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Home My WebLink AboutBLD29826 Final SFR - BLD Permit / Conditions - 7/14/1992 Shorelines: Plumbing: 3 1 y-gz Setback: MechanicalQV Special Interior:., Conditions: *Final: cv- y i f Yz Mobile Home: Smoke Detector: Remarks:,+ Footing: Qi5 d-iY-y2 O v T Setback: Foundation Walls: �rx.,�,�� 7�-yz�f �•%s�.�1 Framing: Fireplace: Woodstove: AREA: #1 - DON FAWVER TYPE: RESIDENCE Owner: HALLETT, R. L. Tel: 275-5249 Date: 01-15-92 Address: P.O. BOX 1636, BELFAIR, Permit #: 29826 Floors: 1 Sq Ft: 1040 Contractor: SAME Phone: Legal Description: BEARD'S COVE DIV 3 LOT 55 Direction to job site: SANDHILL RD ON NORTH SHORE ANP TAKE FIRST LEFT IT THE FIRST CLEARED LOT ON THE LEFT Plumbing X Mechanical X Woodstove Fireplace Deck Garage X Carport Basement Loft cnndit-om! N"NF BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. sa OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE R WASH 98528 21Z55249 DIRECTIONS TO JOB SITE GO UP SANDHILL ROAD ON NORTH SHORE AND TAKE THE FIRST LEFT, ITS THE FIRST CLEARED LOT ON THE LEFT-ALSO FACING SANDHILL ROAD. PARCEL O- O-OOO LEGAL 12 NUMBER 33 5 55 DESCR. gEA;; rOVE T)TV,#3 LOT 55 NAME MAIL ADDRESS CITY&STATE LICENSE N ZIP PHONE CONTRACTOR P.O . 1636 BELFAIR, WASH.RICHAHCIOILH 98528 2755249 USE OF BUILDING RESIDENCE CLASS OF NEW X ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK BUILD A NEW HOME BEDROOMS DECKS YOR N CARPORT NOTICE TOTAL SQ.FT. DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS- TOTAL SO.FT. TOTAL SQ.FT. CONDITIONING. NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT LIVING AREA I BASEMENT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SO.FT. C9D TOTAL SO.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT X FIREPLACE ATTACHED SEASONAL SHORELINE - DETACHED OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT 1 AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVA 7E�MENT. XOWNER DATE X Y DATE JANUARY 29.91 FOR OFFICE USE ONLY DEPARTMENT YES PPROVE NO DEPARTMENT YES APPROVED NO BUILDING VALUATION HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE f PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY APPR ED R IS$ ANCE PERMIT VALIDATION 'r'Q TOTAL PLUMBING & MECHANICAL PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 I 427-9670 DATE ISSUED QQ PERMIT NO. 1 V� OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE R.L. HA LETT P.O . DIRECTIONS TO JOB SITE GO UP SAND HILL ROAD AND TAKE THE FIRST LEFT, ITS THE FIRST LOT IT ALSO BORDERS THE SANDHILL ROAD LEGAL DESCR. BEARDS COVE DIVISIO CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE R.L. HALLETT P.O . BOX 1636 BELFAIR WIT. RlQHKHC101Lh USE OF BUILDING RESIDENTS PLUMBING FIXTURES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE_OF FIXTURE FEE WATER CLOSETS FORCED-AIR/GRAVITY TYPE FURNACE 6.00 BASINS FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS BOILER/COMPRESSOR 6.00 1 SHOWERS REPAIR/ALTERATION 6.00 1 WATER HEATERS REFRIGERATION COMPRESSOR SYSTEM 6.00 1 AUTO.WASHER AIR HANDLING UNITS 7.50 SINKS HEAT-PUMPS 6.00 FLOOR DRAINS EACH GAS PIPING SYS.2.00 PER OUTLET DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT 10 LAUNDRY TRAYS WOOD STOVES 5.00 CONNECT TO CITY SEWER WOOD FURNACE 5.00 DISH WASHER DISPOSAL URINALS PERMIT BASIC FEE 3.000 PERMIT BASIC FEE 10.00 TOTAL TOTAL SPECIAL CONDITIONS: NOTICE; THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. OWNERS AFFIDAVIT: I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF CONTRACTORS AFFIDAVIT: I CERTIFY THAT I AM A CURRENTLY REGISTERED THE CONTRACT OR REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON CONTRACT IN THE ST TE OF W HINGTON AND I AM AWARE OF THE ORDINANCE COUNTY ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL REQUIRE EN REGULATI T E ORK FOR WHICH THIS PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WORK ONE ILL B N R NCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. WITH UT FIR T O T I P FROM THE BUILDING DEPARTMENT. X OWNER DATE X B DATE FOR OFFICE USE ON Y APPLICATION ACCEPTED BY PLANS CHECK BU�j.L�NG GROUP APP D FjStUA C PERMIT VALIDATION /U�/SI/� rYl IBY �'� CASH CK MO jok) eiv Lvf 55 �lrJlR M�7F��aG, BUILDING PERMIT PLOT PLAN ;� MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. Box 186 SHELTON, WASHINGTON 98584 v?75"--5,—? 427-9670 DATE ISSUED PERMIT NO. NAME MAILADDRESS CITY&STATE ZIP PHONE OWNER DIRECTIONS -� TO JOB SITE e -1 f u Lo ze PARCEL LEGAL NUMBER DESCR. Clf J�5 O� l /ADS D ? ULJ� Indicate below: O Property lines and dimensions. O Easements and roads. O Septic, drainfield and reserve area, or sewer. O Septic tank and drainfield setback distances from foundations. 0 O Location of proposed construction on property. O Building& septic system setback distances from all property lines& easements. Indicate North O Well and water line. In Circle O Saltwater, lakes, rivers, streams,wetlands, drainage. O Attach copy of septic system"as built' or septic permit approval. O Indicate topography profile of property and structure on reverse side. ef— V v a cr do 00 s � � I/We certify that the proposed'construction will conform to the dimensions and us own above an hat no changes will be m e without first obtaini g approval. SI RE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE D C 0 -------------------------------------------------------------------------------- 05/09/90 WATTSUN version 4. 2 - SUMMARY REPORT Page 1 1 FILE s Ci \WS4\SGC496. HSE -------------------------------------------------------------------------------.- HOUSE IDENTIFICATION -------------------------------------------------------------------------------- House ID: SGC496 Utility : Mason County PUD No. 3 Address : BEARDS COVE Analyst : KELLY BUECHEL Builder : HALLETT Location : OLYMPIAI Owner Floor Area: 1040 ft2 QUALIFICATION CRITERIA I I I SUPER GOOD CENTS/ I I NORTHWEST ENERGY CODE REFERENCE CURRENT PROPOSED I I ----------------------------------------------------------------------------- I I Thermal Performance (Btu/hr-F) 267 270 270 1 1 Energy Budget (k.Wh/ft2-yr) 2. 62 2. 66 2. 39 1 II I I * QUALIFIES * I II 1 ICI ! ' I WASHINGTON STATE ENERGY CODE ALLOWED PROPOSED I i ------------------------------------------------------------------------ I I Chapter 4 (UO) 249 220 1 I I * QUALIFIES I I I HEATING AND VENTILATING SYSTEMS CURRENT PROPOSED -------------------------------------------------------------------------------- Heating System Type Wall Mount Wall Mount Heat Pump Heating Season Performance Factor N/A N/A Heat Load at 45 F design temp difference (BTU/hr) 12266. 3 12275. 3 System Size at 150% Design Load (kW (k-BTU/hr) ) 5. 5( 18. 5) 5. 5 ( 18. 5) Average Annual Space Heat Requirement (kWh/yr) 3178 2862 Ventilation System Type NHRV: Integrated Spot & Whole House ECONOMICS CURRENT PROPOSED -------------------------------------------------------------------------------- Incremental Construction Cost ------ $ 0. 00 Projected Yearly Heating Cost 0. 00 0. 00 First Year Monthly PITI ($/month) $ 0. 00 $ 0. 00 Average Monthly Heating Costs $ 0. 00 $ 0. 00 --------------------------- TOTAL FIRST YEAR MONTHLY PAYMENT $ 0. 00 $ 0. 00 30 year Life Cycle Cost $ 0. 00 $ 0. 00 -------------------------------------------------------------------------------- Actual energy use will vary with climate, lifestyle, and construction. Economic and energy use estimates should be used for comparative purposes only. --------------------------------------------------------------------------------- 105/09/90 WATTSUN version 4. 2 - COMPONENTS REPORT Page e 2 FILE i Ci\WS4\SGC496. HSE -------------------------------------------------------------------------------- BUILDING COMPONENT SUMMARY -------------------------------------------------------------------------------- Curr Prop Component Entries Area UA UA Cost •/UA ----------------------------__------------------------------------------------ Below-grade walls 0 0 0. 0 0. 0 Slab perimeters 1 136 61. 9 61. 9 Floors over crawl spaces 0 0 0. 0 0. 0 Walls 2 926 46. 6 46. 6 Windows 2 147 67. 3 67. 3 Doors 1 36 6. 8 6. 8 Skylights 1 8 9. 0 4. 5 Ceilings 1 1040 28. 6 33. 3 Air Leakage Control 1 8320 52. 4 52. 4 Mass 1 1040 3120. 0 6240. 0 --------------------•--------------------------------------------------------- TOTALS 272. 6 272. 8 -------------------------------------------------------------------------------- GLAZING ORIENTATION -------------------------------------------------------------------------------- CURRENT PROPOSED Area Effarea %F1oorArea Orientation Area Effarea %F1oorArea ----------------------------------------------------------------------------- 80. 0 80. 0 7. 7 South 80. 0 80. 0 7. 7 0. 0 0. 0 0. 0 Southeast 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 East 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 Northeast 0. 0 0. 0 0. 0 66. 5 27. 8 6. 4 North 66. 5 27. 8 6. 4 0. 0 0. 0 0. 0 Northwest 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 West 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 Southwest 0. 0 0. 0 0. 0 --------------------------------------------------------------------------- 146. 5 107. 8 14. 1 TOTALS 146. 5 107. 8 14. 1 -------------------------------------------------------------------------------- I-------------------------------------------------------------------------Q---'--- I05/09/90 WATTSUN version 4. 2 COMPONENTS REPORT (cost. ) Page 1 3 . FILE 1 C 1\WS4\SGC496. HSE -------------------------------------------------------------------------------- jSLA6 PERIMETERS ------------------------------------------------------------------------------- Description F-value Pmtr UA */If Cost ----------------------------------------------------------------------------- C) Slab/R-10 insul. /2' horizontal 0. 455 136. 0 61. 9 P) Slab/R-10 insul. /2' horizontal 0. 455 136. 0 61. 9 -------- ----------------------------------------------------------------------- WALLS Description_-- -- U-va 1 ue Area UA $/sf Cost ----------------------------------------------------------------------------- C) 2x6 R-22 batt/advanced 0. 051 873. 5 44. 5 *SKYLIGHT SHAFT R-30 0. 040 52. 0 2. 1 --------------------------------------- TOTALS) 925. 5 46. 6 P) *2X6 R-21 bat t/advanced 0. 051 873. 5 44. 5 *SKYLIGHT SHAFT R-30 0. 040 52. 0 2. 1 ------------------------------------- TOTALS> 925. 5 46. 6 ------------------------ ------------------------------------------------------- WINDOWS ' -------------------------------------------------------------------------------- Description U-value Area UA $/sf Cost ---------------------------------------------------------------------------- C) *MILGARD VINYL XO 0. 440 106. 5 46. 9 *M I LGARD VINYL PATIO 0. 510 40. 0 20. 4 --------------------------------------- TOTALS) 146. 5 67. 3 P) *MILGARD VINYL XO 0. 440 106. 5 46. 9 *M I LGARD VINYL PATIO 0. 510 40. 0 20. 4 --------------------------------------- TOTALS) 146. 5 67. 3 -------------------------------------------------------------------------------- ------------------------------------------------------------------------------- S/09/90 WATTSUN version 4. Q - COMPONENTS REPORT (cont. ) Page t 4 FILE i Ci\W84\SOC496. HSE ------------------------------------------------------------------------------- OORS ------------------------------------------------------------------------------- Description U-value Area UA $/sf Cost ------------------------------------------------------------------------------ > Metal foam core, flush w/TB 0. 190 36. 0 6. 8 P> Metal foam core, flush w/TB 0. 190 36. 0 6. 8 -------------------------------------------------------------------------------- IKYLIGHTS ------------------------------------------ ------------------------------------- Description U-value Area UA $/sf Cost ------------------------------------------------------------------------------- > *M I LGARD 0. 560 16. 0 9. 0 > *MILGARD 0. 560 8. 0 4. 5 -------------------------------------------------------------------------------- CEILINGS --------------------------------------------------------------------------------- Description U-value Area UA $/sf Cost --------------------------------------------------------------r- - - ------ C> R-49 standard 0. 027 1040. 0 28. 6 P> R-38 standard 0. 032 1040. 0 33. 3 --------------------------------------------------------------------------------- IR LEAKAGE CONTROL ------------------------------------------------------------------------------- Description ACH Volume UA $ Cost ----------------------------------------------------------------------------- > Standard Air Sealing -above grade volume 0. 350 8320. 0 52. 4 > Standard Air Sealing -above grade volume 0. 350 8320. 0 52. 4 -------------------------------------------------------------------------------- ASS ------------------------------------------------------------------------------ Description M-value Area BTU/F $/sf Cost --------------------------------------—------—----------------------------- C> Light frame construction BTU/F-ft2 flr 3. 000 1040. 0 3120. 0 > Slab-carpet, rubber pad BTU/F-ft2 flr 6. 000 1040. 0 6240. 0 ------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- Actual energy use will vary with climate, lifestyle, and construction. Economic and energy use estimates should be used for comparative purposes only. -------------------------------------------------------------------------------- 3/09/90 ---- - WATTSUN-version 4. 2 - HEATING SYSTEM REPORT Pap• S FILE i Ci \WS4\SOC496. HSE ----------------------------------------------------------__--__-------------- 3YSTEM CURRENT PROPOSED --------------------------------------------------------------------------------- Heating system type Wall Mount Wall Mount Ducts Size Lgth Rval Size Lgth Rval ------------------ ------------------ -------------------------------------------------------------------------------- UILDING HEAT LOSS CURRENT PROPOSED - - Envelope 272. 6 BTU/hr-F 272. 8 BTU/hr-F Ducts 0. 0 0. 0 ----------------------------------------- TOTALS) 272. 6 272. 8 -------------------------------------------------------------------------------- DESIGN RESULTS CURRENT PROPOSED -------------------------------------------------------------------------- Design heat load 12266. 3 BTU/hr 12275. 3 BTU/hr 3. 6 kW 3. 6 kW System size (150%) 18. 5 kBTU/hr 18. 5 kBTU/hr 5. 5 kW 5. 5 kW Total Space Heat 3178 kWh/yr 2862 kWh/yr -------------------------------------------------------------------------------- BASED ON THE FOLLOWING DESIGN CONDITIONS Winter design wind speed 15 mph Thermostat set point 70 deg F. Winter design temperature 25 deg F. Design temperature difference 45 deg F. -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Actual energy use will vary with climate, lifestyle, and construction. Economic and energy use estimates should be used for comparative purposes only. ------------------------------------------------------------------------------ BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES 426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 427-9670 rr DATE ISSUED �C C-�1 .S 13e t( 64,, PERMIT NO. OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE DIRECTIONS TO JOB SITE „ O (j PARCEL LEGAL ,� gam- / J NUMBER DESCR. U S �7 c / 0r ' NA E MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO. CONTRACTOR G USE OF BUILDING CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK AREA: NUMBER OF: PLEASE INDICATE: NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR RESIDENCE LqFt STORIES SHORELINE❑ CONDITIONING. BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT DECKS $ Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR q ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED, CARPORT SgFt FIREPLACE IS CARPORT/GARAGE GARAGE SgFt ATTACHED O DETACHED O OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK F 11j,1CH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST colMAN CEREWITH.NO CHANG SHAL�L �/E[!M/JApWIT'HO'UT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. PRALFROMTHEBUILDINGDEPA T ENT OV S. l- X OWNER DATE DATE FOR OFFICE USE ONLY DEPARTMENT YES PPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION HEALTH PUBLIC WORKS FEE PLANNING FIRE MARSHAL BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION '�, SHORELINE r WOODSTOVE In .., , AP, a j 0 PLUMBING 'l MECHANICAL �1✓ STATE BUILDING FEE c_ F APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL IBY [CASH CK MO -PLUMBING & MECHANICAL PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES 426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 427-9670 DATE ISSUED •' II PERMIT N NAM AIL ADDRESS CITY a STATE IP PHONE OWNER ALA. a � 7 R'T6C DIRECTIONS TO JOB SITE lis LEGAL O DESCR. SIfQ/�1C),Y / �i �-" G G N ME M L ADDRESS CITY ST TE LICENSE NO. ZIP PHONE CONTRACTOR �( q� USE OF BUILDING PLUMBING FIXTURES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE OF FIXTURE FEE WATER CLOSETS FORCED-AIR/GRAVITY TYPE FURNACE 6.00 BASINS FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS BOILER/COMPRESSOR 6.00 SHOWERS REPAIR/ALTERATION 6.00 WATER HEATERS _ REFRIGERATION COMPRESSOR SYSTEM 6.00 AUTO.WASHER AIR HANDLING UNITS 7.50 SINKS HEAT-PUMPS 6.00 FLOOR DRAINS EACH GAS PIPING SYS.2.00 PER OUTLET DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT LAUNDRY TRAYS FIRE SUPPRESSION 5.00 CONNECT TO CITY SEWER WOOD FURNACE 5.00 DISHWASHER DISPOSAL URINALS PERMIT BASIC FEE 3.00 PERMIT BASIC FEE 10.00 TOTAL TOTAL SPECIAL CONDITIONS: __ NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. OWNERS AFFIDAVIT: I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF CO NT S AFFIDAVIT: I CERTIFY THAT I AM A CURRENTLY REGISTERED THE CONTRACT OR REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON CO ACTOR IN E STATE OF WASHINGTON AND I AM AWARE OF THE ORDINANCE COUNTY ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL QUIR REMENTS RE ULATING THE WORK O WHICH THIS PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WORK DONE WIL BE IN CON MA T NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. WITHOU ST TAINING APPROV OM G DEPARTMENT. X OWNER DATE .X DATE FOR OFFICE USE ONLY APPLICATION ACCEPTED BY PLANS CHECK BY T ILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION APPLICATION ACCEPTED BY PLANS CHECK BY BY CASH CK MO PLOT PLAN ADDRESS 11 N.E. ANC;HCjR T)RTVF FFLPA TR ., W��4T TNC Tnj PERMIT NO. 0 i z > s o 0 LEGAL DESCRIPTION S LOT RFART)E�' (,ICIVF BLK ADDITION T)TVT,,2T0N # N SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 1CyL' Sq. Ft. INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION AND SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' Ob / 3 ' i / CA j I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval. R.L. HALLETT CONSTRUCTION NAME(a) OF OWNER(!) OF SITE i STRUCTUREIS) (PRINT) I{i R O WNERIl1 OR -UT.ORI ED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE