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Home My WebLink AboutBLD99-00795 Cancelled SFR - BLD Permit / Conditions - 10/25/2004 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 E3 U I L_ D I N G PERM I T FOR INSPECTIONS CALL 427-9670 BF TWEEN 5pm AND klam 427-7262 BLD99-0795 PARCELe321275300107 PLAT :LAPLO DIV : BLKc .JOB ADDRESS : 381 E DARTMOOR DR SHELTON � OWNER : TOM SWIDECK1 876-7548 Q� - CONTRACTOR : RJF CONSTRUCTION INC 253--804-8546 �0%v LEGAL : LAKE LINERICN F TRACT 111 CLASS OF WORK . . :NEW BEDR : 3 BATH : 3 FTYPE AMOUNT BY OAtf AEC[ TYPf��:�': . ; BY DATE RECEIPT TYPE OF USE . . . . c S F STORIES . . . . . . . :? -� - OCCUP . GROUP . . . :Rai BLDG . HEIGHT . . : O .Oft PLCK 1 638.46 KN 98131199 51402 ADJ 1 6.50 KS 19123199 51661 TYPE OF CONST . . :5N FIREPLACES . . . . : 0 EHCP 1 50.60 KS 19123f99 51661 MCH f 65.10 VS 09123199 51661 OCCUP . LOAD _ . : 0 'WOODSTOVES . . . . : 1 PANT 1 992.25 KS 09123199 51661 NCH1 11 22.01 KS 09123/99 51661 DWELL .UNITS . . . . . 1 PARKING SPACES : 0 PLM 1 82.54 KS 19123199 51661 Addit iml fees eut skuvn here. . .. . . INSPECTION AREA : 2 SHORELINE? , . . . ;N PtMI 1 20.01 KS 19123199 51661 TOTAL: 1923.21 VALIKATIONc 121631 SETBACKS------ -- ------ TOILETS . . . . . . . . . . : 3 FUEL TYPES--- ----- --- BOILERS/(;OMP-.-•-- MOBILE HOME-- FRONT „ . . O .Oft BATH BASINS . . . . . . : 3 : /EL.E/ / / 0-3 HP . :- 0 REAR . . . . O .Oft BATH TUBS . . . . . . . . : 2 3--15 HP . : 0 MODEL : SIDF( 1 ) . O .Oft SHOWERS . . . . . . . . . . : 0 FURN <: 100K BTU : 1 15-30 HP . : 0 --MAKE•- - - - --•- SIDE ( 2 ) . 0 .0ft. WATER HEATERS . . . . : 1 FURN >-100K BTU : 0 30-50 HP . : 0 SIIRL I NE . O .Oft CLOTHES WASHERS . . : 1 FURN - FLOOR < . . : 0 50+ HP . ; 0 --YEAR-- AVEA ---- ______ _. .__.__ KITCHEN SINKS . . . . : 1 HEAT PUMP . . . . . . : 1 LOT SIZE . . : FLOOR DRAINS . . . . . c 0 VENT SYSTEMS . . . : 0 EVAP COOLERS : 0 LENGTH : 0 BUILDING . . . : 2132sf DRINKING FOUNT . . . z 0 VENT PANS . . . . . . t 5 HOODS . . . . . . . . 0 WIDTH . : 0 BASEMENT . . . : Osf LAUNDRY TRAYS . . . . : 0 DOMES . INCiN :0 -SERIAL#-- - ._ DECKS . . . . . . : Osf DISHWASHERS . . . , . : 1 AIR HANDLING UNITS--- COMML . INCIN30 GARiCARP :7 Osf GARB DISPOSALS . . . : 0 <= 10000 ^frn . . 0 F?ELOC/REPAIR : 0 AT/DT . :? URINALS . . . . . . . . . . : 0 > 10000 cfm . : 0 OTHER UNITS . : 4 MISC PLM FIXTURES : 4 GAS OUTLETS . : 0 PROJECT DESCRIP?loot RESI9ENCE PAtECT LOCATION-TAKE HWY TO MASON BENSON RD TAKE L TO DARINOOR OR TAKE R SITE IS APPROX 112 MILE DOWN ON LEFT. THIS�P�PMIT BF.COkES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMOCEII WITHIN IS# DAYS, OR IF CONSTRUCTION OR WORT: IS SUSPENDED FOR .A PERIOD OF I� -JAYS AT ANY TINE AFTER WORK IS CONNENCED. EVIDENCE Of CONTINUATION OF WORK IS A PROGRESS INSPECTION WITHIN THE 110 DAY PERIOD. FINAL INSPECTION NUS1 BE APP' :E BEFORE- BUILDING CAN BE :OCCUPIED. .\ OWNER 01 9AGENT: r r' ( .' ! ( _ DATE -__.__ 8l0 PINT, rev: 03131191 COMPLIANCE TO ATTACHED CONDITIONS IS REOU 1 RED CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date lb -/I -9` by Gas Piping date b ' Foundation Walls date by Set Up dale /Q- -11 by INSULATION date by BG/SLAB Insulation Floors Final date aRAMING by date by date by Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date /Z-/ -`� by j/ date by Water Line / FINAL INSPECTION date by Y/ date by I date by 110 T-17 ec. c U �CT c'or mac. 4i`cs� F tr/v i- .S vo/J c lr D ty,rs 12, -8—r 5 Z-13- - _�� -r�� - - 5 ani -4�e_ id ' _ g r i// k L -fee hoyer �--- - Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD99-00795 OWNER: TOM SWIDECKI RECEIVED: 8/31/1999 CONTRACTOR: RJF CONSTRUCTION INC LICENSE: EXP: ISSUED: 9/23/1999 SITE ADDRESS: 381 E DARTMOOR DR SHELTON EXPIRES: 3/21/2000 PARCEL NUMBER: 321275300107 pp�� LEGAL DESCRIPTION: LAKE LIMERICK 4 LOTS: 106 & 107 PROJECT DESCRIPTION: DIRECTIONS TO SITE: vt ML & V RESIDENCE TAKE HWY TO MASQk+ENSON RD TAKE L TO DARTMOOR DR TAKE R SITE IS APPROX 1/2 MTLE DOWN ON LEFT. General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: 5N Type of Use: SF Insp.Area: 2 No. of Bathrooms: 3 Occ. Group: R3 Lot Size:O Deck: 0 Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ. Load: 0 Building:2,132 Valuation: Building Height: 0 Occ. Status: Basement:0 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: 0 Ft. Front: 0.0 Ft. Shoreline: 0.0 Ft. Water Body: Rear: 0.0 Ft. Slope: Ft. SEPA?: Unkn Model: Width: 0 Ft. Side 1: 0.0 Ft. Shoreline Desig.: own Year: Serial No.: Side 2: 0.0 Ft. Comp. Plan Desig.: Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Final Expired Permit NJP 4/16/2004 $58.00 S22004 Building plan check* KW $638.46 51402 EH Plan Review KS $50.00 51661 Building permit....* KS $992.25 51661 Plumbing Fee KS $82.50 51661 Plumbing Base Fee KS $20.00 51661 Adjust PI.Check Fee KS $6.50 51661 Mechanical Fee KS $65.00 51661 Mechanical Base Fee KS $22.00 51661 Woodstove Fee KS $42.00 51661 Building State Fee KS $4.50 51661 Total $1,981.21 BLD99-00795 Please refer to the following pages for conditions of this permit. 1 of 4 • • MASON COUNTY Mason County Bldg. III 426 W. Cedar RO, Box 186 Shelton, Washington 98584 PC.F2M I T OONO I T I C") N Ca. e No . : BLD99-0795 For : TOM SWIDECKI Page : 1 1 ) Owner/ builder assumes all responsibility if drainfield/ reserve area is encumbered . 2 ) This app4ication Is subject to Buffer and Landscaping requirements as established under Masg4t-County `Ordinance 1 .03 .036 . X 3 ) The use ,-J34adling and storage of hazardous materials or fIammable and combustible liqui in a cess of 10 gallons is not allowed without the approval of the Mason County Fire jVarShai, X 4 ) Proposal.-structure or any portion thereof greater than 30" in height from grade line , mus"aintaln a minimum of 5 ' setback from all property lines , easements and 10 ' from al County 4nd State Road right of ways . XL 5 ) 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 branted 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 Masan County Road , Contact the Mason County Public Works Department Friot to construction at Ext 450 . or 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 work which may affect your project . 6) Structure must be setback 5 ' from all utility and drainages easements , a total of 10 ' from each property line , or a variance must be obtained from the Building Department . MASON COUNTY Mason County Bldg, III 426 W, Cedar P,O, Box 186 Shelton, Washington 98584 X .- 7 ) All uR1�Ati, areas disturbed or newly created by oon3truction activities shall be seeded, vegetated o`f given some other equivalent type of protect i o)i against erosion . g ) Approved per dimensions and setbacks on submitted site plan . X _. 9 ) Water quality is not to be degraded to the detriment of the aquatic environment as a result of this project . X 10) Temporar erosion control measures must be implemented to prevent water, quality degradatiy on of adjacent waters or wetlands . Silt fencing must be installed and mwijn3AJjned until upland vegetation has become established . X- .� --- — 11 ) Appl arit cknowledges this site has ground water seepage . Provisions need to be made to , rect ater away from homey (french drains etc.. ) . X 12 ) A'II approved plans are required to be on-site for inspection purposes . it 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 bey-44oJiected by this department prior to any further inspections being performed or apprgata i granted . X 13 ) 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 INSPFGT-IONS . r' X MASON COUNTY . Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 14 ) The correction 1i6t . along with the Fnergy Compliance Worksheet (when applicable ) Is part of the plans and must remain attached thereto . It is the responsibility of the applicant to make corrections indicated on the pplans from the correction lists . Once the plans are marked APPROVED, they ma not be changed or altered without authorization frum the Building Official . The permit holder is reponsible 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 by such permits is suspended or abandoned at any time after the work Is commenced for a period of 180 days . X 15) UMC Chn ter 7 . In buildings of unusually tight construction , fuel burning appliances shall o n combustion air from outside (excluding cooking appliances and clothes drye ., X y, 16) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL. CODES AND UBC REQUIREMENTS AND OCCUPANCY " II144=11 TO THE PERMITTED AND APPROVED CLASSIFICATION . ANY CHANGE OF USE OR OCCUPANCY ►ouUt1) RE LT IN PERMIT REVOCATION . CHANCE OF USE MUST BE APPROVED PRIOR TO CHANGE 17 ) Proposed structure or pportion _.thereof with an projection over . 30" in height from grade line, must maintain a 5 ' sratton distance between adjacent structures and that furthest projection . X 18) Changes to approved building plans that effect compliance to the 1991 Washington State Energy Code , 1991 Ventilation and Indoor Air Qualityy Code, the Uniform Building Code and/or Mason County Rp,� -ations must be approved by Mason County prior to - constructionXi 19) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AIR-E,0UIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE . x -*" ?_W) ALL C_ 0 TRUCTION MUST MEET OR EXCEED LOCAL CODt IF ANY QUESTIONS, PLEASE CA1�1r HIS OFFICE BEFORE CONSTRUCTION . X// l r i 0 �o CONCRETE MECHANICAL MANUFACTURED HOME o Footings / Setbacks Date By Ribbons (0 Date By Gas Piping Dat.r B'." Foundation Walls Date B y Set-up Date By INSULATION Date B.0 B G / Slab Insulation Floors Final Date By Date B y Date B� FRAMING Walls FIRE DEPT Date By Date By Date B?; PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILING D.W.V. Date By Date By FINAL INSPECTION Water Line Date By Date By Date P T+ t, U s S (D O O 7 cc N r o d g � d o J I/r rr ".p m 0 Building Permit # MASON COUNTY 11 00'7`/S BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location �8 I `h pz � d This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items Listed below must be corrected to gain code compliance HOWSe; ( ) GecnABLR Nay-d-CAt I RFa',D Q Alt a4gqS ,j*13 es Mw� �4ns 4io,,9-d S - F . e P �A �F c; H 7- , GEC ;f --rooe couK w-el I AV F d oo-I Y.sL Z ?FI �1 I tia - S i h OFF , I f 1 F R IQ.J o v UsT le ,Add. `hv op k i /Q.Ct Q 1/4 cz� �du K`�, D � • You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be on next inspection rpp' Qtr- OK .4 ❑ This is not a omplete inspection Department Date �'� Inspector uov NUT ► n Mo sV , T lm%h, TAu Case Activity Listing 8/7/2002 3:14:13PM T I D E M A R K Case#: BLD99-00795 COMPU74R SYSTEMS. INC. AssignX� B oAne`,,.X Descri tion Date ate 2 �a Date 3 ..Hold Dis � �< �"ted U dated B BLDC1 iml _ 9i 11/2000 9/11/2000 None FAIL LW 10/23/2000 LW THE HOUSE IS NOT READY FOR INSPECTION,NO PORCHES STEPS HANDRAILS GUARD RAILS ETC.ETC. NOTE:MR SWIDECKI PROVIDED A LETTER FROM SIMPSON TIMBER CO.PLYWOOD SECTION FROM A MR.HAL STUDER THAT STATED THE AN INSPECTION WAS DONE BY HIM AND THAT THE PLYWOOD ON SITE WAS STRUCTURAL SOUND AND THAT THE BLOWS WERE ONLY PAPER BLOWS.I ALSO CALLED SIMPSON AND SPOKE TO MR.STUDER AND CONFIRMED THE LETTER AND THAT HE OILED THE PLYWOOD. BLDAS 9/12/2000 None DONE SKM 9/12/2000 SKM Last inspection 12/13/99 1997 UBC section 106.4. Inspection fees shall be paid for each inspection at 47.00 per visit.The applicant has the option to renew perni t with a fee of 50%of the permit price. BLDA900 Telephone Call 9/12/2000 None DONE SKM 9/12/2000 SKM CALLED MR.SWIDECKI REGARDING THE INSPECTION THAT WAS SCHEDULED FOR MONDAY THE I ITH.DUSTY STATED THAT HE DID NOT HAVE ADEQUATE INFORMATIN TO COMPLETE A"FINAL"INSPECTION AND THE ISSUE OF NON-LABLED PLYWOOD SECONDS(BLOWS)FOR THE ROOF SHEATHING HAS NOT BEEN RESOLVED.I WILL REFER THIS BACK TO LARRY WHEN HE RETURNS ON MONDAY THE 18TH SINCE HE AND DANA HAVE BEEN WORKING ON THIS SITUATION.(I BELIVE). MR.SWIDECKI ALSO INDICATED THAT HE NOW HAS DOCUMENTATION ON THE PLYWOOD FROM THE SIMPSON CO.AND WILL PROVIDE THIS TO LARRY W.UPON REQUEST.09/12/00 SKM. Page 3 of 3 Casonctivity.apt Case Activityg Listin 8/7/3:14:47PM7PM T I D E M A R K Case#: BLD97-00995 COMPUTER SYSTEMS, INC. Assigned Done Activity Description Dateai ., . .- DatZ , Date 3 Hold Disp To By Updated Updated By BLDA010 Application received 8/21/1997 8/25/1997 None DONE TMJ 8/25 1997 TMJ BLDB135 Addressing 8/25/1997 8/26/1997 None DONE GMM 8/26/1997 GMM BLDB130 Planning Review 8/27/1997 8/27/1997 None DONE MMS 8/27/1997 MMS BLDB138 Planning Pre-Review 8/26/1997 8/27/1997 None DONE MMS 8/27/1997 MMS BLDB110 Structural Plan Review 8/27/1997 9/2/1997 None DONE JQ 9/8/1997 DLC BLDB200 Environmental Health Review 9/8/1997 9/9/1997 None DONE CAJ 9/9/1997 CAJ BLDA100 Approved For Issuance 9/9/1997 None DONE KS 9/12/1997 KS BLDA015 Waiver in File None 8/25/1997 TMJ BLDB134 RLC Review None DONE 8/27/1997 MMS n/a d� 901-- - Page 1 of 1 CaseActivity-rpt JDM . , 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 701+ f 1�1441 Sw1 wt ck Contractor Name t T F C6.411, rite. Mailin Address �' 18J Ne famr V r. Mailin Address 3,X 1 S�rt IV City w State� Zip Code� — City A State�y. Zip Code 00 Phone(�� 01(>,Other Ph.( Ph. 4n�Other Ph.(tf3 )_JU 1 07 Lien/Title Holder Co " M s Contractor Reg. Q T F GOZ04 Address16210jr-2 kVZ 040�!I,'k 2fi: fSQ�Z-fY.141Expi ratio ONO 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. 32 12-7 /-3/ O61 O7 Fire District Legal Description l,K1L k,**14.-*/C.K * !q La+ 191 1 I6') Site Address(Please include street name, street number andcity) I I D P. Directions to site tJ i'y1~ De �0 Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water ( ame) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Describe Work Sj��k �3 fgm�Te�t4ct No. of Bedrooms T No. of Bathrooms4lff SQUARE FOOTAGE-1 st Floor 1081 2nd Floor 3rd Floor Loft Basement Deck Other COIre.,ed Dc-a--:g: sq. ft._-5';72, Garage_QAttached 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-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 obtainin 1pr;pv Qp X Date X2M Date g-2f` // FOR OF,-ICIAL USE BEYOND THIS POINT C Accepted by Date '�d- Submittal Amount Due Receipt N DEPARTMENTAL.iREVIEW: APPROVED DENIED CONDITION CODE$ Building Department v-N Q-zz-91 Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ F!~I*S Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) :»�•+:G:::�i': ::i:;:+:•,YSi{i`:'}::�:':{:::?:uu S::iv:::i::ii'•isLi:+¢}'.::viiii:L::::J:vi:•i:•iY:"jii.... .......:•::.::.:.:;:,..,.,:::<.:::3.::::..•:>:..::.:,.:,..:.......<....:.......:Y........ TOTAL FEES PERMIT NO.: MASON COUNTY s 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 IN FORMATION CONTRACTOR INFORMATION Owner EGK Contractor Name Mailin5tdl ss r �►1e•/' "I Mailing Address City. `` // On Sta e . Zip Code City State Zip Code Phone(1 O 7 OS�ther Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit T x Parcel No. 3a� 1 � -7 / S_3 / CEO/O"7 Fire District Legal Description Z rr7er , L Site Address(Please include street name, street number and city) B1 r- Directions to site 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 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 2( Type of Unit No. of Units Fees Bath Basins 21 - Furnace Bath Tubs .00 Heatpumps '_. Vent Fans Water Heater T— Propane Tank Laundry Wsher of Pectl lets Sinks I oa Wooas/Pellet Stove YZ_ Dishwasher -2.� Vent? Other rlox I5so3 g 5•SO Other Other Other Base Fee 210 r Base Fee TOTAL PLUMBING 2•So TOTAL MECHANICAL GS.O° 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-1 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 t is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in c f m ce t rew't h. N ian be made without approval. first obtainin X V- 9 22 Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. AEPARI"NEEiVTA�IRM. , W;:>> liFPROVED C?t"NIE0 4ANCfF1I(31V GOl3> 5 Building Department Occ Group Type Constr. Planning Department Other Other ::::::::::::::...................................................................................................................................................................................................... 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 l _ FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name /' PARCEL NUMBER 321P Si Cl7 Date_ SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography i Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line4 , d I <—adjacent property line i v S'�Pt I � I I � I I I I I - I � � I I �►a I I 4' I adjacent property line-> I ;1.,}�'OnG frr 1 Fadjacent property line SAMPLE SITE PLAN adja t property lined _ _ E-adjacent property line D 30' FRZScava SEASo wJ AL '• h J. CREEK \ I n fi MOM tr I Gg6.lN �I I H O ccl fc I j PrioPosen sQpt:e -�I I 1 , I R i VACM,T I V0.oPosCD 'k �\ T Fw2scu.�rLLn�� So � 1 I I � I 1 I RR\\ I i I \ I \ \ I /00" L- -eLL I I I I I I xt /00' I I � MIA, A I adjacent property lined ; ► ��. c \; Fadjacent property 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 d15+a"c4L to rutl-t.-►'C- d;st'Or�LG t0 SI0P' to � dia+ana� — 1 � Signature Date