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Home My WebLink AboutBLD96-00299 Final SFR and Deck - BLD Permit / Conditions - 1/22/2014 W 0 CONCRETE MECHANICAL MANUFACTURED HOME T Date By --- D o Footings !Setbacks Gas Piping Ribbons � Interior Date By interior.Date By Date By 3 co Exterxw Date By Exterior-Date By set.UP n Point Load!Isolated Footings INSULATION -- Date By D Date By BG I SLAB INSULATION FIRE DEPARTMENT r Data By Foundation Walls Floors Date By Date By Date By DECKS FRAMING Walls Date By Date Ry, Data By PROPANE TANKS PLUMBING Vault Date eye Date By OTHER Groundwork Attic Type. Date By Date By Date By D.W.V DRYWALL type. Int Brace Wall Date By � Date By Date By FINAL INSPECTION v r N Water Line Fire Separation CD v Date By Date By Date By tp m � g Pass or Request Inspect. c Type of Insp. Fail Date Date Dane By Comments CD CD CA a 0 O a o' N O S a (D R 3 N CD 0 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 E3U I L_ D I N G P E R NA 1 T FOR INSPECTIONS CALL 427-9670 BETWEEN 5pm AND 8am 427-7262 BLD96-0299 PARCEL :3213533OO000 PLAT : DIV : BLK : LOT : JOB ADDRESS : E 4771 STATE ROUTE 3 SHELTON OWNER : MICHAEL O 'DAY 954-9836 CONTRACTOR : LEGAL : SW SW CLASS OF WORK NEW BEDR : 4 .BATH : 5 TYPE AMOUNT BY DATE RECEIPT TYPE AMOUNT BY DATE RECEIPT TYPE OF USE . . . . :SF STORIES . . . . . . . .2 i OCCUP . GROUP . . . :? BLDG . HEIGHT . . : 0 .oft iPRMT $ 566.50 CPH 05106196 41830 STFE $ 4.50 CPH 05106196 41830 TYPE OF CONST . . :? FIREPLACES . . . . : 0 f P L C K $ 279.25 CPH 05106196 41830 OCCUP . LOAD . . . . : 0 WOODSTOVES . . . . : 0 IPLM $ 72.00 CPH 05106/96 41830 DWELL .UNITS . . . . : 0 PARKING SPACES : 0 IMCH $ 81 .00 CPH 05/06196 41830 INSPECTION AREA : 2 SHORELINE? . . . . :N IWDST $ 25.00 CPH 05106/96 41830 !TOTAL: '028.25 VALULATION: 270620 i I SETBACKS-------------- TOILETS . . . . . . . . . . : 0 FUEL TYPES---------- BOILERS/COMP---- MOBILE HOME-- FRONT . . . N 56O .Oft BATH BASINS . . . . . . : 0 0-3 HP . : 0 REAR . . . .S 67O .Oft BATH TUBS . . . . . . . . : 0 3-15 HP . : 0 MODEL : SIDE ( 1 ) .E 78O .Oft SHOWERS . . . . . . . . . . : 0 FURN < 1O0K BTU : 0 15-30 HP . : 0 -MAKE------ SIDE (2 ) .W 45O .Oft WATER HEATERS . . . . : 0 FURN >=1O0K BTU : 0 30-50 HP . : 0 SHRLINE . O .Oft CLOTHES WASHERS . . : 0 FURN - FLOOR . . . : 0 50+ HP . : 0 -YEAR------ AREA ---------------- KITCHEN SINKS . . . . : 0 HEAT PUMP . . . . . . : 0 LOT SIZE . . : FLOOR DRAINS . . . . . : 0 VENT SYSTEMS . . . : 0 EVAP COOLERS : 0 LENGTH : 0 BUILDING . . . : Osf DRINKING FOUNT . . . : 0 VENT FANS . . . . . . : 0 HOODS . . . . . . . : 0 WIDTH . : 0 BASEMENT . . . : Osf LAUNDRY TRAYS . . . . : 0 DOMES . INCIN :O -SERIAL#---- DECKS . . . . . . : Osf DISHWASHERS . . . . . . : 0 AIR HANDLING UNITS-- COMML . INCIN :O GAR/CARP : ? Osf GARB DISPOSALS . . . : 0 <= 10000 cfm . : 0 RELOC/REPAIR : 0 AT/ DT . :? URINALS . . . . . . . . . . : 0 > 10000 cfm . : 0 OTHER UNITS . : 0 MISC PLM FIXTURES : 0 GAS OUTLETS . : 0 PROJECT DESCRIPTION:RESIDENCE AND DECK PROJECT LOCATION:SITE ACCROSS RD IS LOCATED ON NORTHWEST SIDE OF STATE ROUTE 3 APPROX 5 MILES NORTHEAST OF SHELTON. 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 COMMENCE EVIDENCE OF CONTINUATION OF WORK IS A PROGRESS INSPECTION WITHIN THE 180 DAY PERIOD. FINAL INSPECTION MUST BE APPROVED BEFORE BUILDING C BE OCCUPIED. OWNER OR AGENT: DATE:_ 1p l�Q(p BLD-PRMT, rev: 0313 OMPL I ANCE TO ATTACHED COND I T�I S REQUIRED MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 PERM I T C O N D I T I O N S Case No . : BLD96-0299 For : MICHAEL O 'DAY Page : 1 1 ) The use , handling and storage of hazardous materials or flammable and combustible liquids in xce s of 10 gallons is not allowed without the approval of the Mason County Fire Mars X 001, 2 ) Proposed structu or any portion thereof greater than 30" in height from grade line , must maint in a nim m of 5 ' setback from all property lines , easements and right of ways . X 3 ) ALL D ELOPMENT 0 E PARCEL MUST BE CONSISTANT WITH THE BALD EAGLE MANAGEMENT PLAN DEVELOPED BETWEEN THE PROPERTY OWNER AND THE WASHINGTON STATE DEPARTMENT OF FISH & WILDLIFE . THIS PERMIT IS SUBJECT TO SAME CONDITIONS SPECIFIED IN BALD EAGLE MANAGEMENT PLAN . BALD EAG MANAGEMENT AREA PLAN MUST BE ADOPTED PRIOR TO ANY DEVELOPMENT OF THE SITE INCLUDI S I STALLATION AND CLEARING . X 4 ) Al upl d are dis ed or newly created by construction activities shall be seeded , v et d o en me other equivalent type of protection against erosion . X 5 ) All approved pians a: -equired to be on-site for inspection purposes . If inspection is called f r and pla are not on site , Approval WILL NOT be granted . In addition , a Re- Inspec on fee in the amount of $30 .00 per hour ( minimum 1 hour ) will be charged and must be 1 1 ��- ted h\, th i s department prior to any further inspections being performed or approv or ted . X 6 ) P SUANT TO 199 Uf: M BUILDING CODE , SECTION 305 ( C ) AND SECTION 513 , ALL SITES MUST H VE 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 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O, Box 186 Shelton, Washington 98584 J _ Au REINS PECTION FEE , BASED ON RATES IN TABLE 3A OF THE 1991 UNIFORM BUILDING CODE WILLZ: BE ASSESSED - = ' CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECT ! X 7 ) Th c rrection list , along with the Energy Compliance Worksheet (when applicable ) is p t of the plans and must remain attached thereto . It is the responsibility of the applicant to make corrections indicated on the plans from the correction lists . Once the plans are marked APPROVED, they may not be changed or altered without authorization from 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 b Idi o work authorized by such permits is not commenced within 180 days from the d e of ance , or if the building or work authorized by such permits is suspended or y time after the work is commenced for a period of 180 days . X 8 ) ALL447:—> /�NSMUST MEET OR EXCEED AL LOCAL CODES A D EQUIREMENTS . X9 ) The owner shahave available on site for inspection by Mason County a report indicating the name and license number of the installer , the amount o+ pressure at the time of testing and the length of test time . This report shall be signed by the person conducting the test . X 10 ) anges to ap roved building plans that effect compliance to the 1991 Washington State nergy Code , 1991 Ventilation and Indoor Air Quality Code , the Uniform Building Code and/ or Mason County Regul ions mus be approved by Mason County prior to constructionX 11 ) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS QUI ER SON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE . x 12 ) If the tank size is between 125 and 500 gallons you must follow these guidelines : 1 . Tank is to be 10 feet from any buidling , public way or property line . 2 . If the tank is exposed to probable vehicular damage , provide MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 3 . All weeds grass , brush , trash and other combustible material shall b kep minimum of 10 feet away from LP containers . X Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352 Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, WA 98584 i� RESIDENTIAL BUILDING PERMIT BLD96-00299 OWNER: MICHAEL O'DAY RECEIVED: 3/21/1996 CONTRACTOR: LICENSE: EXP: ISSUED: 5/6/1996 SITE ADDRESS: 4771 E STATE ROUTE 3 SHELTON EXPIRES: 11/2/1996 PARCEL NUMBER: 321353300000 LEGAL DESCRIPTION: SW SW TR 2 OF SURVEY 18/9 PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESIDENCE AND DECK SITE ACCROSS RD IS LOCATED ON NORTHWEST SIDE OF STATE ROUTE 3 APPROX. 5 MILES NORTHEAST OF SHELTON. General Information Construction&Occupancy Information Square Footage Information No. of Bedrooms: 4 Type of Constr.: ? Type of Use: SF Insp.Area: 2 No. of Bathrooms: 5 Occ. Group: ? Lot Size:O Deck: 0 Type of Work: NEW Fire Dist.: 5 No. of Stories: 2 Occ. Load: 0 Building:0 0 Valuation: Building Height: 0 Occ. Status: Basement:0 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: 0 Ft. Front: N 560.0 Ft. Shoreline: 0.0 Ft. Water Body: Rear: S 670.0 Ft. Slope: Ft. SEPA?: Unkn Model: Width: 0 Ft. Side 1: E 780.0 Ft. Shoreline Desig.: own Year: Serial No.: Side 2: W 450.0 Ft. Comp. Plan Desig.: Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Final Expired Permit TW 9/19/2012 $73.00 S220120000000i Building permit....' CPH $566.50 41830 Building plan check' CPH $279.25 41830 Plumbing Fee CPH $72.00 41830 Mechanical Fee CPH $81.00 41830 Woodstove Fee CPH $25.00 41830 Building State Fee CPH $4.50 41830 Total $ 1,101.25 BLD96-00299 Please refer to the following pages for conditions of this permit. Page 1 of 3 CASE NOTES FOR BLD96-00299 CONDITIONS FOR BLD96-00299 1) The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons is not allowed without the 9 approval of the Mason County Fire Marshal.X 2) 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 right of ways. X 3) ALL DEVELOPMENT OF THE PARCEL MUST BE CONSISTANT WITH THE BALD EAGLE MANAGEMENT PLAN DEVELOPED BETWEEN THE PROPERTY OWNER AND THE WASHINGTON STATE DEPARTMENT OF FISH& WILDLIFE. THIS PERMIT IS SUBJECT TO SAME CONDITIONS SPECIFIED IN BALD EAGLE MANAGEMENT PLAN. BALD EAGLE MANAGEMENT AREA PLAN MUST BE ADOPTED PRIOR TO ANY DEVELOPMENT OF THE SITE INCLUDING SEPTIC INSTALLATION AND CLEARING.X 4) All upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given some other equivalent type of protection against erosion. X 5) 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$30.00 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. X 6) PURSUANT TO 1991 UNIFORM BUILDING CODE, SECTION 305(C)AND SECTION 513, 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 IN TABLE 3A OF THE 1991 UNIFORM BUILDING CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS TO POSTADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS. X 7) The correction list, along with the Energy 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 plans from the correction lists. Once the plans are marked APPROVED, they may not be changed or altered without authorization from 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 8) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND UBC REQUIREMENTS. X BLD96-00299 Please refer to the following pages for conditions of this permit. Page 2 of 3 9) ' The owner shall have available on site for inspection by Mason County, a report indicating the name and license number of the installer, the amount of pressure at the time of testing and the length of test time. This report shall be signed by the person conducting the test. X 10) 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 constructionX 11) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BUILDING CODE.x 12) If the tank size is between 125 and 500 gallons you must follow these guidelines: 1. Tank is to be 10 feet from any buidling, 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. X 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. Proof of continuation of work is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. OWNER OR AGENT: DATE: BLD96-00299 Please refer to the following pages for conditions of this permit. Page 3 of 3 Press ESC to continue. . . ATTRIBUTES : View Add Change Delete Esc View notes about this parcel PARCEL NOTE PARCEL FLAG (S) 321353300000 TAX CODE. . . . . . . . . . . . . : 0190 : PROPERTY OWNER CENSUS TRACT. . . . . . . : KATHRYN GUNTER;JAMES GEIST ETA ZONING. . . . . . . . . . . . . : TAXPAYER#. :MORA5500 COMPLAN. . . . . . . . . . . . . . . . PARCEL ATTRIBUTES >> EAGLE TERRITORY- - - - - - - - - - NOTES (max 254 char))UPDATED: 08/23/94 KW » = Special flag Press ESC to continue. . . Case Activity Listing 9/19/2012 1:55:55PM Case#: BLD96-00299 i� Assigned Done Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By 131-DA010 Application received 3/21/1996 None 3/21/1996 KW BLDB200 Environmental Health Review 3/21/1996 3/26/1996 None DONE PSD 3/26/1996 PSD This is new construction of a 4 bedroom residence.There is an approved design in the file.The plot plans and bedroom match.psd BLDB210 Water Adequacy 3/21/1996 3/26/1996 None HOLD PSD 3/26/1996 PSD Need water adequacy application,well log and water sample.psd BLDB135 Addressing 3/27/1996 None DONE GMM 3/27/1996 GMM BLDB130 Planning Review 3/26/1996 3/29/1996 None DONE GBM 3/29/1996 GBM Bald Eagle Management Area-subject to plan developed between owners and the Wash State Dept of Fish&Wildlife BLDB134 RLC Checklist Review 3/29/1996 None BE GBM 3/29/1996 GBM Bald Eagle Management Area BLDBIIO Structural Plan Review 3/29/1996 4/26/1996 None DONE SKM 4/26/1996 SKM BLDB120 WSEC Compliance Review 4/26/1996 5/1/1996 None DONE TDH 5/1/1996 TDH heat pumpp with backup BLDB210 Water Adequacy 5/1/1996 5/5/1996 None DONE JWT 5/6/1996 JWT TURNED IN WELL LOG,AND WATER SAMPLE I PLACED IN PAMS TIN BIN WAITING FOR REVIEW ON 4/23/96 CHRISTINE BLDA100 Approved For Issuance 5/6/1996 None DONE CPH 5/6/1996 TW BLDA500 (F)Issue building permit 5/6/1996 None DONE CPH 5/6/1996 TW Page 1 of 2 CaseActivity-rpt 2012 Case Activity Listing 9/19/ 1:SS:S5PMSPM Case #: BLD96-00299 i� Assigned Done Activity Description Date I Date 2 Date 3 Hold Disp To By Updated Updated By BLDC110 Footing inspection 5/15/1996 5/16/1996 5/16/1996 None COND LAW 5/16/1996 LAW CONDITONAL APPROVAL: 1.FINISH LEVELING FOOTING AN MAINTAIN 7 INCHES OF DEPTH MINIMUM.2.MAINTAIN 3 INCHES OF CLEARANCE BETWEEN THE GROUND AND BAR. OK TO POUR WHEN DONE. BLDC115 Foundation wall inspection 5/24/1996 5/28/1996 5/28/1996 None PASS DH 5/28/1996 DWH BLDC140 Fr/PI/MC/Pen Inspection 12/13/1996 12/16/1996 12/16/1996 None PASS DH 12/16/1996 DWH Seal registers to the floor.Provide trusse engineering on site. BLDC150 Wallboard inspection 1/6/1997 1/10/1997 1/10/1997 None C/P DH 1/10/1997 DWH HUDSON DRYWALL. BLDC155 Final inspection 5/16/1997 5/19/1997 5/19/1997 None FAIL LAW 5/26/1997 LAW CORRECTIONS GASKET OR CAULK ALL EXTERIOR PENETRATIONS,LIGHTS,SWITCHES,OUTLET BOXES ET(!)4ANCHOR WATER TANK WITH PROPER STRAPS.3.SEAL EXTERIOR PE TRATIONS.TEMP.OCCUPANCY OK FOR 180 DAYS. BLDA560 Permit cancelled 1/22/1999 None DONE KW 1/26/1999 KW BLDA510 Reprint Building Permit 9/19/2012 None DONE TW 9/19/2012 TW FOR FINAL INSPECTION BLDA540 Print Inspection Card 9/19/2012 None DONE TW 9/19/2012 TW Page 2 of 2 CaseActivity..rpt Building Permit Application Enclosures 1. 1 copy of BUILDING PERMIT APPLICATION FORM with Attachments: Attachment A: Vicinity Map Attachment B: Copy of Septic Tank and Drainfield Permit #94-2077 Attachment C: Legal Description Attachment D-1: Site Plan Attachment D-2: Enlarged Site Plan Attachment E: Spec sheet for wood stove 2. 1 copy of WASHINGTON STATE ENERGY CODE AND VENTILATION & INDOOR AIR QUALITY CODE COMPLIANCE FORM 3. 2 complete sets of BUILDING PLANS/BLUEPRINTS 4. SEPTIC SYSTEM INFORMATION, see Building Permit Application Form, Attachment B 5. APPLICATION FOR THE DETERMINATION OF WATER ADEQUACY. Well drilling is scheduled for March 8, 1996; Water Certification expected within 30 days. 6. NOTE: Site is subject to Washington State Bald Eagle Protection Rules. Owners have met with Shelly Ament, Wildlife Biologist with the Washington Sate Department of Fish and Wildlife (360-681-4276) to develop a cooperative Site Management Plan. Ms. Ament is in the process of completing the site management plan. Permit No. �� 1'�✓'�a� MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 er M%C"Ac, �� 'q+JIS Snl�c� Phone# Ate Address E 4-7-7 I 5 P� 3 FireDistrict#ty E L--r a i.! St Zip 9'8 S 8 Directions to Job Site 5►r&- AW A-Z N C-5 T s o 6' o-R 5 T4'n A-6 ^E 3 " a A-d,c i M G 9-s T 0 I� ►t&,, SEA ✓ c �1 r T-t wt A-P A 7'n4cri Owner Mailing Address C '7-7 City , St CA)' Zip 46 sus Lien/Title Holder Address Clty St Zip 4FALTH SERVICE #2 Contractor Name O w N ZLA .L--D C-� Contractor Reg# Address Expiration Date City St Zip Phone # s&-& �T'T 7�t►t+K6w. r — "P r d F' S Er #3 If septic is located on project site, include records. ►' "`" r' It! z0-1-7 Connect to Septic? X Public Water Supply Well X Connect to Sewer System? Name of System (If residential, proof of potable water is required) P A-P r= 1 #4 '�ar�l No. 32-1'35 - 3'3 - 0000c) 4Cgal Description 5 C-le_ a #5 Building Square Footage: (existing/proposed) 1st Fl c _/ 178 96 2nd FIB_/ /2tD(L 3rd FI 5� /_ ( Loft Vr Basement/ o( Deck / 3 5 2- #bedrooms K/7_#bathrooms 0 / Garage 0 /_ ^ Carport Pf / (Circle: Attached or Detached?) Other tj At sq. ft. / #6 Use of building Describe work Z. I S7o x.y 4 ��Y-PC-i✓V�fC. Ca' d 1 -� t-Tl Cy` �u i`fl ,^�is �'R_� i S c-L. `�--y-�t�� N Ura IC 1e< o r k '71tA I ✓k�,.f a (oo r I-X , 1 ra.-0 farms cn.srr c n #7 Type of Job: New_ E Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION - ///ICV Model Year Make Model Length Width Serial No. # Bedrooms # Bathrooms Type of Heat Purchase Price $ #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: it/&n./4-- River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other 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 Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW ATr?s<ft MO,T D-Z APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW wmSv 11+\j6-5wPt,- 6?)6 r L I Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No. 5 Toilets CIRCLE FUEL TYPE: Gas, Electric, Jr Bath Basins 15 HeDatpump, Other Bath Tubs (el No. Units Fees 3, Showers 6/9 _ Furn BTU .w 2 Hot Water Htr(L � (P Heatpumps Laundry Washer 3 _ �ent Systems Sinks 3 spot Vent Fans _Floor Drains No. Boilers/Compressors _Laundry Basins _ HP Dishwasher J� No. Air Handling Units Disposal cfm# _Urinals No. Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. Other Gas Outlets � C� Woo Gas, Pellet Stove 2 5 NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $ I pO OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OF THE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER _ X BY DATE DATE i FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: -7- e r k? f6 gy iVo �ZoP -7' Environmental Health: Building Plan Review Occupancy Group: c- Type of Const:_ N Fire Marshal: Other: Special Conditions: FEES Building Permit 5 66-SO Plan Check 7Z Z Plumbing Fee 7Z°' Mechanical Fee - Wood/Gas/Pellet Stove S - Radon Monitor Violation Fee Site Inspection Building State Fee 5o Other Deck 352.x 6. = Z/iZ, Ni Other Building Valuation: x4l2. = izsszo : 152S.so -.5 `� TOTAL FEE