HomeMy WebLinkAboutBLD97-00388 Final Storage - BLD Permit / Conditions - 11/18/1997 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
f3F IWFFN 5pm AND Sam 427--7262
f3LD91--0388 PAPCEL :2 23047690 101 Pt. AT : D I V a 7 BLK :7 LOT 17
JOB ACbPF`�S - NE 6901 TAIiU'Y** 4LACKSM1114 tall IAIIt
OWNER - ROP 01110O 4SHANK 692--5847
C ON I'll AC IC R
LECIAL. : TO 6-A OF $tIRY 1716Q 11 K Of rt 11934 IF 6991 14`01A FIACKSOITN 10
()I' WORK, :Fitt W 13f I)p 0 0ATI-I : f1tPf AN9tlNi By 0A11 AffFIPT T�Pf AY0tlN1 BY RATE RECEIPT I
I Y P f l/`!F t_I"Q f r A C(• tY�l�tl t l •', . t(�1 �
t>CCt11' . CaRhUf 1'1 fit I)(; HE rC;F1 + . _ n 0 .01 t IPNNT t 73,Vi KS 44443 1
TYPE Of C'ONSI :':,N F" IRI Pl..,?XF3 : tit ;Pt(I! t 29.90 KS 051U01 44453
0 Wl)OOSTOVt : 0 """tfF $ 4.5O KS 05112I9i 44453 I
I)WFi L . UNI1 ;; . . 0 P,ry.f2K: IN(, .,PAC'F.S : 0 rH';P I 2f.00 kS 1511219I 44453 �
INSPF (;'vION ARF: r 1 fit-IORFI. INF •7 N, 161A1 : 133.40 YAt0141110111 7I76
' �„�.r.,vrm:m��.- �sosr:sax.:...s.:..tr.•s:a^-a�-:_:a�cvscca.�.e•::_�..._-a.�n:•:x.�r.t�eaxs_,xvt�aa:raarxr
IGILETS . . . _ . . . . . . 0 FIIFI, T 1'1:', —_ RCIt_E111-11i^0Ivip - MOBILE HOME -
FHON1* L 10 .Of t 6AT ti BA'= I Nti . . . . . . . 0 [i ;i Ilf` : 0
REAR . . . .W 210 ,0f t SAT14 'rUk3t . . . . . : 0 4 15 HF' . : 0 MODEL
S I DE ! 1 > .N 180 .Oft SHOWE14 S, . . . 91 f ORN < I00K BTU 0 1 S 0 HF' . 0 MAKE
S I r►E t ;? ) 90 .Oft WATER FIEATERS . . : . 0 F URN :.<TA 00K. RTU 0 30 50 HP . : R
SF1111. INF PI i'l0ftlP. WASI#F FIR, : . : kT F11111.1 1 ► ()OR 0 .+A { Hf 0 YEAR
AREA - KITC11EN SINK . 0 HEAT" V0MP . . . . . _ : 0
t 0i c: 1 7 1- : F1 oon r;IIAINS 0 VFNT �.."rSTF1 ':,' ; 0 ("VAP COOL FP.', 0 1, FIVGII1 : 0
RUILD1NG 57�.-) >f DRINKING FOUNT , 0 VFN1 VANS , . : 0 . HOODS . . . . . . . . 0 WIDTH . 91
RASFMLN'l- 0-f I AUNDRY If1AY,, , . . 0 � DOMES , INCIN :0 Al IN
D1 {'K'> 0; >` D I SHWASNFRS 0 AIR HANDI_ I NO UNITS-- COMML . 1 N(; I N :121
9 OAP /CAPP :G I.0 he,I %,r1HR 1)k `'ti1'(1S Al S, . . . 0 10000 i.-im , - N RE1,OCi14f"PAIke 0
Ar/DT . : '7 11RI (IAI :; , 0 > 10000 (`.flit . : 0 OTHER UNITS . : 0
MIST, 111.M k- IXI'"RFS : 0 GAS 0011,1: 1 `; 0
::.a%:naa.::;'-st9r:�'r..vf.^_e.-=ceva.�cx.":�-'s:.c's:.�,::r.-":� u-r� .c.:•.:-...m-..�:-:nu zc t... �t :_T.n:.:.f:-.:�v."2���•^'t-s:�asrt.nna....:a•?.:x..:f'x_-maR.:ru:.:sti:��:.,.;_..a.x�tc.-e..c:3u0as a:rta.:x.a'sene...�:_r as.w ..:-:nXaO':a�acs•ressec>-.:...r. Z.,:...-c•aa._:saa:r.-rY.�^..
A1'IdfCT OFSCP1tTl"1N;a1QPA�E ,)atY �_
PP, I-IiCT HICA1104001 i+R REAR iuftK OFIAIIA RD If20N 91!) k'f-! sA1R NIY G41NO 10-6O1,S1 IRON SHf'All GO APPROx 10 M1IFi AND ii4 lift 9R TAHUYA R' ;'fF`N# tN RR 41t9
Of A IIItE TIII, THE: ROAD CORYF'z TO 1l11` Ri9Af .AQ ANOT"FN 2'!10 AF, A N11_f 10 101` 9A;ON FNE :RIGHT Slfl .
�1111 PIQ14T U OW111 NOl' AND V0ID It em OR FONS10100141 AUIHGAI:FQ. 1S $(IT CONNENt-f@ U-11114 19i RAYS., ON it fONSTR(ICTION 09 1911i 1`. t11SPfN"fft 09 ". lil =IAA
Of 191 OV " AT ANY 111111' AFTFA IORF iS 0011ENCf-0. fVl@FACf: -#F COAI1kVAI!00 Alf 1019 IS A 4006IFSS iNSREC1i1iN 11111111 TRi 16/ PAY P[h1O4 fINA► !Np P; Ctl4M Iiiil KI
;',FPROVFD Al i ORf B1111.910t CAM RE 'ICCt1p If D.
4iIFR 0 diik►llcf` � 0�1Fs n 7`'.
Bt Q�NRIT, , rU: 1301111 GOMPL I ANCE 1'0 A I 1 A 11F_1) t;ONO 1 1 11041% 18 11i OU I Nf-U
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
BETWEEN 5pm AND 8am 427-7262
BLD97-0388 PARCEL :223O4769O2O1 PLAT : DIV :? BLK :? LOT :?
JOB ADDRESS : NE 6901 TAHUYA BLACKSMITH RD BELFAIR
OWNER : BOB CROOKSHANK 692-5847
CONTRACTOR :
LEGAL : TR 8-A OF SURV 12168 TR A OF SP 1E1934 ME 6901 TAHUYA-BLACKSMITH RD
CLASS OF WORK NEW BEDR : 0 BATH : 0 ITYPE AMOUNT BY DATE RECEIPT (TYPE AMOUNT BY DATE RECEIPT
TYPE OF USE . . . . :ACC STORIES . . . . . . . :0
OCCUP . GROUP . . . : U1 BLDG . HE I GHT . . : 0 .Oft iPRMT $ 73.50 KS 05112/97 44453 I
TYPE OF CONST . . :5N FIREPLACES . . . . : 0 IPLCK $ 29.40 KS 05/12197 44453
OCCUP . LOAD . . . . : 0 WOODSTOVES . . . . : 0 ISTFE $ 4.50 KS 05112197 44453
DWELL .UN ITS . . . . : 0 PARKING SPACES : 0 EHCP $ 26.00 KS 05/12/97 44453
INSPECTION AREA : 1 SHORELINE? . . . . :N TOTAL: 133.40 VALULAT ION: 7776
SETBACKS-------------- TOILETS . . . . . . . . . . : 0 FUEL TYPES---------- BOILERS/COMP---- MOBILE HOME--
FRONT . . .E 7O .Oft BATH BASINS . . . . . . : 0 0-3 HP . : 0
REAR . . . .W 21O .Oft BATH TUBS . . . . . . . . : 0 3-15 HP . : 0 MODEL : `
SIDE ( 1 ) . N 18O .Oft SHOWERS . . . . . . . . . . : 0 FURN < 1O0K BTU : 0 15-30 HP . : 0 -MAKE------
SIDE (2 ) .S 9O .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 . . . : 576sf 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 :G 576sf 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 DESCRIPT10N:ST0RAGE ONLY
PROJECT LOCATION:LEFT ON BEAR CREEK DEWATTO RD FROM OLD BELFAIR HWY GOING TO GORST FROM BELFAIR GO APPROX 10 MILES AND GO LEFT ON TAHUYA BLACKSMITH RD 9110
OF A MILE TILL THE ROAD CURVES TO THE RIGHT GO ANOTHER 2/10 OF A MILE TO LOT 8A ON THE RIGHT SIDE. �t E
OF1180EDAYS ATCANYSTIMEL AND AFTER W0RKIIS WORK
0MMENCED. EVIIDENOCE OFTCONTINOATION NOT
OFCWORKNISDAWPROGRESSHIN 0INSPECTION OR IWITHIINTTHET18 11 VD 1IN4�1���SP�,`���MIOD B
APPROVED BEFORE BUILDING CAN BE OCCUPIED, tf � �wool M
OWNER OR AGENT: / l 2/ DATE:
COMPLIANCE TO ATTACHED BLO_PRMT rev; 03l31191 CON T
IS REQUIRED
r
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
PERM 1 _T C, C?Ntl 1 `t' I %ji-J ::::;
Case No . r BLD147 0386
For BOP, CROOKS11ANK
Pages 1
The undersigned pro erty owner It: aware of the unaertaInty reffarding Mason Counly
"i •,, development regulations created by the Growth Managment Hearings Board 's Order of
October 2 , 1996 , and in oonsideration of Mason County wiIiIngness to proceed with
processinq of appl ications which alight be affected by the Order , they undersigned
propesr ty owner hereby agrees to waive arty lawsuit , aot I (in, or c. i a I m for damages aqa I rr, t Y
anon County which ma arise out of mason County ' s actions in acceptance , procesf; ing
anchor isstiance of such permits or approvals ( hereinafter "permitting aotianr " > , which
damages are attributable to the County 's decision to tako permitting actions despitm
the risk that changes to the County 's development regulations m i qht later make the
Coun y ' pe m t�i nq act I one. Invalid .
X -_�- -
The use, handling and itoratle of hazardous mat er lair or f i p mmab l e and aombu^t i b i e
liquids in excess of 10 gallons is not allowed without the approval of the Mason County
Fire Marshal .
x... 6-t2?-
)o Propoved structure or .riv portion thereof greater- thati 30" in height from a nde line ,
must maintain a minimum of 5 ' setback from _a l i property i i nes , easements and 10 ' from
aI ! &pun `_ c ta.4te Road right of wary: .
4tr, Approved per dimensions and setbacks on submitted site plan . x
5 ) All approved plans i:►re required to be on-site for Insp ect i on purposes . It i nspeot i on
is c=al led for and plans are not on Ite , Approval WILL NOT be granted . 1n addlt . on , a
Re-- i nspe3ct i on fee In the d►l►ount ref $32. .00 pNr hour (minimum 1 hour ) wi 1 i be charged and
must be: collected by this department prior to any further Inspections being performed or
raper va l ranted .
y
6) PURSUANT TO 1994 UNIFORM BUILDING CODE , SECTION :305(C). AND SECTION 513 , All- S I TFS MI1S1
ON COUNTY
MASON JllTj 5 �9°7 Mason County Bldg. III 426 W. Cedar
P,O, Box 186 Shelton, Washington 98584
M R M i T C O N E) i f i O N S
Case No . : BLD97-0388
For : BOB CROOKSHANK
Page : 1
The undersigned property owner is aware of the uncertainty regarding Mason County ' s
development regulations created by the Growth Managment Hearings Board ' s Order of
October 2 , 1996 , and in consideration of Mason County ' s willingness to proceed with
processing of applications which might be affected by the Order , the undersigned
property owner hereby agrees to waive any lawsuit , action , or claim for damages against
Mason County which may arise out of Mason County ' s actions in acceptance , processing
and/ or issuance of such permits or approvals ( hereinafter "permitting actions " ) , which
damages are attributable to the County ' s decision to take permitting actions despite
the risk that changes to the County 's development regulations might later make the
Xoun y ' s ,permj,t i ng actions i nva I i d .
-- —�7
2� 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 Marshal . q
X zf- 7
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
XI I ter— Lev an 7 �tate Road right of ways .
Approved per dimensions and setbacks on submitted site plan . 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 $32 .00 per hour (minimum 1 hour ) will be charged and
must be collected by this department prior to any further inspections being performed or
ap
X gva l .granted .
PURSUANT TO 1994 UNIFORM BUILDING CODE , SECTION 305 ( C ) AND SECTION 513 , ALL SITES MUST
P1e�se sign, date, Initial all
c04tions and mail back
t� me,
THANK YOU
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
-t vl%h +MU N 1 fii (Ali I lit- 6 11ok a I If I S Bt. i OMPL.t. i L L) i'P I (."i ! l H!_ i NU i Oh AN1 - i I t_ i f+!�iifL; I I UNS . A
RE1NSPECTION FEE BASED ON RATES IN TABLE 3A OF THE 1994 UNIFORM BUIL.DING CODE WILL. BF
ASSF'SSED IF OWNFA/CONTRAC TOR FAILS TO POST ADDRE'.�S ON SITE PRIOR TO REODUST i NG
INSPEg IONS
7,* TH i r STRUCTURE I S CONSIDERED UNHEATED SPACE (NOT' TO EXCEED 1 WATT/5',00ARF" FOOT OR ;i .4
BTU/HR!SQUARE FOOT) . AT SUCH TIME THIS CONDITION CHANGES, A CHANGE OF USE PE T
MECHAN I CAt. PF RMi T SHALL BE APPI. I FI) FOR AND APPROVED PRIOR TO THE CIIANG . X.__ _ p`
9 No OccupanQv .. This structure Is limited to U-1 uses 9fily . Any other use will be in
violation of the Uniform Building Code and Mac.zon t' my ectrgir�i� o
unless a "Change of Uso" permit Is approved . X
9? ALL _ iNST 1C; O �,!.�`'T MEET OR EXCEED ALL LOCAL. rODFI, AND UBC REQUIREMENTS .
101, Ch(-,ar;ges to approved bui Idint) plans; that offec' nompl ianue to the 1991 Washington Stator
Energy Code, 1991 Ventilation and Indoor Air Qualityy
Code, the Uniform Building Code and/or Mason County
be approved by Mason CounfV prior, to construct i onX_._, _ �
1 1.) ALL CONSTRUCTION MUST MFFT OR EXCEED LOCAL. CODES , i F ANY QUESTIONS, FLEAS[.:
C:AL.t. HIS OF I Cf BEFORE CONSTRUCTION .
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE
DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A
REINSPECTION FEE , BASED ON RATES IN TABLE 3A OF THE 1994 UNIFORM BUILDING CODE WILL BE
ASSESSED IF OWNER/ CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING
INSPEIONS c
X Z,- ,,2
THIS STRUCTURE IS CONSIDERED UNHEATED SPACE ( NOT TO EXCEED 1 WATT/SQUARE FOOT OR 3 .4
BTU/HR/SQUARE FOOT ) . AT SUCH TIME THIS CONDITION CHANGES , A CHANGE OF USE PEBYJT {kND-�A�
MECHANICAL PERMIT SHALL BE APPLIED FOR AND APPROVED PRIOR TO THE CHANGE . X C�
No Occupancy . This structure is limited to U-1 use only . Any other use will be in
violation of the Uniform Building Code and Mason my e la o
unless a "Change of Use" permit is approved . X � Z—� /
ALLe0NSTRUCTJ Of�..I�,ST MEET OR EXCEED ALL LOCAL CODES AND UBC REQUIREMENTS .
X 0 .��CC—z /
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 Bu i I d i ng Code and/or Mason County Reg u i or1,su�t
be approved by Mason County prior to constructionX
1)() ALL CONSTRUCTION MUST MEET OR EXCEED LOCAL CODES . IF ANY QUESTIONS, PLEASE
CALL THIS OFFICE BEFORE CONSTRUCTION .
X
Please sign, date, initial all
conditions and mail back
to me.
THANK YOU
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date Cc- / —?7 by z 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 by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date / 0" 7e7 by date by
L FT, q-3- 97
C� c c„ j4f- e- Stu C
L,4,0
i
i
i
ding Permit # MASON COUNTY
BUILDING III 426 W. CEDAR
q7- SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location / kt't- 6t-
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
l • 07
You are hereby notified that the above corrections shall be made BEFOR
PROCEEDING WITH ANY FURTHER WORK
*Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OK to
Department
Date L. - 6-1- - -7 Inspector -
01004 F:o *T rk Mo *V It I T
" ,�
i�.
r— 4ft
P. --No. 1 CASE HISTORY FOR CASE NO.: BLD97-0388
BOB CROOKSHANK
NE6901 TAHUYA BLACKSMITH RD BELFAIR
07/08/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
BLDA010 Application received / / / / 04/11/97 04/11/97 KW
BLDA015 Waiver in File / / / / 04/11/97 DONE KW 04/11/97 KW
BLDA100 Approved For Issuance / / / / 05/06/97 DONE KS 05/08/97 KS
BLDA500 (F) Issue building permit / / / / 05/02/97 DONE KS 05/12/97 KS
BLDB110 Structural Plan Review 04/23/97 / / 05/05/97 DONE SAC 05/05/97 WLC
BLDB130 Planning Review 04/15/97 / / 04/23/97 DONE AHB 04/23/97 AHB
BLDB134 RLC Review / / / / 04/23/97 SEASONAL DRAINAGE ON PROPERTY BUT NOT A N/A AHB 04/23/97 AHB
BLDG SITE. AHB
BLDB135 Addressing 04/11/97 / / 04/11/97 DONE GMM 04/11/97 GMM
BLDB138 Planning Pre-Review 04/11/97 / / 04/15/97 DONE MMS 04/15/97 MMS
BLDB200 Environmental Health Review 05/05/97 / / 05/06/97 There is no plumbing and no conflict/ no DONE PSD 05/06/97 PSD
existing septic system.psd
BLDC111 Footing/Foundation Wall Inspct 06/05/97 06/06/97 06/06/97 CORRECTIONS: FAIL LW 06/12/97 LAW
1. NO PLANS ON SITE, THE APPROVED PLANS
ARE REQUIRED TO BE ON SITE FOR ALL
INSPECTION.
2. VERT. REBAR IS REQUIRED TO BE 18
INCHES O.C.
BLDC111 Footing/Foundation Wall Inspct 06/10/97 06/11/97 06/11/97 DONE LW 06/12/97 LAW
1
Pe'DN.STgTFo
GARY YANDO, DIRECTOR
SO x
U DEPARTMENT OF COMMUNITY DEVELOPMENT
N Y �? PLANNING - SOLID WASTE - UTILITIES
OJ aoy BLDG. I • 411 N. 5TM ST. • P.O. BOX 578
1864 SHELTON, WA 98584 • (360) 427-9670
DISCLAIMER/WAIVER OF COUNTY LIABILIT'1': PERMITS ON E7UST'ING LEGAL LOTS OF RECORD,
LAND DIVISION APPROVALS, SUORELI7NE PERMITS, VARIANCES, AND SPECIAL USE PERMITS:
The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations creatod
by the Growth Management Hearings Board's Omer of September 6, 1996, and in consideration of Mason County's
willingness to proceed with processing of applications which might be affected by that Order, the undersigned property
owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of
Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter "permitting
actions'), which damages are attributable to the County's decision to take permitting actions despite the risk that changes
to the County's development regulations might later make the County's permitting actions invalid.
-�- N 0-1b --7 (.P Q O`a-o
Date (Parcel No. or Legal Description)
Property owner's signature(Notarized)
(or the County may accept the signature of the owner's authorized agent upon proper proof of authorization)
ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL)
STATE OF
COUNTY OF
On this _day of , in the year before me Notary Public,
personally appeared personally known to me to be the person whose name is
subscribed to this instrument, and acknowledged that he/she executed it.
WITNESS my hand and official seal.
- For County use only -
Reviewed by applicant on
4- 1J^ q::)
Notary's signature (Date)
My Commission Expires: Staff Initial:
ICe u 5 eA s 1'� V-\
Permit No. -n 00
MASON COUNTY s
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 er IIC L3 CECO K S HA N IC Phone# (09 2 - 52 y I
Address NE G401 TRHUYA - QLRCKSM ITIA RD. Fire District# 28
ity � ��I St W R
Directions to Job Site LEFT OM ROAR CRCE IL- DE WRTrO RUC u FROM OLD i3E1SVA11k
ftY C IM& TO GOIZ53 FROM 6tL'F(NIfL- &D RPP RDXI MFI-TELY ID MILES "D G-O
LEPT ON TR14kAVR- BLACK5MITA RD. 4/10 DF R MILE TILL THE KDAD WZVES
TO SIC RIGHT. CGO RNDThYC7-, Z/ID OF A MILE TD UT ?A ON TH'C 1ZI&HT SIDE
Owner Mailing Address 35 3 D OLD BELFR I R HI,IY # 5S
City 13ELPRI1k St VVR Zip q%5zg
Lien/Title Holder REIN RERLTY
Address 3350 KITSIR P WRN
city bREMERTDN St WA Zip CIT317-
#2 Contractor Name SELF Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records. NONE
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If resi ntial, proof of potable water is required)
#4 rcel No. Z230L1 - llo - 902.01
Legal Description -' 'A-A OF SUIRV 1 Z/lob TK A OF S P 4 1934
#5 Building Square Footage: (existing/proposed)
1st FI 0 / 5 A G 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage D / 5110 Carport / (Circle:Attached or Detached?)
Other sq.ft. /
#6 Use of building 5-MKRGE - 5UMMEIZ CRMP 03 Cs. Describe work
#7 Type of Job: New X Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION N!A
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 pro erty:
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences I
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
SEE R17RTLHEQ PI)&[y5
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
,I
Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each)
No. 0 Toilets V CIRCLE FUEL TYPE: Gas, Electric,
u Bath Basins Heatpump, Other
O Pa�h Tubs d No. Units Fees
G Showers 0 0 Furn �,R BTU
O Hot Water Htr CJ O Heatpumps
O' Laundry Washer O D Vent Systems G
O Sinks 0 G Spot Vent Fans C;
U Floor Drains G No. Boilers/Compressors
0 Laundry Basins O U NFL HP U
U Dishwasher O No. Air Handling Units
O Disposal O O cfm# ti R C)
O Urinals U No. Fire Protection Systems
O Other—Ni A O U Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 16.75 0 Auto Fire Sprink Sys 35.00
TOTAL PLUMBING $ No. Other
U Gas Outlets U
Wood, Gas, Pellet Stove
U L R C�
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF (U
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $
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 OFTHE 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 ' 11eL 4 '7G , X BY
DATE q`q-q Z DATE
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
[Approved Cond. Hold
Approval
Planning:
Environmental Health:
Building Plan Review ObI -40 Qe
goFOG
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee p
Other
Other
Building Valuation: TOTAL FEE