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HomeMy WebLinkAboutBLD99-0631 Add Garage Upper Floor Bedroom - BLD Permit / Conditions - 2/25/2000 r MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 E3 LJ 1 L... f7 I N G PERM 1 T FOR INSPECTIONS CALL 427-9670 1 BETWEEN 5pm AND Sam 427--7262 BLD99-0631 PARCEt_. :322345000027 PLAT :MAPLO DIV : BLK : LOTS .JOB ADDRESS : 13071 NE NORTH SHORE RD BELFAIR OWNER : DENNIS MCDOWELL 360--779-5469 CONTRACTOR : LEGAL : 1ADIONA 110111INGS11E BCH TRACTS TO 27 1 T.L. CLASS OF WORK . . sNEW BEDR : 2 BATH : 2 TYPE AMOUNT BY DATE RECEIPT 17YFE AMOUNT BY DATE RECEIPT TYPE OF USE . . . . :ACC STORIES . . . . . . . s 2 -.. :� ©COUP . GROUP . . . :R3U1 BLDG . HEIGHT . . : 0 .Oft PICK t 418.28 KW 17113199 157A PLN1 t 28.00 NJP 011191#0 52535 TYPE OF CONST . . :5N FIREPLACES . . . . : 0 FHCP t 58.00 NJP 811191// 52535 ADJ t 85.31 NJP 0111911# 52535 OCCUP . LOAD . . . . : 0 WOODSTOVES . . . . c 0 PLRS t 38.11 NJP #M91111 52535 NCH t 44.88 NJP 01 f 19188 52M DWELL .UNITS . . . . : 0 PARKING SPACES : 0 PRO] t 114.75 NJP 01119/01 52.535 Addltleeal fees not slaw§ here.. .. . . INSPECTION AREA s 2 SHORELINE? . . . . :Y PLM t 82.80 NJP 8111910/ 52535 ITOTAL: 1548.34 VALUI AT 10N: 8179d -.-.._�.....��. :C�.:.zsCi�a� m�-R a �a^a-. `r'�4�1. r-r.�=3e�3 SETBACKS-----__.__.__.____ TOILETS . . . . . . . . . . . 2 FUEL TYPES-----------. B01 LERS/COMP-- -- MOBILE HOME.. _ FRONT . . .N 81 .Oft BATH BASINS . . . . . . : 2 i /ELE /L.PG/ ! : 0-3 HP . s O REAR . . . .S 47 .Oft BATH TUBS . . . . . . . . . 1 3- 15 HP . : 0 MODEL : I SIDE ( I ) .E 5 .Oft SHOWERS . . . . . . . . . . . 2 €'URN < 100K BTUs 0 15--30 HP . : 0 --MAKE-. -- S1DE(2) .W 12 .Oft WATER HEATERS . . . . . 1 FURN >=100K BTU : 1 30- 50 HP . : 0 SHRL I NE .S 47 .Oft CLOTHES WASHERS . . t 1 FIIRN FLOOR . . . : 0 50+ HP , : 0 --YEAR- -___-. _ AREA ---______ _. _ _...-____ KITCHEN SINKS . . . . s 1 HEAT PUMP . . . . . . : 0 LOT SIZE . . :. FLOOR DRAINS . . . . . : 0 VENT SYSTEMS . . . : 0 EVAP COOLERS : 0 LENGTH : 0 BUILDING . . . e 1898sf DRINKING FOUNT . . . : 0 VENT FANS . . . . . . : 3 HOODS . . . . . . . : 1 WIDTH . : 0 BASEMENT . . . : Osf LAUNDRY TRAYS . . . . : 0 DOMES . I NC I N :O --SERIAL #- - ­ DECKS . . . . . . . 73 sf DISHWASHERS . . . . . . : 1 AIR HANDLING UNITS —. COMML . I NC I N :O GARICARP :G 483sf GARB DISPOSALS . . . : 0 <— 10000 cfm . : 0 RELOC/REPAIR : 0 AT/DT . :A URINALS . . . . . . . . . . : 0 y 10000 cfm . : 0 OTHER UNITS . : 0 MISC PLM FIXTURES : 4 CAS OUTLETS . . 4 ,•� �••••••�•-»..._.:xc_z':=��.suc;;�:�r:•:s..--ursvu_-s-_�:a-s-::,r.� •.-•--tCe-.c;-.e.�[ccxxrearse:�.. .• ,�.a:rx�.r-:ac...s::..:.x�^.aex:-��:;sr_.>sc�::s-.:.- �arrYc,. PROJECT OESCRIPTIM ADD GARAGE UPPER FLOOR BEDROOM PROJECT LOCATION0 3 NIIFS OUT NORTH SNORE 10 Al NAI1801 12921 TURN 0 F f HIGHWAY THIRD HOUSE ON LEFT FLAT ROOF HOUSE. THIS PERMIT BECOMES NULL AND VOID IF WORK 08 CONSTRDC1I00- AUTHO111ED IS NOT COMMENCED WITHIN 180 DAYS. ON If CONTINUCTION OR 1001 IS SUSPENDED FOR A PERIOD Of 181 DAYS AT ANY TINE AFTER WORK IS COMMENCED. EVIDINCf Of CONTINUATION OF WORK IS A PROGRESS INSPE 71011 WITHIN THE 180 DAY PERIOD. FINAL INSPECTION MUST BE APPROVED BEFORE Buyl-11106 CAN of OCCUPIED, OWNER OR AGE111 s I CGti:.:AETE MECHA ICAL MOBILE HOME Footings-Setback dateMWIV by Ribbons date t ( by Gas Piping C- I—)— date b Foundation Walls t date , 7- =0 by Set Up data VJ by INSULATION date by BG/SLAB Insulation Floors Final ! date by date by date by FRAMING FIRE DEPT. Walls date /�" L by date 9/� ^o Z by T� date by PLUMBING Attic OTHER Groundwork date by date by D.W.V. WALLBOARD NAILING yY y Z date ( Z by date/o-/ -� by Water Line FINAL INSPECTION date by date �o� by date by -�"-CDC) tid T I z- y-z✓--,�Lz q. r,_r Tit i'c /T v /W -3 G-off �'G,k,_CJ �- �®- Y�Y- �-�o-o� �/��'�/IG1SS Ok O %/� �/O,t=�✓�No,stccc�/ � s jIq, II r f- 3e,_oGG. %in- FaiAL FA;"tffo IC) i 7 IQ,', 101 ZCk42, f3l.S S,FE 61T&-ffFv MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 �" F if3M I T- CC3N [a 1 -IF 1 C_1N Cask? No . : BLD99-0631 For DENNIS MCDOWEL.L Page : i ,- 1 ) - Approved per dimensions and setbacks on submitted site plan . X ' 2 ) The applicant acknowledgges that they existing wall of the residence near the east propgFty boundary is 1 M 9 in . from the property fine , and that if the replacement of t01191 wall Is n**ded a new wall shall meet the current standard of 5 ft . setback from the side ,P" r y line . X 3 ) The proposed prkject must: be consistent with all applicable poIiaies aril other provisions of t;he. Shore iwe Management Act , its rules , and the Mason County Shoreline Master Program X 4 ) . Propos d structure or any portion thereof greater than 30" in height from grade line, must r alfntain a.- inimum of 5 ' setback from all property lines , easements and 10 ' from a l i C t�IfS State Road right of ways . X r 5 ) All upland areas disturbed or newly created by construction aotivities shall be seeded, vegetated ,or given some other equivalent type of protection against erosion . X 6 ) The use. hand 1A ng, and stofage of hazardous materials or flammable and combustible liquids In exdesg of 10. Oal dns is not allowed without the approval of the Mason County Fire Marshal , !'r X----- /,c ,c`� �' 71 Owner/ buiYder assumes all responsibility If drainfield/ reserve area Is Xncumbere,�d i ':ONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date b Foundation Walls dav by Set Up date b date b Y Y INSULATION BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by —�I ------------- ------------ MASON COUNTY Mason County Bldg. III 426 W. Cedar RO, Box 186 Shelton, Washington 98584 8 ) Aerobic system to be installed before final / temporary occupancy can be O I von 9) All approved plans are required to be on-site for inspection purposes . If inspection is called for and pYans are not on site , Approval WILL NOT be wanted . In addition , a Re-. Inspection feen the amount of $42 .00 per, hour (minimum 1 hour ) will be charged and must be collected 4y this department prior to any further inspections being performed or approval granted . \. ---____ 10) PURSUANT TO 1997 UNIFORM BUILDING CODE , ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY . MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A RE: INSPECTION FEE , BASED ON PAT VS AS ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESS IF OWNER/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING I NSPECT I ONES X 11 ) The correction list , ' Ion with the Energy Compliance Worksheet (when applicable ) is part of the plans and mus? remain attached thereto . It Is the responslbility of the applicant to make corrections indicated on the plans from the correction lists . Once the plans are marked APPROVED, they may not be changed or altered without authorization from the Building Official . The permit holder is reponsible to retain the complete approved set of plans on site for the du r lot) of the project . Failure to comply will result In fa i I lire of required build i n In; actions . Every pewit i t sha I l expire by limitation and become null and void �f th building or work authorized by such permits ., Is not commenced within 180 days from the data 4 A soduance, or if the building or, work authorized by such permits Is suspended o �.� 'a d6iWd at any time after the work is commenced for a period of 180 days . X ( ! 12,) The approve4 plot plan Is required to be on-site for inspection purposes . if inspection,-' Is called for and plot plan is not on site, Approval WILL NOT be granted . In addition . ,a Re - inspeotion fee in the amount of $42 .00 per hour (minimum 1 hour ) will he ' charged and must be collected by thIF4 department prior to any further inspections being performed gr approv-jil granted . X / CONCRETE MECHANICAL MOBILE HOME j Footings-Setback date by Ribbons date by Gas Piping date b Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date 1 by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date -- by date by MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 13 ) UMC Chapter 7 . In buildings of unusually tight construction , fuel burning appliances shall obtain combustion air from outside (excluding cooking appliances and clothes; dryers ) , / r 14 ) An stun es in construction shall be reviewed b engineer of record and submitted In writio �he Mason County Building Department prior to construction . X.- h 15 ) ALL ON TRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND UBC REQUIREMENTS AND OCCUPANCY IS L MI ED TO THE PERMITTED AND APPROVED CLASSIFICATION . ANY CHANGE OF USE OR OCCUPANCY WOUL 'R -SULT 1N PERMIT REVOCATION . CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE . x 1 16 ) Proposed structure or nortiono thereo with an projection over 3L0" in height from shade line, must maintain a 5 ' sep ra,'"/bn. with between adjacent structures and that furthest projection . X___ 17 ) Changes to approved building plans that effect compliancejto 'the 1991 Washington State Energy Code, 1991 Ventilation and Indoor Air Quality Code, the Uniform Bu i 1 d i ng Code and/or Mason County Regu I t i CV'�rrr ai'ust be approves! by Mason County prior to construction X 18 ) CONSTRUCTION PROCESS TO BE FIELD CORRECTED A3 l�Q1�4-RFaD PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE .x ("+�% r' • 19) THE EX1STIgG EAST WALL. WILL. BE REQUIRED TO BE 1 -IIOUR-FIRF.. RESISTIVE CONSTRUCTION WITH WITH A CLA. S 8 ROOFING MATERIAL AND NO OPENINGS IN THE BUILDING AND FOUNDATION . NEW ADDITIONS ' TO ;THE STRUCTURE SHALL. MEET THE 5 ' PROPERTY LINE SETBACK AS PER MASON COUNTY POLICY . Case No . : 13L.D99-0631 r ,ONCRETE MECHANICAL MOBILE HOME ootings-Setback date by Ribbons date by Gas Piping date b Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by L /,?� C , i _ C�a-cool ll 6 PERMIT NO.: BLD l ASON 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 64-6968 AFPLICA VT INFOr MATION > CONTRACTOR INFORM TIQN Owner W r Is I)/C R'-OC < < Contractor Name MaiIin Address 2 8,7 2 / Mailing Address City. 04 State icW Zip Code 3 G City ell ate Zip Code Pho e(3Lo') V ther Ph.C:, 4z, 7.77-5W Ph.( Other Ph.(� Lien/Title Holder Ve--✓� Contractor Reg. # Address /3 07/ n6Pz1,y/*>'__Sfi6e 114 Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Se�yer System Well Water System�Name of Water System /1� iYd ✓ �� �fi P �j� �o PARCEL INFORMATION-12 digit Tax Parcel No. Fire District_ Legal Description Site Address(Please include street name, street number and city) /Vo21/S'"- S a 4" Directions to site V.- o v as 41/ , Ie S6s0 ,l C,4vAyow, � iv 0,1W L,,lif Pi- o a✓ r w/r/1 Will timber be cut and sold in parcel preparation? (Yes/No)" Is your property within 200' of the following: Body of Water(Name) /Yc--e7/COW—,C--E[ Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New_,__,Add Alt Repair Other Use 9f Building /cl ��iCC1/S; i Describe Work 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. r 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•9mployees 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 co ce therewith. No Chang s II be made without first obtaining shall be done in conformance therewith. No changes shall be made without ap roval. first obtaining approval. Date G X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by �� Date j i Submittal Amount Due 4� Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED 1'W CONDITION CODES Building Department P _-� [-6-� `� GGhet 1' , e� i 1A1.rNIA4^- Occ Grou - - Type Constr. - m�,� �.►� cg Planning Dep ment ccs gEc,ss c D .��--- Environmental Health Department Public Works Department I Fire Marshal Valuation $ Lr FEES .. Building Permit Fee 7SSite Inspection Plan Review Fee j UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee _ Other _ ee Q Other Viola i F p� Pre-Paid at Submittal ( 'De) :i id:•F�iiri'i'}ii::iiiii::iiii}ii:tii:�iii:vi ............:::::::::. •::::::::.::v:::::::::.::::::.::::::::::::........... ::<:::::..>;:«:.::,:...,:::.<>,<::•::........,.:::...................:.. TOTAL FEES Yr M PERMIT NO. /.lam~'�i ?% 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 z, - OGt)L- t < F Contractor Name Mailing Address - Zr, n /✓G Mailing Address City StatetdO,& Zip Code-2F:,7<' City State Zip Code Phone(IL—"L— )ZT9>Other Ph.( Ph.(� Other Ph.( Lien/Title Holder < Contractor Reg. # Address C' iY /� ✓ - Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. — / 4 5 / Z/ Fire District Legal Description Site Address(Please include street name, street number and city) 1 7-f��,7 1 f\ Directions to site �?^-j I — c_—>c csE 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 1 st 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 Bath Basins -- Furnace C)s?-ect vEvT s� Bath Tubs Al Heatpumps Showers _ Vent Fans 3 j9�Sc7 Water Heater bzRCct uerrt' Propane Tank Laundry Wsher �_ Gas Outlets Sinks _� 7 - Wood/Gas/Pellet Stove Dishwasher Direct Vent. Other tggre s Other Noad Other Other Base Fee -2-D Base Fee 2 Z— 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;APROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information providedtis 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-]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 therewitZNochages shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. t � X ` ° �/J Date X Date FOR OFFICIAL USE BEYONb0ThI,"[11NT Accepted by Q Date i/ C Submittal Amount Due Receipt No. l DE'P'AR IVENT-AE ttE41�EW APPROVED DENIED � COI�iDT#7QTitC41NI% Building Department 1-G Occ Grou - T e Constr. _ Planning Dep ment Other Other I FEES Permit Fee Site Inspection Plan Review Fee _� _ UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee l._. Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES (� , F'LtASteKtSSHAKU MASON COUNTY PROJECT SITE INFORMATION Case No. Name 6t;hOWaL PARCEL NUMBERJ22341—SO-0007-�7 Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line4 I / <-8 Jjacent property line I i I d 4 T ' J/� -P J<�C9s e I I I , I , RECEIVED I V I U627 98 I I I I q1Q, I , adjacent propline I I Fa jacent property line SAMPLE SITE PLAN adja t property line4 D 3 30. r1-7 �RvE Fadjacent property line I .SCA.0 w/A L. I a ,3-4' CREEK I V+ 71c L _]�PTSL_�I J I � I HOME I .Gas.Eu I F 5b I I-IG cts f� 1 ) Frio PasLD s¢ptJ c >I I 1 — I -- bo' J30 � R — VAGIvT If iT C ARAC d \ I 3o I i/i VAoPosCD T A&R=941T'LL iAL So' I !F-4o•--� \ YOB I I �--80,--91 , � I \ I I I I I I I /00' —� I t. ...rr I adjacent property line--,* c \I (-adjacent ro ert'line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE d1.S+a"c0- to ructt.�Nt 6 ni SC��p7c Stopa -raa �� dii+ana� I 2 T �� Signature Date f . y Request To Revise An Approved Plan _ Permit Number: BLD - ��1 Name f l c (�� P l7.eh r1i C Parcel Number LZ 3 / 5 O / Go Z Phone Number G ) X7�—s/ 7 Project Address C9" Mailing Address i/�� � Ec�Z•� -/y, I Please a complete, detailed description of the pr posed revisions to the approved plans: G �/ !vT _O dS v G cfl �/l S Are the site building plans, approved by Mason County, included with this application? 0 Yes 0 No Are two sets of the revised plans or addendum indicating the changes included? Ikl—es 0 No Are the revisions clearly and accurately identified on the plans or addendum? J'kes 0 No Does the plan contain an engineer's or architect's lateral or vertical analysis? Ct+'`lifes 0 No If Yes, Has the engineer or architect approved this revision? ❑ Yes 0 No Is a stamped and signed approval included with this request? 0 Yes 0 No (Note:No structural changes to an engineered plan will be approved without the written consent of the engineer or architect of record.) Does the proposed revision modify the footprint or location of the structure? 0 Yes L No If Yes, Is a revised site plan, drawn to scale, included with this request? Yes E No Additional Information: d Applicant's signatur ��( Date: Received by: _---Date: Ise Only Forward to departments indicated below: Approval/Date Original Valuation: Building b/ Additional Valuation:U60.4% 'I Planning ` Sq Ft/5b x 5».08 g Sq Ft Environmental Health *Total New Valuation: Public Works Additional Fees: Additional Plan Review d. (A Additional Conditions/Con Additional Building Permit Comments: -� Additional Plumbing Additional Mechanical Other 2 hY''5 X S o Total Amount Due: S c F'1 reet per.rvw�C �l2 $IAAL� r o a ") 14741 - — � � � r; �a"-:� • cud - QC — t - - '� �� - -- ��°ems � /• - ¢ 1 tp�� � � �a��S ----} - 40 . �^�,v,a a ��. _ moss r�2 oab • �-1-— "j F i , i � - � ---- -•`"""�Ynw elk Z r � ht aQ Q aI M►d T� • w3iAC'7^h11t r\c; !t a •:d Aw O 1 tI -rtrM �71 i -fir. ifl 1 2ty ' 71r 40. % 't`�� n a> H C 1tfQQ