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HomeMy WebLinkAboutCOM2002-00138 Restaurant Interior Change - COM Permit / Conditions - 10/25/2002 �Qry1 2CO2- \�\� N!w .itir" �a * t 3 w •' '� ".ti"�dw. '" �v r° e">i *� �� jeri:t d'��:�.\•". 0`�.'' ',a�` „v�e+,':�' "``- ry��,�e �. w '?�� iy .:,5. _d�45 ,d \r dfi ,9. a.�.���• � ,d.��9 P�e "q •.d`��:,. � �;1. ^:,r� `.,'r. i 31' :,``' \. - . i ��a!✓����r-�': a. ��:� �6... ri, f s i i, rye • .9iq y• { �'s� f� ors;. Certificate of Orrupancp t,•: ,fflaon Countp Jguirbing Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building > Code certifying that at the time of issuance this structure was in compliance with the various 1., . ordinances of the County regulating building construction or use.For the following.• Use Classification RESTAURANT Bldg. Permit No.COM 2 0 n 2—0 01 3 R Urban Growth Group A—3 Type Construction VN Fire Zone 2 Use Zone Suites ,' .•. Owner of Building PT,,nRn T.ni:)F.9. Address 23969 NR STATE RT n91n same Bel ai W 98528>��j,• Building 1� ress Locality Fire Mar halLarry I � �.. `.... LPL.. �/ `� •+r Date 01 /24/2003 ' w Building Offic6V = `>=^ POST IN A CONSPICUOUS PLACE �` :N' .:'{rbi,,� .� ���a� bye/'r� � �v�x:':! � /'�ii:��� yS�iq`�4} q�g;��F' rryy.,y.2.` ghy 4Y �2�` � i ��;�Y�r ��,P\� � :i � �,�, x� \� � R t \ S 17,.• ♦ 4f5 �': nM ::yir,y;H,r�"�C� w!4 .� /i"'l:tiq'P+-�re�/iieWAa ri riV d. ,�4Mr�" nW�Nett 07NRW��J• 4�•m N�w� r4 bmWa ..i@ e� MAY`y ! H t�` J' `�' Ci H^^". 9,�N a • - MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)127-7262 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext. 352 Shelton,WA 98584 COMMERCIAL BUILDING PERMIT COM2002-00138 OWNER: PEDRO LOPEZ RECEIVED: 9/19/2002 CONTRACTOR: LICENSE: EXP: ISSUED: 10/25/2002 SITE ADDRESS: 23969 NE STATE ROUTE 3 SUITE C BELFAIR EXPIRES: 4/25/2003 PARCEL NUMBER: 123294190021 LEGAL DESCRIPTION: TR 2-A OF NE SE TR A OF SP#423 #351008 PCL 1 OF BLA#98-58#671493 PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESTARAUNT- INTERIOR CHANGE STATE ROUTE 3 AT THE BELFAIR VALLEY PLAZA IN BELFAIR General Information Construction &Occupancy Information Type of Use: RESTARAUNT Insp.Area: No. of Units: Type of Constr.: VN Type of Work: ALT Fire Dist.: 2 No.of Bathrooms: Occ. Group: A3 Valuation: No. of Stories: Occ. Load: 121 Building Height: Pre-Manufactured Unit Information Square Footage Information Make: Length: Lot Size: Model: Width: Building: 2,400 Year: Serial No.: Basement: Parking Spaces: Setback Information Front: Ft. Shoreline: Ft. Shoreline & Planning Information Rear: Ft. Slope: Ft. Water Body: Shoreline Desig.: Side 1: Ft. SEPA?: Comp. Plan Desig.: Side 2: Ft. Fire Protection System Information Auto Fire Alarm System?: Emergency Key Box?: Standpipe?: Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?: Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?: COM2002-00138 Please refer to the following pages for conditions of this permit. 1 of 5 Plumbing Fixtures Mechanical Fixtures FEES Tyne Qty. Type Qty. Type By Date Amount Receipt Water Heaters 1 Exhaust Hood 1 Remodel<50% Tw Q/1g0nnm ,�?19 nn anFr,9 Grease Traps 1 Ventilation System 1 Planning Review Fee RANA Qr,?n19nn9 z AA nn F1 nFQ Trap Primer 4 Building State Fee ni n Qrgr;rgnrr» Oa rn FinsQ Kitchen Sink 4 Plumbing Fee ni r. inriargnn T.77 nn F1nrQ Dishwasher 1 Plumbing Base Fee ni r. 1nriannn r9n nn ninsQ Mechanical Fee ni tr 1wiargnn Q91 *in RinFQ Mechanical Base Fee ni r. in/1A/9nn owi sn F1nsQ Plan Check Fee ni r. 1n11a19nn a,)nQ?n a1nra UFC Plan Check Fee ni r, inriar?nn 1na An Rin5Q EH Plan Review r.Fw inr99r9nn .M;nn RinSQ Total $785.10 CASE NOTES FOR COM2002-00138 CONDITIONS FOR COM2002-00138 1) This application is subject , r and Landscaping requirements as established under Mason County Ordinance 1.03.036.x f L( 2) The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallon s, t allowed without the approval of the Mason County Fire Marshal. 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 wXF�rWi>�h�may affect your project. COM2002-00138 2 of 5 4) Q Hood and Duct fire suppression system meeting or exceeding UL 300 standards is required. This system shall be c cad to the building fire alarm system as a dedicated zone. Seperate plans and permit are required. X 1 (one)2A 10BC and 1 (ono clb'ss,K (in kitchen)fire extinguisher are required to be placed in an approved location and manner. X y T— 5) An ad f� meeting Mason county standards is required to be placed on the building. X ,Z 4 6) 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 1-800-647-0982. The person signing this conditi is; 11 h the homeowner, agent for the owner or a registered contractor according to WA state law. X i� 7) All approved plans are required to be on-site for inspection purposes. If inspection is called for and plans are not on site, Approval WILL NOT be granted. In addition, a Re-Inspection fee in the amount of$52.30 per hour (minimum 1 hour)will be charged and mpst ollected by this department prior to any further inspections being performed or approval granted. X 8) PURSUANT TO 1997 UNIFORM BUILDING CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE, BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE 1997 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWN CTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS. X / 9) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND UBC REQUIREMENTS AND OCCUPANCY IS LIMITED TO THE PERMITTED AND APPROVED CLASSIFICATION. ANY CHANGE OF USE OR OCCUPANCY WOULD R U IN ERMIT REVOCATION. CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE. x -- 10) Changes to approved building plans that affect compliance to the current non-residential Energy Code (NREC), ventilation and Indoor Air Quality Code (VIAQ) Uniform Building/P gl echanical Codes and/or Mason County Regulations shall be approved prior to construction. X 11) CONSTRUCTION PROCESS TO BE FIELD CORRECTED IRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE.x 12) 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 County ordi nid building regulations. X L—� COM2002-00138 3 of 5 T,tiis pem4 becomes null and void if work ugonstruction 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. i OWNER OR AGENT: DATE: COM2002-00138 4 of 5 O CONCRETE MECHANICAL MANUFACTURED HOME N 0o Footings / Setbacks Date By Ribbons bN Date By Gas Piping 1,7- Date By 0 w Foundation Walls Date /L-1¢oZ B y 7-/Z, Set-up 00 Date By INSULATION Date B y B G / Slab Insulation Floors Final Date By Date By Date By FRAMING Walls FIRE DEPT Date By Date By Date By PLUMBING Attic OTHER Groundwork C amp, Date By Date // By 1-7 2- WALLBOARD NAILING D.W.V. Date By Date By FINAL INS ECTION Water Line _ Date 03 By RL5� Date /�-Ld-©?-B !� r� µ � �;. : � Date By cc ,-,d rx-> /''✓JT..� C G,i-Y!r ���� �G��/�r��'i) p v f Lcx�1? SO/�i9j ✓� ���CI��/v 2. i10 4CS f e!!;'� S�1✓�_/ O/",-I L '7 fe 6Ay JS O 3, Icon s s �.o�J , n //vr�x �JS ��s ,�� /� L/ N Y, / ,O t-1 c-4 ) �L) e—J `7a0 � 4 �' rL 52Qr�SS 22 zz Cn iL ` 2c� z iZ -/�-�'- GAS T,CxST i CONCRETE MECHANICAL MANUFACTURED HOME Footings / Setbacks Date By Ribbons Date By Gas Piping Date By Foundation Walls Date B y Set-up Date By INSULATION Date By B G / Slab Insulation Floors Final Date By Date By Date By FRAMING Walls 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 FINAL NSF CTION Water Line Date Q( 0 B y LDS D atq By Date By 0 3 ikl(i t 2 03 0 cc 0 yZj O 8 � Q O 1 W Vv i O PERMIT NO.- BLD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner PEbkP r-C*CL Contractor Name , . /�.� ��(n osv�/i�(^raS:/. Ny. T- Mailing Address IMI C?4� AUC- 61(t-re /0/ Mailing Address !,+: -.� ~•-� l.:r City -f fQC,4019.0 State 122A Zip Code City State Zip Code ,�4­3-)o Phone(&yp 916 13le Other Ph.(�51ee:, )� Ph.( ) ��ox Other Ph. 31 13 1 G�?I Lien/Title Holder L Coi -irrVF dt 0 4- t004V ntractor Reg. # r?,e°,2- c,vi t 7-7 iLC . Addresstenk IIDaY AV b16 Sfo-,� Expiration / •' -7r / 2 C,� 3 SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System /`t t ft +w1.>R 122 DiS"L G i PARCEL INFORMATION-12 digit Tax Parcel No. 12 2 /�_/ Fire Distridf Legal Description`s ACC-tio?J-5 Site Address(Please include street name, street number and city) A Ulk, s I-Le liA" ;�-15 Ire 7.f- Directions to site ` AT . U_ Na 1''. -� )tZ. Jpr 24 1 (Cl i 1 Will timber be cut and sold in parcel preparation? (Yes/No) � I f�CA- Is your property within 200' of the following: Body of Water (Name) IVb Saltwater 110 Lakes River/Creek tSD Pond IJO Wetland_Py0 Seasonal Runoff t•� Stream %-1 Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Other V Use of Building Repf i 7T7TA&7MA. T Describe Work W01)EL No. of Bedrooms No. of Bathrooms_?SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other �PA'CCC 5U14F,4 G+.Esq. ft. a UU Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL 8,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-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 c� h r ges shall be made without first obtaining shall be done jA conformance therewith/I>ro changes shall be made without approval. ,.. first obtaining'`approval. X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by '} Date 'Submittal Amount Due Receipt Nd/. ,� _ DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group Type Constr. V 1 Planning Department i Environmental Health Department S Public Works Department 426 W.CEDAR i Fire Marshal te0.s� U Valuation $ /0// FEES Building Permit Fee 2 Site Inspection Plan Review Fee 4� a® EH Review Fee Plumbing& Base Fee Planning Review Fee Mechanical&Base Fee Otherr/RC— AIAfZ , (, (0 d Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal amp ° TOTAL FEES PER D MASON COUNTY o01316 BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner J• iL Contractor Name Mailing Address �`� � � #t•;r GCI`ir / ( Mailing Address City State +L!� Zip Code 476" City State Zip Code Phone( ) Other Ph.( ) ciq x Ph.( ) Other Ph.( ) Lien/Title Holder nip i s t Contractor Reg. # Address „r *�' ft Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. / 1`4 / ` Fire District Legal Description03-5 Site Address(Please Include street name, street number and city) I✓ t �' 1AL L,-y 01142-A :a.-')%ret -,-- Directions to site 3 :.: TM i { r _ L.i A Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) !YlN Saltwater t4o Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Other "'F Use of Building K4, ; Describe Work _-i+` 42 1 ;Z -RC Ivy EC. No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other C -,I:sq. ft. L,+L: Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. 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-]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 X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEIIV APPROVED DENIED CONDITION CODES Building Department Occ Group Type Constr. Planning Department tS� C V L Environmental Health Department 3 2� Public Works Department S7. 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 e t FORM MUST BE COMPLETED IN INK PE44XA L �� PLEASE PRESS HARD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O. Box 186,Shelton,WA 98584 Shelton(360)427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 11F);ilL 4 E2- Contractor Name LZ,2 . A.v-4A r,t-A N (�c�.r;7, Mailin Address 16''I! 0!�11 /��'T su1'ier ict Mailing Address jcf!; City 2Y 02,COA AD State J&�il Zip Code e7-?36 & City 4Jh ter% State i,.;� - Zip Code K,:,: r Phone( k&D) 76 /315" Other Ph.( %11;-,, Ph. Other Ph. �i r�i Lien/Title Holder fader5L4 COmroat'.(al - Ft7Y ntractor Reg. # Address Wig �ID�` C S 61��'�b�v Expiration /;e� / '` T66UFIVOA� WA q9ON1111 SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System %/*'Name of Water System_1?iEl-1=7j�-IPQ 0A-JZ-7Q L>S- tL-r } PARCEL INFORMATION-12 digit Tax Parcel No. 2 3 /�_/ Fire Distri t Legal Description 2-5t�/.:'flunl6 F f V°`= k jr 4"j-rC6 Site Address(Please include street name, street number and city) ` WA Directions to site • f RE * oZ1(O n P:iI­ c5U Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water (Name) '7 '"� -Saltwater tic, Lake_ River/Creek 11"V Pond t,G, Wetland t,.�C> Seasonal Runoff_ Stream 00 Slopes or Bluffs PERMANENT RESIDENC REST E❑ TYPE OF JO "w Add Alt epal Other Use of Building mr-- � I TT,4aT Describe rk No. of B drooms No. of Bathrooms QUARE FOOTAGE-1st Floor 2nd Floor 3rd Floo Loft Ba nt Deck Other c. Pi"l-CF/ SUCrTIF4 6'1;4:�-sq. ft. CX� Garage etached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. 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-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 r ulating the work for whi h jk s permit is issued and all work conformance therewith. No ch s shall be made without first obtaining shall be done' conforma rewith o changes shall be made without approval. r_ �� first obta approval. X ' Date l' X Date _ FOR O%1 )3 SE BEY THIS PONT Accepted by Date bmitta( ount Due zeipt IDEPARTMENTAI»:REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group Type Constr. Planning Department ►.YS 9Z17 Environmental Health Department 10H [ d S Public Works Department Q 3/1 I--t 01 I .7 Fire Marshal t Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee j Plumbing& Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTALFEES MASON COUNTY 001 PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275.4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner a E I")Q 0 Contractor Name +"(DVV4 Cbt&7 "-r Mailing Address t :29-1 DLhIN SLUAC tolt Mailing Address 14q5s t.#J I-le City - tate U>A Zip Code C4Salde City t kS State LOA Zip Code 4 O Phone "r' Other Ph. 4g04WiI Ph. �,�' (�►fpU) W. (� ) ( -�') ) Other Ph.(�[eo )✓13l (Q$kl Lien/Title Holder = n� 'nAaCtg4, Pfa'r.."t Contractor Reg. # 1311✓A&W11We, Address_UW %, �lYd'` �— Expiration I" /mi l �z5p3 A )04 SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System /�f � aC�-1,'�CC sa'1� WT 14- 14)A7l�R IS 1" A14 67rL D(STQ./G7 a a. -- PARCEL INFORMATION-12 digit Tax Parcel No. / 1 / Fire District 7- Legal Description I- 61S Site Address(Please include street name,street number and city) ;I "f C` Directions to site Is your property within 200'of the following: Body of Water(Name) lib Saltwater l—NO Lake 1->d River/Creek y; Pond t9 Wetland Seasonal Runoff t ;3 Stream k j Slopes or Bluffs t I Q TYPE OF JOB New Add Alt Repair Other .1 Use of Building 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 Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater B Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stov Dishwasher Kitchen Exhaust Hoo /"53 1 Hosebibs v Dryer V nt Othe6lea.4L �' 0 Other AAK¢-u / T� Base Fee 'r 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-[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. Date:.'" 'J�<=/,/(�� X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. AkARTIVIENTAI R>^VIEW.: RP.:.R(]VED CJENIEf3 GOft[DfTIQTVG Building De m t ^��p, ° ' Occ Grou T e Constr.`�u FYI � Planning Department S Other 426 W. CEDAR STa Other . IrfES ...... .. .. . .. ... .. _.. Permit Fee ® Site Inspection Plan Review Fee ® UFC Plan Review Fee Plumbing&Base Fee ®, Other Mechanical&Base Fee D 3®, Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES