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HomeMy WebLinkAboutBLD2006-00086 SFR - BLD Permit / Conditions - 2/23/2006 Inspection Line(360)127-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton,WA 98584 too RESIDENTIAL BUILDING PERMIT BLD2006-00086 OWNER: CHRISTOPHER DROUIN RECEIVED: 1/23/2006 CONTRACTOR: ADAIR HOMES INC (360)352-8571 LICENSE:ADAIRH*262RZ EXP: 1/9/2007 ISSUED: 2/23/2006 SITE ADDRESS: 410 E OLYMPIC VISTA DR UNION EXPIRES: 8/23/2006 PARCEL NUMBER: 322345100033 LEGAL DESCRIPTION: OLYMPIC VISTA TR 33 &VAC ST ADJ &VAC OLYMPIC VISTA DR PROJECT DESCRIPTION: DIRECTIONS TO SITE: New SFR Brockdale Rd. to left on McReavy Rd., right on Dalby-Hwy 106 Stock Plan #2003-0098 General Information Construction &Occupancy Information Square Footage Information No.of Bedrooms: 2 Type of Constr.: VB Type of Use: Insp.Area: No.of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck: Type of Work: Fire Dist.: No. of Stories: 2 Occ. Load: Building:1,680 Valuation: Building Height: 22 Occ. Status: Primary Basement: COVPORCH 182 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: S 25.0 Ft. Shoreline: Ft. Water Body: Rear: N 40.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Shoreline Desig.: Not Applicable Side 1: W 7.5 Ft. Year: Serial No.: Side 2: E 14.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Plan Check Fee KKK 1/23/2006 $215.55 S22006000 Hosebibs 3 Ventilation Fan 3 Planning Review Fee KKK 1/23/2006 $155.00 S22006000 Kitchen Sink 1 Dryer Vent 1 Building Permit Fee KKK 1/23/2006 $1,077.75 S22006000 Lavatories 2 Building Permit Fee KKK 1/23/2006 $1,077.75 S22006000 Showers 1 Address Fee GMM 1/26/2006 $140.00 S22006000 Water Closets (Toilets) 2 Building State Fee ARC 2/2/2006 $4.50 S22006000 Water Heaters 1 Building Permit Fee ARC 2/2/2006 $1,077.75 S22006000 Mechanical Fee ARC 2/2/2006 $39.65 S22006000 Mechanical Base Fee ARC 2/2/2006 $23.50 S22006000 Plumbing Fee ARC 2/2/2006 $75.00 S22006000 Plumbing Base Fee ARC 2/2/2006 $20.00 S22006000 EH Plan Review ADR 2/13/2006 $75.00 S22006000 Total $3,981.45 BLD2006-00086 Please referto the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD2006-00086 CONDITIONS FOR BLD2006-00086 1) Approve dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 2) 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 1-800-64�2. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 3) 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 Depart for to any further inspections being performed or approvals granted. 4) 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 5) 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 from the Building Official. The permit holder 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 ed documents will result in failure of required building inspections. X 9 6) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X (7py/ 7) The"approved"site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not 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 shall be collected by the Building De prior to any further inspections being performed or approvals granted. X BLD2006-00086 Please refer to the following pages for conditions of this permit. 2 of 4 8) Washington State Energy Code Compliance has been approved using the following: 'Heat Type: Electric or other fuels, Compliance Method: IV, Window(Max U-Factor):0.40, Skylight(Max U-Factor):0.58, Doors (T x U-Factor):0.40 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38,Vault Insulation R-30, Slab Insulation R-10. X 9) Stock Plan Identification number: 2003-0098 This project is approved subject to the provisions identified the Mason County Stock Plan Policy. The site plan approved by the Planning Department, original building plans, and all attachments approved by the Mason County Building Department shall be available for the Mason County Building Inspector a h required inspection. 10) 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 exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). X 11) The international 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 such road'�' ect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X 12) 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 revo X 13) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. 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 25'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 4az 14) 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 ion, must be reviewed and approved by Mason County prior to construction. X BLD2006-00086 Please referto the following pages for conditions of this permit. 3 of 4 15) 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 s e made prior to requesting additional inspections. X 16) All property lines shall be clearly identified at the time of foundation inspection. X �z 17) 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 inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason Count nances and building regulations. X 18) 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 have nted action from being taken. No more than one extension may be granted. X 19) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connector flashing. Install metal connectors approved for contact with the new types of pressure treated material. 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 inspection.The owneror the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and st cture for review a inspection. OWN ER OR AGENT: _ DATE: BLD2006-00086 Please referto the following pages for conditions of this permit. 4 of 4 N1gIU,(o CO CRETE MECHANICAL MANUFACTURED HOME , X (0�00 ante Footin (0ns C Gas Piping _ o Interior Date4 1 8y Interior-Dane BY Date By Z �/ rn _Exterior Dattf By Exterior-Date By Set-up n Point Load r Isolated Footings INSULATION oats 8y X BG/SLAB INSULATION Date By Data By FIRE DEPARTMENT I Foundation Walls Floors Date By 0 Date N T U- Byt-OL— Data 06 BY IAL DECKS _ F rn FRAMING Wails Date By M Date to c, Data By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Date By Date I b6 B � Type: Y Date By o.w.v DRYWALL Type: Int Brace Wall Date By W _ � � v6 -0 Date D� Dete FINAL INSPECTION p Water Lin Fire Separation C) Date gzjnyy� Date By Date Bho /f p m 6 Pass or Request Inspect. c Type of insp. Fail Date Date Done By Comments o CD a rn 0 r-A I ok6 v y O a L 0 Cn � Sfct,G II� �.ss 41a, '4 7 vc� L40)L- 1Pts(� li � - o . Z%�X LOC FrIVAI- � S'EIF LRS�" C'o2Q�c�i'dr9. t-Lb-bl-2UUb 11;41 HVH 1 K HlJl'ltb-ULTI'Ir 1 H -XA5 743 F7(bl r-.nliai r•w i ri-AIvl Narne r15� tiff' C !n nn-e rp i Mailing Address lqlcl La rll &U-) #97 �� uaA, 9g5oZ Home # 62,2 �5�?• 68Z Wark,# __ cell it (Property Location--41 a �.,v► plc ();S f A M UD1 Legal Address TS ►J R 31�✓ Sec_ To Lat -� County, State of WA:Sti Log&/0 TM1► (KKAT10N011T"5ttOTrLMJFM.s vlrP. NO, FOII iT1 ACLIAACY A4lD[UNPtPT4 !!.!)T tlRt�4� I I -yt9 7FF.nl?TALE"(I 1F7 I 5 I 1 L `-J0 VATAlkj N4 ALL TFf COM4A 1"tS,LOT UK s AIq rn"."rn IFnen sE,nncY s h�gUthEe or . SCALE: I" = MT5Pv art.AW W A(s)TOTHsPLMFMU31OfrnEAFrn1+vE0M111E CtrTE"FIJT AgQnO WaXT11 JLXQl7hICT10K n If 1UMTC A. k I.*FR*n At KI TI14 CON OOtt ^7 n 5i6NA GATE 1 TNE5I6N DATE ,ao 6,9 5`,�� �. air 'b.� 9 /%9 lb r , M ",S^v;l COUNTY Dia-'D FL.' N,,if�t: SITE PLAN F,-:'Q .Ul'?ED TO BE: ON SITE CHANGES SUBJLCT TO R 'PROVAL By J PLAN PLOT REVISION RECEIVED DATE n MASON COON I Y 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.mason.wa.us 74►'Lc APPLI ANT INFORMATIO CONTRACTOR INFO M TIQN Owne 1� Y'-I fI n Company Name ITi'.t A Mailingdress V ilin Address Z �' City 1/ t to ip Code City 1 State Zip Code, Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. U xp. i L E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water Syste�Name of Water System i PARCEL INFORMATION - 12 Digit Parcel No Fire District Legal Description -'LJ Site Address (P include street name, street number and cit ) ectio s to sit V111t leas D t Will tuber be cut and sold in parcel prepara on?Yes/ Is property within 200'of Saltwater Lake River/Creek Pond /(&L- 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 R'SEASONAL ❑ Use of Building ' Describe Work_M( t Q -P� ! l t No.of Bedrooms Za No.of Bathrooms �- le")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 - 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 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. PROD OF CEO T NUATIO. OF WORK IS BY MEANS OF A PROGRESS INSPECTIO X I Date: ( 7 1 i / Owner/Owners Re resentati ontractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date I DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Tiq L- V F7 Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee / 0 7 7 7S Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee ro Planning Review Fee Mechanical & Base fee '03 ( Other Wood/Gas/Pellet Stove Fee State Fee •S Violation Fee D Pre-Paid at Submittal Valuation $ TOTAL FEES 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 IN,�O�#MATION Owner t ' .Y 4�4 Company Name �'�f Mailing Addres r( 'F i' ^' 5iA Mailing Address City— tate (;t Zip Code CIE City Mate Zip Code Phone - �� Other Ph. Phone i Other Ph. Lien/Title Holder Contractor Reg. # `- f(1 2V '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. fit; �� Fire District Legal Description i = Site Address (Please in Jude street name, street number and city) C• t Directions to Site " '�' '` fl r 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 _ o. 91 Fixtures Fees Fuel Type:Electric LPCz_ Natural Gas Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs —i7— 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 01/VNER/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"V4 Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS 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 Site Inspection Mechanical & Base fee -`{c ; UFC Plan Review Fee Wood/Gas/ Pellet Stove Fee Other Violation Fee TOTAL FEES MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT WSEC/ VIAQ Compliance Application Owner Telephone:3b2, 2L4 Parcel#: 33 Type of project ( New Residence ( )Addition ( ) Remodel Total Sq. Ft. V Floor : 2 Id floor: Heated Basement: of heated area:: , ., I(&) I"P A Heating System: 4 Electric wall heater O Electric Central Furnace OLPG Furnace O Heat Pump with Electric Furnace O Heat Pump with Gas Furnace O M-f ify fuel type O Other: Specify: Glazing Prescriptive Option see reverse side circle one: 1 II IV Percentage: Compliance Method O Component Performance , Chapter 5— Calculation worksheets required % Check one.-.- O Systems analysis, Chapter 4 Whole House Ventilation system ;J 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 Room/location U-Factor Size Quantity Square Feet Windows: Windows: Total Sq. ft. Doors: Doors: Total Sq. Ft Total window and door area Total window & door area /(divided by) total sq. ft of heated area = %of glazing MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Assistance Center SHELTON (360) 427-9670 BELFAIR (360)275-4467 SEATTLE (206)464-6968 ELMA (360)482-5269 FAX: (360) 427-7798 WEB SITE: www.co.mason.wa.us P.O. Box 186, SHELTON 98584 2001 Washington State Energy Code (WSEC) effective July 1, 2002 2000 Ventilation and Indoor Air Quality Code (VIAQ) Code Compliance Application Form The following information will be required for the WSEC and VIAQ plan review: 1. Complete the Washington State Energy Code/ Ventilation and Indoor Air Quality Code (WSECNIAQ)application located on the reverse side. 2. Complete the window and door schedule on the reverse side. Include all windows, skylights, sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening dimensions of the windows and doors. Information about the U-factor of the window will also help to expedite the energy code review. If you are complying with the WSEC by prescriptive path and are using the area weighted average method you must include your calculations. 3. On your building plans note the location and fuel type of water heater, location of exhaust fans (bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and slabs, 4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 284. Additional WSEC and VIAQ compliance information is available on the internet at: www.energy.wsu.edu/buildings/ II Prescriptive Requirements 0,1 for Group R Occupancy Climate Zone 1, Table 6-1 Glazing Glazing U-factor Door Wall Wall Wall Area %of Ceiling Vaulted Above interior 4 exterior Slab4 Option Floor „ U 9 2 Ceilin 3 Grade below 4 Below Floors on Vertical Overhead Factor g 12 grade Grade Grade I 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10 * 15%' .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10 IV Unlimited Single Family Res .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10 (R-3)Only 'Reference Case/Call (360)427-9670 ext. 284 for footnote information. Log&solid timber wall with a min. avg.thickness of 3.5 are exempt from the above grade wall insulation requirements. Request To Revise A Plan . Permit Number: BLD2004,a-- &D�g6o Name Parcel Number ?,� 3,4 Phone Number da ime ( 0 ) Project Address b Mailing Address Lue Please provide a com leteLo ,,de 'led descrip 'on of a pr posed revisions to the a. oved plans: . a Lb Are two sets of the revised plans or addendum indicating the changes included? �e ❑ No Are the approved site plans included? n0;6?es ❑ No Are the revisions clearly and accurately identified on the plans or addendum? e'Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes C3 0 If Yes,Has the engineer or architect approved this revision? ❑ Yes O No Is a stamped and signed approval included with this request? ❑ Yes -1 '0 (Note:No structural chanties to a"desimed"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? ❑ Yes ❑ No Additional Information: Applicant's signature Date: Dit y!-0� Office Use Only Received by: Date Sent Assigned To Approved By Date ci B. Original Valuation: $ Additional Valuation: $ P. �ZI6 ZaTJFl p� Sq.Ft. x$ $ Sq.Ft. x$ $ FE, Total New Valuation $ Additional Fees: Additional Planning Dept. $ Additional Plan Review $ New Setbacks: Front / Rear / Additional Building Permit $ Side1. / Side2 / Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. $ Other $ Total Amount Due: $ Amount To Be Paid Up-Front$ TaY P&VIW SRO 2=003 Request To Revise An Approved Plan Permit Number: BLD200(Q - nZ6 Name &A IAJ Mblv) Parcel Number r�,o1 - - C0 C�� Phone Number da Ime C) ) Project Address ql h F- I,d4p ,O& Q ar Mailing Address Please provide a complete,detailed description of the proposed revisions to the approved plans: UJI Are two sets of the revised plans or addendum indicating the changes included? i/Yes ❑ No Are the approved site plans included? ❑ Zes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? EY Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes U/No If Yes,Has the engineer or architect approved this revision? ❑ Yes �1 Is a stamped and signed approval included with this request? ❑ Yes t 20 (Note:No structural chances 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? I/Yes ❑ No If Yes,Is a revised site plan,-with all new setback dimensions included with request? Yes ❑ No Additional Information: 7-Applicant's signature_6)� Date: 3 Office Use Only Received by Date Sent Assigned To Approved By Date. B. Original Valuation: $ Additional Valuation: $ P. � Sq.Ft. x$ $ Sq.Ft. x$ $ E.H. Q Total New Valuation $ Additional Fees: P.W. Additional Planning Dept. $ Additional Plan Review $ New Setbacks: Front / Rear / Additional Building Permit $ Sidel. / Side2 / Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. $;;tS o0 Other $ Total Amount Due: $ Amount To Be Paid Up-Front$ Tab iidd Revised SRG W2V2003 i'CD—YJI—GYJYJO 11•Y1 1'1L1'11f� f'iUl IGJ—lJL 11'fr ii'1 """"' — '— NaMe Mailing Address MIT. , ���•�frr��,��'� D g? 0 YMP-1*9 Horne , ,3spa- ` 66z - Work Cell # Property Lacatto jLeg ai Address TS -2-P +J k -8 W 5ec,,, -,,,A. - Tax Lat ## as& �- ffI_ C�G�f1 .. / .5 County, LAS State 0f �, b 1h4 �06 Im ofD4nAnoF?��tiKSttorrL�l�Ff+4i vtUo QWNm w"a ly=mfu MOW,1)�L f�U Tat ITS AAtYAmCOMPMBtF�a.Z)>��E ' ixt�pQutMEHiiYTiYHEdlti?TACE}'LAGEtIt i e1TAF.IN4ALL"Ca%t"1kc ll,tnTL1KtAJgiCobtAf \ \\i foYYJW a'a A 13WiT111utiSD1{TIO►1-ni�71t I TSCUN • x1 S�GaNr1 RF �6Na �, �. T- v. AF PR t Fey ��Sii`� .000IV�`Y ,i:U PLA!;'�:11VG SITE PLAN RL4QLJi.�EJ TO BE ON SITE CKANGES SUBJECT TO APPROVAL q3 ki Date 16to� PLAN _PLOT. REVISION REGEI ED DATE has ��Tion n� DA LS Y HwV Io& Lfj fSROc.Klal2 �D m IMF— � O SHfL7o Q 4- ' r,r ov STR P MAP rot Comks E- dc L orlwor- �OL 1A) /`�/9 ,Eder�rCP nJ ,DP? Sw, Pt 7 � I 1 5 ATE Un i 0�7 G�lq. cI�S z 3'� Ae ACCESS & GRADE WORKSHEET DATE: / Ise © �' ADDRESS -F- F ✓�en INSPECTOR LL10 -� DRIVEWAY ACCESS Length: 7 Width: Z Surface: )a ) ���� Size of turn-around: Condition of shoulders: Verticle clearance: I GRADE REMARKS r 0 0-- ' A .f--- f �07c> IZo 4io