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C'ONCRETE MECHANICAL MANUFACTURED HOME Footings/ S tb cks Date 2 Cis B Ribbons Date OT By .Gas Piping Date By Foundation Walls DateB y Set-up Date By INSULATION Date By B G /Slab Insulation Floors Final Date By Date 8J2-11 /05 B y � � Date By FRAMING_ / Walls FIRE DEPT Date � z�c-aS- Date By Date By PLUMBING Attic OTHER Groundwork Date By ate By WALL OA D NAILING D.-%V.V. j Date J B y i s c ° D ate 1Zz�v FINAL'INSPECTIODI j Water Line Date ( B '° Tate 2 d H ' Date B y � o �- r yP f�usT �►� � �� CaMrn c PRss CD v k� a o M Via- 1 QO CD 6 8 ,. _ l F t ,7To L cr;,; IL, Q i W { _ g f4 F ,u i e 0 1 t MASON COUIN TY 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.rimason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Mailing Address MailIng Address City State Zip Code City. State Zip Code Phone Other Ph. Pho ie Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Fxisting Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% 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 Describe Work I No.of Bedrooms & No.of Bathrooms Square Footage- 1 st 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. I 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 permission from all the necessary parties.If permission is required from any easement holder or any other parry 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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW AF OVEIP DENIED NOTES Building Department d Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES PERMIT NO. MASON COU Ty PLUMBING/MECHANICAL P RMIT 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 INFORMATION Owner Company Name Mailing Address Mailing Address City State fi Zip Code CityState Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder T"� ' Contractor Reg.4 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. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site lf,4r" r'�r I L` T Is property within 200'of Saltwater. Lake River/Creek Pond Wetland Seasonal Runoff Stream Slo es or Bluffs > 15% 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 Type of Fixture No. of Fixtures Fees Fu I Type:Electric� LPCz_ Natural Gas Heat Pump_ Toilets T e of Unit No. of Units Fees Bathroom Sink Fu nace Bath Tubs He tpumps Showers Sp t Vent Fan Water Heater Pr pane Tank Clothes Washer GasOutlets Kithen Sinks W d/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Ot er 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 obt ined the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this ap plication or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. Th owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the abov described property and structure for review and inspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INS 31ECTION. Date: X Owner Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BE ONDTHIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Tvpe Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee r,ite Inspection Mechanical & Base fee U C Plan Review Fee Wood/Gas/Pellet Stove Fee Cther Violation Fee TOTAL FEES el R d 1a�0 MASON COUNTY DEPARTMENT OF 'COMMUNITY DEVELOPMENT �pR WSEC/VIAQ Compliance Application Telephone:3 -8 7-1819 Parcel#: r1 Zoo 2?5 xD-�0 Type of project (A New Residence . ( )Addition ( ) Remodel Total Sq. Ft. 1 Floor: 2 nd floor: Heated Basement: of heated area:: i LL' l Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type: O Other: Specify Glazing Compliance O Prescriptive O do see reverse side circle one: I;1;` II IV Percentage: Method O Component Performance , Chapter 5— Calculation worksheets required Check one:: O Systems analysis, Chapter 4 O Whole House Ventilation system O Whole House Ventilation using a Heat Ventilation using exhaust fans&window or wall fresh air Recovery Ventilation System (VIAQ 303.4.4) System vents (VIAQ 303.4.1) Check one O Whole House Ventilation Integrated O Whole House Ventilation using an inline with a Forced Air System (VIAQ 303.4.2) supply fan. VIAQ 303.4.3) Window & Door Schedule (if needed, attach an additional sheet) Total Manufacturer Roomllocation U-Factor Size Quantity Square Feet Windows: X Gtd►�C 1t'i eu� v`` x Z (AcL i1 " g#yf3 3 vs ," tir 0oa Y-- Z- X 6' 1 1 ?-- 5F Poo Y-- L'k ' X to/ to 2 Lk �rF F� A-srvg- R afni v 'X\ I I s F 10 C,L Windows: Total Sq.ft. Doors: k� f�/I'► ►o ' x 7` l Lt 2 5 KA,,,7ea ?2e1P1i M70 `A 7 t ( �C 2 5 r� Doors: Total Sq. Ft Total window and door area F Total window& door area 47M 1(divided by)total sq.ft of heated area Z 1`� = l %of glazing 95' LP WAflI p Noe APPR V,ED pLANIUING MASON COUP ®$�� E ON SITE r -SITE P.4AN:REQUV _D T B ,., d, w. CHANGES SUBJ T T APP�O AL �'10K" C ate .�------ , , yc,q,o2 f, (pS�.OZ! L + r� , 111 1`'�D PoSt� �zS�t7eAY-�`; i M� (,,M§jU0lq v)t72t— I IPCP-12 S WAY JL ss IC OOLY� - y2ao Z7S00090 �l2 WAY U 2 q(o 250 TD 5okT" ?POP, (A"C T'{20 PC 5 e !) To Nof Tt! P2oR UtPE ILA 34 '77' I { low too, Wax, RAl7lw& , ►oy D(tA1OF j evC��` or Gap(JCL izQH'J (txISr10Cl) �/Z �0N.STgTFO� MASON COUNTY M P Department o Community Development 4 O ° S N =N Planning Divisio , P O Box 279, Shelton, WA 98584 z� N y y (360)427-9670 OJ �O 1864 NOTIFICATION OF AQUIFER RECHARGE AREA April 28, 2005 MAURICE PERIGO 3345 LADY FERN LOOP NW OLYMPIA WA 98502 Case No.: BLD2005-00662 Parcel No.: 420027500090 Project Description: RESIDENCE WITH GA GE Dear Applicant: The subject property is located within an Aquifer Recharge Area. The owner of any site within a designated Critical Aquifer Recharge Area as identified in the Mason County Critical Aquifer Recharge Areas map, on which a development proposal is submitted, must record a notice with the Mason County Auditor. Once the Title Notification is recorded with the Mason County Auditor's Office, a copy of the notice is to be submitted to the Mason County Planning Department. This opy is required prior to the issuance of the Building Permit(s). A form has been attached for your convenience. Please complete, sign, record and return the form to this office as soon as possible to avoid delays in the processing of your permit. Please be prepared to pay$19.00 for the first page and $1.00 for each additional page at the time of recording. Also included for your referral is the Critical Aquifer Recharge Areas section of the Mason County Resource Ordinance. Please contact me at(360)427-9670, ext. 295 if you have questions. Sincerely, J�ojluyl� a-"ILL Tammi Clark Land Use Planner Mason County Planning Department f cT9 my A T'l n r' b le OF "4 _ SSSSSS ,.r� # i r ` e