HomeMy WebLinkAboutBLD95-01011 Cancelled SFR, Deck, and Garage - BLD Permit / Conditions - 3/12/1999 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
13 LJ 1 U. ID i NI c4 P E= R M I T FOR INSPECTIONS CALL 421-9670
BETWFFN 5pm AND Ram 427-72.62 p��
BL.Q95-1011 PARCEL. :223i0759012O PLATS DIV : BLK. : sa:�' "Y
JOB ADDRESS : NE 74'1 BI,ACKSM I TH DR BEL FA 1 R
OWNER : CARL.A MOORF 830-4183
CONTRACTOR :
LEGAL... : it 12-A OF SURV 5ii38 11 A OF SP 11705 RE 741 BLACKS/ITN 01
CLASS OF WORK . . :NEW BEDR : 2 BATH : 3 TYPE ANOUNI BY DATE RECEIPT TYPE ANOUNI FkY DAZE RECEIPT
TYPE' OF USE , SF STORIES . . . . . . . a3
OCCUP . GROUP . . . :? BI-DG . HEIGHT . N .O-rt RLC 1 42.00 TW #9178195 40361 Siff 1 4.50 TR 0912819S 40361
TYPE OF CONST . . :2 FIREPLACES . . . 0 RADN 1 8.00 TO 09129195 40361 NCH 1 63.00 !W 0912819b 40361
OCCUP . LOAD . . . . : 0 WOODSTOVE S , . . . : 1 PI CK 1 171.00 11 09128/95 40361 I
DWELL .(IN I TS . . . . . 0 DARK I NG SPACES : 0 M N 1 48.00 111 09i?8195 40161
INSPECTION AREA : 1 SHOREL. INE7 . . . . :N ROST 1 ?5.00 II 09120195 41361 TOTAL: 361.50 VAIWAIION: 62177
TO LETS . . . . . . . . . . ; 3 FUFI. TYPES — -- BOILERS/COMP__. .__ MOBILE: HOME --
F'RONI . . N 300 .Oft BATIi BASINS . . . . . . : 0 0—.3 Hp ' - 0
REAR . , . .S 5 .Oft BATH TUBS . . . . . . . . : 1 3-15 HP . : 0 MODFL. :
SIDE ( 1 ) .F ') 'Ott SHOWFRS ,. . < . . . . . 1 I:URN < 100K BTU : 0 15-•30 HP . : 0 —MAKE _. .. .., .
SIDE (2 ) .W 5 .Oft WATER HEATERS . . . . z 1 FURN --1 O0K BTU : 0 30-50 HP . : 0
SHRL i NE . O .Oft CLOTHES WASHERS , . 1 F"URN . F L_OOR . . . 0 f 0 4 HP , : 0 YF,RR
AREA _._ _._ _.. _.____.__ __. KITCHEN SINKS . . . . : 5 HEAT PUMP . . . . .. : 0
LOT S I TF . . . FL OOR LIRA INS . . , . . : 0 VFNT SYSTEMS— : 0 E VAP COOL_F RS : 0 1 l-NGTH : 0
13UII_DING . : f782sf DRINKING FOUNT . . . : 0 VFNT FANS . . . . . . : 0 HOODS . . . . . . : 0 WIDTH . : 0
BASEMENT . . . : 460-f LAUNDRY TRAYS . . . . : 0 DOMES . INCIN :O - SFRIAL #
DECKS . . . . . . : 24Ost DISHWASHERS . . . . . . : / AIR HANDLING UNITS_._ COMML , INCIN :O
GAR/CARP :G 618sf GARS DISPOSALS . . . : 0 <— 1O000 cfm . : 0 PfAOC/REPAIR : 0
AT/Dr . :A URINALS . . . . . . . . . . . 0 ? 10000 c7m . : 0 OTHER UNITS .
MISC PI_M FIXTURES : 0 G/I
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PROJECT OESCR1PT10N:AF5IDENCE, DECK, GARAGE
PROJECT IOCA1ION:IRON BE[FAIN, FO 11O11114 ON OLD BfLfAIR HWY, TURN IfST ON BEAR CREEK RD, 1URN ON AtACKSMITH ORIVI` , PROPERTY IS ON IN[ I CORNEA Of BIACKSNIIH
OLIVE AND FORGE CT.
THIS PERNtT BECOMES Nutt AND VOID If WORK OR GONSIRUCTION AUTHORIZED IS NOT rONNENCFD IIIHiN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED FOR A PERIOD
OF 188 SAYS AT ANY TINE AFTER SONY IS CONNENCEO. EVIDENCE OF CONILNVATION OF WORK IS A PROGRESS INSPECTION IITHIN THE FRS DAY PERIOD, FINAI. INSPECTION MUST BE
APPROVED BEFORE 811110114 CAN BE OCi1101E4.
OWNER OR ACENTc DAIS
81.A P11YT, rev: 03131191 COMPL. I ANCE TO ATTACHED CONDITIONS IS RE:OU I RED
CONCRETE MECHANICAL MOBILE HOME +
Footings-Setback date by Ribbons I
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by
PLUMBING date by OTHER
Groundwork date Attic
date b WALLBOARD NAILING by
D.W.V.
date by date by
Water Line FINAL INSPECTION
date by date by date by
I
I
I
MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
RO. Box 186 Shelton, Washington 98584
P F F1 INA I T C, 0 P4 F-1 I 'Ir 1 ON
Case No . % BL.D95- 1011
for : CARLA MOORE
Page ; I
1 The use , hand I I nq and st oracie of hazardous mater, 1 a I s or f I ammab I e and consbust I b I e
liquid-, in excess of 10 gallons is not allowed without the approval of the Mason County
Fire Marshal .
2 ) Proposed structure or arty port icon thereof greater than 30" in height from grade, I ine ,
must maintain a minimum of 15 ' setback from all property lines , easements and right of
way-_ .
A I I approved p 1 ,4ns are requ I red to be on--s I te f or i n-peot I oti purposes It Ins'pectican Is
called for and plans are not on site, Approval WILL NOT be granted . In addition , a
Pe- Inspection fee in the amount of $30 .00 per hour (minimum 1 hour ) will be charged and
must be collected by this department prior to any further ins. peQtions being performed or
approval granted ,
4 ) PUPSIIANT 10 1991 UNIFORM BUILDING CODE , SECTION 305(C ) AND SECTION 51�3 ALL SITES MUST
HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS To Bt PL*.AINL.Y VISIBI E
AND I. FGl Bt.F FROM THE STRIFFT OR ROAD FRONTING 'THE PROPERTY . MASON COUNTY BUILDING
DEPARTMFNT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS . A
REINSPECTION FFFAJBAe*,FI) ON RATES IN TABLE 3A OF THE 1991 UNIFORM BUILDING CODE WILL 13F
ASSFSSED IF OWNF CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING
INSPECTIONS .
5 ) The correction list , along with the Fiierqv Compliance Work sheet (when A plicable ) it;
part: of the plans and must remain attached thereto . It Is the responsimlitl of the
applicant to make correction�; Indicated on the plans from the correction lists; . 011ce the
plans are marked APPROVED , they may not be changed or altered without authorization from
the BuIldinq Official . The permit holder I ,,- reponsible to) retain the complete approv0d
set, of plans on site for the duration of the project . Failure to comply will result In
fail urns of required building inspections . Every permit shall expirp by limitation and
become null and void if the building or work authorized by such permits is not commenced
within 180 day-. from the date of issuance or if the huildinq or work authorized by such
permits is suspended or, abandoned at any lime after the work Is commenced for a period of
MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
day..
6) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND UBC
RFOUIRFMENTS
7 ) 'Structure must be setback 5 ' 'from all uti I 1 -tv and drainacle ea-ements a total of 10 '
rom each property line, or a variance must be obtained from the Bljildinq Department .
8 ) changes to approved building plans that effect oompliance to the 19P1 Washington State
Energy Code, 1991 Ventilation and Indoor Air Quality
Code , the Uniform Building Code arid/or Mason County Regulations must
be approved by Mason County prior to construction
Date Checklist Prepared
MASON COUNTY BUILDING DEPARTMENT
PLAN REVIEWER AND INSPECTOR CHECKLIST
1991 WSEC AND V&IAQ CODE COMPLIANCE
Permit Number AA`�-/�/� Address 41. 74/ �QC/GS/Yl�f h �� Sq. Ft.A;; �
Name on Permit 1qftRT//11 e6j��A-Mractor/P ne I tsl'30 -. c7//
Compliance Method: ( ) Prescriptive (Option) ( ) Component ( ) Systems Analysis
Date FOUNDATION
Insp. Rev.
( ) (V) Slab: R- ID _(Ext.foundation down to frostline/slab bottom;or interior 24"top of slab&horizontal. Radiant under entire.)
( ) ( ) Below grade exterior wall insulation: R-
( ) ( ) Crawlspace ventilation: _ (1 sq.ft.NFA1150 sq.ft.floor area-cross vanted)
t`S6Wes?t4- FRAMING
Standard ( ) Intermediate ( ) Advanced
( ) (v ) Woodstoves and/or fireplaces: (6 sq.inches combustion air supply duct with damper direct to firebox.)
Standard air seal: (Bottom plate/subfloor,rim joist/mudsill,window/door frames,penetrations condition to nou-condition.)
Attic ventilation (1 sq.ft.NFA/150 sq.ft.ceiling area)
Spot exhaust fans: (4"exhaust-bath/laundry 50 cfm @.25 WG;kitchen 100 din @.25 WG. Vented out with dampers.)
( ) `(A Fresh air Ventilation: Available to all habitable rooms. Installed and operational. (Integrated forced air,windows,wall ports.)
( ) ) Whole house exhaust fan:!;jR&fm (Intermittent system manual&auto controls/cone less than or=to 1.5 at.1 WG)
INSULATION
( ) \ ) Attic baffles installed to deflect incoming air(Rigid material resistant to wind-driven moisture,extend 12"above loose fill or 6"
above batt insulation)
Mechanical ventilation ducts R-4(Exhaust in unconditioned space&supply in conditioned space.)
Wall insulation(above grade) R- 9 M,N.
g ) � Batts face stapled)
( ) ( ) Wall insulation(below grade-interior) R- (Batts face stapled)
Vapor retarders on walls (Faced batt,or 4 mil poly or perm paint.-circle one)
Rlm joist(Insulated with vapor retarder-rigid foam and caulked or 4 mil poly.)
( ) ( t) Vaulted ceiling insulation R- (vapor retarder&V airspace)
FINAL
Floor insulation R- (Substantial contact w/surface,supports less than or=to 24"oC,not blocking vents.)
Ventilation system is operational (spot,whole house,fresh air to all habitable rooms. If integrated system,certification by installer is
required.)
HVAC ducts in unconditioned areas R-8 (Joints sealed;mechanically fastened with a minimum of 3 fasteners.)
Pipe insulation R-3 (Hot and cold lines in unconditioned areas-service or retire.see Table 5-12).
SHW heaters: (NAECA label,separate power or gas shut-off,on R-10 pad if electric in unconditioned or on concrete.)
Heating system type: Elecrt"r�'c_ hca+ 'Pt2mp
( ) (�•) Radon monitor on site with instructions.No. - Supplied by MCBD
Thermostat: (Heat range 55-75;AC 70-85;both 55-85. Backup heat controls(lockout)prevent simultaneous operation of primary system.)
Solid fuel appls.: (Glass/metal tight-fitting doors;dir.comb.air source,or 4"dia.dampered,indir.source for existing coast.)
Ground cover: (6 mil black polyethylene or approved equal lapped 12"at joints,extending to foundation wall.)
Penetrations(All exterior wall and ce'ling penetrations sealed to drywall-plumbing,exposed beams,wall receptacles,fans,recessed lights.)
Ceiling Insulation R-k' _(Insulate&weatherstrip access.baffle to prevent spillover-no cardboard)
( ) ( •) Vapor retarder paint if a vapor retarder was not installed when insulation was installed.
i
GLAZING
Plan Reviewer--Fill out this glazing section or attach a window schedule to this checklist. Inspector- Verify window
information during field inspections. Include skylights,glass doors and all other glazing on this form. Use rough opening
area for calculations.
Date
Size Quantity Area S . Ft. U,Value Manufacturer Rev. Insp.
L'°4 c> I a D Ct5
0�
_ eSS
61140 11 /9a
(0° 9 / yd
2° a to
Total glazing area:
Total conditioned area:
Percentage glazing: `�` Verified:
DOORS
Plan Reviewer-List opaque doors by type(solid core,insulated,etc.)quantity,U-value,and manufacturer. Jimpector-
Verify door information during field inspection.
Date
Type/Quantity U-Value Manufacturer Rev. Insp.
3°(,.g 40 S0C-
J°CaK�w� q-U Gt�oo 0
�(08 c,,� e • �v o� Foam-� eo �
I AJS U e.s9 T-,C—
Signature of Building Inspector: Date of Final Inspection:
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg. III 426 W.Cedar
P.O. Box 186 Shelton,Washington 98584
(206)427-9670
BUILDING PARKS&RECREATION FAIR/CONVENTION CENTER ADMINISTRATION
RE: Permit Number L f1, cs _ La I I
During a recent plan review for your proposed project, it was determined
that the following information needs to be submitted prior to the building permit
being processed for approval: I n
Its c�t� Vw
CIr
A �
rr1
Once the information has been received by our department, the project
will continue to be processed.
If you should have any questions, please contact me between the hours
of 8:00am-9:00am, Monday-Friday at (206) 427-9670 ext . If you can
not make contact between those hours, please call and leave a message and
I will return your call as soon as possible.
Thank You,
r.
Building Inspector
cc: Property File
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
OWNER Carla/I//l6breli�44rles 1d Maa-,i'N- TELEPHONE 36D- d3o- ` 183
COMPLIANCE INFORMATION
TYPE OF PROJECT: ($NEW RESIDENCE O ADDITION O REMODEL O OTHER
AREA(SQ.FT.) 1ST FLOOR ,j ' 2ND FLOOR) Z�() HEATED BASEMENT_—�
Note: Heated basements must be ' ulated and finished to`tn t minimum energy code requirem ts.
TOTAL SQUARE FOOTA OF CONDITIONED �TED) AREA 2,a 6 2
COMPLIANCE METHOD: a-
S
() PRESCRIPTIVE PATH — circle option— I H III IV V 0 VII VIII
Glazing percentage /s�?5 (total glazing area divided by total conditioned area)
() COMPONENT PERFORMANCE — Chapter 5 — attach documentation and worksheets
() SYSTEMS ANALYSIS — WATTSUN 5.2 — attach documentation and worksheets
WATER HEATER
�Q Electric water heater () Gas water heater
HEATING SYSTEM:
ELECTRIC RESISTANCE
() Electric Central Furnace () Electric Wall Heaters () Baseboard Units
() Radiant Panels () Other
OTHER FUELS
,Heat Pump with electric furnace ( ) Heat pump with gas furnace ( ) Gas Furnace () Oil Furnace
() Other () Boiler System ('indicate type)
Make Model
Size AFUE HSPF
VENTILATION SYSTEM:
() Spot and Whole House (,) Central Ducted System 'K Integrated with Furnace
( Heat Recovery System (air to air heat exchanger — heat recovery heat pump)
GENERAL NOTES:
Your building plans should indicate certain compliance measures: framing to be used (standard,
intermediate, advanced); type of vapor barriers being used; location of furnaces, hot water tanks and
other equipment; location of solid fuel burning appliances, fireplaces and their combustion air duct runs;
and termination points of exhaust ventilation fans.
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WINDOW & DOOR SCHEDULE
WINDOWS
INCLUDE ALL WINDOWS, SKYLIGHTS, SLIDING GLASS DOORS, FRENCH DOORS AND
STORE DOORS. ANY WINDOWS IN DOORS (LESS THAN 50% OF AREA) MUST BE
TAKEN OUT OF THE DOOR AREA AND PUT INTO THE WINDOW AREA ON THE
SCHEDULE.
BRAND MODEL U-VALUE QUANTITY SIZE TOTAL SQ. FT.
TOTAL WINDOW AREA z
DOORS
BRAND MODEL U-VALUE LOCATION SIZE TOTAL SQ. FT.
TOTAL DOOR AREA
,N 1-95 THU 11 `_ -.ICI WESTCOASTVINYL, INC FAX NO. 1 206 565 1379 P. 3
ConBol
ccsnSal Testing Services
0 r
747 Tam O'Shonter Drive.Suite 200
rR"F— -I
• Stockton.CA SM210-3370 G
(eOSI 474-8446 FAX P091 474-OB17
WINDOW U-VALUE MATRIX
Manufacturer: West Coast Vinyl Simulation Date: 05-28-93
Product: Serie$ 7400 Sliding Window Expiration Doi 05-28-9" e
Operator Type: Horizontal Slider Revised Date: 09-13-94
Material: Vinyl with alum. reinforcement at fixed meeting rail)
Y ( ,
i
NFRC Accredited Simulator:
/
Kevin Ford
Model Size
11AA1? 11BB"
CTS Simulation #: MK-5033-93-S 60"x36" 72"x48"
Glazing System Description Spacer
IG i_tivp# Glass es, Thickness,gas fills, Eniissivities, etc.) (thicb?ess) Grids l� "AA" "BB"
{
1/2" OA:
#1 DS /DS 1/4" Alum. No 0.54 G.55 C✓1
1" OA:
#2 DS /DS 0.764" Alum. YIN 0.50 0.50
#3 DS /DS - Argon fill 0.764" Alum. Y/N 0.48 0.48
" #4 DS /DS LOF Low-E e_ r 197, surface 43) 0.764" Alum. YIN 0.40 0.40 I
� _ ? surface#3 0.764" Alum. Y/N �� 0.3b 0.36
#5 DS /DS LOF .e 0.19 . surfa } i
with Argon fill
P
96 Triple Pane:
PPG Sungate-100 /DS /DS PPG Sungate-100 II
e= 0.085 surfaces #2 and #5) 2x0.323" Alum. No 0.29
Added 9-13-94:
#7 DS /DS 0.764" Super SpacerTM Y/N 0.4 0.48
IL II
48 DS /DS - Argon fill 0.764" Super SpacerTM YIN 0.46
#9 DS /DS LOF Low-E (e=0.197, surface#3) 0.764" Super SpacerTM YIN 0.37 0.37 1
#I0 DS /DS LOF Low-E (e= 0.197, surface#3) 0.764" Super SpacerTm Y/N1 �� 0.34 0.33
with Argon fill
is-
;01
: l
,.
...1. - .- yliF �., _ _... TT i ...
- _ =:' _ FAX NO. 1 206 555 1379 P. 2
i. All
`, 4 --'',-WIN WS
jNCL' JDB AL I.1iVYNDOWS,SKYLIGMS, SLIDING GLASS DOORS, FRENCH DOORS ",
- - .. . AND ,.,,�;, t • ,,; �.
SWORE DOORS. ANY WINDOWS IN DOORS(LESS THAN"%OF AREA)MUST BE
TAKEN OUT OF THE DOOR AREA AND PUT INTO THE WINDOW ARIA ON THE
SCHEDULE.
BRAND MODEL. U VALUE QUANTITY SIZE TOTAL.SQ. FT.
SW CE!{W •�Q 2 ° `' 28 8
r �
I'
Su n� (� ° 30h;: ,
f
�I
'I
l
I,
• 1
s I
TM AL WINDOW S' '
I
I)OM
BRArrD Ft6
�I. vAlu$ �e
$III5 TOTAL SQ. IF.
C�
v�tJ S
DOTAL DOOR �-
WINDOWS/DOORS NOTED ARE THE WEST COAST VINYL 7400 �
SERIES VINYL FRAMED. l
U-VALUES NOTED ARE W H LOW-f LAST 'kND 1"OA SPACER.
Permit No.
MASON COUNTY O 0\1
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE POINT y-
�
#1 ner' ear-la Phone# 3 - 930 - Y1FL3
ite Address s f Fire District#
City (��/�c,,'� G�/� 2 c185�8 St _ Zip
Directions to Job Site e r cda l yr o�
ear f T a "e 1 b r. P
l�() ep�n e r o-� �fac�5rr�, �'L► �r and Fn
Owner Mailing Address 5,39
City r'm r LLav� St-/ _Zip 83 z
Lien/Title Holder
Address
Clty St Zip
I
#2 Contractor Name Contractor Reg #
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic?— —Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 cel No. 22 3 / U - 75 - 90/2 U
Legal Description TIC /2 -R of 5yr✓eu S//3,�� Ti22 a /70
4W
,15 Building Square Footage:(existing/ ro osed
vl 1st FI / nd FI / /46* 3rd FI / Loft /
'A Basement Deck / Zk bedrooms / i. #bathrooms
`Garage /O Carport / (Circle: ttache r Detached?)
. F9 Vier 55z sq.
/ ` 4 x 20 So
#6 Use of building , Siden t�,Q / Describe work
#7 Type of Job: New V Add Alt Repair Other
#8 MOB IE/MANUFACTURED HOME INFORMATION
M ode l,Year, I Make Model I
Length Width Serial No.
# Bedrooms # Bathrooms Type of Heat
Purchase Price$
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake Marsh Saltwater easonal Runoff Other
Show following on the site plan
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
Drainage Plan Topography
Septic Systems Wells
Proposed Improvements Easements
Name of Flanking Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO-DRAW SITE PLAN BELOW
' 300
�-3 1 �
L4q
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Ve
c�
Plumbing Fixtures ($3 eac!21 Fee Mechanical Fixtures ($6 each)
No. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins oiipump Other
I Bath Tubs No. Units Fees
I Showers / Furn BTU �o
I Hot Water Htr Heatpumps �e
Laundry Washer Vent Systems vO
5 Sinks Spot Vent Fans
Floor Drains No. Boilers/Compressors
_Laundry Basins HP
f 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
DooGas, 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 OWN ER % X BY
DATE `�T 9� DATE
FOR OFFICIAL USE ONLY: Accepted by: ` x Date:
............. .......... .... .
..........................
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: i
Environmental Health:
Building Plan Review
I
Occupancy Group: Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee Z5 C o
Wood/Gas/Pellet Stove �500
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other�oC(� o�
Other
Building Valuation: TOTAL FEE