HomeMy WebLinkAboutBLD2003-01169 SFR Final - BLD Permit / Conditions - 12/17/2007 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
Ir Shelton, WA 98584
P14
RESIDENTIAL BUILDING PERMIT BLD2003-01169
OWNER: TOM ABPLANALD RECEIVED: 8/20/2003
CONTRACTOR: LICENSE: EXP: ISSUED: 9/9/2003
SITE ADDRESS: 212 NE TIMBERLINE DR BELFAIR EXPIRES: 3/9/2004
PARCEL NUMBER: 123204300123
LEGAL DESCRIPTION: TR 7 OF SW SE, W OF RIVER PCL 3 OF BLA#93-24
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
SFR OLD BELFAIR HWY TO TIMBERLINE, GO OVER BRIDGE, RIGHT AT FIRST
DRIVEWAY, GO PST HOUSE, NEXT LOT ON RIGHT , LOT 7
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 5 Type of Constr.: 5N
Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R-3/U-1 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No. of Stories: 2 Occ. Load: Building:2,916 Garage-Attached 523
Valuation: Building Height: Occ. Status: Primary Basement: cov. porch 455
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: W 90.0 Ft. Shoreline: 170.0 Ft. Water Body: Union River
Rear: E 170.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: N 20.0 Ft. Shoreline Desig.: Rural
Year: Serial No.: Side 2: S 50.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Hosebibs 6 Exhaust Hood 1 Plan Check Fee KS 8/20/2003$1,049.98 S12003
Kitchen Sink 1 Furnace<100K 1 Planning Review Fee KS 8/20/2003 $150.00 S12003
Lavatories 3 Gas Outlets 5 EH Plan Review PSD 8/28/2003 $75.00 S12003
Showers 3 Propane Tank 1 Building State Fee SAC 9/5/2003 $4.50 si2ob3
Water Closets (Toilets) 3 Ventilation Fan 4 Building Permit Fee SAC 9/5/2003 $1,615.35 S12003
Water Heaters 1 Heat Pump 1 Mechanical Base Fee SAC 9/5/2003 $23.50 si2oo3
Bath Tubs 2 Propane Stove 1 Mechanical Fee SAC 9/5/2003 $146.95 S12003
Clothes Washer 1 Dryer Vent 1 Plumbing Fee SAC 9/5/2003 $98.00 Si2ob3
Plumbing Base Fee SAC 9/5/2003 $20.00 S12003
Total $3,183.28
BLD2003-01169 Please refer to the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2003-01169
CONDITIONS FOR
BLD20 0 3-01 1 69
1) 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- 2. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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2) In accordance with the Uniform Building Code, all sites shall have approved numbers or addresses located 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 rates as adopted by the jurisdiction and the Uniform Building Code will be assessed if the owner and/or
contracto to post the address on site prior to requesting inspections.
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3) 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. t "
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4) 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 Cou�t�jprdinances and building regulations.
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5) All upland areas disturbed or new ( Bated by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt
fencing or straw matting). X J
6) Approved per dimensions and setbacks on submitted site plan. X 00
7) Proposed s. ,gture(s) must maintain a minimum of a 20' setback from all property lines, easements and 25'from all County and State Road right of ways.
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BLD2003-01169 Please referto the following pages for conditions of this permit. 2 of 5
8) SPECIAL INSPECTION REQUIRED PER NER-515 7.7 (ATTACHED). SPECIAL INSPECTION IS REQUIRED FOR: POLYSTEEL FORM MATERIAL
INSTALLATION, PLACEMENT OF STEEL REINFORMENT, AND THE PLACEMENT AND CONSOLIDATION OF CONCRETE TO ENSURE THE
PROPER FILING OF VOIDS AT EACH LEVEL.
MASON COUNTY WILL ALSO PERFORM TYPICAL INSPECTIONS.
SPECIAL INSPECTION SHALL BE PERFORMED FOR EACH OF THE ABOVE ITEMS AND DOCUMENTED PRIOR TO CALLING FOR INSPECTION
BY MASON COUNTY
9) 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 prior to any further inspections being performed or approvals granted.
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10) The plan review check list and corrections, along with the Energy Compliance Worksheet (when applicable) 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 3e for the duration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections.
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11) All slabs within the heated space shall be insuIP to a minimum R-10 for at least 24". Monolithic slabs shall be insulated around the perimeter from the
top of the slab to the bottom of the footing X
12) ALL FURNACE INSTALLATIONS SHALL MEET THE MINIMUM EFFICIENCIES SET FORTH IN THE 1994 WASHINGTON STATE ENERGY CODE
(WSEC). ANY PORTION OF THE MECHANICAL SYSTEM THAT IS ALTERED QRI REPLACED SHALL MEET THE MINIMUM STANDARDS SET
FORTH IN THE 1994 WSEC AND 1997 UNIFORM MECHANICAL CODE. X
13) The "approved" plot plan is required to be on-site for inspection purposes. If an inspection is requested and the "approved" plot 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
Buildi epartment prior to any further inspections being performed or approvals granted.
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14) 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 (Ty g/,Max 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 P.
15) In buildings of unusually tight construction, fuel-burning appliances (excluding cooking appliances and domestic clothes dryers) shall obtain combustion
air from otyts de in accordance with the Uniform Mechanical Code.
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16) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X ✓%
BLD2003-01169 Please referto the following pages for conditions of this permit. 3 of 5
17) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. A documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charge shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
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18) All construction must meet or exceed all local ordinances and the 1997 Uniform Building Code 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 per r vocation.
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19) Installation of heating equipment in single family residences shall meet the requirement of the current WSEC. The furnace to be installed shall not exceed
200% of the heating design load or prescriptive requirements of Chapter 9. Furnace efficiency shall be .78 AFUE or higher or rated 80% combustion
efficiency. All ducts shall be securely fastened and sealed with welds, gaskets, mastics (adhesives), mastic-plus-embedded-fabric systems or tapes
installed in accordance with facturers installation instructions. Duct tape is NOT permitted as a sealant on any ducts. Ducts in unheated spaces shall
be insulated to R-8. X
20) All changes to"approved"building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance
or regulatimI -
st be reviewed and approved by Mason County prior to construction.
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21) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the Uniform Codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector she made prior to requesting additional inspections.
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22) All propane tanks must be installed in accordance with the Uniform Fire Code and all applicable Mason County ordinances. All propane tanks filled on
site must be located a minimum of 10'from any possible source of ignition (electrical outlets, electrical fixtures, compressors, etc), mechanical system air
intake (direct vent appliance, ventilation air intake, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. Propane tanks
less than 125 gallons must also be located a minimum of 5'from any building opening (foundation vents,windows, doors etc), property line or easement.
If a propank is exposed to probable vehicular damage, protective bollards must be installed.
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23) All propane tanks must be installed in accordance with the Uniform Fire Code and all applicable Mason County ordinances. All Propane tanks between
125 and 500 gallons must be located a minimum of 10'from any building, property line, public way, possible source of ignition (electrical outlets, electrical
fixtures, compressors, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. If a propane tank is exposed to probable
vehicular ge, protective bollards must be installed.
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24) All propane tanks Rnust be installed in accordance with the Uniform Fire Code and all applicable Mason County ordinances. All propane tanks must meet
the installatio irements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks.
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BLD2003-01169 Please referto the following pages for conditions of this permit. 4 of 5
25) Fuel piping shall be inspected after the installation of gas piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the
time of inspection the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall
not be used until the final inspection has been performed and approved by a Mason County building inspector.
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26) Owner/applicant must obtain a seperate pe r the placement of any size propane tank serving a fixed appliance within a dwelling structure or unit
prior to the placement of the tank. X
27) The placement of small propane tanks are not normally subject to a permit review by the Planning Department; however, propane tanks are subject to
Planning Department regulations. Such regulations primarily consist of setbacks from shorelines and features considered to be critical areas (streams,
wetlands, slopes, etc.) If you think such features exist on or nearby your property, please contact the Planning Department so that exact setback
requirements can be determined. X
28) All property lines shall be clearly identified at the time of foundation inspection. X PA
29) 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 h �, revented action from being taken. No more than one extension may be granted.
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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 cc inuation of work is a progress inspection_within the 180 day period. Final inspection must be approved before building can be occupied.
OWN ER OR AGENT: DATE:--C�--1--
BLD2003-01169 Please referto the following pages for conditions of this permit. 5 of 5
iI
o CONCRETE MECHANICAL MANUFACTURED HOME
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w Footings / Setbacks Date By Ribbons
0
Date -/G-4 '. ) By Gas Piping rye Date By
Foundation Walls Date By 7-X1 . Set-up
Date%Z.3-eO By j/2 . INSULATION Date By
B G 1 Slab Insulation Floors Final
Date By Date By Date By
FRAMING � `n� t,< Walls FIRE DEPT
Date By i Date 14 By Date By
PLUMBING Attic I OTHER
Groundwork Date ���,/l 7r/,-'7 By
Date / t�9 1-7 By / WALLBOARD NAILIN
D.W.V. / —L/ —,Y 7-11 Date B y L�
Date B FINAL INS ECTION
Water Line Date Z o.1 By i
Date By Date By
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Pro Peskin
P.O. Box 699
Tracyton, Washington 98393-0699
Phone & FAX (360) 377-1026 ,
Fax Memo September 21, 2003 �---�
To:
Company: Mason County Planning and Community Development
Fax: 427-7798
From: Jay Bartram, SE., PE.
Su_biect: Abplanalp Residence, Mason County 2003-01169
We were requested by Stan Palmer construction to review the reinforcing in the
Polysteel walls for this residence. On page 3 of our drawings the section
indicates to reinforce the walls with #4 @ 12 vertical and #4 @ 16 horizontal.
However the typical Polysteel reinforcing is for #3 @ 16 horizontal. We have
reviewed the use of #3 horizontal reinforcing and it complies with UBC97 and is
acceptable for this project.
Please call if there are any questions.
Cc: Ablpanalp 674-7190 674-2002
Stan Palmer Const 674-7190
C- BAR T itWAS
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Q(PMES LLI r
Td WJOS:80 200E TZ .daS 9Z0T-2Z2-092 : 'ON Xdd NOISBQO�Jd WOa-d
rsrazall & Associates , Inc .
FIELD REPORT NO: 3236n
GEOTECHNIC!AL ENGINEERING • ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION
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DATE: CONTRACTOR: 1 IA t\ lam k'n'
PROJECT#: JURISDICTION:
PROJECT: >>�t,1� '� s l A �(` \F PERMIT#:
LOCATION: ; `, INSPECTOR: ,• i
KRAZAN PROJECT MANAGER: =. WEATHER: TEMP:
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To the best of my knowledge,the above WAS/WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements.
Superintendent/Representative: Technician:
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275 West Dakota Ave.,Clovis, CA 93612 (559)348-2200 1501-15th St,NW Suite 106,Auburn, WA 98002 (253)939-2500
4231 Foster Ave.,Bakersfield, CA 93308 (667)633-2200 20714 State Hwy 305 NE Suite 3C,Poulsbo, WA 98370 (360)598-2726
1025 Lone Palm Ave.#8G,Modesto,CA 95357 (209)572-2200 79507-744th Ave.NE#F-300, Woodinville, WA 98072 (425)485-5579
545 Parrott St.,San Jose, CA 95172 (408)271-2200 72876 NE 95th St.Suite B-700, Vancouver, WA 98682 (360)254-3200
123 Commerce Circle,Sacramento, CA 95875 (976)564-2200
4227 Brickell St.,Ontario, CA 91767 • (909)974-4400 Revision 0
Effective Date:8/16/02
The information provided on this report is prepared for the exclusive use of the client. This report may not be reproduced in any format without the written pernvssion of the client and Krazan&Associates
FIELD REPORT NCB.
K.,raZar1 & Associates , Inc .
GEOTECHNICAL ENGINEERING • ENVIRONMENTAL ENGINEERING
CONSTRUCTION TESTING AND INSPECTION • NATURAL RESOURCES/WETLANDS
DATE: k— `s CONTRACTOR:
PROJECT#: - L v-a 1-�'y JURISDICTION:
PROJECT: C�r°'i-�►J��-�' St� (Z PERMIT#:
CLIENT: � INSPECTOR:
KRAZAN PROJECT MANAGER: WEATHER: �i r TEMP:
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To the best of my knowledge,the above WAS/WAS NOT performed in accordance with the approved plans,specifications,and regulatory requirements.
Superintendent/Representative: Technician:
akota Avenue Clovis,CA 93612 (559)348-2200 1501-15th St.NW Suite 106 Auburn, WA 98002 (253)939-2500
Ave. Bakersfield,CA 93308 (661)633-2200 20714 State Hwy 305 NE Suite 3C Poulsbo, WA 98370 (360)598-2126
Dalm Ave.#8G Modesto,CA 95351 (209)572-2200 19501 144th Ave.NE#F-300 Woodinville,WA 98072 (425)485-5519
St. San Jose,CA 95112 (408)271-2200 11913 NE 103rd Ave. Vancouver,WA 98662 (360)254-3200
erce Circle Sacramento,CA 95815 (916)564-2200
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APPROVED
MAPON COUNTY DGD PLANN NG �9
4ITE AN 'r''6?UIRED TO BE ON SI E
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TOPOGRAPHY PROFILE: __. .. ..
Building Permit number. Direction: Scale: Approval:torolrioe use
/ ';- So' Building:
Owner/Applicant: 22 Date of Planning:
Paroel Number. 1"3� Z�Z00) a"J application: Env. Health:
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Direction: Scale: Approval: for otroeuw
Building Permit number: Building:
- So 9:
Owner/Applicant: Date of Planning:
Parcel Number. ��20 `'t-
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MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION J
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 in
TI2� I F RM T I
Owner m� al IOil ract e 1op AWAA AA
Mailing Address ng Ad
City State�Zip Code Sow tt
Phone moo) ther Ph. ) }!J (qOa► ( ) : tLien/Title Holder ractor R p
Email Address ' C Y . n I AddresT fq e`, `l
SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing 8eptic
Connect to Sewer System Name of Sewer System
Well Water System Name of Water System 99TA I r
PARCEL INFORMATION - 12 digit Tax Parcel No. a / / Fire District
Legal Description F jZ IV P P BLA 3`,�
Site Address (Please include street name; street num er aq jty) r_- 1
Directions to site IY Y►'1 1 ne 0 O V&_ 1'I
Will timber b cut and sold in parcel preparation? (Yes/No)
Is property located within 200' of saltwater t4 Lake N River/Creek Y Pond N
Wetland L-L Seasonal Runoff Stream Slopes or Bluffs'
PERMANENT RESIDENCE SEASONAL RESIDENCE ❑
TYPE OF JOB - New Add Alt Repair Other Use of Building re5f ifil Q
Is this permit sub i I e result of a Sto o
Work Notice,Correction Notice or other enforcement action?(Yes/
Describe Work
No. of Bedrooms _ V. of Bathroom ,_L SQUARE.FOOTAGE - 1st Floor I W5a 2nd Floor
3rd Floor Loft Basement Deck Other sq. ft.
Garage� ched 7 Detached Carport Attached Detached
MANUFACTURED 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCUR40 INg9RMATION MAY
RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS ILLSIGJeTUk� BELOW:
OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT- I certify;2it 1 4M cutrently regis-
ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Wash on 00 thdY4 am aware
of the ordinance requirements for which this permit is issued and of the ordinance requirements regulatinte v�ro k fd�which this
that all work will be done in conformance therewith. No changes permit is issued and all work shall be dollawn co*ormance there-
shall be made without first obtaining approval. with. No changes shall be made without IM obtaining proval.
X �� Date Date
Date
FOR OFFICIAL USE BEYOND THIS POINT ,
Accept by ^� J Planning Pd i no Ck# U 0 5 b
Date « — Bld Pd. 51 Reciept No. S 12.,),)3- ` .f J
DEPARTMENTAL REVIEW APPRQVED DENIED CONDITION CODES
Building Department
Occ Group Type Constr. ; . c _•r�'�
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
Valuation$ 4
FEES
Building Permit Fee ,�� " Site Inspection
Plan Review Fee O EH Review Fee
r
Plumbing 8 Bage F I f Q� „/1 Planning Review Fee
M isse iF D Other
Wood/Gas/Pellet StoveFee State Fee
Violation Fee Pre-Paid at Submittal
TOTAL FEES
PERMIT NO.:
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Shelton(360)27-9670/Beellf ir(360)�75�6n'Elma(360)482-5269
APPLICANT INFORIVIATIQN CO T Cke
TION]
Owner Co tra oraMailing Address M in
Cit State ZipCode Ci f ate iPh ne her Ph.C,,(00 ) Pther Ph.Lien/Title Holder C n actAddress E pi doLl V V V�
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION- 12 digit Tax Parcel No. 0 / / o o 19 Fire District
Legal Description
Site Address(Please include street name,street number and city)
Directions to site b Y t .
In MA 0 FS
Is your pr perty 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 V Add Alt Repair Other Use of Building P
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 FixtWaa Fees LPG Natural Gas Heatpump
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace eWtr16
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater _�_ ,` Propane Tank
Clothes Washer �_ Gas Ou is
Kitchen Sinks �_ WoodGa a elT t StoVe
Dishwasher Kitchen xhaust Hood
Hosebibs a 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-1 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 g7 ' X Date
ffV
OR OFFI IAL-USE BEYOND THIS POINT fW9V_al "
Accepted by Date Submittal Amount Due Receipt No.
OEPAR7MENTAE #Z1^V[E1N APPROVED RENTED " CONDITION Cf�ffEs .
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