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HomeMy WebLinkAboutBLD2005-02160 Final SFR - BLD Permit / Conditions - 12/28/2006 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 RESIDENTIAL BUILDING PERMIT BLD2005-02160 OWNER: JIM STOCKTON RECEIVED: 12/22/2005 CONTRACTOR: REALITY HOMES INC. 253-926-6330 LICENSE: REALIH1984CN EXP: 2/15/2008 ISSUED: 1/31/2006 SITE ADDRESS: 1451 NE MUNSON BLVD BELFAIR EXPIRES: 10/11/2006 PARCEL NUMBER: 223097790280 LEGAL DESCRIPTION: TR 28 EX OF SURV 13/234 TR A OF SP#1892 PROJECT DESCRIPTION: DIRECTIONS TO SITE: CONSTRUCT NEW SFR BEARCREEK DEWATTO ROAD TO LEFT ON TAHUYA BLACKSMITH ROAD, LEFT ON MUSON BLVD, LEFT AT Y TO PROPERTY ON LEFT JUST BEFORE BEDROCK LANE. General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: V-B Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: R-3, U Lot Size: Deck: Type of Work: NEW Fire Dist.: No. of Stories: _1 Occ. Load: Building:2,114 Garage-Attached 484 Valuation: Building Height: Occ. Status: Unknown Basement: Cov. Porch 180 Manufactured Home Information Setback Info ation Shoreline& Planning Information Make: Length: Ft. Front: S 48.0 Ft. horeline: Ft. Water Body: SEASONAL POND Rear: N 40.0 Ft. I Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: W 118.0 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 CMH 12/22/200 $846.14 B12005000 Hosebibs 1 Furnace<100K 1 Planning Review Fee CMH 12/22/200 $155.00 612005000 Kitchen Sink 1 Ventilation Fan 3 EH Plan Review TW 1/3/2006 $75.00 s12bb6b00 Lavatories 2 Dryer Vent 1 Building State Fee JRN 1/4/2006 $4.50 S12006000 Showers 1 Building Permit Fee JRN 1/4/2006 $1,301.75 S12006000 Water Closets (Toilets) 2 Plumbing Base Fee JRN 1/4/2006 $20.00 S12006000 Water Heaters 1 Plumbing Fee JRN 1/4/2006 $82.00 S12006000 Bath Tubs 2 Mechanical Base Fee JRN 1/4/2006 $23.50 S12006000 Clothes Washer 1 Mechanical Fee JRN 1/4/2006 $54.45 S12006000 Address Fee GMM 1/5/2006 $140.00 S12006000 EH Permit Revision TW 4/11/2006 $35.00 612006000 Total $2,737.34 BLD2005-02160 Please referto the following pages for conditions of this permit. 1 of 4 Inspection Line(360)127-7262 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 RESIDENTIAL BUILDING PERMIT BLD2005-02160 OWNER: JIM STOCKTON RECEIVED: 12/22/2005 CONTRACTOR: REALITY HOMES INC. 253-926-6330 LICENSE: REALIH1984CN EXP:2/15/2006 ISSUED: 1/31/2006 SITE ADDRESS: 1451 NE MUNSON BLVD BELFAIR EXPIRES: 7/31/2006 PARCEL NUMBER: 223097790280 LEGAL DESCRIPTION: TR 28 EX OF SURV 13/234 TR A OF SP#1892 PROJECT DESCRIPTION: DIRECTIONS TO SITE: CONSTRUCT NEW SFR BEARCREEK DEWATTO ROAD TO LEFT ON TAHUYA BLACKSMITH ROAD, LEFT ON MUSON BLVD, LEFT AT Y TO PROPERTY ON LEFT JUST BEFORE BEDROCK LANE. General Information Construction &Occupancy Information Square Footage Information No.of Bedrooms: 3 Type of Constr.: V-B Type of Use: SF Insp.Area: No.of Bathrooms: 2 Occ. Group: R-3, U Lot Size: Deck: Type of Work: NEW Fire Dist.: No.of Stories: 1 Occ. Load: Building:2,114 Garage-Attached 484 Valuation: Building Height: Occ. Status: Unknown Basement: Cov. Porch 180 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: S 38.0 Ft. Shoreline: Ft. Water Body: SEASONAL POND Rear: N 44.0 Ft. Slope: Ft. SEPA?: NO Model: Width: Ft. Side 1: W 118.0 Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: E 55.0 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 CMH 12/22/200 $846.14 B12005000 HOsebibs 1 e Furnace<100K 1 Planning Review Fee CMH 12/22/200 $155.00 812005000 Kitchen Sink 1 Ventilation Fan 3 EH Plan Review TW 1/3/2006 $75.00 §12006000 Lavatories 2 Dryer Vent 1 Building State Fee JRN 1/4/2006 $4.50 S12006000 Showers 1 Building Permit Fee JRN 1/4/2006 $1,301.75 S12006000 Water Closets (Toilets) 2 Plumbing Base Fee JRN 1/4/2006 $20.00 S12006000 Water Heaters 1 Plumbing Fee JRN 1/4/2006 $82.00 S12006000 Bath Tubs 2 Mechanical Base Fee JRN 1/4/2006 $23.50 §12006000 Clothes Washer 1 Mechanical Fee JRN 1/4/2006 $54.45 512006000 Address Fee GMM 1/5/2006 $140.00 S12006000 Total $2,702.34 P&BLD2005-02160 Please referto the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD2005-02160 CONDITIONS FOR BLD2005-02160 1) All approved 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 granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Depagnpt prior to any further inspections being performed or approvals granted. X a_ 2) 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-T-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 3) 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 jurisdiction and the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting inspectio X �-1:5 4) 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 p roved documents will result in failure of required building inspections. X 5) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL.X LS 6) 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 /Max 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 BLD2005-02160 Please referto the following pages for conditions of this permit. 2 of 4 7) ., Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). y X K� f 8) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee(refer to current fee schedule, minimum 1 hour)will be charged andesll be collected by the Building Department prior to any further inspections being performed or approvals granted. X F_- 9) 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 o n. X 10) 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 project. es 1 11) 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 roads c rya,ect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X L: . 12) All changes to"approved"building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or relation, must be reviewed and approved by Mason County prior to construction. X �=,�2 13) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction 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 sh II be made prior to requesting additional inspections. X � 14) All property lines shall be clearly identified at the time of foundation inspection. X BLD2005-02160 Please referto the following pages for conditions of this permit. 3 of 4 15) 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 County ordinances and building regulations. X 16) 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 have prev�nted action from being taken. No more than one extension may be granted. X K `-� 17) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connector, nd flashing. Install metal connectors approved for contact with the new types of pressure treated material. X 18) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X � 19) Water qua lit is not to be degraded to the detriment of the aquatic environment as a result of this project. X r� 20) Prior to final approval, all upland areas disturbed or newly M d by construction activities shall be seeded,vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 21) Approved dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. - K_ 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 owneror the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described props y and structure for review and inspection. OWN ER OR AGENT: C l' m ` DATE: t ' 21 , BLD2005-02160 Please refer to the following pages for conditions of this permit. 4 of 4 o{♦ CONCRETE MECHANICAL MANUFACTURED HOMECA Date �,i3^�6 By ✓�� O Footings 1 Setbacks Ribbons 0 Gas Piping N InteriorOate t\�' By. Interior-Date BY Date B coir No Y O o Exterior Date 14J BY Exterior-Date B Z INSULATION Point Load 1 isolated Footings Date By BG f SLAB INSULATION Date BY Data By FIRE DEPARTMENT Foundation WalNFloors Date By k\ By R1, Data - By DECKS FRAMING waft Date By Date/-/ —t�G By�"' Data By W/ PROPANE TANKS PLUMBING - vault Date By Date By OTHER Groundwork Attic Date By Data By Type: Date By D.w.v DRYWALL Type: Gate ?—��j,©6 By Int Brace Wall Date By W Date 6y FINAL INSPECTION 0 Water Line 'f Fire Seperation K) Date By w Date Z,� �jj By Date l L Lg , By m Pals or Request Inspect. N Type of Insp. Fail Date Date Done By Comments m ti r a` T i 14 ks ' o RE- ITC. ,sE� A-7w1*0 cr a E- RE . .SEYOX 16 FAT7UV odj-& LS s OsA, to qfi 0 bq w ac f it K LS �iD S OF -7kt6 -7 jXjDG �oz F1 tila L Fi9-rLED 1118166 R ZZIC. KC-S /97' t I /Z ,'�- Apr 07 OB 09: Kris 5' 360-830-2690 p. 3 c� ;. PLAN PLOT REVISION 1 DATE -1 C � - J VA oN `n AO Z�10i E� GNP / o, r � r � I , \ /^ 1 O ly —V-1 , F (D-260S --02 Approval:for office use Building Permit number. -(op Building: _ i Owner/Applicant: � ---� Date of Planning: application: Env. Health: Parcel Number: i u� •C ti A HIM ■ ■ \► � �/� irk :- rrl ■ ©�. ■.:� � .rev PINES ME ■■PIN -� E �!! �■ ■ ■■r� ■■ ■■ ■PIE ,■ . E■ ■ EM = ■■■I■ ENWme!name PIEMINOR mus- ISM NOMENINOWN MENIM 0 CAULVA ■ / _Ii� ; I ��■ ■[ �. dimMOMIN IN cl Lin isUirall HAS one '_ MEMO' ■11■IL'=■MIAAJ IMIIJINW . w! ■ � :, !!�! ■ rap- SEP-19-2005 MON 03:45 PM LAND TITLE SHELTON FAX NO, 3604278574 P. 07 497 OIL, ' .tea z r.�,.�+�,Sr,�.►e- _ A. �LIS, I Area_ 2.50 Acres _� L✓� 45 Area: 2.50 Acres Legal Dmscriptirm Tract 28 of Munson A-reage Trects as per sarvny recvrtiod In volume 13 �� of Surveys, Page 234, Masan county Auditor's File No, 492052, Mason County, Washington. Heing a portion of the southeeet quarter of Sec. 9, T 23 N, R 2 W, WM WARNING: Mason Cbmity has no responeiblity to build, improve, rtainta or otherwise service the private roads contained within or providing service to the property described in the short plat. 1111i1 SAort Su6dalslon;�4r,9.,�.,,,,^� V OWNER: Erickson Lake Associates Ap mvw: S-1 'Cr2 n Attn: Jerry Reid Reid Realty Drawer TT, Wycoff Station Bremerton, Wa 98312 PH: 377-0046 V DuE x.) 7 w...ac.� s2a.6� v�sA,e�`�/�s .•c,ar•' a6 iuenAreEQ 1" 700 i2" e� .C.+1F7u4T S00oe- • fir%r.�z-�-B.ve w/xE��ow��,•vsy.�c.�.o � h � C� 0 VICINITY MAP N SHOR 41, f rPLAT ��,, � ��` (77 L�. �awoa�s „s�..w�s. gtIcxSota AssocIATES C ow Twaffw.LWW WA cry.�" 9 �t1L741 g E;fr URA► T , a cr 91� � AEG Apr r7 06 09: 53a Kris Stockton 360-830-2690 p. 2 04/07/2006 09:36 FAX 360 427 7798 MASON CO PERMIT CTR Z 002 Request To Revise An Approved Plan Permit Number; BLD200-5----17Z I(o Name -:Sn me--' Parcel Number_2 Z,�LCCI - -7 7 -c?n phone Number da ime ,�9xO ) Project Address Iq5 i M un so r) 72,jycl. Mailing Address -4RJ Al of-t-e cA -ic , A G'iR i Please provide a complete,detailed description of the proposed revisions to the approved plans: D 'i `' e I'1Cl t1P I Are two sets of the revised plans or addendum indicating the changes included? Q Yes o Are the approved site plans included? ja Yes 11 �N Are the,revisions clearly and accurately identified on the plans or addendum? ?Z! Yes 07ma Does the plan contain an engineer's or architect's lattaal or vertical analysis? Yes 17 No If Yes,Has the engineer or architect approved this revision? O Yes QrwNo Is a stamped and signed approval included with this request? -1 Yes o No (Note:No etrnrnerat S-hwAa 9 a"designod-III without the written cammt of the endna wdlor an hi—of ncnrd.l 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? PeYes ❑ No Additional Information: Applicant's signature(i.� n . �1 ..li '!C1 ' .7 �zC Date: Olrim Use Orrty Reoetred by:: l' Date Sant Ibstpned To Approved By elate B. Original Valuation: S Additional Valuation: S Sq.Ft �O sq.Ft =s s I _Total New Valuation s P_W. l� Additional Pees: Additional Planning Dept. S New Setbacks: Front / Additional Plan Review S t'�rat Additional Building Permit S Sidel. J 5ide2 / Additional Plumbing S Additional Conditions!Conwnents: Additional Mechanical S Additional B.H.Dept, S Other 5 Total Ametrat Due: S Amount To Be Paid UP-Front$ T. A&V.O SAO rffiOm MASON COUNTY PERMIT 0. BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 - Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ZSNHE5 S-rtY kTC)l J Company Name i<_E HLIT'1 HC 1. CS- 10C Maili g Address 3`Ig I r Mailing Address L - City �� State Zip Code 9 City <r State L � Zip Code Z Phone lac-S 1J '2L,t-�1- Other Ph. '�-21aS S Sd',� Phone Z53 ` 7-6-C,&In Other Ph. -- Lien/Title Holder Contractor Reg. # Exp. E mail address tr 4 +gck4 v E Mail Address Drivers Lic. # STUCK, DOB ID-2-614 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. _ — Fire District Legal Description ' Site Address (Please include street name, street number and city) Directions to siteltAlLyet r -nrl. 'A AL ILI -kc P L. on -Te hit t Lek 11',7ICt(k mm ii l in ?rl � L c r) tvt L ♦ , e . o Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff7_Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work No. of Bedroom No. of Bathroom Square Footage- 1st Floor ZI I L-1 2nd Floor 3rd Floor—Basement Deck Covered Deck 190 Other Sq. ft. Garage L Attached Detached Carport Attached e MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms MCBgh�o Type of Heat Purchase Price$ Replacement Unit? Yes o 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 for this permit and conduct the work proposed. The owner or agent on 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. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY M S OFAPROGRESS INSPECTION.INACTIVI OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X EA Date: LL. 22 2L)0,5 t6iwne ,Owners Representative/Contractor (i dicat hich one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES — Building Department_ %N10C' ao Planning Department Environmental Health Department —400713 Fire Marshal FEES Building Permit Fee -7S Site Inspection Plan Review Fee L 1y EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee 6° Violation Fee Pre-Paid at Submittal o Valuatin $ �d TOTAL FEES LA MASON COUNTY PERMIT NO. PLUMBING/MECHANICAL PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner SC(M,e^N 5-trC�-4 C- t Company Name �AL�'►�l ' ��5 Mailing AddressI ► QLA� MailingAddress ! ' At t-x Ati`ty F' City 13rPm -E r L, State tOA, Zip Code AI Z City tIFlr State ' — Zip Code ,, Phone cc) ' - i1- Other Ph. -, -Zt -5`: Phone _ ien" o- t. Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address J tt r�uer-n hlP E Mail Address Drivers Lic.# ;-T,{Y-P-I,21,7,"!)7 DOB 10 Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septicy Existing Septic. Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. ZZ- 1r"i --77- Ir S, Fire District Legal Description Site Address (Please include street name, street number and city) Directions tositelk'A 'Tn/hci+r'.i nrrr„�j�tl R.-! Lt:n M+L1 Is property within 200'of Saltwater Lake River/Creek Pond — Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type.Electric— LPG— Natural Gas_ Heat Pump_ Toilets �_ Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer —L— Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood 1 Hosebibs Dryer Vent 1 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 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 for this permit and conduct the work proposed. The owner or agent on 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 inspectionL. PROOF OF CONTINUATIO OF WORK IS BY ME/NS OF A/PRO�RESS INSPECTIQN. � c� X r r rn n ( Lc" r / r Date: '� J DEC 2 2 2005 Owner/Owners Representative/Contractor (indicate which one) BELFAIR OFFICE FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group—Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspect on Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES