HomeMy WebLinkAboutBLD93-00863 Final SFR - BLD Permit / Conditions - 10/21/1993 MASON COUNTY
Mason County Bldg. III 426 W, Cedar
e P.O, Box 186 Shelton, Washington 98584
>k� N,..N N 4.. 1 'k 1' IP•!I F,:y A :r 1 : "v,� ��71 1 M
HLt)9:i--@8raf t'fitc+ # # ;, . •+aY;9a� ! .,
3131t A1)Ukt `,'. E 19 t 1 ON(- ItH 1 hR 14t ,;III I
rti:.INI.k DAVk SMI I I t
t.�[)1,41FIfo, 10tq ADAIR 110M 1!, '1l1141
!U 1:1
I I i` Of 1111t h i•lt t! I;t+ IIt 11.iP€ ANr.ilpl t+i; 31r?!i ef+ # IPC � tPt riM+rUl#I i1 IIAI# Yli€IM'I#
I Y1'i' 1)I !,i II ;I I I!" 1 d)
()1 s.4lf . 1 Irif<ul3! i;# 1{!r i1E t +:,N # a^ # ► �PRO1 j �#FR �� K'� ;f1' s , !A:"+ '�1fi- - tiR I+; b lilrj4t ��� u
CtrN l # t't if flint f} RAgN t 4... # ;
i)+ I,fit, . I IIA(i 0 1.i1)ill)" I ovi
It ;
+,A 4011LAI100 i i6il
IMIl I 1' M011t11 WWI
FF2' NT #: # ,'49 1 P Fi51 I Ii It t', t #i`,
Rk AN . . I,1 1 ,'r. 41 I r Itii I I{ !r1; ; I t11' bi IiI)31# 1
tt(
I rMIN # o)t)#'. tall# it io 1,0
i r4
fel�� 6� . i t_ ! u f i1! l.Jr1�� {f 1��. . . 1 i{IWN fl� tiiil_ gat eg n #t1' '! — r`I Fitt--
r1 _ __ _ k. # ! , Itt vd 1 # I°lift
#.Ii f 1 21: _ . A1: 1 i ,!1W tit t I t}'. H Jt !d # lit' i Iirll 1 1% o
fail I t I I IV6 . t 4t.' # I)t 1 NI, 1 NIj I I11it! i 4) `:/1 14 1 1 riN` 1111171r, k) L•#1 #1 I Fi . N
HA';#. #tit N I o i ! f111IAIi1rY I Iti1'`r t'l1 1 14 41 ; it I +I 141
Cal I.K ', 4a•:, 1 U 1 ',HWA`,ifI li;; lialttl#i# 1 rJr. IIIJ t 1 ', ! !+ttilit i fit 11J a;
t:.li li ;I fA k I t l ft�I i9 t # !ti li k it 14 I :1 I'I I Fit . . t) ( yi r)4a 4) #111 i i is! 1 r)! ,`1•) 1'r t t }; - ��
F1 1 f(� # r� 1•)ti.# (�11I '� 4) i a9�7�iRa') , i !Il N3 k7 I ##i I: IIiJ i 1 '. N
t�iL �,1 1'i � t ! x # #1t�# ':, �r +,ti`; I+1+ # # t # •, .y
=soe�+ca��-r.*•��::�ara��crsrx�- asmetier..rae.u�W�:.'ars:za� �c',anr_c-,sscmue�.xv-^.^-razxsearm:.z: -.....rx-...r. ..a..:xrn.�.n..--`�rzemrrT-,rs-_.._�.:.a.^e..-,.. ax.«•,,:•.-za m�...:,-:i•:-n..^-z-�-..3:.�.v.-:-cx m�a.x ... ...:.>rj:+•.r..J+:..
P64,1€1I +Itg61P11@N:#iI5#BfN%f
PRQ3Et1 tdlpllt)N° 1A13' ill NURiN6ttH#D PAS1 SAAD[RI, #N IiIl6 to ftpQt.IbAlf RIIA11, �Ii{�rI r ti � ► � A NfL�S, (ltltN B16Ni Af f #RAvt# i Nl#.1", f1l .t€N',1`N
68AD f , .I 111.0 S,IAY iN Lff# I'�R _ 5111 IS i4l 3 #HMIA6.':Ak P1Ai1 �
gg N)) pp p p g qqyy 1 tl yy
f3'1'1 it',AflIR'L6i�l11�`> Nl �� 1Vl litk1l�UAlieNtlultQ1+ tA�P�6ekf �SA#�i���l�l (vit it
�R Tit
0)"efolik , -Iti1•.P#NlM ;
APPK!3!,rl� 6000 611110106 (All 6€ utz61111!
—Bit, 4khl r " 441 1lw1 (:13011111 tA141..1• 10 Al 1 AC111FA) C111It11 1 ION-, 14,; lit, difi rut ti
1993 MASON COUNTY
JUL Mason County Bldg, III 426 W. Cedar
S �V�CE� P.O. Box 186 Shelton, Washington 98584
E;.9 N....N :::N::: N..... L] :::X:: r4 d c R E.:, N::::: Fk 1'X'N :::q:: N F O R INSPECTIONS CALL 4 2 7—9 6 7 0
BETWEEN 5pm AND Sam 427-7262
BLD93-0863 PARCEL : 321322390003 PLAT : DIV : ? BLK : e L01 - ?
JOB ADDRESS : E 191 STONEBRIAR PL SHELTON
OWNER : DAVE SMITH
CONTRACTOR : ADAIR HOMES 352-7641
LEGAL : S11 NH EX
CLASS OF WORK . . : NEW BEDR : 3 BATH : 2 (TYPE AMOUNT BY GATE RECEIPT TYPE AMOUNT BY DATE RECEIPT
TYPE OF USE . . . . : SF STORIES . . . . . . . : 0
OCCUP . GROUP . . . : ? BLDG . HEIGHT. . : 0 . Ott IPRMT $ 384.11 KS 17/11/93 2129 STFE = 4.50 KS 67/17/93 2129
TYPE OF CONST . . : ? FIREPLACES . . . . : 0 R A D M $ 8.00 KS 17/17/93 2129
OCCUP . LOAD . . . . : 0 WOODSTOVES . . . . : 0 'PLCK $ 192.41 KS 17/17/93 2129
DWELL . UNITS . . . . : 0 PARKING SPACES : 0 P L M $ 45.00 KS 07117/93 2029
INSPECTION AREA : 2 SHORELINE?. . . . : N MCH $ 19.00 KS 17/17/93 2029 TOTAL: 652.51 VALULATION: 76764
SETBACKS-------------- TOILETS . . . . . . . . . . : 2 FUEL TYPES---------- BOILERS/COMP---- MOBILE HOME--
FRONT. . . E 120 . Oft BATH BASINS . . . . . . : 2 : /ELE / / / : 0-3 HP . : 0
REAR . . . .W 126 . Oft BATH TUBS . . . . . . . . : 2 3-15 HP . : 0 MODEL : ?
SIDE ( 1 ) . N 8O . Ott SHOWERS . . . . . . . . . . : 0 FURN < 1OOK BTU : 0 15-30 HP . : 0 —MAKE------
SIDE (2) . S 80 . Oft WATER HEATERS . . . . : 1 FURN >=1OOK BTU : 0 30-50 HP . : 0 ?
SHRLINE . ? O . Ott CLOTHES WASHERS . . : 1 FURN — FLOOR . . . : 0 50+ HP . : 0 —YEAR------
AREA ---------------- KITCHEN SINKS . . . . : 1 HEAT PUMP . . . . . . : 0 ?
LOT SIZE . . : AC FLOOR DRAINS . . . . . : 0 VENT SYSTEMS . . . : 0 EVAP COOLERS : 0 LENGTH : 0
BUILDING . . . : 1702st DRINKING FOUNT . . . : 0 VENT FANS . . . . . . : 3 HOODS . . . . . . . : 0 WIDTH . : 0
BASEMENT . . . : Ost LAUNDRY TRAYS . . . . : 0 DOMES . INCIN : O —SERIAL#----
DECKS . . . . . . : Osf DISHWASHERS . . . . . . : 1 AIR HANDLING UNITS-- COMML . INCIN : O ?
GAR/CARP : G 440sf GARB DISPOSALS . . . : 0 (= 10000 cfm. : 0 RELOC /REPAIR : 0
AT/DT . : A URINALS . . . . . . . . . . : 0 ) 10000 ctm. : 0 OTHER UNITS . : 0
MISC PLM FIXTURES : 0 GAS OUTLETS . : 0
PROJECT DESCRIPTION:RESIDENCE
PROJECT LOCATION:TAKE 111 NORTHBOUND PAST SANDERSON FIELD TO BROCKDALE ROAD, RIGHT ONTO BROCKDALE FOR 3./ MILES, TURN RIGHT AT T TRAVEL 3 NILES TO JENSEM
ROAD E, .4 MILES STAY TO LEFT FORK, SITE IS LOT 3ST°NEBRIARPLACE.
bHI1ORRMMYTT MM EL W "STTVTTNpoppppppTHH
T TNN ATRWppffS KKNppNCCCpo IIgg p° `poMMMMEE NCCEE DWIIiiHHIINN 11Bg Ippppyygg pppp IF CpNg Tgpg TIpp OYWp IO .SpA ° pp SRR Tpp PP EpplIpppp
BE
APPROVED BEFORE BUILDING CAN BE OCCUPIED. �] G 1
OWNER OR AGENTXC4� DATE• ` ( J
B L 0 PRMT, rev: 13/31/91 COMPLIANCE TO ATTACHED CONDITIONS IS RFOt1TRFn
CONCRETE )MECHANICAL -. MOBILE HOME
FootiDgs-Setl; date by Ribbons
date �� ! by �� ' Gas Piping date b
Fou all iA date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
� �,
date `fH i5'� by ,
date (y q 3 by K//" date by
PLUMBING Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date O _ a _19 y /9 date by
.a L
Uc+
.6
J
MASON COUNTY
VOVU NTY
/ y
-� Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
5
MASON COUNTY
Mason County Bldg, III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
V11 M:::::: 1:�t M ^�. .._I_.. C. 0 Nkl 1_ :1 C:) N
Case No . : BLD93-0863
For : DAVE SMITH
Page : 1
1 ) The use , handling and storagge of hazardous materials or flammable and combustible
liquids in excess of 10 galions is not allowed without the approval of the Mason County
Fire Marshal
X
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date b date by 1
D.W.V. y WALLBOARD NAILING (4�J� 17��
date by date by VO
Water Line FINAL INSPECTION v
date by date by date by
it
I
�7- /
loot�'
.S 'S5�4/''E I NIE7A L.
��A/VZ:)A/`Yl))
I
I -
APPROVED
MASON BUILDING INSPECTOR
C NGES SUBJECT TO APPROVAL
o DATE
47
SyZ-7 /,
x>c>c>e-
S7ar/E RiATZ
cz-
ym67
VII
f
93'IZ)bAV9
op
17ZF r4r d
WATTSUN 5 .3 1991-WA STATE ENERGYCODE COMPLIANCE REPORT ^- 09/14/92
FILE : C:\WATTSUN5\NEWFILE HOUSE ID:
Site: Analyst:
Jurisdiction:
( ) - utility:
Homeowner : House Type: Single Family
Floor Area : 1702 ft2
Builder : ADAIR HOMES INC . Weather Data : Olympia , WA
2303 93RD . AVE . S .W . Climate Zone: 1
( 206 )352-7641
The PROPOSED design *COMPLIES* with 1991 WA State Energy Code . '
REFERENCE PROPOSED '
COMPONENT PERFORMANCE 276 261 Btu/hr-F '
ENERGY BUDGET 3 .50 3 .36 kWh/ft2-yr ;
--------------
REFERENCE DESIGN
Reference
Component Value X Area = UA
---------------------------------------------------------------------------
Floor U-0 .029 1702 49 .4
Glazing @15% U-0 .400 255 .3 102 . 1
Doors U-0 .200 38 .0 7 .6
AG Wall U-0 .058 1115 64 .7
Ceiling , Attic U-0 .031 1702 52 .8
Infiltration ACH-0 :350 13275ft3( 85 .0 )
----------------------------
Reference UA 276
--------------------------------------------------------------------------
PROPOSED DESIGN COMPONENTS
Component Description Value X Area UA
--------------------------------------------------------------------------
Floor R19 vented P&B 48oc U-0 .038 1702 64 .7
Glazing @13% **N .W . ALUM . VINYL W/ARGON U-0 .360 -p .-46 -Igo-
Doors **STANLEY METAL PANEL-FOAM FILL U-0 .240 20 .0 4 .8 /
**STANLEY 1/2 LITE-FOAM FILL U-0 .240 18 .0 4 .3
AG Wall R19 + R4 STD T1-11 U-0 .050 1157 57 .9
Ceiling R38 blown Attic STD baffled U-0 .031 1702 52 .8
Infiltration Standard Air Sealing ACH-0 .350 13275ft3 ( 85 .0 )
_ ------------------------
`O x '49 - � ' 74/1 Proposed UA .2Ert
Items in parentheses not included in COMPONENT PERFORMANCE totals .
** Denotes non-standard values - check calculation of thermal value .
Page1 ----______-_---___--_--___---____--
WATTSUN 5 .3 1991 WA STATE ENERGY CODE COMPLIANCE REPORT 09/14/92
FILE : C : \WATTSUNS\NEWFILE HOUSE ID:
Struc Mass Light Frame , Sheetrock walls M- 3 .000 1702 5106
--------------------------------------------------------------------------------
HEATING/COOLING/VENTILATING SYSTEMS
PROPOSED
Heating System Type: Electric: Zoned
System Efficiency: 100
Modified Efficiency: 100
Design ACH: 0 .60
Heating Load( at 53F dt ): 21563 Btu/hr
System Size: 6 .3 kW
Maximum Size ®150%: 9 .5 kW
Average Annual Heat: 8292 kWh
Annual Cost : $ 456
Ventilation System: Integrated Spot
& Whole House
Cooling System:
stem:
SEER: 0 .0 ( )
Cooling Load( at 5F dt ): 18290 Btu/hr
Recommended Size ®125e: 2 .1 tons
Annual cool requirement : *** kWh/yr
Solar Access: Partially Shaded
--------------------------------------------------------------------------------
GLAZING ORIENTATION
PROPOSED PROPOSED
South 53 .2ft2 North 53 .2ft2
Southeast : Northwest :
East 53 .2 West 53 .2
Northeast : Southwest :
--------------------------------------------------------------------------------
-----------------------
Economic and energy consumption estimates are designed for comparative
purposes only . Actual cost for heating will vary depending on weather
conditions , occupant lifestyle and other factors .
Page 2
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
COMPLIANCE INFORMATION
TYPE OF PROJECT: 00 NEW RESIDENCE ( ) ADDITION ( ) REMODEL
AREA (SQ.FT.) 1ST FLOOR 1702 2ND FLOOR BASEMENT
TOTAL SQUARE FOOTAGE OF CONDITIONED AREA 1702
COMPLIANCE METHOD:
t
( ) PRESCRIPTIVE PATH .-- circle option -- I II III IV V VI VII VIII
Glazing percentage (total glazing area divided by total conditioned area)
( ) COMPONENT PERFORMANCE -- Chapter 5 -- attach documentation and worksheets
()0 SYSTEMS ANALYSIS -- WATTSUN 5.2 -- attach documentation and worksheets
HEATING SYSTEM:
ELECTRIC RESISTANC
O Electric Central Furna El ctric Wall Heaters O Baseboard Units
( ) Radiant Panels ( ) Other
( ) 2,000 sq.ft. or less -- Name
SS or FED.ID#
OTHER FUELS
O Heat Pump ( ) Gas Furnace O Oil Furnace O Other
( ) Boiler System (indicate type)
Make Model
Size AFUE HSPF
VENTILATION SYSTEM:
¢C) Spot and Whole House ( ) Central Ducted System ( ) Integrated with Furnace
( ) Heat Recovery System (air to air heat exchanger — heat recovery heat pump)
GENERAL NOTES:
Your building plans should indicate certain compliance measures: framing to be used (standard,
intermediate, advanced); type of vapor barriers being used; location of furnaces, hot water tanks and
other equipment; location of solid fuel burning appliances, fireplaces and their combustion air duct runs;
and termination points of exhaust ventilation fans.
NAME ON PERMIT V��� �J rn 4h
WINDOW SCHEDULE
WINDOWS
Brand Model U-Value Quant . Size Area (Sq. Ft)
NW ALUMINUM VINYL/Argon .39 6 4 x 5 120
3 6 x 4 72
1 4 x 3 12
1 3 x 3 9
TOTAL WINDOW AREA 213
SKYLIGHTS
Brand Model U-Value Quant . Size Area (Sq. Ft)
TOTAL SKYLIGHT AREA 0
DOORS
Brand Model U-Value Quant . Size Area (Sq. Ft)
Stan le Foam filled ,2 1
20
�0 ? t
TOTAL DOOR AREA 36
ADAIR HOMES) INC.
� J
JUA IQ
BEAVERTON OFFICE
1111 S.W. 170th //��c�
BEAVERTON,OR 97006-4220 GENA,ERA► 'J'Fr�#�+I GM
SALES(503)645-3547
CONST(503)645-1156
FAX(503)645-9715
June 8, 1993
BEND OFFICE
63309 NELS ANDERSON RD. Mason County Building Dept
BEND,OR 97701-5743 426 W Ceder
SALES/CONST(503)382-4068
FAX(503)382-8989 Shelton, Wa, 98584
OLYMPIA OFFICE
2303 93RD AVE, S.W.
OLYMPIA,WA98512-9156 Deer Official,
SALES(206)352-8571
CONST(206)352-7641 please find enclosed a buildingpermit application
lication
FAX(206)943-0701p p p
for Dame and Karen Smith. They Will be building a
BUSINESS CENTER 1702 Sqf t home on Stonebri ar Pl. (This is our base
1111 S.W. 170th plan * 1 12791 DH)
BEAVERTON, OR 97006-4220
(503) 645-4730
FAX (503) 645-9715 The Smiths inform me that they Will provide you
With the approved septic design and Water system
tiKuuu�
information immediately.
�Yli f(0 tI1\t
Enclosed are two sets of blueprints, strip map to
site, plat plan, energy form and wattsun report.
If I have forgotten anything or if your requirements
have changed, please notify me at (206) 352-7641 .
Thank you very much for your time and assistance.
Carol Schmidt
Administrative Assistant
Adair Homes Inc.
Date Checklist Prepared
MASON COUNTY BUILDING DEPARTMENT
PLAN REVIEWER AND INSPECTOR CHECKLIST
1991 WSEC AND V&IAQ CODE COMPLfANCE
Permit Number 9,:3'036 3 Address Garr 3-6TDA)EBR A4' J?111� Sq. Ft. l -7 ate`
Name on PermitIC— M I T E+. K&ren j D a,ve Contractor/Phone# a�r• - 701-1 `
Compliance Method: O Prescriptive (Option) -1(-4 ) Component O Systems Analysis
Date FOUNDATION
Insp. Rev.
( ) ( ) Slab:R- (Ext.foundation down to frostline/slab bottom;or interior 24"top of slab&horizontal. Radiant under entire.)
( ) ( ) Below grade exterior wall insul{tion: -
(���(�► ) Crawlspace ventilation: l' (1 sq.ft.hTA/150 sq.ft.floor area-cross vented)
FRAMING
( ��) `(a ) Standard ( ) Intermediate (` ) Advanced
( ) rL)'bn� oodstoves and/or fireplaces: (6 sq.inches combustion air supply duct with damper direct to firebox.)
( ) (V) Standard air Seal: (Bottom plate/subfloor,rim joist/mudsill,window/door frames,penetrations condition to non-condition.)
ft( ) ) Attic ventilation (1 sq. . JW150 sq.ft.ceiling area) t 1.-51 +�C — 2 ,q = 14; � � �PA.
$ t exhaust fans: (4"exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 din CAA.25 WG. Vented out with dampers.)
Fresh air ventilation: Available to all habitable rooms. Installed and operational. (Integrated forced air,windows,wall ports.)
Whole house exhaust fan: B(Cfm(Intermittent system manual&auto controls/sone less than or=to 1.5 at.1 WG)
INSULATION
( �) Attic baffles installed to deflect incoming air(Rigid material resistant to wind-driven moisture,extend 12"above loose fill or 6"
above batt insulation)
( ) Mechanical ventilation ducts R-4(Exhaust in unconditioned space&supply in conditioned space.)
Wall insulation(above grade) R- + R (Batts face stapled)
( ) ( ) Wall insulation(below grade-interior) R- (Batts face stapled)
Vapor retarders on walls (Faced batt,or 4 mil poly or perm.paint.-circle one)
( ) ( ) Rim joist(Insulated with vapor retarder-rigid foam and caulked or 4 mil poly.)
( ) ( ) Vaulted ceiling insulation R- (vapor retarder&1"air space)
FINAL
( ') ) Floor insulation R- _(Substantial contact w/surface,supports less than or=to 24"OC,not blocking vents.)
( �) Ventilation system is operational(spot,whole house,fresh air to all habitable rooms. If integrated system,certification by installer is
required.)
( ) ( ) HVAC ducts in unconditioned areas R-8 (.joints sealed;mechanically fastened with a minimum of 3 fasteners.)
( � ) Pipe insulation R-3 (Hot and cold lines in unconditioned areas-service or recirc.see Table 5-12).
SHW heaters: (NAECA label,separate power or gas sh t-off,on R-10 pad if electric in unconditioned or on concrete.)
( �) Heating system type: Ae/QC'77'' c !.L � A-/TE 9• 5-r-
Radon monitor on site with instructions.No. - Supplied by MCBD
( ) ( ) Thermostat: (Heat range 55-75;AC 70-85;both 55-85. Backup heat controls(lockout)prevent simultaneous operation of primary system.)
( ) ( ) Solid fuel appls.: (Glass/metal tight-fitting doors;dir.comb.air source,or 4"dia.dampered,indir.source for existing const.)
Ground cover: (6 mil black polyethylene or approved equal lapped 12"at joints,extending to foundation wall.)
Penetrations(All exterior wall and ceiling penetrations sealed to drywall-plumbing,exposed beams,wall receptacles,fans,recessed lights.)
Ceiling Insulation Rj�(Insulate&weatherstrip access,baffle to prevent spillover-no cardboard)
Vapor retarder paint if a vapor retarder was not installed when insulation was installed.
GLAZING
Plan Reviewer-Fill out this glazing section or attach a window schedule to this checklist. Inspector- Verify window
information during field inspections. Include skylights, glass doors and all other glazing on this form. Use rough opening
area for calculations.
Date
Size Quantity Area S . Ft. U-Value Manufacturer Rev. Insp.
'C3,- ' a A., A/vrn��r1�
o 6k c.
Total glazing area: ✓� "' —
Total conditioned area: / �4
Percentage glazing: Verified:
DOORS
Plan Reviewer-List opaque doors by type(solid core,insulated,etc.)quantity,U-value,and manufacturer. Inspector-
Verify door information during field inspection.
Date
Type/Quantity U-Value Manufacturer Rev. Insp.
Signature of Building Inspector: Date of Final Inspection:
Permit Nol.,093 600�3
MASON COUNTY
BUILDING PERMIT APPLICATION
PLEASE PRINT
#1 Owner S Ph ne#
Site Address Fire District #
City 11 St Zip
Directions z
Job Site
�d
L?C( 07
.Lf t `.
Owner, Mailing�ddress ►�Yl�
City
St Zip 5
Lien/Title Holder
Address (�
City C) �mc )4QI Q-1 t ZipG$5IZ
r -�,� nC
#2 Contractor Name � Contractor Reg#-ADAJ P._-tfZSlbp
Address e2; ) AX1e aA�) Expiration date l q
city nwy\f\!(Ji c� StVPL-Zip CIS rJ Phone
#3 If septic is located on project site, include records.
Connect to Septic?_V'- Public Water Supply_ Well
(If residential, pro13,of potable water is required)
#4 Parcel No. Z1 52- -Oo oo
Legal Description LDr 3 , L 1 Z(M, 1? 3 W, Wrn
�1 �� z5l ► tf ,q-5sdc. AIt ZZ�3c hYs l NCp20c, maswL c<) .
#5 Building S are Footage:
1st F11 2nd F1 3rd F1 Loft Basement
Deck #bedrooms #bathrooms_ Garage_ Carport
Garage Ev Attached art: r Detached
Other_ \(��
#6 Use o b J
�u1Y�ing Describe work �U 6
#7 a of Type Job: New_l�— Add Alt Repair Demolition
Re-Roof Bulkhead Other
#8 MOBILE HOME INFORMATION
Model Year Make Model
Length Width Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or adjacent to property: saltwater lake
river pond wetland seasonal runoff
other
i
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Scale:
Name of Fronting Street Date:
APPLICANT TO DRAW SITE PLAN BELOW
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
l
Plumbing Fixtures Fee Mechanical Fixtures
No. Toilets 2 —� Primary Heat Source (clrcte type)Bath Basins Elect/heatpump/other CleL
i Bath Tubs —�-
-Showers NO. FEE
1 Hot Water Htr _ Furn
Laundry Washer _ Heat Pumps
Sinks 3 Vent Sys (Central)
Floor Drains "Vent Fans (Spot/Whole)
Laundry Basins Boilers/Compressors ;50 c0
Dishwasher _ Hp
Disposal Air Handling unit
Urinals cfm.
Other Fire Protection Systems
Permit Basic Fee �}
TOTAL PLUMBING $
Other
Gas Outlets .Hookups
Wood/Pellet/Gas Stove
Other
Permit Basic Fee 1 5
TOTAL MECHANICAL $��
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 ANYTIME AFTER WORK
IS COMMENCED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE 1 CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR
CONTRACTORS REGISTRATION LAW RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE
OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH
THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE 1N THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE
WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING
DEPARTMENT. DEPARTMENT.
X OWNER
X BY I , ►�
DATE DATE
Return permit to: Department of General Services
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
FOR OFFICM t18R ONLY: AcCepted by. Date.
II Igvsos :uOTjvnTPA buTPTTnell
993 a;PIS buTPTTnHII II II
I. I 'I II II
II I aag aAo-4BPooMil II II
II _ r-� it II II
aa3 T1'oTu'egoaWll II II
I I II II
s
II I 9a3 buTgnTd II II II
II I XOagD ueTall II II
I� I it II II
II I 993 uOTae6T-4sanuj uOTIPTOTAII II 11
I I II II
II I ea3 uoTT2TOTAil ll II
h9 I :lTuu;Dd FuTPTTnHII II II
I II II
II I uoTjoadsui alTSll 11 :suoTITPuOD TPToadSll
:-Xeg40
TuT192vH GaTA
(" :dnojo Aoupdn000
:149TA9H UVTd BuTPTTng
:RlT>?eg T>Qlaemuo.zTAIIg
:buTuagTd
lenoiddy
P1OH PU03 Panojddy
a�u�o $sn soilao Wig
MMAM rlVJLIWUHVd3Q