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Home My WebLink AboutBLD95-00073 Final Mobile Home - BLD Permit / Conditions - 10/24/1995 MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 83 LJ 1 L- D 1 N Ca PERM 1 -U FOR INSPECTIONS CALL, 427_-9670 BETWEEN 5pm AND Elam 427-7262. BLD95-0073 PARCE:L :223097500240 PLAT : DIV : BLK : LOT : JOB ADDRESS : NE 461 HORSESHOE DR BEL.F'AIR OWNER : BRiAN HUGHES 373-2595 CONTRACTOR : LEGAL_ : TO 24 OF SONVEY 7117 SEE SWNVEY 41121 FS 15374:24 SF 166A CLASS OF WORK . . :NEW BEDR : 2 .BATH : 2 ITYPE AMOUNT BY DATE R ('E1Pi tYPE AMOUNT BY OAT[ RECEIPT TYPE: OF USF . . . . :MH STORIES . . . . . . . : 1 _ ...--•- x :: ----- --- -.�—:�..�� :� �. -�tt,z -.,: b OCCUP , GROUP , . . :? BLDG . HE 1 GHT . . : 0 .A-F t NHOF ! ia0.e4 CPH 04/14195 36800 TYPE OF CONST , . : ? FIREPLACES . . . . : 0 SIFE $ 4.50 CPR 04114195 38800 I OCCUP . LOAD . . . . : 0 W00DSTOVES . . . . : 0 ADDR 1 5.10 CPR 04114195 38500 DWFL.L .UNITS . . . . : 0 PARKING SPACES : 0 RtC 1 42.10 CPR /4M4195 3991/ INSPECTION AREA : 3 SHORELINE? . . . . :Y EHIP 1 50.00 CPH 04!14195 38810 ITOTAI: 2P1 .5? VALUTAIIJN: 15128 SETBACKS--------------- TOILETS . . . . . . . . . . : 0 FUEL TYPES----------- BOILERS/COMP- --- MOBILE HOME -- FRONT . . .W 50 .Oft BATH BA&I-NS . . . . . . 1 0 : : 0-3 HP . : 0 REAR . . . .E 200 .Oft BATH TUBS . . . . . . . . : 0 3--15 HP . : 0 MODEL :L. I BE:RTY SIDE: ( 1 ) .N 100 .Oft SHOWERS . . . . . . . . . . : 0 FURN < 100K STU : 0 15-30 HP . : A MAKE--- SIDE (2) .S 100 .Oft WATER HEATERS . . . . : 0 FURN >=100K BTU : 0 30-50 HP . : 0 SHRI_ INE . 0 .Oft CLOTHES WASHERS — : 0 FURN - FLOOR 0 504 HP . : 0 -YEAR--- AREA __ _-__.__-________. KITCHEN SINKS . . . . : 0 HEAT PUMP . . . . . . : 0 88 LOT SIZE . . : FLOOR DRAINS . . . . . : 0 VFNT SYSTEMS . . . : 0 EVAP COOLERS : 0 LENGTH : 14 BUILDI.N(3 . . . : 950st DRINKING FOUNT . . . : 0 VENT FANS , . . . . . a 0 HOODS . . . . . . . : 0 WIDTH . :66 BASEMENT . . . : Osf LAUNDRY TRAYS . . . . : 0 DOMES . INCIN :O SERIAL#_.___ DECKS . . . . . . . Osf DISHWASHERS . . . . . . : 0 AIR HANDLING UNITS- -- COMML . INCINtO 09L22 GAR/CARP :? Osf GARB DISPOSALS . . . : 0 <¢ 10000 cfn) . % 0 RELOC/REPAIR : 0 AT/DT .. :? URINALS . . . . . . . . . . ; N 10000 oft . : 0 OTHER UNITS . : Ill MISC PLM FIXTURES : 0 GAS OUTLETS . : 0 PROJECT RESCRIPTIO1:M08ILE NONE PROJECT 10CA11011:LEFT OFF 80LLY-BEAR CREEK 10; LEFT ON BIACKSNITH ON: RIGHT ON ANVIL LANE, AND, LEFT 04 PORSESHORF PAIVE TNIS PERMIT BECONES NULL AND VOID IF WORK 01 CONST14CTION AUTHORIZED IS NOT CONVINCED WITHIN 180 NAYS, 01 If COMSIOUCTION 08 WORK IS SUSPENDED FOR A PERIOD OF 160 DAYS AT ANY TINE AFTER WORK IS CONVINCED. EVIDENCE OF CONTINUATION Of WORK IS A PROGRESS INSPECTION WITHIN THE 180 DAY PERIOD. FINAL INSPECTION MUST BE APPROVFO BEfrBE BUILDING CAN Of OCCUPIED, 0111FR 0R AGE11 Rjg agpt, ��a: /3J3iJ91 �•� COMPLIANCF TO ATTACHED CONDITIONS IS REOUiRED CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons,_ v/ date by Gas Piping date Z 6 U� b Foundation Walls date b Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date /0- 2 y— `7 7 by J FRAMING Walls FIRE DEPT. date by date by date by PLUMBING Attic OTHER Groundwork date by date b D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by 9 rJO),k Zeta S71 LE:I > Ou I I MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location q( I tf!!r6e-- eska)a' i0F 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 �, 4-0 ' +-- S Gs 4 C1'A )S r tsr c f' TZSY C -v( e_ C.—' 2 r .3 X 3/ ! �s�i/[ LJvl !k G rv�'/4 t•!s ef- h�i .-(i.� ./s V LD+'� 4 ! f L� c5�1 � Q�� --� � Yt•L.�� LG�i+-� �/'^4� s/ C/!?� G- t7Ar�Lt ��i"�7`�r ! Tf14 c>locos all f L-,u. arc re-, e � -�L.� �s males �G�ce--4y-s LOL You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ' all for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑OKto Department Date Inspector ■ oosNOOT MOOV T 1, _ TmLolm MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 08584 (360) 427-9670 CORRECTION NOTICE Job Location 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 re7,),4 0 O 'LL laj/ 9��-4-e=, C-5'� I P-4 4J'6L�2 0 (A Z�-� A '1- -6 A You are hereby notified that the above corrections shall be BEFORE PROCEEDING WITH ANY FURTHER WORK a Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑ OKto Department Date `1 6 Inspector • so * [:' *T F1 Mo *V T ' I` T' ,* a) MASON COUNTY Mason County Bldg. III 426 W. Cedar RO. Box 186 Shelton, Washington 98584 j PF_ RU4 1 _r 0C3ND lI _r I (DrN Case No . s BLD95-0073 For , BRiAN HUGHES Page : 1 ` 1 ) The use, handling and storages 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 . X 2 ) Sublect to conditions of Resource Lands and Critical Arens (RL.C ) Cheo.klist . RLC95-0039 3 ) Proposed structure or any portion thereof gresator than 30" in height from grade line must maintain a minimum of 5 ' setback from all property lines , easements and right off' ways X 4 ) PURSUANT TO 1991 UNIFORM BUILDING CODE , SECTION 305(C ) AND SECTiON 513 ALL SITES MUST i1AVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO Bt 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 BU} L.DING CODE WILL BE. ASSESSED IF OWNEDJCONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO AFOUESTING INSPECTIONS . I " I 5 ) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL. CODES AND UBC REQUIP MENTS X_ s- 6 ) REQUIRED INSPECTIONS ( Footing Insp H ection--prior to pour , Set--up Inspection-prior to skirting Final Inspection-prior to occupancy) . I have received a copy of the General I nformat on and Gu i de I i ness-Mob i 1 e/Manuf act ured Housing Installations andout for, detailed descriptions of all required Inspections on my mobile/manufactured home installation . i hereby assume all responsibility for the scheduling of these required inspections , if these required inspections are not regi.►ested, inspected and signed off (approved) by the Inspector in the prescribed order , I understand that reinsppeotion fees, and an hourly investigation fee pursuant: to the 1991 UBC, Table 3A will be assessed in addition to nay original permit flees to resolve an questionable practices or problems theft have been discovered . I further understand .hat this investigation will be scheduled as time 1 r MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 allows . Until reL-oiution of anv/ail problems no occupancy ( Fo ,al Inspection ) will be granted for the residence . OWNER/CONTRACTOR ( indicate which ) Signature X __ L ! A-Lj, 7 ) All mobile/manufactured home landings or decks must be freestanding ( self supporting ) . The Jarc�et i tend i ng or deck perm► I tied without drawings or a building permit is 36" x 36" . Any landing or deck that Is 30" or more in height from walking surface to finish grade requires a guardrail . Any landing or deck that has 4 or, more risers requires t, handrail . Any landing or, deck larger than 36" x 36" must be permitted which requires structural drawings and a building permit ap . Iication . This Insta� ilatiorn Permit does NOT include any landing or deck larger than t .e 36" x 36" size . X B ) CONSTPUCTION PROCESS TO BE FIELD CORRECTUL-0 RFOUIRED PER MASON COUNTY BUILDING DEPARTMENT AND UNIFORM BU I VD I NG CODE .x 1 MASON COUNTY ASSESSORPS NOTICE OF CHANGE OF VALUE THIS IS NOT A TAX STATEMENT DATE OF NOTICE: 7/21/94 ASSESSMENT YEAR 1994 TAXES PAYABLE 1995 LAND BLDGSo MH, ETC, TOTAL. FORMER MARKET VALUE-.*. lOt260 10260 NEW MARKET VALUE 20,090 20090 FORMER CURRENT USE VALUE NEW CURRENT USE VALUE-: BRIAN E HUGHES & MARK S HUGHES HUGH1220 PARCEL 0 22309 75 00240 FS 05374:24 BN 066A TITLE HOLDER BRIAN E HUGHES & MARK S HUGHES --------------------------------------------~---------------------------~------ IF YOUR ESTIMATE OF VALUE OF YOUR PROPERTY DISAGREES WITH THE NEW VALUE SHOWN, PLEASE CONTACT THE ASSESSOR'S OFFICE AS SOON AS POSSIBLE TO DISCUSS IT, IF PLEASE STILL DISAGREE YOU MAY APPEAL THE VALUE TO THE MASON COUNTY BOARD OF EQUALIZATION, PETITION FORMS MUST BE OBTAINED FROM THE CLERK OF THE BOARD, � � BE COMPLETED AND FILED WITH THE BOARD WITHIN 30 DAYS OF THE "DATE OF NOTICE`' , � � OR JULY 1 OF THE ASSESSMENT YEAR, WHICH EVER IS LATER. PETITIONS FILED AFTER EITHER DATE SHALL BE DENIED AS NOT TIMELY FILED. SENIOR CITIZENS OR DISABLED RETIRED HOMEOWNERS MAY BE ELIGIBLE FOR A PROPERTY TAX EXEMPTION IF THEY OWN AND LIVE IN A RESIDENCE, MOBILE HOME OR MANUFACTURED HOME IN MASON COUNTY/ WILL BE 61 OR OLDER BY DECEMBER 31 OR RETIRED BECAUSE OF PHYSICAL DISABILITY^ AND HAVE A COMBINED INCOME OF $26'000 OR LESS. LAND USED FOR FARM AND AGRICULTURE PURPOSES, PRESERVING OPEN SPACES OR GROWING � AND HARVESTING FOREST PRODUCTS, MAY QUALIFY FOR ASSESSMENT BASED ON CURRENT USE UNDER R^C~W^ 84.34. 1604 MASON COUNTY ASSESSOR'S OFFICE MASON COUNTY BOARD OF EQUALIZATION P^O^BOX ".Y' / SHELTON WA 98584 P,O. BOX 400' SHELTON WA 98584 206-427-9670^ FROM NORTH MASON AREA 275-4467, FROM SEATTLE 464-6988^ WA TOLL FREE 1-800-562-5628^ ASSESSOR EXT 489/491 ^ DOE EXT 397^ AN INFORMATION PAMPHLET DESCRIBING THE WASHIMGTOH STATE PROPERTY TAX SYSTEM MAY BE OBTAINED BY CONTACTING THIS OFFICE, ^ - 1 _SLACKSMITH LAKE ACRAGE T'---�ACT_S `'y.<<i X . t %ASON COUNTY, WA. 7J•.;. 53 54 dljz . � - ./e- !�•-��- " T-=` T,L� I � »« j 1� f l l• 7 •� + v�� +,w�.•„a � ,�'�• ..y _ T, ;�-`�==� _ '( - . 1' 4- +fin�•5,73 x. Z4 at 30 .. • s .r'.' tl +�t 400 7r /� M•r'wf4 / •Alww� twat •tP hwiwaMlTY -� M,IR 36 �, �.-' a"t .• _ ♦UGUS- 10 1464 I- `� 1 "'�I• � BLACKSMITH _AK: • fa f�J//3 i s - IRWIN-ENGINEERING - SEE/YAP29-ROAXWP FR/TAPS-K/TSAPCOC/VTY SEEPfAP-V-ROAQQLOIO I-AOS-K/TSAPC0&VTV 4 r r r 4 i i I I --------- — �AP__0 32 V _ 1-3 34 ' _ Y—]6 ` �S 36 . MASON - ----- -- --------- < < 3 -------------- N -- ----- - -----Z--i 0 � � I � ' ' i I 1 z i ERICKSON Q - - i RD- � 1 ------------r --------?----------- - - - --------;-----------r---------- ��- ----' ----i--E' -------- -- i 1 8 � N i BLAUCSMITH \ ! - LAKE T : s I i 8 s is I 1 Il _~ igg99�"ssrr/ I It 12 1 1 i �nH9Q J l o-,Y I s•1j� ; tWi 3 z6 W smEt t I I I LIB e � I 1 1 � Q 7 i 1 , vi+alr_srm�e a ------ ------- w t Lit 1 I 1 W (l� I , 1 W 4 d O j a"E. ! I 2O' �{ COPYRIGHII 1993 ROADRUNNER MAPS i F I 1 ALL RIGHTS RESERVED I Y t 1 I I I I i T : 8 s R is I 11 12 1 10 : 11 ' C jr — --�______ 1 : 3s : lT I 17 : IB 161 15 16 : 14 14 13 1 , i I I I 1 rs E weae,._ ip. I 11I / ' -- A --moo ------------ ----------------i ------ - ------- -------r-- --- ----------------- - ArP POND I S 2 IA5 II — I 1 6 ITWtNLAKEs IC P K L<UCKELL POND ' is IT �mn ; IT _t8 1 1 m. 1 t 18� 16�� ' lA 16 ; 14 : 13 �. / 1 1 Arm ; , 22 27 I 22 : 1 Glrl]mR fio L11�a� � I • I 1 A A A -- - A � CFF MAD R j 4 O 26 �9 O 6-7 �► I N 8-7ul� 45 4p1, 5 AC , �.I 3 �.1 25 Ts "� - 0 T AG . 3I m m r J � , 20 � S 38' l , . 13 E N ?,5 CD 1 � U A • cn 3 0 •` o •s. 4 AC. ACCESS E UTI L1TY EPASF_ I Z 9-'7 . �O� 3-5" W �co I N S. 3 O -� � 7.5 3. z. \ � J I � 23 22TO 5.4 Ac . mN m t N 7s'�,.�� N I � ► `� OZ. --1 0R. V: SAC. 1O T1NP. , RGg �3N., E N. w . M . �FOUN D Z11 IRO I�l P1 P�� Controlled L.AONmAIRE ° Air Water S stem Tanks Design Series y Recent improvements make Features CON-AIRE tanks better than ever: • Nitrogen-rich precharge Rugged Construction-Sturdy heavy decreases air permeation three to gauge steel body. four times over straight air Replaceable Air/Water Separator- A precharge. Rugged, seamless"bag"helps prevent the most common cause of pump • Helium leak test is performed at motor failure-"waterlogging".Water -- -- the factory to detect problems never touches metal. Flexible, before tanks reach you. nonporous separator resists acid and • Bottom flange nuts are checked alkalies...will not impart taste or odor. for optimum torque. Translucent material permits manufac- • Rubber ring on base cuts down on turing quality control through detection corrosion problems. and rejection of bags with the slightest y • New universal jet pump flange is imperfection. standard on the CA42. Easy Service Design-Air/water Applications separator can be removed and replaced should that become neces- Use wherever tanks are needed in sary,without removing and replacing water systems applications. tank. Air volume controls are not Materials necessary with this unique air/water separator. Shell-heavy gauge steel Air Charge Valve-Enables installer to Skirt-heavy gauge steel with reduce or increase precharge pressure protective edging depending upon pressure switch set- Air/water separator-PVC made ting.Tanks are precharged to 40 PSI from FDA-listed material before leaving the factory. Flange-epoxy coated Bolted-On Flange-Designed to Finish-baked-on polyester paint function as a natural relief valve if the Ordering Information pressure switch should fail and high pressures build up. Flange will"give" Max. and allow controlled leakage to keep Catalog Capacity Tank Tank Tank Tank Disch. Approx. Max. Oper. the pump from overpressuring the tank. No. U.S.Gal. Diameter Height Length Tapping Wt.Lbs. Press.(PSI) Universal Mounting Bracket-May VERTICAL MODELS be used with any domestic water pump. CA8 2.7 12" 101, — 3/4" 12 100 Bracket is included on CON-AIRE, CA15 6 12" 16-1/8" — 3/4" 20 100 CA15H, CA42 and CA42H tanks. CA42 19 20" 23-1/8" — 1" 57 100 Improved Tank Skirt-Wide accept- CA42T 19 16" 30-3/8" — 1" 52 100 ance opening on vertical tanks provides CA75T 32 16" 45-1/2" — 1" 66 100 clearance for easier installation and CA82T 35 20" 34" — 1" 72 100 increased air circulation. Protective CA120 50 24" 36-3/8" — 1-1/4" 110 100 edging helps prevent corrosion. CA220 85 24" 54" — 1-1/4" 135 100 Tough, Baked-On Finish-Before HORIZONTAL MODELS separator is inserted,tanks are CA15H 6 1 12" 13-3/4" 16-1/8" 1 3/4" 21 1 100 electrostatically powder-painted,then CA42H 19 1 16" 17-1/2" 28" 1 1" 58 100 oven-baked for a smooth, high-gloss, ACCESSORIES appliance-quality finish. PKG 198-Jet Pump Mounting Bracket Economical-Required high capac- PKG 111-Pump to Tank Fitting Package for PL and PIN Series jet pumps ities can be obtained by using multiple PKG 112-Pump to Tank Fitting Package for AN, BBN, BBL and AL Series jet pumps CON AIRE tanks rather than a large, hydro-pneumatic tank. °CON-AIRE is a registered trademark of Sta-Rite Industries, Inc. STA-RITE. Built On Commitment. STA-RITE Controlled Air Water System Tanks Sequence of Operation AIR AIR AIR AIR F i WATER i WATER WATER SEPARATOR IS WATER BEGINS TO PUMP-UP CYCLE WATER IS BEING COMPLETELY EMPTY: ENTER THE TANK: COMPLETED: Air is now DRAWN FROM THE A new cycle is ready to Air is compressed above compressed to the cut-off TANK: Compressed air begin.Simple,positive the separator as it fills setting of pressure switch. in the tank forces water action produces with water. out of the separator. maximum drawdown on every cycle. CON-AIRE Sizing Chart To use the following chart, pick the appropriately sized pump by GPM rating and then follow down the recommended size column to pick the appropriate tank(s). Recommended size tanks provide for longer pump life due to fewer pump operation cycles. The larger the tank, the greater the drawdown and reduced pump cycles. CON-AIRE Tank Sizing Recommended Models and Quantities (Minimum) Rule: Size Tank for one gallon of drawdown for each gallon per Submersible Pumps Jet Pumps minute of pump capacity. 5 GPM 7-10 GPM 15 GPM 20 GPM 30 GPM Most Models CA42& ✓ ✓ For a 1 HP 20 GPM unit pumping CA42T 25 gallons per minute on a 30-50 CA75& ✓ ✓ ✓ pressure switch setting, the properly CA75T sized CON-AIRE tank is a CA220 CA82T ✓ ✓ ✓ which as a 26.0 gallon drawdown. CA120 ✓ ✓ ✓ CA220 ✓ ✓ ✓ ✓ 2 STA—RITE. Built On Commitment. STA-RITE" CON=AIRE Design Series e Pkg. No. 198 `;, Pkg. No. 111 or 112 Universal Jet Jet Pump to Tank Mounting Bracket Mounting Pkg. UIII ;` 14 Tank Acceptance Pressure Switch Setting CA8 CA15 CA42 CA75 CA82 CA120 CA220 20-40 CON-AIRE® .8 2.2 6.9 11.6 12.7 18.3 30.0 30-50 CON-AIRE° .7 1.8 5.8 9.8 10.7 15.5 26.0 40-60 CON-AIRE® .6 1.6 5.0 8.5 9.3 13.4 22.0 NOTE: Pumps installed with a CON-AIRE®tank require a 100 PSI relief valve.Pumps installed with a conventional tank require a 75 PSI relief valve.Relief valve must be capable of relieving entire flow of pump at relief pressure. Water yield between the start and stop cycle of a pump is the absolute measure of tank efficiency.The CON-AIRE®is more efficient than a conventional tank twice its size.Pump life is extended due to the ability of the CON-AIRE°tank to provide maximum drawdown consistently on every cycle.Tank should be selected to provide 1 gal.of drawdown for each GPM of pump capacity. S3 STA—RITE. Built On Commitment. STA-RITE' Controlled w ° Air Water V UrimAIRE System Tanks Design Series CON-AIRE- Professional Performance Tips (j) Size tank to one gallon drawdown for each GPM capacity. (2) Adjust factory precharge at installation, if needed. Securely tighten sealing cap on air valve. ® Check precharge every 6 months. STANDARD STANDARD 22.4 12.2 STANDARD 8.4 STANDARD 4.3 -- .. STANDARD ——— 26 1.5 15.5 CON-AIRE —— 10.7 CON-AIRE 5.8 CON-AIRE CON-AIRE CON-AIRE w 15 GAL. 42 GAL. 82 GAL. 120 GAL. 220 GAL. a MULTIPLE TANK INSTALLATIONS CON-AIRE®tanks can be connected together to increase the supply of usable water (drawdown). Two tanks of the same size will double the supply and three tanks will triple the supply. See Figures No. 1 and 2 for the typical installations of this kind. TANKS TANKS FROM WELL TO SERVICE FROM WELL TO SERVICE PIPING PIPING PRESSURE PRESSURE SWITCH SWITCH Figure 1 Figure 2 Printed in U.S.A. STA-RITE/a WICOR company 1993,Sta-Rite Industries,Inc.,Delavan,WI S4530WS(Rev.5/93) Permit No. MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670/1-800-562-5628 Val PLEASE PRINT #1 Owner _Phone# � ��73- Site Addreu ess_ M- iiV I, .�0e 5h6�E brMF- Fire District# ___# UL? R St �. Zip `�' Citya ltV Directions to Job Site L. L H — L� P'g12_CES Owner Mailing Address ES PIS e=>&x (0 a 3 City St t 3 ' Fl Zip Lien/Title Holder t-7 . ' Addresses Mn as f4 ?"hnite; City St Zip #2 Contractor Name N l� - MoIZZI-= 1-6M E Contractor Reg# Address Expiration Date City St Zip Phone# #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 Parcel No.a-r)-30G - '76- - Cf�)4,qQ Legal Description ' E L��d� 7 g jg�r / ar Suko `1 7 / "MA #5 Building Square Footage: (existing/proposed) U) 1 st FI>L 9kin/ 2nd FI 1v 1A / 3rd Fl- A)/A/ Loft y/ Basement_/ Deck / #bedrooms d / 01 #bathrooms / Garage / Carport c3�-- 1 5- (Circle;J�r Detached?) Other sq.ft. / #6 Use of building 6W MA@,y '1�1 ELc—LJA- Describe work #7 Type of Job: New X Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year--t —Make Model Length 1 4 Width�(,,' Serial No. #Bedrooms_ # Bathrooms Type of HeatJ2,rg: RR—P 4A Purchase Price$ #9 Indicate b circling the applicable source if any water is on or adjacent to subject property: River Pond;Creek Stream Wetland Lake Marsh Saltwater 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 Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW r_ co v APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW 15 b G�� Plumbing Fixtures ($3 each, Fee Mechanical Fixtures ($6 each) No._Toilets CIRCLE FUEL TYPE: Gas, Iect irit c _Bath Basins Heatpump, Other _Bath Tubs No. UDija Fees _Showers Furn BTU _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 $ No. Other Gas Outlets Wood, 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 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 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 j/ �!' DATE -- FOR OFFICIAL USE ONLY:Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: S(Ae3 i eJ 1 `I ^ UO 01 Environmental Health: Building Plan Review M F'(= S pre S , poS7— /VO lltf( 06AD Occupancy Group: IZ� Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit �(70 o� Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee '� •.� Other 12-L C— c{2- Other IF f( R-W i Building Valuation: TOTAL FEE \.