Loading...
HomeMy WebLinkAboutBLD97-00518 Final Addition - BLD Permit / Conditions - 6/8/1998 N MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 1 t-1 1 R_ " 1 N CA P €_ F4 P1.4 i .f FOR 1 NSPF CT I C+NS CAL€, 427-9670 F.ETWEEN 5pm AND Sam 427-7262 BUD97-0518 PARCEI :2n3107990742 PLAT ! D 1 V : BLK : t OT : .10B ADDRESS : NIF 80 I AKT'WAY PR S RFLrAIP OWNER - FLWOOD MEL.L 1 S 377-•2756 CONTRACTOR z VAN SLYKE CONSTROCTION 876-5283 1_EGAL : 11 149 Of SURVEY 11117 1R S 3F 3P 11487 " _.rmraxr_aa=:msarm��z:--r1-Fx�-.::.rs.w-sneesm_�c:�s+� . CL ASc OF WORK :ADPE�E1►F2 : 0 f A tf1 : f TYPE A#iOUR; 81' UPI[ AE6E lP1 TYPF AMOtjN1 By DATE Rf-.F IPi i T'YPF OF 0";v . . . . :4F STOR IfS. . . IT , f} 0 .4'�1''K EKICP ! ?ti.0r3.x OCC UP GROUP . _ . : 030 06124197 44772 TYPE Of CONST . . :? F I REPLACE S , , . . . 0 PROT t ?41.50 NJP 00124191 44712 � ! OC',CU€' LOAD . . . . : A WOODSTOVFS - 0 P€fM t 96.60 NJO #f124191 44172 Pfft L. .UN I TS . . < . : 0 PARKING SPACIS. e 0 IFIRP t 33.00 NJP O 124197 44772 ! � I NISPIF( I.' I ION ARFA f� 1 11HORE I NE? . , . , :Y $} TFE S 4.50 44? 06174197 44172 170TAL: 01.64 VAIUtATI04: 6��74CaRF±SA`� SS'S*... ..�f'„:..J2fc3'aY�a�...:.:.-:^.Y'-?+,3ft�.t¢�.S10.�u'.'^e4SC'T"T2!Y'^�"gC5t#tKCL•':5.:5:Y,"�YIYSHGCSiFiK'L.�A..:. i��••.,�j FTBACKS-_... _.__ _._.- _ ._..._ _. TOIL.FTS . . . . . ., , . . , : e FUEL TYPES----- I1OILERS/C0f-AP-.-.__ "OBILF HOME---. FOUNT , W 160 .Of1 BATH EIA`IN°S . . . . . . : 0 : 0--3 Nf. : 0 REAR . . . .E 420 ,Of t BATH TUBS . < . .. . , . . : 0 3-15 HP . . 0 MODEL : S I CIF ( 1 ) ,N 40 .Of t 1011#OWEPS . . . . . . . . : . , 0 FURN, 10OK BTU 0 15--:30 HP . : ill _!4AF f: SIDE (2 ) .S 60 .0f t WATER HE:ATE RS . -. . : 0 F ORN >—100K BTU :­0 30-50 HP . < 0 SHRI. I NF .W 160 .Of k CLOTHE` WASHE RS . . . 0 FURN --- FLOOR . . . : 0 50.# HP . . 0 - YEAR- AREA -.- _.._w__. __ ..____.__ KITCHEN SINKS .. . . . : 0 HEAT PUMP . . . . . . : 0 LOT SIZE= . . e FIOOP DRAIN3 . . . . : 0 VENT SYSTEMS : 0 EVAP COOLF.IRSt 0 LIFNCiI# : 0 BUILDING - -- 563 sf DRINKING FOUNT . , . : 0 VENT FANS . . . . . . : 0 HOODS . . . . . . . 0 WIDTH . : 0 BASEMENT . . « a Osf LAIINDRY TRAYS . . . . s 0 POMES . INCIN !O --`�FRi/li.#--- BECKS . . . . . . . 08f DISHWASHERS . . . . . . t 0 A 114 HANDLING UNITS-- COMMt , T NC I N ,O GAR/CARP : ? Osf GARB DISPOSALS . . . 0 10000 cfm . : 0 FTEL()CiREPt, IR : 0 AT'/I)T . :? URINALS . . . . . . . . . . : 0 10000 cfm . : 0 OTHER UNITS . : 0 M I SC PI. M F"1 X TURi`S, 0 GAF, OUTLE'l IS 0 ..^��..S:z.ab�..�sYY,x::as^�L':aw^ms�azSaSss"S-+sz.��+t�a�icx'Ys.^SRi��.'P«'+s�.Y9i"'� ZasR:x^H[awca:'FRpn:::��cAGLi:�. "•L:d.�tRSrittciK*S�.�F^.:_:.�^xJ.�Act•:v nSL'�.+a�vAfII.".:ZM.-.r„�L'Li-.-�uxaz=IICCW^w'i_w:::-Yfffi���a:.-:.s��tr5^_sS/Wr.:_....,t...y,�,:�Af•.�._^xc,S�f:':a+�u:aa9Le�r¢•-�" #OJ£CT OESC11Pi101:A001TION TO fTISTIIIEr 1l011f. ROJECT LOCATION.OIP gftf#.11+ RVY SEAR CPfEX OFIATIP-00 PtAGASMIIII (AkE DRIVE Iff] ON tAKfIAY €OT OR tffT 11R Pf11IT .1TECONES 0011 AN11 VOKO IF WORK 01 CONSTIfUCT1'01 A911149I"E0 13 NOT COMi1fRCED 11,61111 144 DAYS .01 IF COISTRUCTKOI OR 1001 IS SUSPLIO[l) FOR A PF.PION F 186 OA,YS AT ARY TINE AFTER 10119 13 CO#1fl1ff0. EVIDtNCf 4f CONTINUATION Of WORK( IS A PP06RESS INSPUTION W1TRIN TILE 180 DAY PERIOD, 1`111A1 INSPECTION RUST Rf 'PPPOvff1 'RETORF RHKI:A1Mh CAR OF 4GCUPif1a, . I41 OR A6fN1, DATE: � '� _:.-%'.5!'__. _. 0 0911_ :,..; e,1$1:46t rnuni rAMI-F rnmn.1strsus rs_ nr1ns1_1nrv _ r CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date S c r-- t%f v 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 date by PLUMBING Attic OTHER Groundwork date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date G _,c� by date by C-)CA G 1D� -1 r"y ) d:: 3 �[ .� � L��.^►.., c.J c. (� �d� -�t�Ck.a-, �-� �''�- ��. � ��/X I L BuildingPermit # �� 7--�/� —� � MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location L/9,1`F_ tv6r 4/7 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 o G A- rZ-11,2Y - --4 T © sl"aec 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 ❑ OK to pc-c ,:D Co D� Cs ❑ This is not a complete irfspection Department 1,3 Clt,51 Date 151-yk Inspector ■ sk 0 AnT .MOOV THI T ALL Building Permit # MASON COUNTY i ' BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 ORRECTION 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 gai dZ ompliance $ 7. Pre— /O t T CND G 4::—ct o k—.-- 12 o-1 -,6a f-ti S/c('cs, /lc�-`/ G " d.� ��r4, r Ql® She- You are hereby notified that the above corrections sliialf tie made BEFORE PROCEEDING WITH ANY FURTHER WORK c4 ne_'_`_�- �-r v ❑ Call for re-inspection when corrections are made before continuing (e, ❑ Make corrections, items will be checked on next inspection L �r✓ ❑ OK to Department Date Inspector ■ oo * NnT Mo *V THI, TmLolw' Building Permit # MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location F0 try Cam` 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 ie � .L•/,s� l/ „Z;s � �avYa U`,s .r�. o�g�-�L ,`o;-s 1� -� le��c� _ /��' �� �� � .ram+. a// ;s S r.✓- r4.� r A /o .,�� b0 "� cry r` '•-.._._ ,✓t � � 2' � -� eJ �/ G4" PaS / s nO G✓ Y You are hereby notified that the above c Ions shall be made BEFORE PROCEEDING W TH ANY FURTHER WOK �` ho lcQ �awr+s ne,e f � 6rcss �i< <'� Jco— d- e +` a��� fl, 3. �• revµ. a Call for re-inspection when correctrons are made before continuing a Make corrections, items will be checked on next inspection l� OK t0 ±pf �i I`� lhin i �� �'; gl` c•'e- e-y 10/S %S DU C'f epartrtment I Date r-- Inspector L3 ■ iok s NnT MnV 1 TmLolw MASON COUNTY Mason County Bldg. 111 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 ! PFFIMIT CONDITIaWS jCise No . 3 81-D97-0518 Fort Ei-wont) E mm- is I The undersiqned property owner, is aware of the unoer-tainty regarding Mason County 's development regulations created by the Growth Managment Hearings Board ' s Order of October 2 , 1996, and In o.niusideration of m9son county 's wimncinef;s t o n�roceed with processing of applioations which m a e aright be ffectd by the Order , the undersigned ropertV owner- nerobv agrees to waive any lawsult , action , or claim for, daioaqes a( I ri .-t F. � lason County which may arise out of Mason County ' s actions In acceptance ponessing and/or Issuance of such perm ltE; or approvals ( hereinafter "perm t iting art r ions " ) , which damages are attributible- to the County 's decision to take permitting actions tleqplt�-* the risk that chanues to the County 's development requlat I on,4 mlqht later make the County 's perm ittinq actions I nva I its . X 42 ) Thit, appi lcatloii i -, sii l rect 'to Buffer and L a a atidsoping reqtilrements as estblished under Mason County Ord nano" 1 .03 .036 . X 3 ) The use, hand I I ng and storago.- of hazardous mater, I at I s or flammable and combustible liquids in ex,,)ess of 10 galloop, Is riot . allowed without the approval ot the Mason County Fire Marshal . X 4 N oposed strituture or any port ion thereof (.1reater than 30" in height from grade line , must maintain a minimum of 5 ' setback from all property lines , #ZL4sements anti io from all Cottrity and State Road right of ways . X-- 4- IJI7i �5) Teroporeiry er-oslon control measures mu tit be implemetited to prevent water qua lltv deqra atlon of adjacent waters or wetland-,; . . X 6) Approved per dimen,, lotis Arad solrbticks on ,,,ut,,mItterJ site plan . X- MASON COUNTY Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, Washington 98584 7 ) All approved pfan- are required to be on-.site for inspput ion purp'users . if Inspe4cf icon is ca l led firs and plans aue not on sites, Approval WI LI. NOT bo oranted . Ire add i t i ors , a Re.- Inspection fee In the amount of $32 .00 per hour (m i n imam i hour, ) wi 11 be oharged .and must be Collected by t h i ::, departmets t prier to any f ui t her• i nrgper,t l ons:, be? I ng performed or approval granted . 8 ) The correction I ist , along with the Ene?rgV Compi lance Worksheet (when ap pf icable ) Is part of the plan:; and must remain attached thereto . it Is the r'esporif it.'i I Ity or the appp l i cant to make corrections I nd f oated on the 3 i ans from the correction 1 i sts . onoe> tite plans are mrarke,l APPROVED, they may nv.)t be changed or, altered without authorIzratrcin from the Building Official . The permit holder Is reponsible� to retain the complete approved set of plans on site for the durratiort of the projoc't . Fa rare to oompIV wi I I result in failure of required buiidin Inspections . Every permit shall expire by limitation and become nu I i incl void ?t the bu i l d i itq or wor, is tit hor I zed by sual► ErerIII i t 3 is not Commenced w i t h i o 180 days from the dates of Issuance, or 11' the building ur, work author i zed by such perm ) t- Is or, a edoned at any time after the °vork is cornmenoed for a per i o(1 of 180 days . X ✓ •��7 ___ ____. _�..___ _ ._.._.._._ A) AI.1 C K RUC'i ION WJ,8T MEET OR EXCEED ALL LOCAL CODES AND 09- C.: REQUIREMENTS . X 10) Changes to approved bul Iding plan�i that offec-f comps ianoe3 to the 1991 Washington Sfifitf> Energy Code, 1991 Ventilation and Indoor Air Qualityy Meade, the Unlforar Kullding {'ode Hrtd/ar AAann ;c.�.rnty Recy l t n�. must be approved by Masan County prier to Cori st1,uctiorlx � 11 ) ALL CONS?RifCTION MUST MEET CAR EXC'EFD LOCAL COU€:S . IF ANY QUESTIONS, PLFA:3F" CALL H( OFFICE BEFOPE CONSTRUCTION . /X__ � 4. Pagd No. 1 CASE HISTORY FOR CASE NO.: BLD97-0518 ELWOOD E MELLIS NE80 LAKEWAY DR S BELFAIR 08/04/97 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By ------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- --- BLDA010 Application received / / / / 05/12/97 05/12/97 KW BLDA015 Waiver in File / / / / 05/12/97 DONE KW O5/12/97 KW BLDA100 Approved For Issuance / / / / 06/23/97 DONE KS 06/24/97 KS BLDA500 (F) Issue building permit / / / / 06/24/97 DONE NJP 06/24/97 NJP BLDB007 Plans Revisions Submitted 06/23/97 / / 06/23/97 put info in file DONE DC 06/23/97 DLC BLDB110 Structural Plan Review 06/10/97 / / 06/23/97 PLAN DOES NOT MEET THE 2326. I COPIED DONE SAC 06/23/97 WLC THE PLAN AND DREW A COUPLE OF OPTIONS THAT WOULD MEET THE PRESCRIPTIVE REQUIREMENTS. CALLED AND LEFT A MESSAGE ON THE CONTRACTOR'S PHONE AND SPOKE TO THE OWNER ABOUT REQUIRED CHANGES. SAC PLANS ARE IN SHERI'S RESUMITT BOX. 06/16/97. BLDB120 WSEC Compliance Review 06/23/97 / / 06/23/97 other fuels, option 7 28% glazing DONE DC 06/23/97 DLC BLDB130 Planning Review 05/22/97 / / 06/09/97 PROPOSED ADDITION IS WELL AWAY FROM DONE AHB 06/10/97 AHB LAKE. AHB BLDB134 RLC Review / / / / 06/09/97 IRO LAKE ON SITE. N/A AHB 06/10/97 AHB BLDB135 Addressing 05/14/97 / / OS/20/97 DONE GMM 05/20/97 GMM BLDB138 Planning Pre-Review 05/20/97 / / 05/22/97 DONE MMS 05/22/97 MMS BLDB200 Environmental Health Review 05/12/97 / / 05/14/97 This is a shoreline expansion. The DONE PSD 05/14/97 PSD septic system is less than 3 years old adn a reserve area is identified.psd BLDC111 Footing/Foundation Wall Inspct 06/29/97 06/30/97 06/30/97 CONDITIONAL APPROVAL; COND LW 07/01/97 LAW 1. MAINATAIN A 1/12 INCH CLEARANCE BETWEEN THE INNER EDGE OF THE FORMS AND THE REBAR. 2. THE LAST HORIZONTAL BAR NEED TO BE WITHIN 7 INCHES OF THE TOP OF THE WALL. BOTH OF THESE ARE LOCATED AT THE STEP IN THE FORMS. OK TO FIX AND PROCEED WHEN DONE. post-it"brand fax transmittal memo 7671 *ot pages s Frornko To C40 �t f i FaxCCJ r-• �O� Faze O� Q 41 A . -- - .� ( ��-RA_T 3 SL,aCmSMlTH LAKE T,9ACS T 7-SAf, GOuTIT Y 3 2 �� ' FOUND 1�JplY tJ�1EN7 C ONC W/SAASS S4 0 5El IRON ap,ft CD In ME,4NDER COFj. E AST SNORE AC. 8! AtkSM/TN L,4K�`.7 0 p i ? 5 F-C. urSAP counTY .� ' S o) r q 3 MASON CouNZ`/ •3 2eFl� VV I.27 AC. 6�R S r S Q R tlV, 111/.M. w To MA-A `rj d' �.•' �" J b4 \ � UTILITY EASE o i r'l n O� M p QA" ♦ h - �` S to `' 17, I}+ �'1.60 ^�S , A" � e) K, / �O WARNING — yaaon vounty sO�AC[ESS �a AC C� � \ r ~ f/ � � 1�j 6 / `� �j ��'� has no respnns-bill ty La ��-, ' �.�/ ' buil4, improve, maintain NILy { '� 1 ,p or other wise service the to V / �, 6/a ,{� r' az�0 �� private roads contained `✓1G/NITY MAP ' �$ `G! `S� within or providing service SCALE =/ "= z MILE s69 OR, Ty �•X / j o �/ to the property described in SEC !p, Tz3N,R z W i 1,7 6a w � �z J °� j the short gtat.. SHOS i PLAT FOR ° 6 0'. V z / Ff�F PESTS .-v DRAWAI J K F,8 59 �- sus 1.6 4 AC.. o / /19ARNINC: Mason County has no responsibility to G a build, imrrove, maintain, or otherwise s�•••rice t / S� 9 ' �Yu• ; / private ro0s contained within or providing 6 / service to the property described in the short pl it S90 , Ao o SNORT PLAT FOR S FREO PESTS IRwIN ENGINEERWNG / 30 ,i DRA��✓N : J K FC3 59 CSoR E�c +d"'d Lrd / O/ � 4 +� r ►A WA DATE : '7-3-84I JOg (;, �D I 05/07/1994 06:32 876-8703 VANSLYKE CONSTRUCTIN PAGE 01 co, Lg i/v1SPcr.-f on ��—f w Q AUG 0 41997 9EALTH SERVICES Nov o� i' "`1r-f Alt p— ( I(s r �. /`�-�reps _ � � �--Q �2�.►-ter T.�f.-P r- w4 s VAN SLYKE CONSTRUCTION 6 O ?� SZ �3 P. O. BOX 1106 Port Orcherd, WA 98366 O 7 g� � ` V`4 `�(ems �G✓� ' V 1994 04: 27 876-8703 VANSLVKE CONSTRUCTIN PAGE 01 � t � ID � Q ----- AUG 19 M? , HEALTH �` ERVICES y � Yff 0 �--f c.� 'A a-f,� � ��t w �. �� awl�` � , VAN SLYKE CONSTRUCTION -3 19 P. 0. Box 1106 Port Orcherd, WA 98366 t� FILL IN As REQV pp ROOFW, MATERIAL: ROOF SHEATH W-3 TN IC IQ*E°-8: ROOF SYSTE II: ROJF M3ULATION: ROOF P(TCta:-' 9(DMCs tiATEP(AL: y'�' '�.�•c �.l.:dT�, ,l�l��Cl�it'f� WALL -%4EAT14W-% REO'D (Y /N A. T(-IICIQ,IE35 WALL FRAMR-r-i: U16LL MULATION: FLOOR FR MW-%.- �QXly Q FLOOR M.`3l,ILATION: /19 r FOOTIWz WIDTN:_I- r - FOOTq-s THICK),Ems: STEM WALL HE P,-W: STEM WALL TNICfQ�98 '�_ tie srnrf Department of Labor&Industries '" ALTERATION PERMIT Factory Assembled Structures Section 31 d�a�Y: Do not complete shaded areas INSTRUCTIONS: errntt 73513 1. Complete all spaces,including the signature box(marked with an X). Invoice# 2. Draw a map on reverse side of WHITE copy only. 3. Forward completed permit and fee to the nearest L&I office. See list on reverse. 4. Contact and schedule the inspection with the same L&I office within 15 days. lnsignia'4 Owner jiAast name first name Day time phone Date ....................I'1.E'. ..+.1........................Afr..I.....1 L? .5� ------.............---... ...... ........................ ........-..... 7---............ Address City State ZIP Installer/Contractor/Dealer Phone Contractpr s registration number �, /��4f+a� .6Ed...------`?76.-..._Jze�.--.............. w �l .�.,�. -=-.. --------- ----------'---:'t-F--e.e..-....-.�.._... ---------_-- ---.. ry a -. .. Address Ci State ZIP+4 Check the appropriate boxes in section A and section B. FEES A Commercial Coach B J Alteration Inspection(check appropriate boxes below) $75.00 Air Conditioning/Heat Pump Serial No. Electrical Electrical Appliances f , Mobile Home Fire Safety 0.t/08r 97 ID 14 97101.834 Serial No: Gas Furnace 75.00 Gas Piping HUD No: Plumbing Structural Recreational Vehicle or ❑ Park Trailer Wood/Pellet Stove— — Serial No. Serial No: Plan Review — —— — — —— — — — — — — — — — — — $70.00 RV Inspection — — — —— — — — — — — — — — — — $70.00 Model No.or Plan" Original Permit royal No. Reinspection — —— —— No $50.00 Technical Inspection — — — — — — — — — — — — — — — $50.00/hr Signature of applicant uthorized representative Make check payable to: Dept.of Labor&Industries FEES DUE $ artment use Request approved or ❑ Request denied because of specific violations of Washington rules and regulations. Violations must be corrected and reinspection requested within 10 days for recreational vehicles and 20 days for mobile homes and commercial coaches of the notice of violation date. (This does not apply to technical inspections). It is unlawful to offer for sale, rent,or lease any non-complying mobile home,commercial coach or recreational vehicle. - _ - - --- - - -- - - - -- - - - - - - - - -- - - - - - -- - - =-------- - - - - - - - -- - - - -- - --- -- - - -- - - - - - - - - - - - - - - -- - - - -- - - - - - - - - - f - - - - - - - - - - - - - - - - - - -- - - - -- - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - -- -- - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - -- - - - - - - - - - - - - - - - --- - - --- - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - AW . ... . . . . . .... . ._ - _- - .. . . . .. . .. . - . . ._. . .. ... . .. .. . . . . .. . . . . Included are forms required which must be completed and fees submitted before reinspection. Date Area office Inspector Total pages F622-012-OW alteration permit 4-96 White-Olympia Green-Contractor Canary-Inspector Pink-Purchaser Goldenrod-Purchaser Draw map givingdirections to location on the WHITE COPY ONLY. EAddrmes,s State ZIP N W E S Department of Labor&Industries Offices ABERDEEN EPHRATA OKANOGAN TUMWATER 415 W Wishkah Ste 1-B 21 C Street SW 1234 2nd Ave S PO Box 44850 PO Box 66 Ephrata WA 98823-1895 PO Box 632 ^'vmpia WA 98504-4850 Aberdeen WA 98520-0013 (509)754-4608 Okanogan WA 98840-0632 .0)902-5800 (360)533-9300 (509)766-2291 (509)826-7345 VANCOUVER BELLEVUE EVERE77 PORT ANGELES 312 SE Stonemill Dr Ste 120 616 120th Ave NE Ste C201 Evergreen Way Business Center 1026 E 1st St Ste 1 Vancouver WA 98684-6982 Bellevue WA 98005-3037 8625 Evergreen Way Ste 250 Port Angeles WA 98362-4020 (360)896-2300 (206)453-7048/7074 Everett WA 98208-2620 (360)457-2572 (206)290-1346/1347 WALLA WALLA BELLINGHAM SPOKANE 1815 Portland Ave Ste 2 1720 Ellis St Ste 200 KENNEWICK 901 N Monroe St Ste 100 Walla Walla WA 99362-2246 Bellingham WA 98225-4600 500 N Morain Ste I I10A Spokane WA 99201-2149 (509)527-4437 (360)647-7300 Kennewick WA 99336-2683 (509)324-2568 1-800-544-1509 (509)735-0100 WENATCHEE TACOMA 519 Grant Road BREMERTON LONGVIEW 1305 Tacoma Ave S Ste 305 East Wenatchee WA 98802-5459 500 Pacific Ave Ste 400 900 Ocean Beach Hwy Tacoma WA 98402-1988 (509)886-6500 Bremerton WA 98337-1904 Longview WA 98632-4013 (206)596-3814 (360)478-4926 (360)577-2200 YAKIMA 1716 S 16th Ave COLVILLE MOUNT VERNON T UKWILA Yakima WA 98902-5789 298 S Main Ste 203 525 E College Way Ste H 12806 Gateway Dr (509)454-3769 Colville WA 99114-2416 Mt Vernon WA 98273-5500 PO Box 69050 (509)684-7417 (360)428-1350 Seattle WA 98168-1050 (206)248-8240 F622-012-000 alteration permit back 4-96 0 �e GARY YANDO,DIRECTOI ..STgrFO A q DEPARTMENT OF CO DEVELOPMENT AU x N PLANNING -SOLID WASTE - UTILITIES N Y Y BLDG. I • 411 N. 5TH ST. • P.O. BOX 578 SHELTON, WA 98584 * (360) 427-9670 1864 DISCLAVAER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by that Order,the undersigned property owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"permitting actions'),which damages are attnlxdable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations might later make the County's permitting actions invalid. Date (Parcel No. or Legal Description) Property owner's signature(Notarized) (or the County may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL) STATE OF COUNTY OF Q�-f/1�� On this _day of , in the year /`7,before me Lindit �C S/L k-� Notary Public, personally appeared f W 00c personally known to me to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed it. WITNESS my hand and official seal. -For County use only- Reviewed by applicant on (Date) *N. rWy's6signature 07 A. � / p Staff Initial: My Commission Expires: 6 / - �_ : :t Z . h Permit No. ` MASON COUNTY BUILDING PERMIT APPLICATION Qn. \do 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 !7 (Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269) PLEASE PRINT N1 #1 /►�v- /14e. H r S Phone# 3 O — Z i e Address O G wa y SDU- Fire District# ity - St ojc� • Zip 5 2$ Directions to Job Site. old rc-aet �L Owner Mailing Addr ss O, 2:; City _ St w4 Zip Lien/Title Holder a L ,n Address City St Zip #2 Contractor Name Contractor Reg# 61&2SLe O 9`FoS Address P.0 c Expiration Date_0 1_L_ f 2 Z City St t�Zip 5 3 Phone# g'7 6- 5 2 8 3 #3 If septic is located on pro t site, include records. Connect to Sep tic?=Public Water Supply Well Connect to Sewer System? Name of System (If residential, proof of potable water is required) #4 o. EZ3/o C�L g I Description a Te- 713 o P 5u n/" l V i-7 t 48� #5 Building Square Footage: 05 76 1st FI 2nd A 3rd FI Loft Basement # Bedrooms # bathrooms Deck Other -6 Garage Carport (Circle:Attached or Detached?) #6 Use of building d I'fr o., ,fir cam, �o�� Describe workcC #7 Type of Job: New AddVloe� Alt Repair Other_ t.-JLJ #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year Make Model O jig cup Length Width (-/(( Serial No. rn C.= # Bedrooms # Bathrooms Type of Heat C Purchase Price$ #9 Indicate by circling the applicable source if ater is on or adjacent to subject property: 1) River Pond Creek Stream Wetlan Lake arsh Saltwater Seasonal Runoff Other Show following on the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Drainage Plan Wells Septic Systems Easements Proposed Improvements Name of Side Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW I Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other __Bath Tubs No. Units Fees Showers Fu rn BTU _Hot Water Htr _ Heatpumps Laundry Washer _ Vent Systems Sinks Spot Vent Fans Floor Drains No. Boilers/Compressors Laundry Basins _ HP Dishwasher No. Air Handling Units _Disposal _ cfm# Urinals No. Fire Protection Systems Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 16.75 _ Auto Fire Sprink Sys 35.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD 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 OFTHE 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 DO WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO C NGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAININ APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER X BY DATE DATE �f�/1_2/ :2 FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: �7 Environmental Health: �© Building Plan Review 01 va Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit �c7 Plan Check °�(e,(op Plumbing Fee Mechanical Fee 0o as/Pellet Stove Violation Fee Site Inspection Building State Fee 4-,g a Other Other Other Building Valuation: TOTAL FEE 1.