HomeMy WebLinkAboutBLD2003-00520 Final SFR - BLD Permit / Conditions - 8/11/2004 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
BLD2003-00520
OWNER: JAY HOLMSTROM RECEIVED: 4/29/2003
CONTRACTOR: BRIKAR CONSTRUCTION CO 360-692-9989 LICENSE: BRIKACCO55DS EXP:7/3/2003 ISSUED: 6/12/2003
SITE ADDRESS: 30 NE LAKEWAY DR SOUTH BELFAIR EXPIRES: 12/12/2003
PARCEL NUMBER: 223107990732
LEGAL DESCRIPTION: TR 73B OF SURVEY 11/17 TR B OF SP#1496 30 NE LAKEWAY DR SOUTH
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
RESIDENCE BEAR CREEK DEWATTO RD TO BLACKSMITH LAKE LAKE RD TO
LAKEWAY DR LEFT ON LAKEWAY DR 150FT SITE ON RIGHT
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: VN
Type of Use: SF Insp.Area: No.of Bathrooms: 2 Occ. Group: R3U1 Lot Size: Deck: 276
Type of Work: NEW Fire Dist.: 5 No.of Stories: 2 Occ. Load: Building:1,428 Carport-Attached 896
Valuation: Building Height: Occ. Status: Primary Basement:0
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: N 415.0 Ft. Shoreline: 110.0 Ft. Water Body: BLACKSMITH LAKE
Rear: S 11 SEPA?: No
Model: Width: Ft. 6.0 Ft. Slope: Ft. Shoreline Desi
Side 1: E .0 Ft. 9.: Urban
Year: Serial No.: Side 2: W 54.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Hosebibs 2 Exhaust Hood 1 Planning Review Fee KS 4/29/2003 $150.00 S12003
Kitchen Sink 1 Ventilation Fan 3 Plan Check Fee KS 4/29/2003 $675.06 S12003
Lavatories 2 Dryer Vent 1 EH Plan Review NJP 6/12/2003 $75.00 S22003
Water Closets (Toilets) 2 Building State Fee TCS 6/12/2003 $4.50 S22003
Water Heaters 1 Plumbing Fee TCS 6/12/2003 $63.00 522003
Bath Tubs 2 Plumbing Base Fee TCS 6/12/2003 $20.00 S22003
Clothes Washer 1 Mechanical Fee TCS 6/12/2003 $39.65 S22003
Mechanical Base Fee TCS 6/12/2003 $23.50 S22003
Adjust Plan Check Fee TCS 6/12/2003 $14.56 S22003
Building Permit Fee TCS 6/12/2003$1,060.95 S22003
Total $2,126.22
BLD2003-00520 Please referto the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLD2003-W520
CONDITIONS FOR
B LD2003-00520
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
1-800-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
2) In accordance with the Uniform Building Code, all sites shall have approved numbers or addresses located in such a position as to be 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 re-inspection fee based on rates as adopted by the jurisdiction and the Uniform Building Code will be assessed if the owner and/or
contractor fail to post the address on site prior to requesting inspections.
X
3) 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. X
4) 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.
X
5) All property lines shall be clearly identified at the time of foundation inspection. X
6) All upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt
fencing or straw matting). X
7) Approved per dimensions and setbacks on submitted site plan. X
8) A total of 65'setback must be maintained between the ordinary high water mark of the lake and the residence. The 65' is comprised of a 50' undisturbed
vegetative buffer and a 15' building setback. X
BLD2003-00520 Please referto the following pages for conditions of this permit. 2 of 4
9) 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
Department prior to any further inspections being performed or approvals granted.
X
10) The plan review check list and corrections, along with the Energy Compliance Worksheet(when applicable) are part of the approved plans
remain thereto. It is the responsibility of the applicant to make the corrections indicated on the plans. Once the plans are marked "APP they
shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the comple a ved set of
plans on site for the duration of the project. Failure to comply and/or removal of approved documents will result in fail re o requi ding inspections.
X /CA /
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 (Type/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
12) All construction must meet or exceed all local ordinances and the 1997 Uniform Building Code 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 revocation.
X
13) Placement of structure must comply with standards setforth per 1997 UBC Chapter 18 regarding descending and/or ascending slopes.
X
14) All changes to"approved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance
or regulation, must be reviewed and approved by Mason County prior to construction.
X
15) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the Uniform Codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector shall be made prior to requesting additional inspections.
X
16) 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
17) 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 prevented action from being taken. No more than one extension may be granted.
X
18) Prior to final occupancy the private two party water system must be approved.
X
BLD2003-00520 Please referto the following pages for conditions of this permit. 3 of 4
r , I
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.
OWNER OR AGENT: DATE:
BLD2003-00520 Please refer to the following pages for conditions of this permit. 4 of 4
6/12/2003
Conditions Associated With 10:49:24AM
T I D E M A R K Case#: BI D2003-00520
COMPUTER SYSTEMS. INC.
Permit Condition Status Updated
item# Code Title Status Changed By Tag Date By
1) 700 RCW 18.27 NOT MET 4/29/2003 KS
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 1-800-647-0982.The
person signing this condition is either the homeowner,agent for the owner or a registered contractor according
to WA state law. X
2) 1002 POST ADDRESS NOT MET 4/29/2003 KS
In accordance with the Uniform Building Code,all sites shall have approved numbers or addresses located in
such a position as to be 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 re-inspection
fee based on rates as adopted by the jurisdiction and the Uniform Building Code will be assessed if the owner
and/or contractor fail to post the address on site prior to requesting inspections.
X
3) 4999 Flammable+Combustible Liquids NOT MET 4/29/2003 KS
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.
X
4) 5019 MCPW Development Requirements NOT MET 4/29/2003 KS
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.
X
5) 5510 Property Lines NOT MET 4/29/2003 KS
"75a� All property lines shall be clearly identified at the time of foundation inspection.
X
6)� 60 Erosion Protection NOT MET 5/8/2003 RAM
All upland areas disturbed or newly created by construction activities shall be seeded,vegetated or given an
equivalent type of erosion protection(silt fencing or straw matting).X
7) 200 Site Plan NOT MET 5/8/2003 RAM
17 Approved per dimensions and setbacks on submitted site plan.X
8) 1000 LAKE BUFFER NOT MET 5/8/2003 RAM
A total of 65'setback must be maintained between the ordinary high water mark of the lake and the residence.
The 65'is comprised of a 50'undisturbed vegetative buffer and a 15'building setback.
X
9) 1001 PLANS REQUIRED ON SITE NOT MET 5/16/2003 DLC
All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans
_ 1�/ are not available on site,then approval will not be granted. In addition,a re-inspection fee(refer to current fee
A ` schedule,minimum 1 hour)will be charged and must be collected by the Building Department prior to any
further inspections being performed or approvals granted.
X
Page 1 of 2 CaseConditions..rpt
6/12/2003
Conditions Associated With 10:49:24AM
T I D E M A R K Case#: BILD2003-00520
COMPUTER SYSTEMS. INC
Permit Condition Status Updated
item# Code Title Status Changed By Tag Date By
10) 1003 PLAN REVIEW CORRECTIONS NOT MET 5/16/2003 DLC
The plan review check list and corrections,along with the Energy Compliance Worksheet(when applicable)
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
approved documents will result in failure of required building inspections.
X
11) 1020 WA State Energy Code NOT MET 5/16/2003 DLC
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(Type/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
12) 5003 ALL CONSTRUCTION NOT MET 5/16/2003 DLC
All construction must meet or exceed all local ordinances and the 1997 Uniform Building Code requirements as
q� adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved
/e,qd and permitted classification. Any non-approved change of use or occupancy would result in permit revocation.
X
13) 5020 Slope Setback NOT MET 5/16/2003 DLC
Placement of structure must comply with standards setforth per 1997 UBC Chapter 18 regarding descending
and/or ascending slopes.X
14) 5030 CHANGES TO APPROVED PLANS NOT MET 5/16/2003 DLC
All changes to"approved"building plans that effect compliance with the Uniform Codes as amended and
adopted,or any other Mason County ordinance or regulation,must be reviewed and approved by Mason
County prior to construction.
X
15) 5045 FIELD CORRECT NOT MET 5/16/2003 DLC
The construction of the permitted project is subject to inspections by the Mason County Building Department.
All construction must be in conformance with the Uniform Codes as amended and adopted by Mason County.
Any corrections,changes or alterations required by a Mason County Building Inspector shall be made prior to
requesting additional inspections.
X
16) 5600 FINAL INSPECTION REQUIRED NOT MET 5/16/2003 DLC
All building permits shall have a final inspection performed and approved by the Mason County Building
a/ 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
17) 5610 PERMIT EXPIRATION NOT MET 5/16/2003 DLC
All permits expire 180 days after permit issuance,or 180 days after the last inspection activity is performed.
,q 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 prevented
action from being taken. No more than one extension may be granted.
X
18) 1000 **WATE EQUACY** NOT MET 6/9/2003 ADR
Prior to al occupancy the priv two party water system must be approved.
X
Page 2 of 2 CaseConditions..rpt
`! CONCRETE MECHANICAL MANUFACTURED HOME
Footings / Setbacks Date By Ribbons
Date By Gas Piping Date By
Foundation Walls Date By Set-up
Date By INSULATION Date By
B G / Slab Insulation Floors Final
Date By Date By Date By
FRAMING Walls FIRE DEPT
Date By Date By Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLBOARD NAILING
D.W.V. Date,;�� By i/�
Date By FINAL INSPECTION
Water Line Date
Date By Date By
cn
CD
`° 0 LS 5EE A-t9� D a
0
a
v
a
8
a
o"
Z)
En
0
m
0
APPROVED
MASON COUNTY DCJ PLANNING SITE
SITE AN REQUIRED TO a ON
C. cc)y
By
110`
J � CIL
5N
OV
15
ell
rJ
c
\A/A
5u/ ZT
PRo PERT;
i
E
I
i
I _ I i
I I
I
1 I
f
p � i
E
-T
i
_.
AC G �
_... _ PRovosto �Pl��
s
L
F' 1 1�
R
i
TOPOGRAPHY PROFILE:
Direction: Scale: Approval: for office use
Building Permit number: - Building:
Owner/Applicant: Y/�fOLif1 Sim Date of Planning:
Parcel Number: �02.� /D 79' �D 7l07 application: Env. Health:
PERMIT NO. BLD �t.A -
MASON COUNTY
BUILDING PERMIT APPLICATION 60b2-0
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton(360)427-9670 Belfair(360)275-4467 Elma(360)482-5269 Seattle(206)464-6968
On the Web www.co.mason.wa.us
APPLICANT II FORMATION - CONTRACTOR INFORMATION
Owner q!' (wSIOWC/117 Contractor Name �,Pit'p.P �o r/STiP!/Cl1cLV�
Mailing Address /?/S ./e-i a! 411,e z- Mailing Address bjCe AAp
City FpBE pp State ',Zip Code 34W3 7e? City �/� +IOAL E State 1 �►Zip Code�Q3
Phone (_ 217.3/,75 Other Ph. L_) Phone(, 0) dy'.0.9 W" Other Ph. (_�2,69.?
Lien/Title Holder Contractor Reg.# e o Exp. /,�f
E-mail Address E-mail Address
SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Sewer
System_Name of Sewer System Well Water System
Name of Water System
PARCEL INFORMATION- 12 digit Tax Parcel No. 9 Fire District
Legal Description 7W 73,8 Os' SA d dwilIC
Site Address (Please include street name,street number and city) JQ 6 4dA6f jd&k AV AE: ►iLP
Directions to site ,, dy"�y 4&-uhf D Al 1i0 A&4d e9AV--7 lI .CR�F �' YO
,IC 'Al2-2
Will timber be cut and sold in parcel preparation? (Yes/No)
Lake River/Creek Pond Wetland Seasonal Runoff Stream
Slopes or Bluffs f" --,oF
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE
TYPE OF JOB- New Add Alt Repair Other Use of Building 4�t►.Sa,T/At. L:+��ire
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? (Yes/No) 44!5
Describe Work s ?Zr ,?_4V,*,e&7- TX*-44 ST,P&e7WW0
No. of Bedrooms_„_No.of Bathrooms_ A SQUARE FOOTAGE- 1st Floor .5946 2nd Floor
3rd Floor Loft Basement :S7Q —Deck A, Other sq.ft.
Garage '<� Attached_ _Detached Carport Attached Detached
MOBILE HOME INFORMATION - Make / Model 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.
NOTICE:THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.The owner or agent on owner's behalf, represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection
of this project.Owner/Builder acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgment
of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
the Contractor Registration Law RCW 18.27 and am aware of the ordi- contractor in the State of Washington and that I am aware of the ordinance
nance requirements for which this permit is issued and that all work will be requirements regulating the work for which this permit Is issued and all
done in conformance therewith. No c ges shall be made without first work shall be done in conformance therewith.No changes shall be made
obtaining approval. .� without first obtaining approval.
X Date X Date -fee-05
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
DEPARTMENTAL IREVI". APPROVED DENIED CONDITION CODES
Building Department
Occ Group T e Constr. 'J-M - G- Of 7.00 — '24 q
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
Valuation$ IN
7-9?--?, ?
FEES
Building Permit Fee Site Inspection
Plan Review Feet�oJ� GX t= EH Review Fee
Plumbing& Base Fee 3 Planning Review Fee
Mechanical& Base Fee SS Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee 1A0 F— Pre-Paid at Submittal ( )
TOTAL FEES
PERMIT NO.:
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 27"67 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner_ Contractor Name 6&944ep
Mailing Address Mailing Address A&fz
City ora&FN� _ State 144 Zip Code rej City,S',,r urnno�E State�� Zip Code ,
Phone( -, _.UZ3„419:Other Ph.( Ph.L )G� P9 Other Ph.
o� 8� (s6y
Lien/Title Holder Contractor Reg. # ,&e4d[�4&-e d�<nrnr
Address Expiration / /
SEPTIC INFORMATION-Connect to New Septic__,'lExisting Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION- 12 digft Tax Parcel No. 2,2 1 lL� �r�9// 5P.I1071a Fire District
Legal Description �Z-�7 ;Z 1,8 �,c
Site Address(Please include street name,street number and city) �:TC --;�i- 14&2css 0 � � -V
Directions to site R 4e zz AW,= e�[2—zo dz fL'�5JW,� 1�r 6?4 dz,1*0 V
.0= 4A/ L.r U-0- age -4 .r4 c�ir- S:w- t~5:.Adr-
Is your property within 200'of the following: Body of Water(Name) �42,eSt_ks,V-,lile zad/:- Saltwater
Lake_River/Creek Pond Wetland Seasonal Runoff Stream
Slopes or Bluffs
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 Fuel Type: Electric
Type of Fixture Alo of:Fixtures Fees LPG 40 Natural Gas Heatpump
Toilets Typf ni No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers _ Spot Vent Fan
Water Heater Ile Propane Tank
Clothes Washer oe Gas Outlets _
Kitchen Sinks _e Wood/Gas/Pellet Stove
Dishwasher 6 Kitchen Exhaust Hood
Hosebibs _-0� Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. first obtaining approval.
X Date X Date`"
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
. ..
DEPARTh?EENTAiwfiEl/IEVt( : 11P,FROVEt): ElVIED CO.NDTTISTN COD7S
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
FEES
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES
-- i