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Home My WebLink AboutMIS97-0820 Remodel - BLD Permit / Conditions - 9/15/1997 MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 %NSPECTIONS CALL 42'1-967P a U 1 11- U-) I N Chi F R 1\111 FOR �-p BETWEEN 5pm AND Ram 427-7262 Bt.D97-0820 PARCEL 023294`� PLAf .- DIV ,? BLKs? LOTi7 JOB ADDRESS , ME 291 ST BE 14'A I R OWNERs 206-622-9740 ('.QXXTIA,CTOR OSTPRUCT ft62i'9740 LEGAL TA 11 OF 11 SE CLASS OF WORK . iREM BEI)Rt 0 BATH : 0 111?[ ANOUNI BY DATE RECEIPT IYFE ANOINT EY DATE RECEIPT TYPE OF USE . . . sCOM STORIES . . . . _ . -2 suaflom= I OCCUP . GROUP — tM BLDG . HEIGHT — : O ,Oft flicp 1 26.#4 TV 09112197 DELFIAR 'TYPE Of CONST . t5N F I REPLACES . . . . v '0 iPRNT $ 3168.10 TV 09112197 efum OCCUP . LOAD . , . 1181 WOODSTOVFS , _ t 0 0 20SC01 IN 69112/17 OfLFIAR1)WFLL .UNITS . . . . . 0 PARKING SPACESt 0 �PtCC slif $ 4.50 11 09111-191 RELFIAR tN�PEC-1' 10N AAFA - I SHOR F L I NE 7 -N 5244,61 VAtUtATIOlt b"Ofe, SFTi3ACK!3- TO I Ll TS . . . . 0 FUEL TYPES----- ------ BOILER,';/COMP----- MOBILE HOME- -- FRONT , . . O .Oft RATH BASINS . . . . . . : 0 t t 0 -3 HP . , 0 REAR . . . 0 .0-rt BATH TUBS ; - . c 0 7--15 tip 0 MODEL stvEm . 0 .01t G H OWE R S . . . . . . . 0 F,UnN <* 10 0 1(. BTU 0 15-30 tip 0 MAKE O .Rift WATER HEATERS . . . . : 0 FOAN >-100K BTU : 0 30-50 HP , : 0 SHPLINE O .Oft CLOTHES WASHERS . > r 0 - F(IPN - FLOOR . . ' ' 0 SO+ tip 0 YEAR- - ARfA i(ITCHEN SINKS . — , 0 HEAT PUMP . . . . . . t 0 LOT SIZE . . FLOOR DRA INS . 0 V E"-N-I' SYSTEMS . . . t 0 EVAP C00t.fPS . V I F NGT" t 0 BUILD-ING , 461368f DRINKANG FOUNT . . 0 VENT FANS 0 HOODS . . . .. . . . . 0" WIDTH ' I 0 BASEMENT . . . of�f LAUNDRY IRAYS . , 0 DOMES . INCIN ,-�O 4V_A I Al- DECKS . . . . . . 09f DISHWASHERS......: 0 AIR HANDLING UNITS—- COMMILI INCIN-0 6AA/CARP :7 Os,f GARR DISPOSALS — - 0 <- 10000 crm . : , 0 RELOC/RFPAIRt 0 AT/DT . t? URINALS . . . . . . . . . . t 0 > 10000 c,r m . 0 OTHER UNITS . s 0 MISC 111,N1 FIXTURE : 0 0 GAS OUTLETS , t 0 PROJECT LOCATI00;RWY 3 SO1110, Of BRENflION, AT Illy soll 10 PFIJAIR 701S F!RMII RFCOVES NU11 AND VDID If WORK Oi CONSTRUCTION A"INORI?ED IS NOTJONNINfao 111011 too DAYS I If CONS11194,111011 OR VORY Is SUSPENDED FOR A 1,1`0100 OF 16&f4YS AT ANY 111f A F,1_E4 it Is C01111cm. EVIDENCE Of CONT I##A f I ON Of MORE IS A FROCIPSS j9PFh1I 010 11 IM I I T#f 181 DAY PEI 100, f IVAI. I IISPECT 101 NIST BE APPR BEE ONE BVII. , . j9.1nomfo�. OR AcifNis DAI —Z V1, 13,31191 COMPLIANCE TO ATTACHED CONDITIONS IS RUOUIRLO 4 CONCRETE MECHANICAL MOBILE HOME 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 date by FRAMING Walls by FIRE DEPT. date by date by date by PLUMBING Attic OTHER Groundwork date by date by WALLBOARD NAILING D.W.V. date by date by Water Line FINAL INSPECTION date by date/Z—/2 by date by ;fir t 1 ,7 9'7 lgae/E IO5-r-/ Pr�C:�,ji h'IS /D—/J''`7'7 Cc�'�i r/Y �,•i9 Gc- (v �Oi7� nL lrll�/�o �' ��s��(�� O� y1G � sS.foD f Page No. 1 CASE HISTORY FOR CASE NO.: BLD97-0820 QUALITY FOOD CENTERS INC. NE201 STATE ROUTE 300 BELFAIR 10/09/97 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By BLDA010 Application received 07/10/97 / / 07/14/97 DONE KW 07/14/97 KW BLDA015 Waiver in File / / / / 07/14/97 DONE KW 07/14/97 KW BLDA200 (H) Hold 08/22/97 08/22/97 09/12/97 sent file to BSC Cons. for review sent DONE WLC 09/12/97 WLC file to Fire Marshall for review. BLDA500 (F) Issue building permit / / / / 09/12/97 DONE TW 09/12/97 NJP BLDB009 Fire Marshal Review 08/22/97 / / 08/28/97 DONE DLS O8/28/97 DLS BLDB110 Structural Plan Review 07/15/97 / / 09/12/97 snet file to Fire Marshall for reveiw. DONE WLC 09/12/97 WLC BLDB120 WSEC Compliance Review 09/12/97 / / 09/12/97 LIGHTING ONLY. pROPOSED LIGHTING BUDGET DONE DC 09/12/97 WLC ATTACHED TO APPROVED PLANS BLDB130 Planning Review 07/15/97 / / 07/15/97 REVIEWED PLANS AND NOTTED THAT NO CHANGE DONE AHB 07/15/97 AHB IN BLDG FOOTPRINT IS PROPOSED. BLDB134 RLC Review / / / / 07/15/97 DRAINAGE AT REAR OF LOT LIMITS SEPTIC N/A AHB 07/15/97 AHB AND BLDG EXPANSION. BLDB135 Addressing 07/14/97 / / 07/15/97 DONE GMM 07/15/97 GMM BLDB138 Planning Pre-Review 07/15/97 / / 07/15/97 DONE MMS 07/15/97 MMS BLDB200 Environmental Health Review 09/05/97 / / 09/12/97 return to warren when done. DONE PSD 09/12/97 PSD the plans were reviewed by Will, food program manager. He has dealt with teh food requirements. There are removing the bakaery, so thery will be a reduction in sewage.psd BLDC135 Mechanical inspection 09/26/97 09/26/97 09/26/97 pressure gas test on deli blakley. Roll PASS TR 10/03/97 TLG out trapprimer plumbing on floral sink dwv supply . framing on mansard SS clgc �_ °� Page No. 1 CASE HISTORY FOR CASE NO.: BLD97-0820 QUALITY FOOD CENTERS INC. NE201 STATE ROUTE 300 BELFAIR 10/01/97 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By ------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- --- BLDA010 Application received 07/10/97 / / 07/14/97 DONE KW 07/14/97 KW BLDA015 Waiver in File / / / / 07/14/97 DONE KW 07/14/97 KW BLDA200 (H) Hold 08/22/97 08/22/97 09/12/97 sent file to BSC Cons. for review sent DONE WLC 09/12/97 WLC file to Fire Marshall for review. BLDA500 (F) Issue building permit / / / / 09/12/97 DONE TW 09/12/97 NJP BLDB009 Fire Marshal Review 08/22/97 / / 08/28/97 DONE DLS 08/28/97 DLS BLDB110 Structural Plan Review 07/15/97 / / 09/12/97 snet file to Fire Marshall for reveiw. DONE WLC 09/12/97 WLC BLDB120 WSEC Compliance Review 09/12/97 / / 09/12/97 LIGHTING ONLY. pROPOSED LIGHTING BUDGET DONE DC 09/12/97 WLC ATTACHED TO APPROVED PLANS BLDB130 Planning Review 07/15/97 / / 07/15/97 REVIEWED PLANS AND NOTTED THAT NO CHANGE DONE AHB 07/15/97 AHB IN BLDG FOOTPRINT IS PROPOSED. BLDB134 RLC Review / / / / 07/15/97 DRAINAGE AT REAR OF LOT LIMITS SEPTIC N/A AHB 07/15/97 AHB AND BLDG EXPANSION. BLDB135 Addressing 07/14/97 / / 07/15/97 DONE GMM 07/15/97 GMM BLDB138 Planning Pre-Review 07/15/97 / / 07/15/97 DONE MMS 07/15/97 MMS BLDB200 Environmental Health Review 09/05/97 / / 09/12/97 return to warren when done. DONE PSD 09/12/97 PSD the plans were reviewed by Will, food program manager. He has dealt with teh food requirements. There are removing the bakaery, so thery will be a reduction in sewage.psd yck�>D Cn/y, gy CONCRETE MECHANICAL MOBILE HOME Footings-Setbabk 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 PLUMBING date by OTHER Groundwork Attic date b date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by � �i- 3-217 l�Tr�loi7 �� f /��- Pal"/o.>✓S FiPq��yG 1�� .C�,/ /� OiS�S�C---o / Z —/2 -';;- Ohs t f fills - �� - �6�/ ,��c..c--,� o� T-✓�. MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 7-7 7) PIORSUANT TO 1994 UNIFORM BUILDING CODE SECTION 309:1 (C) AND SECTION 513 ALL. S i T ES MUST HAVE APPROVED NUMPERS OR ADDRESSES PRhVIDED IN SUCH A POSITION AS TO Bt PLAINLY VISIBLE AND LEGIBLE FROM T11E STREET OR ROAD FRONTING THE PROPERTY . MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A REIN SPP T�ON FEE BASED ON RATES 1N TABLE 3A OF THE 1994 UNIFORM BUILDING CODE WILL BE ASSES,SE r' 1 FI OWNED/CONTRACTOR FAILS TO POST ADDRESS ON S I TF PRIOR TO REQUESTING 1-1. E� i'O N S X 8 ) Any aha .g.e�i. I n const root I on sha I I be rev i ewpd by eng I veer of record and 4ubtn i t t ed it) writ,in to `the Mason County Building Department prior to con-struotion . 9) XL ��s OCTION MUST MEET OR EXCEED ALL LOCA1_ CODES AND UBC RE001REMEWS . 10) Channes t-�' approved building plans that effect comp 1 i anc.e -$fir t e 199'1 Washington State Energy Code , 1991 Ventilation and Indoor Air Quality J/ Code, the Uniform Building Cede anti/or Mason County Rtr9�i,41 s must be approved by Mason County prior to oonstructionX� 1 1 ) ALL. .00I14STRUCT 1 ON MUST MEET OR EXCEED LOCAL_ CODES . IF ANY QUE-ST 1 ONS, PLEASE GALL. Tf�i F I CF BEFORE. CONSTRUCTION . 12 ) CONSTRUCTION PROCESS TO BE F I F[ U CORRECTE¢---A,5�RF rQQ RED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE .x~i= / __ ___-- MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 PERM i T C'. C31N110 IT I C. 1tN Case No . : Bt_097-•0820 Fort QIJAI I TY FOOD CENTERS INC . Pages 1 1 ) ApF,r,+ v d per dimensions and setbacks on submitted site plan N changes t t>uildirill o,,o pr t Is pi oposed . 2 ) 1 . MODIFICATION OF' THE SPRINKLER SYSTEM REQUIRFD . CONTACT A LICENSED FiRt SPRINKLFR CONTRACTOR TO tVAIA)ATE NEED TO RELOCATE EXISTING SPRINKI..ER HEADS OR ADD NEW HEADS , A SEPARATE PERMIT IS .REQUIRED FOR THE MODIFliATION OF A FIRE SPRINKLER SYSTEM . 2 . ANY NEW COOKING EQUIPMENT THAT EMITS GREASE-LADEN VAPORS IS TO BE PROTECTED BY A FIXED FIRE SUPPRESSION SYSTEM 3 . RE :ATiON OF PORTABLE FIRE EXTINGUISHERS MAY BE AFQUIRFD . CONTACT THE MASON CDU'TNY FIRE . RSI4AL TO ARRANGE FOR AN ON-SITE INSPECTION . X 3 ) Proposed structure or any portion thereof greater- than .10" in height from grad" tine, must ,,mjw '"ta i n a minimum of 5 ' Bert bark from all property i i ne.s, easements and 10 ' from a.! 1 ,1 my .end c.*.ate Road right of ways . X �`, 4 ) They use , handling and stora a of hazardous matey i a i s or flammable and combustible liquids ft:� excess of 10 ga bons is not allowed without the approval of the Mason County Fire -Mar ltaI . X 5 ) 1 ) , IF NEW -OVERHANGS EXTEND MORE THAN 4 FEET FROM THE FACE OF BUILDING, ON IF NEW CONCEALE CO)MHUST t SLE SPACES ARE CREATED, PROVIDE SPRINKLER COVERAGE , , 2) . _A 5E F PERMIT IS REQUIRFto FOR THE FXTEN% ION OF THE SPRINKLER SYSTEM . X a ) All approved plans are required to be on-s i to for, ins eat i on Purposes If I n!,pecit i on Is called for and plans are not on site, Approval WILL NOT be granted . In addition, a Re- Inspect 1 on fee In t-he amourit of *32 .00 per hour (m i.n i mum 1 hour ) will be charged and must be collected by this department prior to any . fiirther inspections being performed or approval granted . CONCRETE MECHANICAL MOBILE HOME 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 by date by FRAMING Walls FIRE DEPT. data by date b Y date by PLUMBING Attic OTHER Groundwork date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by f Page No. 1 CASE HISTORY FOR CASE NO.: BLD97-0820 QUALITY FOOD CENTERS INC. NE201 STATE ROUTE 30^3ELMIR 11/13/97 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By ------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- --- BLDA010 Application received 07/10/97 / / 07/14/97 DONE KW 07/14/97 KW BLDA015 Waiver in File / / / / 07/14/97 DONE KW 07/14/97 KW BLDA200 (H) Hold 08/22/97 08/22/97 09/12/97 sent file to BSC Cons. for review sent DONE WLC 09/12/97 WLC file to Fire Marshall for review. BLDA500 (F) Issue building permit / / / / 09/12/97 DONE TW 09/12/97 NJP BLDB009 Fire Marshal Review 08/22/97 / / 08/28/97 DONE DLS 08/28/97 DLS BLDB110 Structural Plan Review 07/15/97 / / 09/12/97 snet file to Fire Marshall for reveiw. DONE WLC 09/12/97 WLC BLDB120 WSEC Compliance Review 09/12/97 / / 09/12/97 LIGHTING ONLY. pROPOSED LIGHTING BUDGET DONE DC 09/12/97 WLC ATTACHED TO APPROVED PLANS BLDB130 Planning Review 07/15/97 / / 07/15/97 REVIEWED PLANS AND NOTTED THAT NO CHANGE DONE AHB 07/15/97 AHB IN BLDG FOOTPRINT IS PROPOSED. BLDB134 RLC Review / / / / 07/15/97 DRAINAGE AT REAR OF LOT LIMITS SEPTIC N/A AHB 07/15/97 AHB AND BLDG EXPANSION. BLDB135 Addressing 07/14/97 / / 07/15/97 DONE GMM 07/15/97 GMM BLDB138 Planning Pre-Review 07/15/97 / / 07/15/97 DONE MMS 07/15/97 MMS BLDB200 Environmental Health Review 09/05/97 / / 09/12/97 return to warren when done. DONE PSD 09/12/97 PSD the plans were reviewed by Will, food program manager. He has dealt with teh food requirements. There are removing the bakaery, so thery will be a reduction in sewage.psd BLDC100 Inspection 10/09/97 10/09/97 10/09/97 CALLED OUT FOR GAS TEST COULN'T GET TO FAIL TR 10/10/97 KW GUAGE BECAUSE OF WET TILE. BLDC100 Inspection 10/15/97 10/15/97 10/15/97 gas test and trim out in deli OK and PASS TR 10/23/97 TLG curtain wall at produce and ceiling grid and floral BLDC125 Framing inspection 10/09/97 10/09/97 10/09/97 1 PASS TR 10/10/97 KW BLDC125 Framing inspection 11/03/97 11/03/97 11/03/97 INTERIOR NON BEARING PARTITIONS - BAKERY PASS TR 11/04/97 KW BLDC135 Mechanical inspection 09/26/97 09/26/97 09/26/97 pressure gas test on deli blakley. Roll PASS TR 10/03/97 TLG out trapprimer plumbing on floral sink dwv supply . framing on mansard BLDC135 Mechanical inspection 10/09/97 10/09/97 10/09/97 1. AT FURNACE SECURE INSULATION TO DUCT, FAIL TR 10/10/97 KW THIS WILL HELP W/CLEARANCES SHIELD W/SHEET METAL BETWEEN FLUE AND INSULATION ALSO EXTENDING SINGLE WALL FLUE PIPE WILL HELP W/CLEARANCES TO COMBUSTABLE BY CENTERING PIPE IN CHASE. BLDC150 Wallboard inspection 11/10/97 11/10/97 11/10/97 PASS TR 11/10/97 TMJ BLDC230 Woodstove Inspection 10/09/97 10/09/97 10/09/97 COMBUSTION AIR TO EXTERIOR NEED TO BE FAIL TR 10/10/97 KW DRILLED OUT THROUGH RIM JOIST, IT CAN BE TRIMED W/A DRYVENT TYPE FITTING WITHOUT THE BACK DRAFT DAMPER LOUVER S v 774 , - - L- i1 r, H r- C r, i r- _ _ T. = P - C� 1994 Washington State Nonresidential Energy Code Compliance Form f Summary �'`� •. 14WWe3h"wgt0n Stets IJenrsfldential Enerpy Code Compnence corms Socor I Edtlon•June 1995 Project Info Project Address Z � _ Date For Building Department use Applicant Name: Applicant Address: Applicant Phone: Project Description ❑ New Building 0 Addition Alteration ^� Compliance Option U Prescriptive ' Ming Power Allowance ❑ systems Analysis (See Qualification Checklist(over).Indicate Prescriptive&LPA spaces dearly on plans.) Alteration Exceptions ❑ No changes are being made to the lighting (check appropriate box) ❑Less than 601/6 of the fixtures are new,and installed lighting wattage Is not being increasjid Maximum Allowed Lighting Wattage (Interior) Location (noor/room no.) Allowed Occupancy Description Watts per It'•• Area in fe lJIl x Area From Table 15-1 (over)-document all exceptions taken from footnotes Total Allowed Watts Proposed Li Min Wattage (Interior) (May not exceed Total Albwed Watts for Interior) Location (noodroom no.) Number of Watts/ Watts Fixture Description Fixtures Fixture Proposed 2 g G.( L( uC vo S ^i mil' O Total Proposed Watts may not exceed Total Alknved Watts for interior Total Proposed Watts Maximum Allowed Likjhting Wattage (Exterior) Location Description Allowed Watts Area In ft2 Allowed Wang Covered Parking per fe or per if (or if for perimeter) [fe or x it) . Open Parking pz W/}t2 Outdoor Areas 0.2 W/fi1 Bldg.(by facade) 0.2 W/te Bldg (by Perim) 0.25 We Note.for building exterior,choose either the facade area or the perimeter method,but not both 7.5 WAt Total Allowed Watts Proposed Li htin Watta a (Exterior) (May not exceed Total Allowed Watts for Exterior) Location Fixture Descrf lion p Number of Watts! Watts Fixturestures Fixture Proposed Totai Proposed Watts may not exceed Total Allowed Watts for Exterior Total Proposed Watts a Iv1A5UN COUNTY DEPARTMENT of IIEALI I SERVICES RECEIVED Shelton,Washing►on 98584 "] u 9 1997 (360)427-9670• Belfair:275-4467 WOODMAN CONST., INC. ENVIRONMENTAL HEALTH - V--- ---- P.O. BOX 1666 PERSONAL HEALTH 303 N. FOURI-1-1 WATER O P.O. BC Mason County Environmental Health Departmen Septic Tank Pumping Report Form Property Owner/Mailing Address —C Al�,' Site Address Tax Parcel Number Legal Description. T (PunpeN s Finding's) All items must be filled out completelY, circle answer as no-ded. Septic Tank Information 1) Tank pumped and inspected: Effluent level: liigli --a or no � / low 2) Tank size: .5 a74- Fr— �, 3) Tank constructs or de Tank material: metal wood conclrete lirafiberglass oilier 4) How many compartments? single ou e 5) Inlet Baffle condition: Outlet Baffle condition: isfacto / needs repair is .acto / needs repair. Center Baffle condition: at's act d- yes _ / needs ,repair / not applicable Effluent filter cleane j no not app ica e 6) Does the system leave a pump chamber? yes r—„� / unknown Did the pump chamber need to be pumped? yeses`/'Jno / not applicable 7) Tank condition: damaged / good Were the tank or the baffles repa' ed? yes 1 Solids .level (optional) : Sludge c` j� / clot applicable g / Sctun_�`r Draiiifield condition: back�jspos�e lie taiil; / seepage irl �i�r iiif field / 8) Location where sewage no 9) Abnormal observations: (if repairs were made, please explain) Findings and determinations Of this inspection reflect conditforrs ns they existed on the day the septic tank Was pumped. No claim is made by this compan ither expressed or implied, concerning success orfailure of the septic system. Signature of certified pull Name of Company Date (t)ller.ycled GARY YANDO,DIRECTOR sraTFo� A U N U DEPARTMENT OF COMMUNITY DEVELOPMENT x s N PLANNING -SOLID WASTE - UTILITIES �o N Y oy BLDG. I • 411 N. 51 ST. e P.O. BOX 578 SHELTON,WA 98584 • (360) 427-9670 1864 DISCLAIMER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by that Order, the undersigned property owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter "permitting actions'), which damages are attributable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid. Da (Parcel No. or Legal Description) ro owner' signature otarized) (or thexourity may accept a signature of the owner's authorized agent upon proper proof of authorization) t ACKNOWLEDGEMENT CERTIFICATE(INDIVIDUAL) STATE OF COUNTY OF On this day of in the year , before me Notary Public, personally appeared personally known to me to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed it. WITNESS my hand and official seal. -For County use only- Revie e p on to Notary's signature Staff Initial: My Commission Expires: Permit No. MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 \ �a� b$ PLEASE PRINT I #1 caner QU . J:r/ �D CkE `� 1�(- Phone# Zoe �oZ-L 7 CD Site Address I�•�, ZOI S - _ � 3Oo Fire District# City St L'�AZip Directions to Job Site 1A L Owner Mailing Address D eDc)4 CityU,�V�E Lien/Title Holder /4Dt�r= Address_ Clty __ St Zip Name OC7bN'IPc GD J C-Tl C�� Contractor Reg # k6GVAL--T � tot Address ?2 LL-VJEE ZC:)I Expiration Date O O S City i3rcUacV. St U'A Zip 9K-COS Phone' < z #3 If septic is located on project site, include records. Connect to Septic?X _ Public Water Supply_Well I Connect to Sewer System? Name of System 3 2� i w Q-s�—c 2 (If residential, proof of potable water is required) D , J 4 �QOQ # Parcel No. Legal Description h Tit. 10 0� n w -,-LE :L 8 E x #5 Building Square Footage: (existing/proposed)<j4p 1 st FI �'5 13(o/ 13(0 2nd FI ---7 3rd FI _ / Loft - -f Basement _ / Deck -4 # bedrooms / # bathrooms / Garage / — Carport / (Circle: Attached or Detached?) Other — sq. ft. / #6 Use of building __ �7�` 1-'1 PET C/ 't .__` � Describe work I #7 Type of Job: New Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION D Model Year Make Model JAL 1997 Length Width Serial No. # Bedrooms # Bathrooms Type of Heat p`' Purchase Price $ HEALTH SERVICES #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the site plan /---- Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other Bath Tubs No. Units Fees Showers Fu rn BTU Hot Water Htr _ Heatpumps _Laundry Washer _ Vent Systems Sinks _ Spot Vent Fans Floor Drains No. Boilers/Compressors _Laundry Basins _ HP Dishwasher No. Air Handling Units _Disposal cfm# Urinals No. Fire Protection Systems Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 16.75 _ Auto Fire Sprink Sys 35.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING PP OVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPA pM14Y3 X OWNER X BY DATE DATE — — FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold nn Approval PlannineV g: ' Environmental Health: Building Plan Review ��L �2- Occupancy Group: 1\A Type of Const: SN Fire Marshal:" g,rz-`3 co pt-0 tjL- ln�l1L. Other: Special Conditions: FEES Building Permit 3 �j b Plan Check zo s y•07 Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee !� Other Other Building Valuation: fo S do O TOTAL FEE