HomeMy WebLinkAboutBLD94-01541 Final SFR - BLD Permit / Conditions - 5/12/1995 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
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131._1394-1.541 PARCEL 132136/600010 PL.A f c 01 V s L31.K : LOT :
JOB ADDRESS - F 591 GOSSFR RD SHELTON
OWNER : CAS GARCIA
CONTRACTOR : HEARTLAND HOOFS 720-6919
L.F6/^1.. : TR 1 Of SURVEY 9112 FS 08941:1
fs. :-�:.;..;,sr..•zcn:s�;•rrrrs-.�-.-r;r,�oausc.::.aspr..+�.�z:.r:,ar:��s�.:r..�aa:�sxcn�*--n.�.�..-rz�:>:::..:x.�:sx.�rra^,x:.x.r.xr�r:.e',�
CL.ASc� OF WORK . . -NEW BEDS : 3 BATH : 2 JTYPE AMOUNT BY DATE RECEIPI jTYPE AMOUNT BY DAIE RFCEIPTj
TYPF OF USE :SF
O(;CIIP . GROUP . . :? BL.DG . HE 1 GHT . ,. : O .Ott PANT 1 399.O0 TV 12121194 38929 �WDST 1 25.00 11 12121144 36029
TYPE ',)F CONS T . . :'7 FIREPLACES . . . . : 0 11011 t 8.00 TO 12121194 38029 ISTFE f 4.50 iN 12121194 38029
OCCUP . LOAD .. . . : : 0 WOODSTOVES . . . . - PICK I 199.59 TN 12121/94 36329 EHfE I 25.90 TN i`>121194 38929 +
DINE L .UN I 'l ^ . . . , : 0 PARKING SPACES ., 0 I'PtM I 48.00 Ill 12121/94 .38029 1
INSPEE'TION ARFA : 4 SHORELINF? . . . . :N MCH 2 51.00 TV 12121194 38029 ITOTAI: 760.00 VALUTATION: 813191
SETRACK >— -.__—_.__..____ _.._ T 0 11.E T!3 . . . . . . . . . . . 3 FUEL TYPES_ _ __... __.._._. SOILERS/COMP._. - -- MOBILE: HOME---
FRONT . . .W r1 .Of't BATH BASINS . . . . . . c 0 : / Et..E/ / / 0 ;3 HP . -I 0
REAR . . .0 5 .Oft PATH TUBS . . . . . . . . 2 3-15 HP . : 0 MODEL :
SIDE ( 1 ) .N . Oft SI4OVV RS . . . : . . , . . . : 0 FORK 100K. BTU : 0 15-30 HP, : 0 --MAKF,._.__ -._
SIDF (2 ) .S 5 .0ft WATUR HFATFRS . . . . 1 1 FURN >=1O0K PTO : 0 30-50 HP . : 0
SHRI I NE 0 ,Oft C.t OTHF.fi WASHERS r 1 FURN -- FLOOR . . 1 50+ HP . - 0 - YEAR---
AREA ------- ____ ...___ . K I TCHEN S I NKS . . . . : 3 HEAT PUMP . . . . . . 0
LOT SIZE . FLOOR ORAINS . . . . . _ 0 VENT SYSTEMS . . . : i EVAP COOLERS : 0 1FNGTH : 0
RU I L D I NG . . . :- 1 8IIA4 f DRINKING, FOUNT . . . : 0 VENT' FANS . . . _ . : 3 HOODS . . . . . . . . 0 WIDTH : 0
BASEMENT . , . : ;)Sf LAUNDRY TRAYS . . . . t 0 OOMEh . I NC I N :O -SErR I AL #
1)ECKS . . . . . . . 91 ,HWA3HFRS . . . : 1 A 1 fl HANDL_ I NG ON I TS-- COMML . I NC I N :O
GAR /CARP :G <, f reRB DISPOSALS : 0 <- 1O000 efm . : 0 AEl_OC/REPAIR ; 0
AT/DT , cA U INALIS . . . . . . .
. . . . 0 > 10000 c;fm . 1 0 OTHER UNITS . : 01
04XC PLM FIXTURES : 0 GAS OUTLETS . : 0
z'tears:�.aetm7.a.:v_aw^:.;:ct:....�_:i.^s at:rs':':.....xz.:. .. ..:.. .. ...��s�•-x-sx.-.��:�tat�:sta.^.-':tmx:v�c'�.:;c.���r_-r_'rxst�izrxa�:zs.�:-ranearz:.�zzz•xta�-:z':t._—.,�i::rs�r_-.-r>;C'::.ac-••-•��.-,:t�...:�:::ata:a,"'�^c:rxs:ss^u'cs^.- s_'^ns�na.^:xs.:r.:
PROJECT OE�CRIPT4N;RES111EMCI
PROJECT LOCATIONcHWY 3 RIGHT ON CK: GHT ON GOSSER
THIS PERMIT BECOMES NULL AND VOID W,, OR STRUCTION AUTHORIZED IS NOT CONNENCID 11111111 180 DAYS: OR If CONSTR€+CTION OR R(+RK I', SUSPENDED FOR A PERIOD
Of 169 DAYS AT ANY TIME AFTER WORK C NC EVIDENCE OF CONTINUATION OF WORK 1S A PROGRESS INSPECTION WITHIN THE 110 DAY PERIOD, HIM INSPECTION MOST BE
APPROVED BfFOR BU LDING C)►4 BF 0 D.a�
401 ON AGENTc DATE: �/ y
bil PANT, rev, #1/3;191 COMPLIANCE TO ATTACHED'CONDITIONS IS RFQUIRED
CONCRETE MECHANICAL - MOBILE HOME
Footings Ibacor date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date I /I QP� 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
WALLBOARD NAILING
D.W.V. date -Z`�-`Z� by
date by
Water Line FINAL INSPECTION
date by date by date by
/i �u9'Io(V f ✓n �� 1 C 4
czo-
�WWLvr�F A-f `m a- 1' AA
CONCRETE MECHAIG'{'CAL 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 po / O—
date by date r4 by Z��6� o
WALLBOARD NAILING
D.W.V.
date by date by
Water Line FINAL INSPECTION
date by date�,� byV date IZ�f �� by
—
p .-
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MASON COUNTY
� ► 1 I �11 '/ , 1 �� BUILDING • CEDAR
CORRECTION NOTICE
6�n��AcL
'•i
and the fojlp VIOLATION of County Laws and Ordinances has been
found: (n)= '-� a,
Items listed below must be corrected to gain code compliance
This structure has been inspected by Mason County Building Department
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MASON COUNTY
BUILDING III 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location CI11-16gj
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
k,K H-ZLD 11W Q;�Qy D&�nb�2�
- '��rY c,e c7 b� c'y) R-(0 InC'C r i/1.&
T Al'A rnft uy)Ae y -bu i W y�4 do �o 6-dz ny
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 checked on next inspection
Q OK to 1fk OGz�-e c, Aky ab,-uP
jgwd oFf Department Tc n
Date` ►'R-`�� 3 ��� Inspector
• 100 0 1:0 OT 'Mo *V T 1 T' ,01 M
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
F- n IN I _T' r- rl rA n 1 r- i
For : COS GARGIA
Page : 1
1 ) The uc,,e, handIinp and storage of hazardous materials or flammable and combustible
licauids in excess 0�1 10 gallons is not allowed without the approval of the Mason County
Fire MaT�haI . , "
2) �Subjec.t to conditions of Resource t.ands and Critical Areas (RI_C ) Checklist .
R ,C 94--.1193
f'
3 PropoE.ed structure or any portion thereof cheater than 30" in height from grade line ,
mini- maInta1,n a minimum of 5f setback from al property IIn�:s , easements and right of
ay . ;
.4 ) All approved plans are required 'to be on-�; i to for inspection purposes . If Inspection is
called for and plans are not on site, Approval WILL NOT be granted . In addition , a
Re- Inspeotion fee in the amount of $'10 .00 per, hour (minimum 1 hour ) will taw charged and
` must be collected by this department prior to any further inspections being performed or
pproval.i quarirtecl.
5 ) 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 81F PLAINLY VISIBLE
AND LEGIBLE FROM TIME STREET OR ROAD FRONTING THE PROPERTY . MASON COUNTY BUILDING
DEPARTMENT RE..QUIRFS THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS , A
RE1NSPECT1ON FEE BASED ON RATES IN -(ABLE 3A OF THE 1991 UNIFORM BUILDING CODE WILL RE
ASSESSED IF' OW EIi/CONTRAC'TOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING
I NSPECT,1- NS .
O ) ALL. CONSTRUCT IPN I UST MCf T OR EXCEED ALL. LOCAL CODES AND UBC
REQIJ I RE191;ENTS /
71 hanges to approved buiIding plans that effect oomplianc,e to the 1991 Washington State
Energy Cede , 1991 Ventilation and Indoor Air Quality
I
i
MASON COUNTY
Mason County Bldg, III 426 W. Cedar
Code, the un I f riit P.O. Box 166 Shelton, ,Washington 98584
he approved by Maur, pi n X
8 ) CONSTRUCTION PROCi ; I F I FL.D Ct E T E RE U I 44TY BUILDING
DEPARTMENT AND UN I FUNM BUILDING COD! �
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GLAZING
Plan Reviewer-Fill out this glazing section or attach a window schedule to this checklist. Spector- 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.
o't)o w 3 _ t,c�
0-4 L40
IL7 I
Z dS� I I l l 1+0
D� 1
Lt03(p i Opp
40� 3
Lie-
Total glazing area: Z-70
Total conditioned area: k J'f
Percentage glazing: � Verified:
DOORS
Plan Reviewer-List opaque doors by type(solid core,insulated,etc.)quantity, U-value,and manufacturer. hgpistor-
Verify door information during field inspection.
Date
Type/Quantity U-Value Manufacturer Rev. Insp.
8
LA O :�-:)O l t-c(, COQ-C
Signature of Building Inspector: Date of Final Inspection:
Date Checklist Prepared 10-
MASON COUNTY BUILDING DEPARTMENT
PLAN REVIEWER AND INSPECTOR CHECKLIST
1"l WSEC AND V&IAQ CODE COMPLIANCE
Permit Number Address --L>A. Sq. Ft. I S U
Name on Permit Garua, C7N!�-, Contractor/Phone# 1- ao (Dglq
Compliance Method: (O'irescriptive Zit- (option) ( ) Component ( ) Systems Analysis
eke—
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 insulation: R-
( ) ( 0-�Crawlspace ventilation: lC A71 1W,,_7. :2-)(1 q.ft. rNFA/150 sq.ft.floor area-cross vented)
FRAMING
(-►) ( L�Y 'Standard ( ) Intermediate ( ) Advanced
Woodstoves and/or fireplaces: C(65in s combustion air supply duct with damper direct to firebox.)
Standard ail'seal: (Bottom plate/subfloor,rim joist/mudsill,window/door frames,penetrations condition to non-condition.)
(') ( L.�Attic ventilation (1 sq.ft.hTA1150 sq.ft.ceiling area)
(�) ( &K Spot exhaust fans: (4"exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 cfme 751wq. Vented out with dampers.)
( ) ( vY Fresh air ventilation: Available to all habitable rooms. Installed and operati(0 forced air,windows,wall ports.)
( ) ( a/Whole house exhaust fan: /ccfmm(Intermittent system manual&auto controls/sone ess than or=to 1.5 at.1 WG)
INSULATION
(S:* 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.)
( L;r�Wall insulation(above grade) R- 1 C1 Batts face stapled)
( ) ( ) Wall insulation(below grade-interior) R- (Batts face stapled)
Vapor retarders on walls (Faced batt,or mil pot r perm.paint.-circle one)
Rim joist(Insulated with vapor retarder-rigid foam and caulked or 4 mil poly.)
Vaulted ceiling insulation R-?0 por retarder&1"airspace)
FINAL
Floor insulation R- 30 (Substantial contact w/surface,suppo -
( L,�— Ventilation system is operational(spot,whole house,fresh air to all habitable rooms. If integrated system,certification by installer is
required.)
(� ( t.Y HVAC ducts in unconditioned areas R-8 (Joints sealed;mechanically fastened with a minimum of 3 fasteners.)
(7) 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 shut-"off,on R-10 pad if electric in unconditioned or on concrete.)
( ) ( L)/ Heating system type: l-�C rC erg ,r' 1 L+4.1)py
( ) ( t)/ 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.)
( ) ( tK 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.)
( ) (Veiling Insulation R-�1 nsu ate&weatherstrip access,baffle to prevent spillover-no cardboard)
apor retarder paint if a vapor retarder was not installed when insulation was installed.
WASHINGTON `
ENS BuildingRecord Attachment B
CODE WSEO Contract# 91-19- �_
PROGRAM For Site-Built Residential Buildings Heated by Electric Resistance or Heat Pumps
CLASSIFICATION _ .
�NewBuilcling
ease check one) (please check one)
❑Addition over 500 sq. ft. Single Family ❑Duplex
Jurisdiction: ❑Multifamily ❑Zero Lot Line Home
❑Planned Unit Development�.
please check one: ❑ City County Permit# / 4 — 15y/
File ID#(if different from Permit in
CONSTRUCTION
A. Site Information B. Owner Information
Address E �'�,� ��;;�r i� Owner (owner atdmeofconsmxwonreoeluesubil ment
Ans 7QrC�a
City e he Zip ��8-��b � _ Company
Assessor's Property Tax#(or attach leg deal scription): Address
City N, e Jj6t 1 State dlq Zip 1
-Servicing Electric Utility - �O/D\-3 Phone
C. If Single Family, Zero Lot Line or D. Duplex E.If Multifamily(R-1)
Planned Unit Development — ---
First Duplex Unit _ s .ft. Total#/Bld s.
Total Conditioned Floor Area f�D ft. Second Duplex Unit sq.ft. Total#/Units
. = EATOU
_— -- --- - H S---RCE
A. Primary Space Heat Type B. Secondary Space Heat Type C. Water Heat Type
(check one) _ (check all that apply) (check one)
❑ Electric Baseboard ❑ None Electric
❑ Electric Wall Heater Wood ❑ Gas
�. Electric Furnace ❑ Electric Baseboard ❑ Other (specify below)
❑ Electric Heat Pump ❑ Other(specify below)
Other
'' ''ic ., ,;� .�,`•` .�. -� '. - .:�Ftf!*.°r>r''..; ..:.,._;•,. - - .; ,....;
COMPLIANCE INS ECTIONXNFORCEMENT
WSEC Compliance Method For Heat Pump Only:
Date of Permit Application y
1 Prescriptive Path Built to the Electric
f p ._ // —
❑ Component Performance Requirements of WSEC? Date Building Permit Issued /a -a �T—
❑
Date of Insulation Inspection System Analysis ❑ Yes ❑ No (If yes, Date of Final Inspection /
utility may offer incentive.)
I hereby certify that this building or addition has been inspected for the measures required
by the 1991 Washington State Energy Code(WSEC), that it is in substantial compliance with
the WSEC, and that the ��EC checklist for this building is on file.
� r� -7_ S
Signatur of wilding Official or Authorized Representative Date
■ Building Department:Return white copy to Kathleen Skaar,Washington State Energy Office, P.O.Box 43165,Olympia,WA 98504-3165.
■ Owner or Building Deparment: Forward canary copy to the servicing electric utility to trigger WSEC compliance payment.
■ Building Department: Retain pink copy for jurisdiction's building file. I
WSFOa94 015 r 2 94
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
OWNER IL, � ( TELEPHONE j j o i -7,)v (,
COMPLIANCE INFORMATION
TYPE OF PROJECT: (�N/EW RESIDENCE O ADDITION O REMODEL O OTHER
AREA(SQ.FT.) 1ST FLOOR Z 2ND FLOOR ZI Z HEATED BASEMENT —'
Note: Heated basements must be insulated and finished to meet minimum energy code requirements.
TOTAL SQUARE FOOTAGE OF CONDITIONED (HEATED) AREA��O
COMPLIANCE METHOD:
() PRESCRIPTIVE PATH — circle option— I H III & V VI VII VIII
Glazing percentage HI L' o (total glazing area divided by total conditioned area)
() COMPONENT PERFORMANCE — Chapter 5 — attach documentation and worksheets
() SYSTEMS ANALYSIS — WATTSUN 5.2 — attach documentation and worksheets
WATER HEATER
(.Electric water heater () Gas water heater
HEATING SYSTEM:
ELECTRIC RESISTANCE
Electric Central Furnace () Electric Wall Heaters ( ) Baseboard Units
O Radiant Panels O Other
OTHER FUELS
() Heat Pump with electric furnace ( ) Heat pump with gas furnace ( ) Gas Furnace ( ) Oil Furnace
() Other () Boiler System (indicate type)
Make Model
Size AFUE HSPF
VENTILATION SYSTEM:
(- pot 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,
',ntermediate, advanced); type of vapor barriers being used; location of furnaces, hot water tanks and
rher equipment; location of solid fuel burning appliances, fireplaces and thei<combustion air duct runs;
d termination points of exhaust ventilation fans.
WINDOW & DOOR SCHEDULE
r�
WINDOWS
INCLUDE ALL WINDOWS, SKYLIGHTS, SLIDING GLASS DOORS, FRENCH DOORS AND
STORE DOORS. ANY WINDOWS IN DOORS(LESS THAN 50% OF AREA) MUST BE
TAKEN OUT OF THE DOOR AREA AND PUT INTO THE WINDOW AREA ON THE
SCHEDULE.
BRAND MODEL U-VALUE QUANTITY SIZE TOTAL SQ. FT.
TOTAL WINDOW AREA
DOORS
BRAND MODEL U-VALUE LOCATION SIZE TOTAL SQ. FT.
TOTAL DOOR AREA
HEARTLAND HOMES, INC.
3216 South Tacoma Way,Tacoma,WA 98409 475-3537
License#HEARTHI077NQ
r � al/ 3 ��
d
atAA,vrlT 410
S-� G YL
CASIMIRO G. GARCLA ' 4 -/s 4 I __-__--
E 591 GOSSER RD. —a l — � ;�-c P'NTW;F
SHELTON, WA 98584 FEHt�L i
� � - TUN.Wr,
JUL
�s5n�
$2.52
CERTIFIEDFold at line over top of envelope to the 0
right of the return address
Z H07 275 aye /? O. x
�7'rH: -ro H i 116tZ MAS S EN
MASON COUNTY DEPARTMENT OF HEALTH SERVICES
POST OFFICE BOX 1666
SHELTON, WA 98584
(206) 427-9670
FAX 427-7798
DATE:
7
BUILDING PERMIT t�L y
PARCEL ##
Your building permit cannot be processed by Environmental Health until the following items are
completed and turned in:
Application of Water Adequacy
Approved sewage system permit a design
13 A complete set of septic records including an As-built
(for existing septic systems)
Q A complete and accurate plot plan
13
If you have any questions, please call Helen Syferlich at extension 546 from 8:00 to 9:30 Monday
thru Friday.
REvIEWING SANITARIAN
r'
lAanville
Gold Fiber Glass Insulation D
Installation Record itILI o 199.
f,,ENERpL-SERVICe!F'
Batts& Blankets _
Description of Area Sq. Ft. of Insulation R-Value @ Thickness
Ceiling
Ceiling
Wall
Wall Exterior 1450 R19
'Floor over garage 354 R-30
Floor twined 1118 R-30
If batt or blanket insulation has been installed in enclosed cavities,those cavities are deep enough to allow insulation to
expand to the labeled thickness unless exceptions are noted above.
Blowing Wool in Ceilings
Nominal Net Sq. Ft. Minimum
Bag Weight Insulated No. of Bags R-Value Required Thickness I
40 600 14 R-4 R 1611 -
Blowing wool, if used, has been installed in the ceiling in conformance with the manufacturer's requirements shown
on the bag.
t
Location
St.or Lot# E 591 Gosser RD
City Shelton WA 98584
Builder
Company Name Heartland Homes
Signature Date
Insulation Contractor
Company Name Washington Insulation
Signature Date SS
Manville
Manville Building Insulation
A Division of Schuller International. Inc.
1. Original for Homeowner 2. Copy for Home Builder 3. Copy for Insulation Contractor
Pnnted in USA
61C 212A 0, Q)
Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628Q6 �h
PLEASE PRINT
#1 &aiwte
nerPhone#
Address soz Fire District#
City j li✓A ` kV796! St Zip
Directions to Job Site �c.J_7— 03 L-P. a-r- orrr► Gam cGn. 3ell
.3
Owner Mailing Address �L) �eXo S
City �p (I i'b' St Zip
Lien/Title HolderA(�vni G�92ci.¢
Addressrx
Clty St Zip
#2 Contractor Name /AAl—?" Zo5welt4 t:z Contractor Reg# c GL
Address 3 216 S• 7.4 corn-4 w14-Y Expiration Date_
City TAc yKA L' r i moo St Zip Phone# )y -7ao 6 f'4
—r—
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 eagal No. 32136 - 76 - c� 00/0escription 1 a
#5 Building Square Footage: (existing/proposed)
�1 st FI ZO 1-1 '7/ ?i 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms—/ #bathrooms Z /
Garaged/ Carport �" / (Circle:Attached or Detached?)
Other sq. ft. /
#6 Use of building Sim c'cr 1;9na . c3• Describe work
I
#7 Type of Job: New _Add Alt Repair Other
—#
#8 MOBILE/MANUFACTURED HOME INFORMATION
nn
Model Year Make Model t
Length Width Serial No. �� D
# Bedrooms #Bathrooms Type of Heat
Purchase Price$
#9 In¢irate by circlirm.the applicable source if any water is on or adjacent to subject property:
fiver.' Pond re 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
�e--
l� W
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
ai
at
of
1 e
O
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: S ,ec�- S�'��s-r r'���f�U n`. Q Rcc C
� i4—jl �
Environmental Health:
Building Plan Review
�i
Occupancy Group:_ Type of Const: S—
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit 3q9,QD
Plan Check In 55
Plumbing Fee !
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
t4/ Violation Fee
Site Inspection
Building State Fee s�
Other
7 v o Other
Building Valuation: [S �— TOTAL FEE
Plumbing_Fixtures ($3 each) Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas Electri
Bath Basins Heatpump, Other
2Bath Tubs N_Q. ni s Fee/es
4;,,Showers Furn BTU �P
Hot Water Htr _ Heatpumps
Laundry Washer Vent Systems
Sinks Spot Vent Fans
Floor Drains No. Boilers/Compressors
_Laundry Basins HP
/' Dishwasher 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 $ `� Cl No. Other
Gas Outlets
Gas, Pellet Stove
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
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
FOR OFFICIAL USE ONLY: Accepted by: Date: