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HomeMy WebLinkAboutBLD2001-01039 Cancelled SFR - BLD Permit / Conditions - 8/28/2014 1 Inspection Line (360)427-7262 MASON COUNTY DEPT. OF COMMUNITY Phone: (360)427-9670, ext. 352 4 � DEVELOPMENT Mason County Bldg . 3 426 W . Cedar P.O _ Box 186 Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT g D 01-01039 OWNER: JIM KILDOW CONTRACTOR: LICENSE: EXP: RECEIVED: 10/3/2001 SITE ADDRESS: 410 E PROBERT RD SHELTON ISSUED: 4/17/2002 PARCEL NUMBER: 221287690091 EXPIRES: 101171200 LEGAL DESCRIPTION: TR 9-A OF SURVEY VOL 2 PG 78 TR A OF SP #540 SEE SURVEY 6/35 PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESIDENCE WY 3 TO RT ON PICKERING TO L ON PROBERT TO 410 E AT SHARP L General Information Construction & Occupa y I formation Square Footage Information No. of Bedrooms: Type ype o str.. V- N Type of Use: SF Insp. Area: No. of Bathrooms: 2 oup: R-3 Lot Size: Deck: 1 1 3 Type of Work: NEW Fire Dist.: 5 No. of Stories: 3 111111, Occ. Load: Building:81 8 Valuation: $54 1 53 BuildingHeight: 32 cc. Status: Basement:643 Manufactured Home Information Setback r f ation Shoreline & Planning Information Make: Length: Ft. Front: S 1 14.0 Ft. Shoreline: Ft. Water Body: Category III wetland Rear: N 127.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: W 95.0 Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: F Comp. Plan Desi .: Rural _j Plumbing Fixtures Mechanical 11tures FEES Type Oty. Type Type By Date Amount Receipt Water Closets (Toilets) 2 Exhaust od 1 Plan Check Fee KLW 10/3/20(S441.19 57516 Bath Tubs 1 Furnace K 1 EH Plan Review CEW 10/10/2( S50.00 59041 Water Heaters 1 Ventilati n Fan 2 Planning Site Inspection RAM 10/15/2( S70.00 59041 Clothes Washer 1 Woodsto 2 Building State Fee MRG 10/29/2( $4.50 59041 Lavatories 3 Heat Pump • ` 1 Building Permit Fee MRG 10/29/2(S678.75 59041 Dryer Vent 1 Mechanical Base Fee MRG 10/29/2( S23.50 59041 Plumbing Fee MRG 10/29/2( S56.00 59041 Plumbing Base Fee MRG 10/29/2( S20.00 59041 Mechanical Fee DLC 11/2/20(S141.85 59041 Total $1,485.79 BLD2001 -01039 Please refer to the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD2001-01039 CONDITIONS FOR BLD2001-01039 1) This applicatio is subject to Buffer and Landscaping requirements as established under Mason County Ordinance 1.03.036.X--- -- --------------------- 2) The use, handling and storage of hazardous materi or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fire Marshal. X__ _�,.______________________ 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 sug esto to contact that office to review future planned work which may affect your project. X--- = - '�---------------------- 4) Proposed structure or any portion thereof greater than 30" in height from grade lin ust maintain a minimum of 5' setback from all property lines, easements and 10' from all County and State Road right of ways. X_ ------------------ 5) 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 in the amount of $47.00 per hour (minimum 1 hour) will be charged and must be,collected by the Building Department prior to any further inspections being performed or approvals granted. X-- - � —--------------------- 6) 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 as ssed i t e owner and/or contractor fail to post the address on site prior to requesting inspections. X-- r--------------------- BLD2001-01039 Please refer to the following pages for conditions of this permit. 2 of 4 7) The plan review checklist 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 site for the duration of the project. Failure to comply and/or removal of approved docu ent 11 result in failure of required building inspections. X---- - ------------------ 8) 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 in the amount of $47.00 per hour (minimum 1 hour) will be char d and II be collected by the Building Department prior to any further inspections being performed or approvals granted. X---- ------------------ 9) Any portion of any structure over 30" in height from surrounding adjacent grade must be setback 5' from all utility and drainage ea eme ts, total of 10' from each property line, or a variance must be obtained from the Building Department. X- - ------------------- 10) All changes to "approved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason Co ty ordin nce or regulation, must be reviewed and approved by Mason County prior to construction. X--- - - 1--------------------- 1 1) A property lines shall be clearly identified at the time of foundation inspection. X-__ _ —--------------------- 1 2) 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 Ma onWCony as being non-compliant with Mason County ordinances and building regulations. X ----------------------- 13) 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 prevented action from being taken. No more than one extension may be gra ted. X--- -1----------------------- 14) Inspection required by engineer at foundation or footing before you pour concrete, Provide a letter from the engineer before you call in for a footing inspection with Mason County. An Inspection is required by the engineer at framing stage, a letter from the engineer is required before you call in for a framing Inspection with Mason County. Befort final approval is granted, a final inspection by the engineer will also be required. X-- -------------------- i 1 5) Thyproposal is subject to a Wetland Restoration Plan, accompanied by cash bond and monitoring agreement. Plantings must achieve a 90% survival rate over the next three years. An annual monitoring report that details the survival of the plantings is to be submitted to the Plannil rnent each year for the next three years on the anniversary of the permit issued date. X------ - - -- ------------------------------- BLD2001-0�039 Please refer to the following pages for conditions of this permit. 3 of 4 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 1 80 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 1 80 day period. Final inspection must be approved before building can be occupied. �f OWNER OR AGENT: -^ �1i_z/ B,j�r - - - ------------- DATE: ------------------ BLD2001-01039 Please refer to the following pages for conditions of this permit. 4 Of 4 t MECHANICAL )`MOBILE HOME FootlnDs•Setback �-J date by FUbbons duleZ d Tf2 , Gas Pk*g date by Set up { Foutdatlon wads date -by < J /ZrNsuLAnoN date by dateBGISLAB hsutatlon d--�r9l���9^�/ F7rs Flna1 oo /�OJ by by date by date FIRE DEFT. ' FRAMING Walls date by date by date by pLUMBWO Attk OTHER (3rgxtdwor . 2v � �/� date by date WALLBOARD NAILING D.W.V. date by d.t. by FINAL INSPE9nON Water Line date by date by date by �l�✓cUE� TES% Rio% V.��-T� Gri/���G �)T%i-��•s_ 02/9,KJ cam11 , ap ll�ls re C c e. G �' /-cam TF_jZ_ 3 AL vp w��� 1 SARGENT Sargent Engineers,Inc. 320 Ronlee Ln NW Olympia,WA 98502 Tel 360-867-9284 Fax 360-867-9318 www.sargentengineers.com February 6, 2003 Mr.Jim Kildow 410 E.Probert Rd Shelton,WA 98584 RE: Kildow Residence Construction Observation PROJECT NO.: A01251.00/A03119.00 Dear Mr.Kildow: On February 6, 2003 and inspection was made at the construction site. Site preparation is complete. Forms and reinforcing are in place for all footings and slabs. As discussed, the slab reinforcing needs to be supported by concrete blocks, and anchor bolts must be in place before the concrete is poured. Some footings are deeper then required, and extra reinforcing has been added. The work performed appeared to be per the structural drawings. If you have any questions or concerns regarding this project,please call me. Sincerely, Sargent Engineers Inc. �,s aL'," Aubrey S. Argerg Design Engineer ASA 6/21/2011 Case Activity Listing 3:11:30PM Case#: BLD2OO1-01039 1� Assigned Done Activity Description Date i Date 2 Date 3 Hold Disp To By Updated Updated By BLDB130 Planning Review 10/4/2001 4/5/2002 None DONE RAM RAM 3/25/2005 KLF A site inspection was conducted on 10/12/01. The parcel contains and is adjacent to Category I,II,&III wetlands. No indication of the proposed homesite location was evident during the inspection. A subsequent inspection that includes an examination of the staked homesite will be necessary. Letter of incompleteness sent. BLDB130 Planning Review 11/1/2001 4/5/2002 None DONE RAM RAM 5/22/2003 KLF Proposed homesite is within the wetland buffer for a Category III wetland. Field confirmation conducted on 10/25/01. Project has created a mitigation and Restoration Plan,accompanied by cash bond and monitoring agreement. Performance bond received 4/5/02. Site inspection to verify adequate plantings completed on 4/12/02. BLDA100 Approved for Issuance 4/16/2002 4/16/2002 None DONE TW 4/16/2002 TW LEFT MESSAGE ON MACHINE.3:OOPM BLDA500 Issue Building Permit 4/17/2002 None DONE KS 4/17/2002 KS BLDC120 Underground Plumbing 5/21/2002 5/23/2002 None FAIL TFR 5/28/2002 KLW NOT UNDER TEST NOT VENTED WRONG FITTINGS,MUST START OVER BLDC120 Underground Plumbing 8/15/2002 8/20/2002 None COND TFR 8/21/2002 KLW B.G.DWV PASS COND TO SLEEVING ON HORZ AND WRAPPING ON VERT. BLDC110 Footing Inspection 2/11/2003 2/18/2003 None PASS TFR 2/19/2003 KLW BLDC100 Inspection 4/29/2003 5/l/2003 None DONE TFR 5/2/2003 KLW UNDER SLAB RADIANT TEST ASS AND UNDERSLAB INS. BLDC100 Inspection 10/3/2003 10/8/2003 None PASS TFR 10/9/2003 KLW FIRST LIFT TO BOND BEAM PASS. BLDC100 Inspection 4/5/2004 4/7/2004 None PASS TFR 4/8/2004 KLW 2ND LIFT ON BOND BEAM PASS. Page 2 of 4 CzwAdivityrpt Case.Activity Listing 6/2 3:11:30P30PM Case#: BLD2001-01039 _ Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By BLDC 100 Inspection 10/8/2004 10/1 1/2004 None PASS TFR 10/12/2004 KLW 3RD LIFT ON BOND BEAM PASS. BLDC100 Inspection 3/4/2005 3/9/2005 None PASS TFR 3/10/2005 KLW BOND BEAM PASS. BLDC100 Inspection 9/7/2005 9/12/2005 None DONE TFR 9/13/2005 KLW LAST LIFT ON CMU WALL BLDC105 Progress Inspection 3/2/2006 3/3/2006 None PASS TFR 3/7/2006 MRB BLDC105 Progress Inspection 9/6/2006 9/11/2006 None PASS TFR 9/12/2006 MRB BLDC105 Progress Inspection 3/30/2007 4/2/2007 None PASS MAU 4/3/2007 KLW SAME 2ND FLOOR FRAMING BLDC105 Progress Inspection 10/9/2007 10/9/2007 None DONE KKK 10/9/2007 KKK Permit extended until 4-3-08 per Phyllis. BLDC105 Progress Inspection 4/10/2008 4/11/2008 None PASS TFR 4/14/2008 KDM ROOF SHEETED. BLDC105 Progress Inspection 10/15/2008 10/16/2008 None PASS MAU 10/17/2008 KDM ROOF FINISHED. BLDC105 Progress Inspection 4/13/2009 4/14/2009 None PASS TFR 4/15/2009 KKK Cross bracing hardware and gables installed. BLDC105 Progress Inspection 10/14/2009 10/14/2009 None PASS PIB 10/26/2009 PIB Progressed over the phone: framed in floor Page 3 of 4 CawActivity-rpt Case Activity Listing6/21/2011 3:11:30PM Case#: BLD2001-01039 t� Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By BLDC105 Progress Inspection 4/6/2010 4/14/2010 None PASS PIB 4/7/2010 PIB Progressed over the phone: calling me back with progress made. Page 4 of 4 CaseActivity..rpt MASON COUNTY DEPARTMENT OF HEALTH SERVICES October 04, 2001 PO BOX 1666 SHELTON, WA 98584 SHELTON (360)427-9670 FAX (360)427-7798 ELMA (360)482-5269 JIM KILDOW BELFAIR (360) 275-4467 10434 LITTLEROCK RD SEATTLE (206)464-6968 OLYMPIA WA 98512 Case No.:BLD2001-01039 Parcel No.:221287690091 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Water bacteriological analysis. IJ Well Log Please call me at (360)427-9670, ext. 353 if you have any questions. Sincerely, Cindy Waite Environmental Health Mason County Health Services Comments: 10/04/2001 1 of 1 BLD2001-01039 P�oN.STA)-e MASON COUNTY O DEPARTMENT OF COMMUNITY DEVELOPMENT O AO (A" Planning Division ►" O T = 7 N y Y P O Box 279, Shelton, WA 98584 1864 (360)427-9670 NOTIFICATION OF INCOMPLETE APPLICATION October 15, 2001 JIM KILDOW 10434 LITTLEROCK RD OLYMPIA WA 98512 Parcel No.: 221287690091 Project Description RESIDENCE Dear Applicant: You have submitted a permit application (case no. BLD2001-01039) for proposed construction or development in the county. Upon review of your application, I have determined that the contents of the application are incomplete or do not provide enough detail for review. Therefore, review of your application will not proceed until the necessary information is provided (see the comment section of this letter for details.) Once the information is submitted and the application is complete, I will continue to process your application accordingly. Please contact me at (360) 427-9670, ext. 577 if you have questions. i Rick Mraz Land Use Planner Mason County Planning Department 10/15/01 1 of 2 BLD2001-01039 NOTIFICATION OF INCOMPLETE APPLICATION 10/15/01 Case No. BLD2001-01039 Comments A site inspection was conducted on 10/12/01 . The parcel contains and/or is adjacent to Category I, II, & III wetlands. No indication of the proposed homesite location was evident during the inspection. The site plan provided was not sufficient to locate the homesite in reference to wetland setbacks. A subsequent inspection that includes an examination of the staked homesite and its distance from the respective wetlands will be necessary. Please contact this office at (360) 427-9670 x577 to schedule a follow-up inspection. 10/15/01 2 of 2 BLD2001-01039 MASON COUNTY Shelton (360) 427-9670 DEPARTMENT OF COMMUNITY DEVELOPMENT Belfair (360) 275-4467 Planning Elma (360 Mason County Bldg.1411 N.5th ) 482-5269 P.O.Box 279 Shelton,WA 98584 February 3,2005 Tp Br Heritage Bank Q ` Kf P�' I Attn: Sarah Salva ! /q�� T�C 5301 Capital Blvd. S EL Tumwater,WA 98501 L F Re: Wetland bond release of assignment for James Kildow. Parcel#22128-76-90091 Account#04040014500 Dear Sarah: This shall serve a notification that James Kildow has satisfied his requirement with Mason County for wetland restoration pursuant to Mason County building permit#BLD2001-01039. Mason County hereby releases its interest in the jointly held account#04040014500. A field investigation of the property was conducted on February 1,2005 to verify that the mitigation planting had survived the requisite three years and were of appropriate density and species composition. If you have any questions in this matter,please contact Grace Miller at(360)427-9670 060. Sincerely, Richargiv: Senior Mason County Department of Community Development Cc: James Kildow File .. e a MASON COUNTY Type of Permit: ��l�n, Po-krA' �>L> QUO \ Owner/Developer/Contractor: Type of Improvement: Project Location: Legal Description of Property: G % 1 cZ N S R .n540SeA With reference to the above-identified matter, this will certify that this institution has a savings account (or loan) for the above-referenced owner/developer/contractor for the project so identified. In consideration of the permitted improvement, and in lieu of a performance bond, this institution hereby agrees that it will freeze the following sums of money for the indicated improvement pending written authorization for release of said funds b the County of Mason in the amount of $ )Rgs. COS' Dollars. The total sum indicated will be withheld by this institution from any disbursements of any kind until written authorization has been received by this institution for the County of Mason to release the sum of money indicated by the written authorization from the County. The design, location, materials and other specifications for the indicated improvement are those required by the County of Mason as appears in the above-referenced document/permit, and shall be in compliance with the Mason County Resource Ordinance No. 77-93. These funds shall be held by the institution for a period of 2C. months/years. In the event the Contractor/Developer/Owner does not comply to the aforementioned requirements, the County of Mason may demand, and the institution shall make, payment to the County of Mason of said funds so that the necessary repairs can be performed immediately to Mason County standards. The institution shall not be liable to the owner for any disbursement of said funds to the County of Mason. - Page 1 of 2 - It is hereby specifically agreed by and between the parties hereto that in the event that any legal action must be taken to enforce the provisions of this bond or to collect said bond, that the prevailing party shall be entitled to collect its cost and reasonable attorneys' fees as a part of the reasonable costs of securing the obligation hereunder. In the event of a settlement or resolution of these issues, prior to the filing of any suit, the actual costs incurred by the County, including reasonable attorneys' fees, shall be considered a part of the obligation hereunder secured. Said costs and reasonable legal fees shall be recoverable by the prevailing party, not only from the proceeds of this bond, but also over and above said body as a part of any recovery in any judicial proceeding, in addition to recovery on the bond. t (cU79 3-SKQpAPPROVED: �:) NAME FBAN HONE # ACCEPTED: OFCE T� c� SDI Cn►92dQI A%A S BANK ADDRE S 3 -S-o;) DATE (3 L1014w145©© ACCOUNT NUMBER STATE OF WASHINGTON, County of`fhLK- }m-, (Individual Acknowledgement) I, A60N)pgsc' 1 Nltoe� , Notary Public in and for the State of Washington, residing at `-n)rrWc_-Q�� , do hereby certify that on this !S day of ,m \ , 20( � personally appeared before me os 0, LL 1cknO, to me known to be the individual described herein and who executed the within instrument and acknowledged that y_signed and sealed the same as free and voluntary act and deed for the uses and purposes herein mentioned. GIVEN UNDER MY HAND AND OFFICIAL SEAL this ` day of�h 20C2c-�. I]Rotary Public in and for the State of Washington, residing at in said County. My Commission expires 16 -IC-3 2c[7"�. , -Page 2 of 2- �.`�P.•s�oN•fX�•�'y'e /// 0 111 NS \`` PERMIT NO.: BLD MASON COUNTY � BUILDING PERMIT APPLICATION a p(o3� 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 Anner, 0, Contractor Name (lul4Fr Mailing ddress Mailing Address City State Zip o e QAsi City State Zip Code Phone Other Ph.0 "— Ph.( Other Ph.(. ) L i e n/T i I rFTorder �bA 1 FM T�}�pr Ca Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic__)�_Existing Septic Connect to Sewer System Name of Sewer System Well XWater System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Z;Z (2 /1,-y6 9009 1 Fire District_ Legal Description 1W r / .Sly J-4o Site Address(Please include street name, street number and city)_ In Directions to site �t� �*�R7a 0 T OPO 6� -t�•�T�F�; Will timber be cut and sold in parcel preparation? (Yes/No) _ Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland_X Seasonal Runoff_Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE❑ TYPE OF JOB New_Y Add Alt Repair Other Use of Buildingf�S,c4nce Describe Work No. of Bedrooms / No. of Bathrooms_SQUARE FOOTAGE-1st Floor .7;Z ?nd Floor 3rd Floor Lofts,;4 Basement Deck - Other,., ,-r�cJ'i�,C�$h¢/° seq. ft. .19+ Garage Attached Detached Carport Attached Detachea�' 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. 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 tdthe 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 exempttrom 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 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 9-23`n( X-7 Date FOR OFFICIAL USE BEYOND THIS POINTS Accepted by Date 2�4A&ubmittal Amoufit\,,,ue �1/ 7 Receipt No.�� DEPARTMENTAL REVIEW APPROVED p ItV Building Department r Occ Group -3 Type Constr.V- 0/ �. Planning Department I Environmental Health Department Public Works Department I Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical& Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar,P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair(360)275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANTINFORMATION CONTRACTOR INFORMATION Owner Ps 0 +7a L. fCa Id e,o Contractor Name C ,ujr7er Mailing Address /9D4. ! ;1fJcf'v,-1r R45W Mailing Address City raf is State Zip Code City State Zip Code Phone,160 ) $4 ,fib Other Ph.( ) Ph.( Other Ph.0 Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATJON712 digit T x�arcel No. �, / / / OU 7� Fire District Legal Description -� ` Site Address(Please include street name, street number and city) a ®r oh r! Directions to site Hw/)[ J rp h �h r�iCkPrrhg �+hJlro rro QlSha!ILL 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 1st Floor 2nd Floor Basement Gw-affe11@nW Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. f Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No. of Units Fees Bath Basins Furnace Bath Tubs _ _��,do�a Heatpumps 41' Showers ��— Vent Fans Water Heater Propane Tank Laundry Wsher—� Gas Outlets Sinks Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other Other 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-1 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 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. /af/X -�J 0 t�G14f�- Date J c�-43-0/ X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTNEENTAE R E1ftf APPROVED DENIED GONDTTK?N CODES:> Building Department Occ Group Type Constr. Planning Department Other Other _.. WPermitFee Site Inspection ee UFC Plan Review Fee ase Fee Other Base Fee Other llet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES r Case Number: ,17 a00/ 9 Mason v County Investigation Report Form Parcel Number: Violation Site Address: Property Owner(s): \ern �� Phone#: Mailing Address: t4 1 C Tenant/Contractor/Operator on site: Directions to Site: Description of Concern: kig— n er W 42. .240, the complainant may indic to a desire for disclosure or non-disclosure of their identity. If non-disclosure is chosen, this portion of this form will not be released to the public unless this case is filed in court. If filed,your name will be disclosed if you are a witness in the case. Mason County investigates possible violations on a complaint basis only. Therefore,the name of the person filing t the complaint should be provided. Please check one of the following: ❑ Please do not disclose my identity. I understand that disclosure may be required by court order or if this matter goes to court. ❑ You may disclose my identity. Name(please print): Phone: ( ) Address: Street City State Zip�� / Signature of Complainant: Date: ## nH SECTION FOR MASON COUNTY USE ONLY Complaint Received by: / Date: Complaint Received by: ❑ PhEmail ❑ Web Site ❑ In Person Department of Concern: Building ❑ Planning ❑ Fire ❑ Public Works Environmental Health: ❑ Solid ❑ On-site ❑ Wells ❑ Food ❑ Other Investigation Date and Findings: Date Closed:_�/ 'V' I�eason Closed: G V M i t* ' Initials: eVtP,c�2 to✓ 6/21/2011 Debbera Coker- i 1 From: Rose Swier To: Debbera Coker Date: 1/ I. Subject: • issues as rred it to a rE +. Pa4F is 221287690091. e Rose Swier, Environmental Health Specialist III Mason County Public Health PO Box 1666 Shelton, WA 98584 (360)427-9670 ext. 584 .► Wsec ' • Y,K F � a