HomeMy WebLinkAboutBLD2000-00650 Final SFR and Garage - BLD Permit / Conditions - 3/21/2001 Inspection Line (360)427-7262
MASON COUNTY PERMIT ASSISTANCE CENTER Phone: (360)427-9670, ext. 352
Mason County Bldg. 3 426 W. Cedar P.O Box 186
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT - os5o
OWNER: ED BLAKE
RECEIVED: 06/05/2000
CONTRACTOR:
SITE ADDRESS: 172 NE MEEK HILL RD BELFAIR ISSUED: 09/200 0
PARCEL NUMBER: 123307590063 EXPIRES: 02109/2001
LEGAL DESCRIPTION: TR 6 OF SURVEY 2/149
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
RESIDENCE AND GARAGE BELFAIR WEST ON N SHORE RD, R ON SAND HILL RD, L ON BELFAIR
MANOR, R ON MEEK, ON RIGHT
General Information Construction & Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: 5N
Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: R3U1 Lot Size: Deck:
Type of Work: NEW Fire Dist__ 2 No. of Stories: 1 Occ. Load: Building:1,340 Garage-Attached 533
Valuation: $80,211 11 Building Height: 15 Occ. Status: Primary Basement: Cvr Porch 16
Manufactured Home Information Setback Information Shoreline & Planning Information
Make Length: Ft. Front: W 80.0 Ft. Shoreline Ft. Water Body:
g Rear: E 197.0 Ft. Slope: Ft. SEPA?:
Model: Width: Ft. Side 1: N 60.0 Ft. Shoreline Desig.:
Year: Serial No.: Side 2: S 61.0 Ft. Comp. Plan Desi .: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Adjust Plan Check Fee MJB 08/02/200 $4.07 BELFAI
Hosebibs 2 Furnace<100K 1 Building State Fee MJB 08/02/200 $4.50 BELFAI
Kitchen Sink 1 Ventilation Fan 2 Building Permit Fee MJB 08/02/200 $768.50 BELFAI
Lavatories 2 Woodstove 1 Mechanical Fee MJB 08/02/200 $77.75 BELFAI
Showers 1 Mechanical Base Fee MJB 08/02/200 $22.00 BELFAI
Water Closets (Toilets) 2 Plumbing Fee MJB 08/02/200 $75.00 BELFAI
Water Heaters 1 Plumbing Base Fee MJB 08/02/200 $20.00 BELFAI
Bath Tubs 1 Planning Review Fee KS 08/07/200 $38.00 BELFAI
Clothes Washer 1 EH Plan Review KS 08/07/200 $50.00 BELFAI
Plan Check Fee KS 08/09/200 $495.46
Total $1,555.28
BLD2000-00650 Please refer to the following pages for conditions of this permit. 1 of 3
CASE NOTES FOR
• BLD2000-00650
CONDITIONS FOR
BLD2000-00660
1) This application is subLectlo Buffer and Landscaping requirements as established under Mason County Ordinance
1.03.036.X
2) The use, handling and storage of hazardousat 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 proposers to be located within 25' of a Mason County road right of way, it is suggested to contact that office to review future
planned work which may affect yop ject
X
4) Proposed structure or any portion thereof greater than 30" in height from grad in , mu maintain a minimum of 5'setback from all property lines,
easements and 10'from all County and State Road right of ways. X
5) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X
6) Approved per dimensions and setbacks on submitted site plan. X
7 All upland areas disturbed or newly creat co truction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt
fencing or straw matting). X
8) 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$42.00 per hour(minimu�) will be charged and must be collected by this department
prior to any further inspections being performed or approval granted. X
BLD2000-00650 Please refer to the following pages for conditions of this permit. 2 of 3
9) ' 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 OWNER/CONTRACTOR
FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.
X
10) The plan review 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 may 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 will result in failure of required building inspections. Every permit shall expire by limitation and
become null and void if the building or work authorized by such permits is not commenced within 180 days from the date of issuance, or if the building
or work authorized b its is suspended or abandoned at any time after the work is commenced for a period of 180 days.
X �
11) The approved plot plan is required to be on-site for inspection purposes. If inspection is called for and plot plan is not on site, Approval WILL NOT be
granted. In addition, a Re-Inspection fee in the amount of$42.00 per hour (mine 1,�our) will be charged and must be collected by this department
prior to any further inspections being performed or approval granted. X ��
12) UMC Chapter 7. In buildings of unusually ti c n s�Wc tion, fuel burning appliances shall obtain combustion air from outside (excluding cooking
appliances and clothes dryers). X
13) 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 RESULT IN PERMIT REVOCATION.
CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE. x
14) Changes to approved building plans that effect compliance to the 1991 Washington State Energy Code, 1991 Ventilation and IncLoor Air uality Code,
the Uniform Building Code and/or Mason County Regulations must be approved by Mason County prior to constructionX
15) CONSTRUCTION PROCES BE LD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM
BUILDING CODE.x
16) All property lines shall be clearly identified at the time of foundation inspection. X '� ZZ
This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period
of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection
must be approved before building can be occupied, l�
OWNER OR AGENT! DATE:
BLD2000-00650 Please refer to the following pages for conditions of this permit. 3 of 3
F E c-p/,® MECHANICAL MOBILE HOME
F uetback date - c `
_ � et {� b �� 2 by/ %/I Ribbons
.._ y Gas Piping date b a
ti, r:;.lation�Walls date b Set Up
date by INSULATION date by
BG/SL, �Insulation Floors Final
date FRAMING by date by date by
Walls ,.-/� FIRE DEPT.
date 2. -D d 0 by date Z -_G�l'i0 by/ /� date by
PLUMBING OTHER
Groundwork Attic
date b date by
D.W.V. _ WALLBOARD NAILING
date by date —/ <-- by
Water Line FINAL INSPECTION
date —2-2 -ccl, by 77Q date /_d� by 7--� date by
� �e�s r P•�� �� �-o Ago v P � �IAQi�o �� t3�.9cX Ly�/,ls
16
� •'Y%�� T,���i:>.�� G c.ems �'i�.L r� �.c��'-,-1 .
I -Z2
Tidemark Residential Plan Review Entry Checklist See Conditions on reverse
BLD2000- OO 6,60 Area Information
Applicant: W-g Lot Size:
Building: T 3 9 O
Construction: Occupancy: Basement:
5 N Deck:
Bedrooms: 3 Type of Const: Garage: 533 et
Bathrooms: c Occupancy Group: 93 U) Carport: AtUDet
Stories: I Occupancy Load: Cvr Porch: 16
Bldg Height:_ Occupancy Status: Other:
Plumbing: Mechanical:
Water Closets: 7.00 Furnace: 1 13.25 13,35
Lavatories: I I q, 7.00 Heat Pump: 9.50
Bathtubs: i 7.00 Vent Fans: a 6.50 �3,00
Showers: 1 1 7.00 loe 7.°o Range Hoods: 1 9.50 9,5 O
Water Heaters: 1 1 7.00 Wood Stoves: j 42.00 w D•OO �
Clothes Washers: 1 1 7.00 Gas Stoves: 42.00
Kitchen Sinks: I I 7.00 Propane Tank: 9.50
Laundry Sinks: 7.00 Gas Outlets:
Dishwashers: 1 1 7.00 List gas appliances `
Hose Bibbs: t 5 00
Subtotal '?5,IXo Subtotal ?l 7 S
Base Fee 20.00 Base Fee 22.00
Total Plumbing `1 S. `'° Total Mechanical
Valuation: Fees:
Use: Square fee Amount
Dwelling R3: 13,1 D 52.18 `131,a 0 Plan Review: y `i s`3
Garage U1: 533 18.92 to,og,4,34, >' Building Permit: 746. so
Deck: 9.50 State Bldg :
Covered Deck: Flo 12.85 X or.6G Mechanical Subtotal:
Carport: 12.85 Mechanical Base: DO
Storage: 11.00 Plumbing Subtotal: 7 S,pD
Basement: 15.58 Plumbing Base: aO,pp
Remodel <50% 16.00
Remodel >50% 52.18 Total Fees $
Prepared by: f3
Total Valuation $ li�o,,�t I i(o Date: .9- o
1001 PLANS REQUIRED ON SITE 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$42.00 per hour(minimum 1 hour)will be
charged and must be collected by this department prior to any further inspections being performed or approval granted.
1002 POST ADDRESS 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 re-inspection fee,based on rates as adopted by the jurisdiction and the 1997 Uniform
Building Code will be assessed if owner/contractor fails to post address on site prior to requesting inspections.
1003 PLAN REVIEW CORRECTIONS The plan review 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 may 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 will result in failure of
required building inspections. Every permit shall expire by limitation and become null and void if the building or work authorized by such
permits is suspended or abandoned at any time after the work is commenced for a period of 180 days.
1005 UNHEATED STRUCTURE This structure is considered unheated space(not to exceed 1 watt/square foot or 3.4 BTU41R/square foot). At
such time this condition changes,a change of use permit and a mechanical permit shall be applied for and approved prior to the change.
1006 SLAB INSULATION All slabs within the heated space shall be insulated to a minimum of R-10 for 24"total. Monolithic slabs shall be
insulated around the perimeter vertically from top of slab to bottom of footing.
1007 INTERIOR REMODEL Any exterior wall cavities exposed during construction remodel shall be insulated to full depth of cavity and
inspected prior to covering.
1008 MECHANICAL PERMIT All furnace installations shall meet the minimum efficiencies set forth in the 1994 Washington State Energy
Code(WSEC). Any portion of the mechanical system that is altered or replaced shall meet the minimum standards set forth in the 1994 WSEC
and the 1997 Uniform Mechanical Code.
1009 ROOF REPLACEMENT Single rafter joist roof replacement shall be insulated to a minimum of R-30 allowing for a minimum of one inch
continuous vented airspace above the level of insulation.
1010 ROOF REPLACEMENT/EXPOSED DECKING Enclosed roof systems that are exposed to the sheathing shall be insulated to a minimum
R-30 and inspected prior to cover.
1012 PLOT PLAN REQUIRED ON SITE The approved plot plan is required to be on site for inspection purposes. If inspection is called for
and plot plan is not on site,approval will not be granted. In addition,a re-inspection fee in the amount of$42.00 per hour(one hour minimum)
will be charged and must be collected by this department prior to any further inspections being performed or approval granted
3006 COMBUSTION AIR UMC Chapter 7. In buildings of unusually tight construction, fuel burning appliances shall obtain combustion air
from outside(excluding cooking appliances and clothes dryers).
4999 FLAMMABLE& COMBUSTIBLE LIQUIDS The use, handling and storage of hazardous materials or flammable and combustible
liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fire Marshall.
5000 U-1 USE ONLY No occupancy. This structure is limited to U-1 use only(private garages,carports,sheds,and agricultural buildings). Any
other use will be in violation of the Uniform Building Code and Mason County regulations unless a"Change of Use"permit is approved.
5001 SPECIAL INSPECTION 1997 UBC Chapter 17,Section 1701: Special inspection is required for the 3000psi concrete. All reports shall
be required to be provided to the Mason County Building Dept. prior to the final inspection, provide copy of approved testing laboratory
certification to the Mason County Building Dept or as approved by the Building Official.
5002 ENGINEERING Any changes in construction shall be reviewed by engineer of record and submitted in writing to the Mason County
Building Department prior to construction. All engineering documents are a part of the approved set of plans and must remain attached thereto.
If engineering documents are removed,approval will not be granted. In addition,a re-inspection fee of$42.00 per hour(one hour minimum)
will be charged and must be collected by this department prior to any further inspections being performed or approval granted.
5003 ALL CONSTRUCTION All construction must meet or exceed all local codes and UBC requirements and occupancy would result in permit
revocation. Change of use must be approved prior to change.
5004 WSEC RESIDENTIAL HEATING EQUIPMENT Installation of heating equipment in single family residences shall meet the
requirements of the 1991 WSEC. The furnace to be installed shall not exceed 150"/o of the heating design load or prescriptive requirements of
Chapter 9. Furnace efficiency shall be .78 AFUE or higher. Ducts shall be taped, sealed and mechanically fastened with a minimum of 3
fasteners per joint. Ducts shall be insulated to R-8.
5008 NON CONDITIONED AREAS This is a non-heated addition(separated from existing home by exterior doors or windows or both) and by
being designated as such is exempt from and will not be constructed to meet the minimum Washington State Energy Code requirements.
5025 SIDEYARD SETBACK Proposed structure or any portion thereof greater than 30"in height from grade line,must maintain a minimum of
5'setback from all property lines,easements and 10'from all County and State road right of ways.
5026 STRUCTURE SETBACK Proposed structure or portions thereof with a projection over 30"in height from grade line must maintain a 5'
separation distance between adjacent structures and that furthest projection.
5030 CHANGES TO APPROVED PLANS Changes to approved building plans that effect compliance to the 1991 Washington State Energy
Code, 1991 Ventilation and Indoor Air Quality Code, the Uniform Building Code and/or Mason County regulations must be approved by
Mason County prior to construction.
5045 FIELD CORRECT Construction process to be field corrected as required per Mason County Building Department and Uniform Building
Code.
5090 PROPANE TANK If the tank size is between 125 and 500 gallons you must follow these guidelines: 1,Tank is to be 10 feet from any
building,public way or property line. 2,If the tank is exposed to probable vehicular damage,provide protective bollards. 3,All weeds,grass,
brush,trash,and other combustible material shall be kept a minimum of 10 feet away from LP containers.
5095 FUEL PIPING/GAS PIPING Fuel piping shall be inspected after the installation of gas piping is complete,and before the attachment of
fixtures,appliances,or shut-off valves. At the time of inspection the test pressure shall be no less than 10psi held for no less than 15 minutes.
Appliance attached to the piping shall not be used until the final inspection has been approved by the building inspector.
5510 PROPERTY LINES All property lines shall be clearly identified at the time of foundation inspection.
1000 CUSTOM CONDITION
P:.,Y, -C) T
PERMIT NO.: BL D ��
S'1 MASON COUNTY
B DING PERMIT APPLICATION G�
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 1�bz)
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner A�ZLJ i/tzi C 6L4KJE Contractor Name ow/VF- C
Mailin Address Nc4J 'A A Mailing Address J471fE
CityeQReme StatewN Zip Code City State Zip Code
Phone 60 3' 7 Other Ph.( Ph.( Other Ph.(
Lien/Title Holder Contractor
Address Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic _Existing Septic Connect to Sewer
System Name of Sewer System Well X Water System Name of
Water System cJ Ei-L L.e W7X 54.S 4t
PARCEL INFORMATION-12 digit Tax Parcel No. ,330 / r�/7OD�.,3 Fire District
Legal Description 4 TtA cat Cb
Site Address(Please include street name, street number and city) / & NE MELX /'(iL.t.
Directions to siteBELFArA WEST oAd N. 5He" Q, R Dw %S+lo,0 N.LL R,11 L 6.y &-c4I=A/R
Will timber bd cut and sold in parcel p eparation? (Yes/No)A)ep _
Is your property within 200' of the following: Body of Water (Name) A11A Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCX SEASONAL RESIDENCE❑
TYPE OF JOB NewX_Add Alt Repair Other Use of Building RRxAbRAj r-E
Describe Work Qu r L a NEW ,3 &&^1 R4M41L&oQ
No. of Bedrooms.d No. of Bathrooms SQUARE FOOTAGE-1st Floor/.730 2nd Floor_U4
3rd Floor Loft Basement ,VA Deck AAOs Other sq. ft.
Garage )( d Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length Width --Seri I No. of Bedrooms No. of Bathrooms
Type of Heat PurG�hase 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 ordinancb 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 gbtaining shall be done in conformance therewith. No changes shall be made without
approval. first obtaining approval.
Date X /U Date
FOR OFFICIAL USE BEYOND THIS POINT
�1
Accepted by ~� DateSubmittal Amount Du -. .4 Receipt No. �,.�;
.................
QEPARTM..ENTAI» REVIEW APPROVED DENIED CONDITJON C0pE5
Building Department
Occ Group U I Type Constr. 5�J g
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
......................................
F�1=S
Building Permit Fee 76(?,SO Site Inspection
Plan Review,.Fee `tr (0 9�� S3 UFC Plan Review Fee
Plumbing & Base Fee ' q J Public Works Review Fee
Mechanical & Base Fee 9 Ct )S Other SirA.- �,so
Wood/Gas/Pellet Stove Fee Other
iefattorree r
Q Pre Paid at Submittal ( yqs y(o )
OTALFEES
FORM MUST BE COMPLETED IN INK PERMIT NO.:
PLEASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton(360)427-9670 Belfair(360)2754467 Elma(360)482-5269 Seattle(206)464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner F Dc.,04" F_ 23 (.04Xf- Contractor Name 414 4 &ME Ot'2&`eA
Mailin Address �".�`/� h!� OwtYE6 Mailing Address
City >�R1=M AN State LA%OV Zip Code c?e3%Z City State Zip Code
Phone( 3�co) 3'fi,Y3 7 Other Ph.L__, Ph.(_ Other Ph.L�
Lien/Title Holder Contractor Reg. #
Address Expiration
SEPTIC INFORMATION-Connect to New Septic___?S_Existing Septic Connect to Sewer System Name of
Sewer System PA vr4-TE
PARCEL INFORMATION-12 digit Tax Parcel No. /a J 3 / 7S` / ),co 63 Fire District
Legal Description _
Site Address(Please include street name, street number and city) i 7.4 NE /'fEek 0,4,<-L
Directions to site BELF*I VV 6A) Al 3*XE Rb . P, 8N 3,JA)Z ,1,L Rb : L 0.-1 ACLF-tJ),Z
MFk�l;cla d a�3 A%t wf�F_K /+� LL! 2i r�ry %1
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__X_Add Alt Repair Other Use of Building RES i a EAjc.E
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
Bath Basins _�_ Furnace
Bath Tubs / Heatpumps _
Showers i Vent Fans 3
Water Heater i Propane Tank
Laundry Wsher f 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-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 changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. first obtaining approval.
t
X `t'i. 4�kDate 691. nZ' X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by IkT/ Date Submittal Amount Due Receipt No.
DEFARTf1AF..tVT, R£11iE'rN:;:::';: >.'::. '.'AF'RL1V D:: DENIEf? QR[DtTICIT--:CODES.': :::.
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
FEES
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION
Case No.
Name F-,hWf f4.h E BLrtKE PARCEL NUMBER /��.3d '75- '7004.3 Date��
SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the
site plan
Lot Dimensions feQG"- E
Driveways `
Structure Setbacks `Strvreffm .
Water Lines Topography
Well Location (including adjacent) Drainage Plan
m Easements
Names of Fronting Streets Septic System 1 �/
DRAW SITE PLAN BELOW Include adjacent propertie if on shorelin or within 100 feet of adjacent property line.
adjacent property lined Fadjacent property line
LOT
I ' I
Aq
I I I
x
4 I l� r�i4StKtJ`'
adjacent property line4 I E-ItA,�� '! I <-adjacent roe line
SAMPLE SITE PLAN 1 7-
adja t property line--) 3io� _ \ Fadjac nt property line
D 30' �rz�saaVe t
SE
w a L _St
I I Hone 6 I GnsEN
crlEE1G \ I n I .
1 j PMOP0%Az smpttc �I
I 1 —
I � bo' —/SO �11
I
VAGwT I fi [,y1rtAG6 � I %
I d I i
T A&R=u_LrLjXAL90,
50
I
80
I
I \
1 \ I
c1.eLL
I \ I
I l_a_.e_LL I
adjacent property lined ; ��. \; Fadjacent ro ert' line
TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the
degree of slopes. See sample topography profile.)
SAMPLE TOPOGRAPHY PROFILE
aI s+a.,« to
ru.cfit.�►'e �
1;.S to r,cG to
Slop¢ fio¢
e1�+3„_ g� t o L
Signature Date