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Home My WebLink AboutBLD2005-00577 Revised - BLD Permit / Conditions - 12/29/2005 Request To Revise An Approved Plan Permit Number: B Name Parcel Numb 42 _ v _gg�- Phone Number daytime Project Address Mailing Address G s/ f .z4;1A,e-S71,v5__ � � Please provide a complete, detailed description of a proposed revisions to the ap AWGI. rA D COUNTY Are two sets of the revised plans or addendum indicating the changes included? [r'Yes ❑ No Are the approved site plans included? .q Yes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? tg'Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? 6/1Yes ❑ No If Yes, Has the engineer or architect approved this revision? Is a stamped and signed a Yes ❑ No p gn approval included with this request? t3/Yes ❑ No {Note:No structural changes to a"designed"Plan will be approved without the written consent of the engineer and/or architect of record.) Does the proposed revision modify the footprint or location of the structure? ❑ Yes ❑ No If Yes, Is a revised site plan,.with all new setback dimensions included with this request? 11 Yes ❑ No Additional Information: Applicant's signature::� �-- Date: 12 Office Use Only Received by Date Sent Assigned T''o Approved By Date ��X�J C 2 Original Valuation: $ 2-77i &ZG-75' Z Additional Valuation: $ Sq.Ft.�__x$_ ��D s� $ 8 O Sq.Ft. x$ $--� H. ( Total New Valuation $ � (0 O P.W. Additional Fees: Additional Planning Dept. $ New Setbacks: Front / Additional Plan Review $ S o� Rear / Additional Building Permit $ e Side1_ / Side2 / Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. $ .P Other $ Total Amount Due: $ �� Q Z 9 O ,SS Zo S 2effAmount To Be Paid Up-Front$ Tah milial Revised SRG B/2M003 Inspection Line(360)427-7262 *. MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2005-00577 OWNER: ROBERT LEMON CUSTOM HOMES RECEIVED: 4/7/2005 CONTRACTOR: LICENSE: EXP: ISSUED: 4/25/2005 SITE ADDRESS: 341 E RAINIER CT ALLYN PARCEL NUMBER: EXPIRES: 10/25/2005 LEGAL DESCRIPTION: LAKELAND VILLAGE 11 LOT: 55 341 E RAINIER CT ALLYN PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW RESIDENCE LAKELAND VILLAGE General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: VB Type of Use: SF Insp. Area: OT No. of Bathrooms: 3 Occ. Group: R3U Lot Size: Deck: 112 Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building:2,624 Garage-Attached 604 Valuation: Building Height: Occ. Status: Primary Basement:2,624 cov porch 128 Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft. Front: N 35.0 Ft. Shoreline: Ft. Water Body: NONE Rear: S 20.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: E 5.0 Ft. Shoreline Desig.: Not Applicable Year: Sedal No.: Side 2: W 5.0 Ft. Comp. Plan Desig.: Urban Growth Area Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Plan Check Fee KS 4/7/2005 $1,246.54 S12005 Hosebibs 3 Fireplace 1 Planning Review Fee KS 4/7/2005 $155.00 S12005 Kitchen Sink 1 Furnace<100K 1 Address Fee GMM 4/12/2005 $140.00 S22005 Laundry Tray 1 Gas Outlets 2 EH Plan Review CEW 4/16/2005 $75.00 S22005 Lavatories 5 Propane Tank 1 Adjust Plan Check Fee DLC 4/21/2005 $47.32 S22005 Showers 1 Ventilation Fan 4 Building State Fee DLC 4/21/2005 $4.50 S22005 Water Closets (Toilets) 3 Heat Pump 1 Building Permit Fee DLC 4/21/2005$1,990.55 S22005 Water Heaters 1 Dryer Vent 1 Mechanical Fee DLC 4/21/2005 $145.95 S22005 Bath Tubs 2 Mechanical Base Fee DLC 4/21/2005 $23.50 S22005 Clothes Washer 1 Plumbing Fee DLC 4/21/2005 $117.00 S22005 Plumbing Base Fee DLC 4/21/2005 $20.00 S22005 Total $3,965.36 BLD2005-00577 Please referto the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD2005-00577 CONDITIONS FOR BLD2005-00577 1) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocation. I� X x r 2) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or re uJation, must be reviewed and approved by Mason County prior to construction. X ZL12� 3) Prior to final approval, all upland areas disturbed or newly Grey construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 4) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting additional inspections. X 5) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to request a final inspe tion or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County j es and building regulations. X �� 6) The internatioanl code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150' from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where X such roads n�gtty6jthya county maintained public road or to another fire apparatus access road which connects to a county maintained public road. BLD2005-00577 Please refer to the following pages for conditions of this permit. 2 of 4 7) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent p nrcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be located within of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your project. X /�,�� 8) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete work eLxposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). X x,�K 9) Water quality is not to a degraded to the detriment of the aquatic environment as a result of this project. X 4 2i1 , 10) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder Ider have pave ( action from being taken. No more than one extension may be granted. 11) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization trom the Building Official. The permit older is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal of appx documents will result in failure of required building inspections. X T 12) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department pr r�Q any further inspections being performed or approvals granted. 13) In accordance with international codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus Access Roads," all new structures that require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from the access road. The numbers shall also be plainly visible and legible from the street or road fronting the property and shall contrast with their background. Mason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted by the jurisdiction and the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting inspections. , X �/ 14) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, ndfl�(shing. Install metal connectors approved for contact with the new types of pressure treated material. X ,, BLD2005-00577 Please referto the following pages for conditions of this permit. 3 of 4 15) ' All propanc'tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must X meet the inst l (oqr requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks. 16) All property lines shall be clearly identified at the time of foundation inspection. X O� 17) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-098Z ,T e person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X .05 �C( 18) Approved er di�ensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X , ice 19) This project is approved with an unheated unfinished basement. Heated spaces must be insulated to current Washington State Energy Code requirements. A separate permit and approval will be required change the use of the area to other than unheated/finished space. X , 20) Washington State Energy Code Compliance has been approved using the following: Heat Type: Heat Pump with Electric furnace, Compliance Method: IV, Window (Max U-Factor):0.40, Skylight (Max U-Factor):0.58, Doors (Type/Max U-Factor): 6 less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-30, Slab Insulation R-10. X l 21) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of work is by means of a progress inspectio .The owneror the agent on the owners behalf, represents that the inforrnation provided is accurate and grants employees of Mason County access to the above described property/and stru e for review and inspection_ OWN ER OR AGENT: ` ' DATE: BLD2005-00577 Please refer to the following pages for conditions of this permit. 4 of 4 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. III 426 W. Cedar P.O. Box 186 Irflo Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2005-00577 OWNER: ROBERT LEMON CUSTOM HOMES RECEIVED: 4/7/2005 CONTRACTOR: LICENSE: EXP: ISSUED: 7/19/2005 SITE ADDRESS: 341 E RAINIER CT ALLYN EXPIRES: 1/19/2006 PARCEL NUMBER: 122175000055 LEGAL DESCRIPTION: LAKELAND VILLAGE 11 LOT: 55 PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW RESIDENCE LAKELAND VILLAGE General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: VB Type of Use: SF Insp. Area: OT No. of Bathrooms: 3 Occ. Group: R3U Lot Size: Deck: 112 Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building:2,624 Garage-Attached 604 Valuation: Building Height: Occ. Status: Primary Basement:2,624 cov porch 128 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: N 35.0 Ft. Shoreline: Ft. Water Body: NONE Rear: S 20.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: E 5.0 Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: W 5.0 Ft. Comp. Plan Desig.: Urban Growth Area Plumbing Fixtures FEES Mechanical Fixtures Type Qty. Type Uty. type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Plan Check Fee KS 4/7/2005 $1,246.54 S12005 Hosebibs 3 Fireplace 1 Planning Review Fee KS 4/7/2005 $155.00 S12005 Kitchen Sink 1 Furnace<100K 1 Address Fee GMM 4/12/2005 $140.00 522005 Laundry Tray 1 Gas Outlets 2 EH Plan Review CEW 4/16/2005 $75.00 S22005 Lavatories 9 Propane Tank 1 Adjust Plan Check Fee DLC 4/21/2005 $47.32 S22005 Showers 1 Ventilation Fan 4 Building State Fee DLC 4/21/2005 $4.50 S22005 Water Closets (Toilets) 5 Heat Pump 1 Building Permit Fee DLC 4/21/2005$1,990.55 S22005 Water Heaters 1 Dryer Vent 1 Mechanical Fee DLC 4/21/2005 $145.95 s22oo5 Bath Tubs 3 Mechanical Base Fee DLC 4/21/2005 $23.50 S22005 Clothes Washer 1 Plumbing Fee DLC 4/21/2005 $117.00 S22005 Plumbing Base Fee DLC 4/21/2005 $20.00 S22005 Plumbing Fee KS 7/19/2005 $49.00 S12005 Plumbing Base Fee KS 7/19/2005 $10.00 S12005 Total $4,024.36 BLD2005-00577 Please referto the following pages for conditions of this permit. 1 of 4 a W r o CONCRETE MEC ANICAL MANUFACTURED HOME 0 10 Footings / Setbacks Date 8� B �� Ribbons C�„ Date ( - & - OS' By Yf LOC Gas PipingT-iT Idly 0 a Date By -4 Foundation Walls Date B y Set-up Date By INSULATION Date By B G / Slab Insulation Floors Final Date By Date 1Z OZ t- By Date By FRAAV N Walls FIRE DEPT Date jZ pZ C)5— By R,LS Date w Z1/06 By 1A)Q Date By PLUMBING Attic OTHER Groundwork Date 711616c, B y C4)*-- (wv- 64 l � r-IA4L Date By WALLBOARD NAILING Fr- D.W.V. Date It loci bS- By F[S Z Date 16 z 0-e By I-O)L FINAL S FtLmAcC Water Line Date Q !� D!o By KC-S Date By m � ' Date By m ` a P.-I s S Z7 O 3v D� LcA� 0 m IN �I' .� 7/�?.�/�'� '7�Z�CJ� L4 4 o 0 v �^ %L r' O s , f N ,..3 0El o r CD fXs2 ti►��[a tc .�e�l �-- d-- fee �ru�w`S, J Fi: O EF, 606ME f)rs5in IZ10tj0jS-- IZ(OZ10c- F?�s T u(v7 o `7.��d Oto 2/J��UG )L - iAll KE -ptt,.^L flasSED 0 13Ic� 02 I4 d RLS a,5-T- C, 6f MOM MOM 0 SOMEONE imsm Mr. on =NONNI No 11 1■11 �■■�■iir�l.� ■I■ 1�1 ■■r Nil N11 ■OE■■IE m= ■1 11N ■■�i1�HE ■ ■1111111►1 us ` sm 111 AM s�lrl�■�■1�■lil�� ■ ■ ■ ILI mom No LIM ME 51 nmm 0 ONE ■ W/,/1■ i�■� ■■ �■►'1 ■■ ■off►/ /�ii■rr ■1�■� I■1■ nWA ON mm ENO o& BOX y Direction: •• • • • v MASON COUNTY PERMIT NO. dem on ��— �' BUILDING PERMIT APPLICATION ,4 t-+. na+ 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 Zip Code I S d Y City State Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address E Mail Address Drivers Lic.# DOB >- - ,f 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 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._ /y 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?YestNo TYPE OF JOB - New_ Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work 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. 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. /ram/ 0, _ Date: Owner/Owners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED PENIED NOTES Building Department ,f `r ►� Planning Department HLULIVED Environmental Health Department Public Works Department Fire Marshal 426 W. CEDAR FEES Building Permit Fee / -S Site Inspection Plan Review Fee `tip' EH Review Fee Plumbing & Base Fee fi 1� Planning Review Fee Mechanical & Base fee 3 `3 / Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee All, Pre-Paid at Submittal Valuation $ 77, (p a(v.7(0 TOTAL FEES JnV}z3�ruA�p 90 X o?o /cvOd 60 lok:� 4x 14) GCS � 3Z 40xv 900 /&,Vlk 01 w!a c� Z 12 S "000 c�3a '00, /" 2 Tore, qy q xl 8' 7%I ag De. c,K- MASON COUNTY PERMIT NO. 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 INFORMATION Owner, Company Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder 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 Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 1 15% TYPE OF JOB - New L Add Alt_ Repair Other Use of Building Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:ElectriG_ LPC Natural Gas_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink \ Furnace EI e air%C_ r Bath Tubs " Heatpumps Showers Spot Vent Fan �+ Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other afA Base Fee Base Fee A.j• 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 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,representq that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review a EPHOW E D PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X b Date: AM 0 7 2005 Owner/Owners Representative/Contractor (indicate which one) 426 W! CEDAR 5T. FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning I'd 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 Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee 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 On the web www.co.mason.wa.us APPLICANT INFORMATION / CONTRACTOR INFORMATION Owner / .4' ,,r3. .7.o Company Name '? Mailing Address=- A; Mailing Address City 4 State Zip Code City State Zip Code Phone ��-� +-' �-.� Other Ph. Phone Other 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. Fire District Legal Description Zi i /24 1,r,,/ : Site Address (Please include street name, ;street number and city) y , '�ZLyA., Directions to site 2 j V ' l � T 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 - 1 st Floor. 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Eees 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 Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove 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 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 /C-Aoll Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department q Occ Group—Type Constr. ' 1 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