The URL can be used to link to this page

Home My WebLink AboutBLD2005-00306 Final SFR - BLD Permit / Conditions - 1/31/2007 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 BLD2005-00306 OWNER: STEVE GILBERT RECEIVED: 2/25/2005 CONTRACTOR: LICENSE: EXP: ISSUED: 3/31/2005 SITE ADDRESS: 6980 NE TAHUYA BLACKSMITH RD BELFAIR EXPIRES: 9/30/2005 PARCEL NUMBER: .223047790091 LEGAL DESCRIPTION: TR 9-A OF SURV 13/40 TR C OF SP#1934 6980 NE TAHUYA BLACKSMITH RD PROJECT DESCRIPTION: DIRECTIONS TO SITE: SFR FROM BELFAIR, TAKE OLD BELFAIR HWY N TO BEARCREEK DEWATTO RD ( L), LEFT ON TAHUYA BLACKSMITH RD, VEER RIGHT AT SPLIT (BUNSON BLVD), FIRST DRIVE ON LEFT. General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: VB Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck: Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:1,724 Garage-Attached 413 Valuation: Building Height: 15 Occ. Status: Primary Basement: COVPORCH 37 Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft. Front: N 70.0 Ft. Shoreline: Ft. Water Body: Rear: S 20.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: W Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: E Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Plan Check Fee KS 2/25/2005 $736.94 S12005 Hosebibs 3 Furnace<100K 1 Planning Review Fee KS 2/25/2005 $155.00 S12005 Kitchen Sink 1 Gas Outlets 3 Building State Fee ARC 3/11/2005 $4.50 B12005 Lavatories 3 Propane Tank 1 Building Permit Fee ARC 3/11/2005$1,133.75 612005 Showers 1 Ventilation Fan 3 Mechanical Fee ARC 3/11/2005 $75.75 612005 Water Closets (Toilets) 2 Dryer Vent 1 Mechanical Base Fee ARC 3/11/2005 $23.50 612005 Water Heaters 1 Plumbing Fee ARC 3/11/2005 $89.00 612005 Bath Tubs 2 Plumbing Base Fee ARC 3/11/2005 $20.00 612005 Clothes Washer 1 EH Plan Review CEW 3/16/2005 $75.00 612005 Total $2,313.44 BLD2005-00306 Please refer to the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD2005-00306 CONDITIONS FOR BLD2005-00306 1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647- The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) The internatioanl code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150' from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such a nect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X — 3) Wat r qua' is not to be degraded to the detriment of the aquatic environment as a result of this project. X 4) Prior to al approval, all upland areas disturbed or newly ted by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 5) Approve r dimensions and setbacks on submitted�plan. Setbacks are measured from the furthest projection of the structure. X 6) All app ved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be grant : In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour) will be charged and must be collected by the Building Depa for to any further inspections being performed or approvals granted. X 7) In accordance with international codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus Access Roads," all new structures that require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from the access road. The numbers shall also be plainly visible and legible from the street or road fronting the property and shall contrast with their background. Mason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted by the juri y�tion and the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting inspec X BLD2005-00306 Please refer to the following pages for conditions of this permit. 2 of 4 Q) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal of " roved documents will result in failure of required building inspections. X 9) THE F NDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X 10) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour) will be charged and shall be collected by the Buil in rtment prior to any further inspections being performed or approvals granted. X l 11) Washington State Energy Code Compliance has been approved using the following: Heat Type: Electric or other fuels, Compliance Method: IV, Window (Max U-Factor):0.40, Skylight(Max U-Factor):0.58, Doors (T ax U-Factor):0.40 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-30, Slab Insulation R-10. X 12) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical co crete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). X 13) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit rev on. X 14) 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 granted 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 Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For 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 proj t. X 15) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordina X nce lation, must be reviewed and approved by Mason County prior to construction. 16) The cons ruction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector made prior to requesting additional inspections. X BLD2005-00306 Please referto the following pages for conditions of this permit. 3 of 4 17) All property lines shall be clearly identified at the time of foundation inspection. X 18) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason Co rdinances and building regulations. X 19) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder hav vented action from being taken. No more than one extension may be granted. X 20) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connecto flashing. Install metal connectors approved for contact with the new types of pressure treated material. X 21) Revised i e plan dated 3/22/2005 replaces all perviously submitted site plans. This permit becomes null and void if work orconstruction 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 rogress 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 wner•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 sting tur r view�nd inspection. OWN ER OR AGENT: DATE: BLD2005-00306 Please referto the following pages for conditions of this permit. 4 of 4 M t CONCRETE MECHANICAL MANUFACTURED HOME Footings/Setbacks GaDate s Piping By Ribbons Interior Date By Interior-Date By Date By Exterior Date By Exterior-Date By Set-up Point Load/Isolated Footings INSULATION Date By BG/SLAB INSULATION Date By Date By FIRE DEPARTMENT Foundation Walls Floors Date By Date By Date By DECKS FRAMING Walls Date By Date By Date By PROPANE TANKS PLUMBING vault Date By �J Date By OTHER Groundwork Attic Date g Date By Type: ` y Date By C � D.W.v DRYWALL Type: Int.Brace Wall Date By Date By Date By FINAL INSPECTION Water Line Fire Seperation Date By Date By Date 31 07 ByR L- Pass or Request Inspect. Type of Insp. Fail Date Date Done By Comments Iglet qZ7/0S_ bgC- 10.0k 0A-L FAW Frame ne6Ia F, 3�8�� 3l co e( �c S �C,� z Ns PT—__i;4E pm4i 8 o N o 1 N IL CONCRETE MECHANICAL MANUFACTURED HOME 0 T Footings /Setbacks Date By , Ribbons C I Date G - L�� By J- Gas Piping 'r lZ GC-�Rl. Date By rn Foundation Walls Date Leg-cj- B Set-up Date [-�o O) INSULATION Date By B G / Slab Insulation Floors Final D ate B y Date B y Date B y FRAMING Walls FIRE DEPT Date //-2 2 -GI ByT/L _ Date Z. oS US By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOA D NAILING Tr3wp D.W.V. Date I /z 7 By Date -L By FINAL INSPECTION Water Line / Date By m Dates/-Z2�'�I/ 1By Date By PC ,44 CD a — 0 �b C U 8 o a21 � y cns r � 0 or— : zH,- f, OL11 rASAIZAI A it 17- 4 a- AmK Res Ix-y c-11 ,�s LPG 4*4Ar- � v-r— fi 6*$ -tv not 4 Cirdl 4&Ck_ 71 C-C- !l�� lyr der �� %`�pc'n�l' /��/�✓ � `�`�a' /��., /-+��./`�,� 4-1/LC- 13,e r"> zpvak- s� Oil1 2_ -LI)C7S- A r,-c ' N. APPROVED MASON COUNTY DCD PLANWNG SITE PLANRLQ'_'i:,?ED TO BE ON SITE ANOES 'I TO AP�O AL U� Dote PLOT PLWo'pj HgRCE i»t 2Z3m�4 -Ti - gOO91 -ITL. c of S.P. \ FOR: 'S-VEv>; Ga uaE17-t` _ BY : -V -JA- sy;? TT T3ES zGrvS — Mo�t� � J 1 CTD 13E -7`+ FoR ResEc��n.�4� 0, 51J, eoz, SOTI_ Locos 1177�� '`'sr � �� CRgtl• 75 of of O �r d t 1-{ARDPAnJ e 'fs� roP pa s e c� P 9 fib"'r 4-�RoP�I ti (ZUDT% TD _- C'c?rTr-T*& o r p�M�TAhK-y i 1 (Mgou� RE" Do�..�NSI..OPC- Ko'��'�L `��u k�z aJ z3UrtE s —� 3 114 of nlv) toll -16"E MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT RECEIVEIbVIAQ Compliance Application Owner: Tele one' 7 Parcel#: :?2 304 7;420 Type of, o ect New Residence ( )Addition ( ) Remodel Total Sq. Ft. loor : fl r Heated Basement: of heated area:: T /7.2 Heating System: O Electric wall heater O Electric Central Furnace $LPG Furnace O Heat Pump with Electric Furnace O Heat Pump with Gas Furnace O Boiler, specify fuel type O Other: Specify. Glazing Prescriptive Option (see reverse side) circle one: 1 II IV Percentage: Compliance Method O Component Performance , Chapter 5 — Calculation worksheets required % Check one: O Systems analysis, Chapter 4 Whole House Ventilation system O Whole House Ventilation using a Heat Ventilation us ng exhaust fans&window or wall fresh air Recovery Ventilation System (viAQ 303.4.4) System vents (VIAQ 303.4.1) Check one O Whole House Ventilation Integrated O Whole House Ventilation using an inline with a Forced Air System (VIAQ 303.4.2) supply fan. VIAQ 303.4.3) Window & Door Schedule (If needed, attach an additional sheet) Total Manufacturer Room/location U-Factor Size Quantity Square Feet Windows: E►4!2 .40 IZ" X (00" 0 Bat'�wo •q0 may* x 3(0 ! a►Y,�l .q 0 124 " X 49 to 2 Fam►j , q0 qg- x qg" Ito StuA '40 49'' x 48" r i (fed 03 . qo o., x 99 a- 40 aSter 0 7.2 x 48 " ! 2 tch ev, '40 8l' k y.2" m►l glider .40 (00` al I 3415 Windows: Total Sq. ft. Doors: 3&" Doors: Total Sq. Ft Total window and door area Total window & door area p8'S ! (divided by) total sq. ft of heated area %of glazing MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Assistance Center SHELTON (360) 427-9670 BELFAIR (360)275-4467 SEATTLE (206)464-6968 ELMA (360)482-5269 FAX (360) 427-7798 WEB SITE: www.co.mason.wa.us P.O. Box 186, SHELTON 98584 2001 Washington State Energy Code (WSEC) effective July 1, 2002 2000 Ventilation and Indoor Air Quality Code (VIAQ) Code Compliance Application Form The following information will be required for the WSEC and VIAQ plan review: 1. Complete the Washington State Energy Code/Ventilation and Indoor Air Quality Code (WSEC/VIAQ)application located on the reverse side. 2. Complete the window and door schedule on the reverse side. Include all windows, skylights, sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening dimensions of the windows and doors. Information about the U-factor of the window will also help to expedite the energy code review. If you are complying with the WSEC by prescriptive path and are using the area weighted average method you must include your calculations. 3. On your building plans note the location and fuel type of water heater, location of exhaust fans (bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and slabs, 4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 284. Additional WSEC and VIAQ compliance information is available on the internet at: www.energy.wsu.edu/buildings/ Prescriptive Requirements 0,1for Group R Occupancy Climate Zone 1, Table 6-1 Glazing Glazing U-factor Wall Wall Wall Area%of Door Ceiling Vaulted Above interior' exterior s Slab' Option Floor Vertical Overhead" Factors Ceiling Grade below Below Floor on '2 grade Grade Grade 1 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10 11* 15%* .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10 IV Unlimited Single Family Res .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10 (R-3)Only "Reference Case/Call(360)427-9670 ext.284 for footnote information. Log&solid timber wall with a min.avg.thickness of 3.5"are exempt from the above grade wall insulation requirements. Request To Revise An Approved Plan Permit Number: BLD200_a_-POGO Nam (�4,( LCIe4 Parcel Number - - Phone Number daytime Project Address Mailing Address Please provide a complete,detailed description of the proposed reyis' ns to the approved plans: Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No Are the approved site plans included? ❑ Yes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? ❑ Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No If Yes,Has the engineer or architect approved this revision? ❑ Yes ❑ No Is a stamped and signed approval included with this request? ❑ Yes ❑ No (Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record 1 Does the proposed revision modify the footprint or location of the structure? ❑ Yes ❑ No If Yes, Is a revised site plan,.with all new setback dimensions included with this request? ❑ Yes ❑ No Additional Information: Applicant's signature s6x-- Date: Office Use Only Received by: Date Sent Assigned To I Approved By Date B Original Valuation: $ Additional Valuation: $ P' / 3 ZZ b Sq.Ft. x$ $ Sq.Ft. x$ $ Total New Valuation $ Additional Fees: P'w' Additional Planning Dept. $ Additional Plan Review $ New Setbacks: Front / Rear / Additional Building Permit $ Side 1_ / Side2 / Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. $ Other $ Total Amount Due: $ Amount To Be Paid Up-Front$ Tan finial Revised sRc W2ZrM 05 &.ef-�64-7 P RECEIVED MAR 6 3 2005 426 W. CEDAR ST, Fro;-�� f ✓�� b e r`�" � � io J -- J 3 6 o) -7 1 0-- MASON COUNTY PERMIT NO � �(� RECEIVE[PUILDING PERMIT APPLICATION 426 W. Cedar • P.O. Box 186, Shelton, WA 98584 FfB, 215f200960) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANTv"� 14216FOJ 'gfPIAR ST CONP RACTOR INFORMATION+, Owner S� eYl (wi Q Com an Name_ Reahl)� ilOMt°5 �nC. Mailing Address 1GQ50 Ale Tl h t;,� G jl ac SkrL A £d Mailing Address 1 30 ,A e x a tlde_r- Ave, City- ae-la t r State UA Zip Code W95 29 City �i el State WA_ Zip Code Phone 634 710- 2`�Other Ph3 -3Q31 Phone L 53) 9z(o- (4330 Other Ph. Lien/Title Holder Klu r� 6,24 Contractor Reg. # RFA L z H X 98 4CN Exp. E mail address SW�� 525 0 Va�7T oo.Co!? E Mail Address Drivers Lic. # DOB 12 5 S/, Drivers Lic. # DOB_ SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Erle ksn)i Lake- Ilorrr aWn ers As HOC, Well Water System Name of Water System PARCEL INFORMATION - 12 Diait Parcel No Fire District Legal Description- rR I_A o� Sid RV 13/Y1O o S # g 3 Site Address (Please include street name, street number and city) F 7-l a a W /3e�l Q�r Directions t�)site e it d e r' Nw v h o r-crep w4 6 d, Je When le n a e r- 1 of ` Mu a 6hd1- -r-"_5t 11 'v2 yr Will timber be cut and sold in parcel preparation. Yes ANJO Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o TYPE OF JOB - New X Add Alt Repair Other PRIMARY RESIDENCE P� SEASONAL ❑ Use of Building rres(d hCCa' Describe Work No. of Bedrooms—3 No. of Bathrooms 2 Square Footage- 1 st Floor /7- 2nd Floor 3rd Floor Basement Deck Covered Deck 37_�06her Sq. ft. Garaged Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make 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. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply fo t 's permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is a e and rants mp oyees of Mason County access to the above described property and structure for review and inspection. PROOF CONTI 1 RK IS BY MEANS OF A PROGRESS INSPECTION. X Date: .;2"..2y-0 S CQW29224ers R s tative/Contractor indicate which one FO CI L USE BE OND THIS POINT Accepted by: Date DE ARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department 404 _VE 0'43 - Qc,,,g5` v Public Works Department Fire Marshal FEES Building Permit Fee `� Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee /b . 00 PlanningReview Fee Mechanical & Base fee q 2S� Other Wood /Gas/Pellet Stove Fee State Fee Violation Fee /VO E Pre-Paid at Submittal Valuation $ Z g Z S— TOTAL FEES PERMIT NO.__ ___ MASON COUNTY - ---- R PP#1��1G/MECHANICAL PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 helto (360) 427-9670• Belfair(360) 275-4467• Elma(360)482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATIO Owner Company Name Xnn' Mailing Addr s �" u a a� Mailing Address 1 309 '� a�e City_ r State�—Zip Code 9A52S� City I e State V� " Zip Code Phone (Z3O� ) '710-c1 q74 Other Ph. - 3q 31 Phone C253 42b- 6330 Other Ph. Lien/Title Holder —V P_K_ture- f3aw Contractor Reg. # REALa.H ggg('11_�xp. E mail address sWeg-t- n)y 525 6�YQhoo,Com E Mail Address— Drivers Lic.# E� 6 Hq.RN DOB 12 q5_0Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic_ Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Diqit Parcel No`_ Fire District 2 Legal Description 7^fZ -�1 Q� u Rv 13 .y p S p # /9 3 Site Address (Please include street name, street number and city) (a 80 WE `I`mil Directions to site r,'L k N h 0 Le_arcree_k E oA 0. Q SON 4 —tr IVP, n L@ Is property within 200' of Saltwater Lae River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 151/. TYPE OF JOB - New Add Alt Repair Other Use of Building r�-51 Location of Fixtures/Units - 1 st FlooL—Z— 2nd Floor Basement Garage__X—Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS ape of Fixture No. of Fixtures Fees Fuel Type:Electric_LPG "✓ Natural Gas—Heat Pump_ Toilets Z Type of Unit No. of Units Fees Bathroom Sink Furnace I Bath Tubs 1 Heatpumps Showers 1 Spot Vent Fan 3 Water Heater 1 Propane Tank I Clothes Washer I Gas Outlets 3 Kithen Sinks I Wood/Gas/Pellet Stove Dishwasher I Kitchen Exhaust Hood 1 Hosebibs Dryer Vent / Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the a 'ion.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any oth r pa in interest regarding this application or the work proposed in the application, I have obtained permission from them to ap his p it an con ct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate an rants e I e s M Nuonty access to the above described property and structure for review and inspection. PROOF OF CONTI ATION W I YF A PROGRESS INSPECTION. X Date:_ 2"a s caner/ wners Represe e/ ractor cate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Plan ' g Pd__ Ck#___ __Date_ ___Bld Pd__ Receipt No._ DEPARTMEN L REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES