INFORMATION-Connect to New Septic Existing Septic—, —Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 digit Tax Parcel No.3Z2��!e / 5�2 Fire District Legal Description Lcasr n-ZZ I.oT (OD l Tr�r Site Address(Please include street name,street number and city) �/o LilaC. Directions to site 10 o Tom-- t =1ZKif Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Y.-_Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric !yDe of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No.of Units Fees Bathroom Sink ty Furnace Bath Tubs Heatpumps Showers Spot Vent Fan C 44 Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent 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. 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-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. N shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date 4�(Oc/O X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. E3A1tt1 ftiA1TA ii£ E1tu. ItiPPR1E1wG1 [il;N1Et3.;... <tG1RfRiT1(?N.Gfl:G5. Building Department Occ Group Type Constr. Planning 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 FIRE MARSHAL Mason County Bldg.111 426 W. Cedar P.O. Box 186 Shelton,Washington 98584 (360)427-9670 Ext.273 z m __4 z::i 2 z -n 0 X X 0 m C, > > 0 m -, K 0 M M r- 0 0 -1 m z m-n 011 gym - > OZ -n (D 0 -- 0 Z1 M Km X 0 0) m m > 0 OZM 0 > 0 C/) o w r -n 0 m > ;u0 0 -J! 0 m 0) G) m > .41 CA =3 — X Fn -n -4 ZM m > 0 MO 09 -4 1 -n 0 --j > m m to m co 0 m K < -<0 > m -n X A :E 0 z to M > -4 'U 0 < m 0 M 0 X co --I (D X m G) 0 MITI �_ >0 5 0 z > m Z J;u Z 0 '�m .. 0 < cn cn 0 cf) z z cl) c/) I 0 > 0 0 --1 X 0 a m =3 m 0 Z g ;7 1 cl) -n m m 0 rn 0 ;ID 0 z m ;6 -n c mnm 0 -n -n CD X 0 0 (n mA X cn Fn 0 > z X I ;U ;a " C) go m �"� Mo . 0 10 0 ;a M 0M > X 0 m > 0 G) --I m 0 z "n < r-j M m z > c/) 0 v 0 m n 0 >0 _0 0 z X 0 0 0 M 0 M Z z m 0 To m -1 > mmC)do m G) <z w 0 m W