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Home My WebLink AboutBLD2001-01288 Final SFR - BLD Permit / Conditions - 9/5/2008 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext. 352 r Mason County Bldg. 3 426 W. Cedar P.O. Box 186 k Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT -------BLD2001-01288 OWNER: MICHAEL RICIGLIANO RECEIVED: 12/18/2001 CONTRACTOR: LUMBERMENS HOMES LICENSE: LUMBEH"011JK EXP: 5/1/2006 ISSUED: 1/11/2002 SITE ADDRESS: 110 NE LAKEWAY DR SOUTH BELFAIR EXPIRES: 4/11/2003 PARCEL NUMBER: 223107990743 LEGAL DESCRIPTION: TR 74C OF SURVEY 11/17 LOT: C OF SP #1487 110 NE LAKEWAY DR SOUTH BELFAIR PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESIDENCE TAKE BELFAIR HWY TO BLACKSMITH DEWATTO RD GO PAST PANTER LAKE WHEY YOU SEE SCHOOL BUS STOP SIGN BLACKSMITH RD IS ON LEFT GO ONE MILE STAY TO RIGHT AT T TAKE LEFT 3RD LOT General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 2 Type of Constr.: 5N Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: r3u1 Lot Size: Deck: 178 Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:1,232 Garage-Attached 560 Valuation: Building Height: 28 Occ. Status: Primary Basement:686 Manufactured Home Information Setback Information Shoreline & Planning Information Make: Length: Ft. Front: E 280.0 Ft. Shoreline: 220.0 Ft. Water Body: Blacksmith Lake Rear: W 220.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: N 55.0 Ft. Shoreline Desig.: Unknown Year: Serial No.: Side 2: S 27.0 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 TW 12/18/200 $582.24 58052 Hosebibs 4 Ventilation Fan 3 EH Plan Review CEW 12/18/200 $50.00 58225 Kitchen Sink 1 Woodstove 1 Planning Site Inspection RAM 12/31/200 $70.00 58225 Lavatories 2 Dryer Vent 1 Adjust Plan Check Fee DLC 1/2/2002 $9.06 58225 Showers 1 Building Permit Fee DLC 1/2/2002 $909.75 58225 Water Heaters 1 Mechanical Fee DLC 1/2/2002 $81.65 58225 Bath Tubs 2 Mechanical Base Fee DLC 1/2/2002 $23.50 58225 Bath Tubs 1 Plumbing Fee DLC 1/2/2002 $75.00 58225 Clothes Washer 1 Plumbing Base Fee DLC 1/2/2002 $20.00 58225 Building Permit Fee JRN 10/28/200 $454.88 B12004 Total $2,276.08 Please referto th following BLD2001 01288 e of owing pages for conditions of this permit. 1 of 4 Inspection Line (360)427-7262 MASON COUNTY DEPT. OF COMMUNITY Phone: (360)427-9670, ext. 352 DEVELOPMENT Mason County Bldg. 3 426 W. Cedar P.O. Box 186 � Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2001-01288 OWNER: MICHAEL RICIGLIANO CONTRACTOR: LUMBERMANS HOMES RECEIVED: 12/18/01 SITE ADDRESS: 110 NE LAKEWAY DR SOUTH BELFAIR '(ION ISSUED: 1/11/02 PARCEL NUMBER: 223107990743 Olt) BY EX EXPIRES: 7/11/02 LEGAL DESCRIPTION: TR 74C OF SURVEY 11/17 TR C OF SP#1487 Ip�l�c'7co�ev — PROJECT DESCRIPTION: DIRECTI O ST ITE: RESIDENCE TAKE BELFAIR HWY TO BLACKSMITH DEWATTO RD GO PAST PANTER LAKE WHEY YOU SEE SCHOOL BUS STOP SIGN BLACKSMITH RD IS ON LEFT GO ONE MILE STAY TO RIGHT AT T TAKE LEFT 3RD LOT General Information Construction & Occupancy Information Square Footage Information No. of Bedrooms: 2 Type of Constr.: 5N Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: r3u1 Lot Size: Deck: 178 Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:1,232 Garage-Attached 560 Valuation: $87,762 J . Building Height: 28 Occ. Status: Primary Basement:686 Manufactured Home Information Setback Information Shoreline & Planning Information Make: Length: Ft. Front: E 280.0 Ft. Shoreline: 220.0 Ft. Water Body: Blacksmith Lake Rear: W 220.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: N 55.0 Ft. Shoreline Desig.: Unknown Year: Serial No.: Side 2: S 27.0 Ft. Comp. Plan Desi .: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qtya Type Qty. Type By Date Amount Receipt Bath Tubs 2 Ventilation Fan 3 Plan Check Fee TIN 1gi1Rm1 (tSR?qa c;Rnrq Lavatories 2 Dryer Vent 1 EH Plan Review r.Fw 1)i1Rm1 ern on FRq?F Bath Tubs 1 Woodstove 1 Planning Site Inspection RAnn iwii/n1 ¢7n nn Showers 1 Exhaust Hood 1 Adjust Plan Check Fee ni r. 1igmo) e4 nF r,R?qS Water Heaters 1 Building Permit Fee ni r. 1nm? �gnca 79; FR?9S Clothes Washer 1 Mechanical Fee rn r. 1i?m,) aR1 RE; SR,)I?S Kitchen Sink 1 Mechanical Base Fee ni r. v?rm ewz Fn r,R9g5 Dishwasher 1 Plumbing Fee ni r. 1igmq �7F nn 5Aggr, Hosebibs 4 Plumbing Base Fee ni r. 1iwmq ¢,)n nn FR9,S Total $1,821.20 BLD2001-01288 Please refer to the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD2001-01288 CONDITIONS FOR BLD2001-01288 1) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. i 2) This applicatio is iLto Buffer and Landscaping requirements as established unde ason County Ordinance 1.03.036. 3) The use, handling nd storage of hazar 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 prof t X 5) Proposed structure any portion thereof greater than 30" in height fro de line, must maintain a minimum of 5' setback from all property lines, easements and 10'from all County and State Road right of ways. X 6) A Road Access Permit or Appr v I ust be granted by the Mason County Department of Public Works. For more information contact Charell Holcomb, at(206)427-9670, ext. 450. 7) 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 8) Approved per dimensions and set (Cks on submitted site plan. 9) Condition is infor ational only: Blacksmith Lake is regulated as a wetland per the provisions of the Mason County Resource Ordinance. Any construction or modifi nd within 140 feet of the lakeshore will require environmental review that may include a wetland typing of the lake system. X - BLD2001-01288 Please refer to the following pages for conditions of this permit. 2 of 4 10) 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 in the amount of$47.00 per hour (minimum 1 hour)will be charged and must be collected by the Building Department p ' any further inspections being performed or approvals granted. X 11) 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 faiIA91ost the address on site prior to requesting inspections. X 12) 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�bbhha�or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans o ration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. X 13) The"approved" plot plan is required to be on-site for inspection purposes. If an inspection is requested and the "approved" plot plan is not on site, then approval will not be granted. In addition, a re-inspection fee in the amount of$47.00 per hour(minimum 1 hour)will be charged and shall be collected by ZeeBuildi artment prior to any further inspections being performed or approvals granted. 14) Washington tate Energy Code Compliance has been approved using the following: Heat Type: Electric Compliance Method: Component Performance 294/289 Window(Max U-Factor): See list on plans, Doors (Type/Max U-Factor): Specified ee foam core U-.14,Wall insulation R-21 , Floor insulation R-30 , Ceiling Insulation R-38 , Sissor Insulation R-38 , Slab Insulation R- 10 X 15) 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 of$47.00 per hour (minimum 1 hour)will be charged and shall nn2� y the Building Department prior to any further inspections being performed or approvals granted. X 16) 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 per cation. X 17) All Chaffto" roved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance or regube reviewed and approved by Mason County prior to construction. X 18) 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 BLD2001-01288 Please refer to the following pages for conditions of this permit. 3 of 4 19) All property lines shall be clearly identified at the time of foundation inspection. 20) 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 rdinances and building regulations. X 21) 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 ha v action from being taken. No more than one extension may be granted. X 22) A Road Access Permit or Approv b ranted by the Mason County Department of Public Works. For more information contact Charell Holcomb, at(206)427-9670, ext. 450. 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 anytime after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before buildinqSan a occupied. OWNER OR AGENT. DATE: BLD2001-01288 Please refer to the following pages for conditions of this permit. 4 of 4 co r o CONCRETE MECHANICAL MANUFACTURED HOME 0 6 Footings / Setbacks Date 3 � By LJ6 Ribbons Date By Gas Wing Date By co co Foundation Walls Date B y Set-up Date By INSULATION Date By B G / Slab Insulation Floors Final Date By Date By Date By FRAMING Walls FIRE DEPT Date 1 3 (j5 By Date By Date By PLUMBING Attic G`'� OTHER Groundwork Date 3 Byt-OX- Date By WALLBOARD NAILING D.W.V. Date a� By- ? Date 3 OS By u*L FINAL INSPECTION Water Line Date B YV ,"r4 xs D ate/G5-9 c By Date By 0 Err S �l3 t) l�/z�/�'1 fir , OC J u'_ P-C r( a L)a,-i-t �,,,s,.1L.��ri t � 'S 5 Z 7r� n cnp`S14�v� �,-(h , bda.�r�JnD 8 O cJV J-,F.��1•-f ur729ri?� Cn Gar 00 CD 00 0 CONCRFE C�r-'.d MECHANICAL MOBILE HOME F c tir ;Setback date by Ribbons _ _�Z �Z_ date � by c Gas Piping date b Foundation Walls c"--30 date by Set Up date INSULATION '—v Z by ��Z date by - 3G/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING OTHER Attic C'roukt�.�� b �/�� date by date WALLBOARD NAILING D.W.V. date by date by FINAL line NAL INSPECTION date by date by date by J UN /fib -/ / � Z I � � )uilding Permit # O -U/Z � „ . MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (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 '5/!/YE O � 7'ClC - /Yd / e % C.9 tit/V eI ca/� / /Xi� C-�y�� - S,E''�- .rev .-w-�fl or - .-- - i mac-✓ S - GL m -ivy �7'� /A- s y Ti _A-/,C3 You hre hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑ OK to This is not a complete inspection Department Z3 �-- Date ZC2 Inspector § VOVL NOT M4 *V T Lmo TAo1q, Building Permit # MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (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 c� E`er i-•--� 77 oZZX S' Ste' v You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection A OK to 13 /,S� !� ❑ This is At a complete inspection Department '/3 clz? Date ��' Z Inspector u NuTo I Mo *V T 1 TAL 1pMason County Dept. of Community Development Mason County Bldg. 3 426 W. Cedar P.O. Box 186 (360) 427-9670 Local (360) 482-5269 Elma Shelton, WA 98584 (360) 275-4467 Belfair r to Notice to Obtain Final Inspection December 19, 2007 MICHAEL RICIGLIANO PO BOX 645 BREMERTON WA 98528-0455 Case No.: BLD2001-01288 Parcel No.: 223107990743 Proiect Description: RESIDENCE The Mason County Department of Community Development is currently reviewing all permits that are expired and have not been approved for occupancy and use. Pursuant to Mason County Code, Title 14 Building and Construction, a permit and final inspection for this type of activity is required under the 2006 International Building Code or the code your permit was issued and your property is currently in violation status of occupancy and use. Please contact our office to make the necessary arrangements 21 days from the date of this letter. Failure to contact our office to make the necessary scheduled inspections will result in enforcement actions. To bring your site into compliance, you must schedule an inspection. One (1) $64.00 site investigation fee will need to be paid prior to inspection along with any outstanding fees currently due on your building permit. For every inspection required after that, you will be charged $64.00 again, per inspection until final inspection and conditions are met. To schedule an inspection, please call (360) 427-9670 ext. 262. If you should have any questions regarding this notification, please contact me at (360) 427-9670 ext 359. Sincere) Terry Ryan Mason County Department of Community Development Cc: Property File December 19, 2007 BLD2001-01288 --�� Enerw Code Information Project: LM Ricialiano Residence Date: June 25 2002 Insulation and Vapor Barrier: A. Minimum R- 38 in ceiling(attic) B. Minimum R- 30 in vaulted ceiling (cathedral) C. Minimum R- 21 in wall D. Minimum R- 30 in floor E. Minimum R- 10 at slab-on-grade edge F. Minimum R- Note: R-Values shown are minimum this option. See drawings for actual R-Values Code Conformance: A. Climate Zone: 1 B. Conforms to the Washington State Energy Code. C. Conforms to the Prescriptive method of Code Conformance Option no. 6 1. Group R Occupancy Heating by Electric Resistance: Yes 2. Group R Occupancy Heating by Other Fuels : No D. See Compliance Report for further information. �gs'Q�'p �yA 0418 Framing Methods: NG£SSUB��/NO /N A. Wall framing method shall be: Intermediate Oqr£ r o4pp�a oR B. Roof framing method shall be: Standard — 4 Floor Area: 1876 Glazing Area: 338 Percent of Glazing: 18.02% 0 �� q� Analyst: Melissa Cotey Foster and Williams Associates, P.S. 2e, ��2 Window & Door Schedule Project iVame.LM Ricigliano Residence Heated Area Only Dare: June 25, 2002 Windows Brand Type or Model U-Value Quan- Size 1/2 1/4 Area rity w H Rd.I Rd. (Sq. Ft) Mil and Honz. Slider AR/LE 0.350 3 5 4 ❑ LJ 60.00 Mil and Honz. Slider AR/LE 0.350 3 4 ° 3 ' ❑ L 42.00 Mil and Honz. Slider AR/LE 0.350 1 4 ° 3 ° ❑ L 1 12.00 ❑ L: ❑ L! Mil and Vert. Slider AR/LE 0.350 1 2 ° 3 ° ❑ !1 6.00 L_ Mil and Fixed AR/LE 0.310 3 5 ° 4 ' ❑ L! 81.00 Mil and Fixed AR/LE 0.310 2 ❑ 34.00 Mil and Fixed AR/LE 0.310 1 1 2 ° 3 ' ❑ ❑ 7.00 ❑ L; Mil and Garden AR/LE 0.480 1 4 ° 3 ° ❑ LJ 12.00 ❑ L.: Peachtree Avanti Swinger 0.290 1 2 6 ° 6 a ❑ L' 80.00 L! L! Seattle Gi. Blk. Glass Block Thin Line 0.570 1 4 ° 1 ° C L_ 4.00 ii ❑ LT ❑ i,J ❑ i C ❑ Total Window Area: 338.00 338 Weighted U-Value: 0.329 —3 Skylights (� Brand Model Number U-Value Quant Size Area w H (Sq.Ft) Total Skylight Area: Weighted U-Value: 0.000 Doors Brand Model Number U-Value Quant Size Area(Sq. w H Ft) Peachtree Exterior Door 0.140 1 iEg 20.00 Tonal Door Area: 20.00 Weighted U-Value: 0.140 F�� Foster and Williams Associates Analyst. Melissa Cotey o � 5 ?570�- �� a 1 N /�c�'J'f'�Pv�' � ►v � 6�� 2 20't- � � \c i I to /,BRA/i1/f�� Aj I c r At �=o /YJ�soiy a�c/ t Or 220' PERMIT NO.: BLD MASON COUNTY �'Z BUILDING PERMIT APPLICATION w 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 APPLICANT INF �4TION CONTRACTOR INFORMATION Owner ' r Contractor Name D ,# Mailin'Address Mailin Address Cit State� ��Zip Code� City State WA Zip Code Phone(03�2 ther Ph.( j Ph.(g(on ) ,9n9SS)/ Other Ph. Lien/Title Holder ► Contractor Reg. # /-4fZU Address Expi ratio nrf._'} J'ium eo S %S ON/ . SEPTIC/WATER SYSTEM INFORMATION-Connect to New eptic u'' Existing Septic Connect to Sewer System Name of Sewer System WeIIWater System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Fire District Legal Descriptio 1 O hWI Site Address(Pleasd include street name, street number and city 1-7y Directions to site / P D _ V . Pe q /. Will timber be cut and sod in prbrcel preparation? (Yes/No)�([� Is your pr perty within 200' of the following: Body of Water(Name) J �M 1/W Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE Q SEASONAL RESIDENCE❑ TYPE OF JOB New• Add Alt Repair Other Use of Building Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor oft asemen Deck /7R Other sq. ft. Garage Attached etached Carport Attached Detached Z MOBILE HOME INFORMATION-Make Mod 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. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 approal ,,// V'AX Date & -.9 -0 X Date h� 17)07, e � i�� Ur1C FOR OFFICIAL USE BEYOND THIS POtN T_ Accepted by Da 4 Submittal Amount Due Receipt No. DEPARTMENTAL.REVIE1!1f APPROVED DENIED '. C(?(VDITI N COpE& Building Department Nofols Occ Group RZ 01 Type Constr.�J IgI, Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ g� �(o�• J�v FEES Building Permit Fee 0 C/• •75 Site Inspection Plan Review Fee 341 EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee5� Violation Fee No el,4 . Pre-Paid at Submittal ( ��• 8' ) 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 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLI ANT INF ATIO CONTRACTOR IN ORMATION Owner �� l('� / /70 Contractor Name / �0i7)rS�~ Mai!in Address Maili g Address City IVF State Zip Code City >. r`° State Zip Code Phone - ther P .�� Ph. / Qther Ph. 00 �'/ O Lien/Title told 4 I f E D Contractor Reg. # fn45 •l1 v Address A p"'` Expiration 66 / 0/ / 402 rZ urn Ui,, : /s� c1 o411,?Ac1 ,e 3-lied 6,1/ SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMAT ON-12 digit TaxParcel-No. / / D Fire Distri t Legal Description OF Jr I WN ,3ANq 6 A Als,%o Site Address(Plea ' Clude reet n me street numb r nd city / 9 A IUQ' D Di ctions to site A >i` A1t1 li 4l mi l O/V 1 KG e /� ,,/ Is your perty within 200' of the following: Body of Water(Name),(%lyf44/.0I//// 44,09 Saltwater Lake AJ River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluff st TYPE OF JOB New 1-" Add Alt Repair Other Use of Building knoo �?oe. Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No. of Units Fees Bath Basins Furnace Bath Tubs Heatpumps Showers Vent Fans Water Heater Propane Tank N/A Laundry Wsher Gas Outlets N/9 Sinks oo Gas/Pellet Stove-7— Dishwash r re Vent? Other Other L* eY 7- f Other /'e:46ZZ4 i Other a / 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 r va Date 0/ Date111yd*1 VI/Mile FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. . F7itZl`NEEfVTAE::RI (fW: APPROVED D>AIVIED GGNDffICJTVCt1[JE5 Building Department Occ Group Type Constr. Planning Department Other Other 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