HomeMy WebLinkAboutBLD96-01261 Final Mobile Home - BLD Permit / Conditions - 5/14/1998 --————————
MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
E�
()R INSPECTIONS CALL 427--9670, U I L- C.? I tJ C-4 P F- F4 M i I
B EFWEEN 5pm AND Sam 427- 7262
BLD96-1261 PARCEL :223107990742 PLATs DIV , BLK - LOT
JOB ADDRESS : NE 80 LAKEWAY DR S BFLFAIR
OWNERS ELWOOD MELLIS 876--9308
CONTRACTOR : MIKE WHITMARSH 876-4923
LEGAL , 10 749 OF SVRVFV f1111 TR 0 of sp #1467
CLASS OF WORK xNFW BEDR .- 3 PATH - 2 Fly PE AMOUNT BY DATE RECEIPT TYPE AVOUNT BY DATE RECEIPT
7YPF OF USE . — :MH STORIES . . . . . . . 1 1
OCCUP , GROUP . z? ELDG . HEIGHT — - 0 0?is f4cp S 26.00 NJ? 16128196 43359
TYPE OF CONST . . :7 F I REPLACES . . . . : 0 SHN f 42,11 NJP 10128196 4335i
OCCUP . LOAD . . . s 0 WOODSTOVES . . . . t 0 11"DF I jsllvfe Nip 1#128196 43359
DWELL .UNITS . . . : 0 PARKING SPACES : 0 SIFE 1 4-511 NJP 1112$196 43359
INSPECTION AREA I SHORELINE? . . . . iN TOTAL: 222.50 VALULATIONt ","i
SETBACKS TOILETS . . . . . . . . . . 1 0 FUEL TY PE F.---------- BOILERSICOMP----- MOB I I.E. HOME
FRONT . . .W 185 'oft 13ATH BASINS . . . . . . : 0 0- 3 HP . : 0
REAR . . . .E 370 ,Oft BATH TUBS . . . . . . . . . 0 3-15 HP . . 0 MODELtFLEEIWOOD
SIDE ( l ) .N 52 .Gift SHOWERS . . . . . . . . .. . 0 F URN -,, I OOK BTU i ki 15-30 HP . : 0 --iAAAKE--
SIDE (2 ) .S 34 .Oft WATER HEATERS . . . . 0 FURN >-100K BTUi 0 '30-50 lip 0 544,3A
SHRLINE .W 18510tt CLOTHES WASHERS . . 0 TURN - FLOOR -- 0 50+ HP 0 -.YEAR---
AREA KITCHEN SINKS . — I 0 HEAT PUMP; . . . . . . : 0 96
LOT SIZE FLOOR DRAINS . . . . . . 0 VENT SYSTEMS . . . t 0 EVAP COOLEPSt 0 1ENG1'Ht44
BUILDING . . .. : 1056sf DRINKING FOUNT . . . : 0 VENT FANS — 0 HOODS . . . . . . . 1 0 WIDTH . :24
BASEMENT . . t Osf LAUNDRY TRAYS . . . . 0 DOMES . INCIN :O --SERIAL#------
DECKS . . . . — t Oat DISHWASHERS . . . . . . t 0 AIR HANDLING UNITS.— COMML. , INCINiO
6AR/CAPPi? Ost GARB DISPOSOALS . — t 0 -- 10000 oft — 0 REL.00/REPAIR : 0
AT/DT . s? URINALS . .. . . . . . . . . . 0 > 10000 offli ' l 0 OTHER UNITS . ! 0
IAISC PLM rIXT0RFS ,- 0 GAS OUTLETS . : 0
PROJECT DESCRIPT ION;V6811f NONE '0 -73
PROJECT L0CATION:01.0 BEtFAIR HWY TO RFAR CREEKIDEVATTO ROAD, FOLLOW BEAR CREEK DEVA-110 RI- TO B1ArX-S1IYH LAKE DRIVE 09 LEFT, FOIA01 TO FIB OF PLACKSNIIH ji
LAXEWAY S. 181.
THIS PERMIT BECOMES NULL AND VOID If WORK 00 CONSTRUCTION AUTHORIZED 19 NOT CONVENCED #17HIII 18.0 DAYS 01 IF CONSTRUCTION OR WORK is SUSPENDED FOR A PERIOD
Of I## JAYS AT ANY TIME AFTER 101K IS '.'O#VfkCfl, fV10110E Of COOTI!)ATI-011 Of V0#I( IS A P0.06llo, 1.13IRTIO11 91THIN THE 180 DAY PERIOD FINA' 1;SPECHOO NVST 8j
APPROVED BEFORE 901101114
91PER 01 AGENT: BATE:
Rto fill, 13131itl -IOMPLIANCF TO ATTACHED CONDITIONS IS, REOUfRED
i
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date OS'- f6 b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date FRAMING by date by date by
Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER r!�
Groundwork Attic 'z _2 3
date b date by
D W V WALLBOARD NAILING I,/- OG�,•� y
date by date by p e
Water Line FINAL INSPECTION
`I date by date S/C/,9'g by T�j date by
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G lib n�p�"s '�C� `�� .bC�,r'� � -. � 4( +�l� <� '�l� ;�✓G�/ •-�t•� '�"LC /n�
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
P F R IVI I T C " N t7 I `T I Ct N S
Case No , : BLD96_ 1:261
For : ELWOOD MEL-LIS
Page : 1
1 ) This appiioation is subject to Buffer and Landscaping requirements ai established under,
Mason County Ordinance 1 .01 .036 .
2 ) The use, handling and stora gie of hazardous materials or flammable and combustible
liquids in excess of 10 gallons Is not allowed without the approval of the Mason County
1= i re�Marsha ! .
X
,I ) Proposed structure or any portion thareof greater than 30" In height from grade line,
must maintain a minimum of 5 ' setback from all property lines , easements and 10 ' from
to I I oP nt and State Road right of ways .
x. ,.
4 ) The a pI ioant ac,kriowIe:dges that this, development was sited su,�h that further shore
pr, . e measures will not be required for protection of the fac i i i ty .
X
5 ) Temporary eror. i on control measures must be Implemented to prevent water quality
degr io of adjacent waters or wetlands .
X� �___ _ __.-_ __ _..
6 ) Approved per dimensions and setbacks on submitted site plan . X
7 ) yub j eeecctt to conditions of Resource Lands and Critical Areas (RLC ) Checklist notification
I e t--- --�.-_
911 PLIASUANT TO 1994 UNIFORM BUILDING CODE SECTION 305 (C, ) AND SECTION b 13 ALL SITES mus'r
HAVE APPROVED NUMBERS OR ADDRESSES PRbVIDED IN SUCH A POSITION AS TO Bt PLAINLY VISIBLE
MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
DL-PAH'IMENY REQUIRES THAI I'HIS BE COMPLETED VRIOR 10 4,ALL. ING FOR AtoY SITE INSPEC'JION'S' . A
REINSPECTION FEE BASED ON RATES IN TASLF 3A or' THE 1994 UNIFORM BUILDING CODE WILL BE
ASSESSED IF OWNEA/CONTRACToii rAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING
INSPECTIONS .
X
9 ) AL� RUCTION W ME
T ET OR EXCEED ALI, LOCAL CODES AND 1JFV F, I� OUIRFIAFNTS .
X
,V J
10) REOUIRED INSPECTIONS ( Footing Inspection-prior to pour , Set-u l Inspection--prior to
skirti , rival Inspection-prior Pto occopancy) . I have recelved a copy of the General
InformNion and Guidelines-Mobile/Manufactured Housinn Installations Handout for
detailed deworiptions of all required I spect i ons on my mobile/manufactured home
installation . I hereby assume all resonsibility for the scheduling of these required
Inspections , Ir these required inspectp ions are not requested, Inspected and signed
off (approved) by the inspector In the piescrlbed order , I understand that reinspection
fees and an hourly Invertigation foe pursuant to the 1991 UBC, Table 3A will he assessed
In addition to my original permit fees to resolve any questionable practices or
problems that have been discovered . I further understand that this Investigation will
be scheduled as time a I I ows Unt i I resolut Ion of anvIal I problems no opc9pancy ( F 1 Ila I
Inspection ) will be granted for the; residence . l
OWNER/CONTRACTOII ( indioate which ) Signature X
11 ) A I I mob i I e/inanuf aotured home: I and I ngs or, decks must be freestanding ( self supporting ) ,
The largest landing or deck permitted without drawings, or a building permit is 36 " x
36" Any landing or deck that is 30" or more in height from wtAlking s u i I soe tea f I n Is h
grade requires a guardrail . Any landing deck that has 4 or more risers requires a
handrail , Any landing or deck farge r ian 36" x 36" must be permitted whloh requires
structural drawings and a building permit applioation , This Installation Permit does
NOT Include any landing or deck larger than the 36" x 36" size .
X
12 ) Proposed structure or port lons tll-ieroof with an projection over 30" In height from grade
fine must maintain a 5 ' sep ration distance botween adjacent structures and that
furtflest projection . X
I- —ter
13 ) ALL CONSTRUCTION MUST MEET OR EXCEED LOCAi_ CODES . IF ANY OLIESTIONS, PLEASE
CALL THIS OFFICE BEFORE CONSTRUCTION .
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
14 ) CONSTRUCTION PROCESS TO BE FIELD CORRECTED` 1 RF D PER MASON COUNTY BUILDING
DEPARTMENT AND UNIFORM BUILDING CODE . x
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v�71-B 71-A
CEO 71-C
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72-A
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mac' 72-B
S-� 72-C
J' 72-D Q
73-A
73-B 1
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73-C \
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74-C
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44'-0" �v
5 LVES
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R. ---' �� �-- SHEL
OR.TlA DEN ''UR.`` Orr. UTILITY
SNOWER w fi :-f KITCHEN ' 1
BEDROOM
O O
BATH �;�� - K~ ra-rz�r-s•+{tfillO -m
r
-}- DINING
Zfill T Iff? Ili [
WALK-IN AREA m ,
CLOSET 'e _ -
24,_B,,
if T
MASTER OOM 11111111111
BEDROOM 1 -a• 2'-0" BEDROOM
12r-10•x 12'-0" 10'-2r_z m-s•
ENTRANCE Y w
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Standard
,4—Built to H.U.D. new code standard Super Good Cents Package
y Organic asphalt shingle roof,high 3/12 pitch Includes:Upgrade insulation R38-11-33(The
Transverse floor systems higher the R-value number,the better the
-r Thermal zone II insulation / resistance and effectiveness of the material.)
.&1.40*roof load 2'x 4'exterior walls
-Ar'2'x 4'sidewalls Steel insulated exterior doors
Bath fans)
!' 12'eaves overhang Vinyl windows Low E,Argon trimed all sides
J1/2'pre-painted hardboard siding eets M.A.P.U-VALUE requirements
,.- Large white framed window
,3,4�ypsum acoustic ceiling
,"athedral ceilings throughout
i►-755-und-deadenin ,sheetrock Interior walls
a � 2 � a,
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WITHIN TOWNSHIP 23 NORTH, RANGE 2 WEST AND
KITSAP COUNTY T. 24 1\
MASON COUNTY T. 23 P
ZONE A
ZONE C
4. 3 2
ZONE
ERICKSON
LAKE
ZONE C
BLACKSMITH
ZONE A ZONE A LAKE
y
y
ZONE C QT
ZONE A
1 11
9
P�v
O
ONE A
ZONE A
OZONE C ZONI
ZONE A
16 ZONE C
ZONE A 15 14
TWIN ZONE A
LAKES ZONE A
JOINS PANEL 0130
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.
-300 Z Lz Z o�� L
3(oo Y o� ` z!O
TOTAL WINDOW AREA l O
DOORS
BRAND MODEL U-VALUE LOCATION SIZE TOTAL SQ. FT.
TOTAL DOOR AREA 7�
` r
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
PRESCRIPTIVE PATHS
OTHER FUELS (GAS, OIL, HEAT PUMP)
HVAC- Glazing Wau Wail int' Wall ext' Slab'
Equip. %Floor Glazing Doors Vaulted Above Bebw Below on
Option Etfic. Area U-Value U-Value Ceiling= Ceiling' Grade Grade Grade Floor Grade
I. Mad. 10% 0.70 0.40 R-30 R-30 R-15 R-15 R-10 R-19 R-10
il. Mod. 12% 0.65 0.40 R-30 R-30 R-15 R-15 R-10 R-19 R-10
Ill High 21% 0.75 0.40 R-30 R-30 R49 R49 R-10 R-19 R-10
...,,.. � ! A1' ' >.:..,; ._,... � :.,......RYg.:;:, R-#Q.;: Reference case
V.% Lnw 21% 0.60 0.40 R-30 R-30 R49 R-19 R-10 R-19 R-10
VI.y Mod. 25% 0.50 0.40 R-38 R-30 R-t9 R-t9 R-10 R-25 R-10
V11.7 Mrad. 30% 0.45 0.40 R-30 R-30 R-19 R49 R-10 R-25 R-10
1 Mtvnw m^puirrrwk+for eacA option Bated• For exartpie,it a prapos.d deeign has 5 Floors over cravA spaoes of expoa.d to arrb-,(air 000dsf&.
a 94UNt9 ratio to tlw oonditmwod Woor area of I M it shall comply with aft of tM
f quinrrww of the 21%9fa_-in9 Cp0 (o(hgker). Proposed deserts which cannot 6 Required slab perinw(w muwa shall be a walsr resimam material,nunufadured
meet dw specific requr-
irtw of a listed option sbwe,may calcufate oonvka for is vvtended uw.and nsiaAed a000rduV to manuladu roes speckralions. See
by Chapters 4 or 5 of this oode. s.ai n 602.4
2 Rsyur-nwxs applws to all cwhngs axoerl,"Vie rafter or past vaulted o"mgs. 7 Th«&options shall be anpC—bl•to buAdwgs leas than hues stories.
AN dwr otee Advanoed Frenwd C.4ing.
8 Th:s watt tiviabon mgwomeM dwx)(es R-19 wall cavity insulation plus R•5 foam
3 Requnnwnt app6�abie only to single MAW of past vauhed ce ings. sheathing.
4 Below grade wafa ehall be irwulated eOw on tha exteror i to a mirirt iaNl of R• 9 Msri" m HVAC EquPnwnt w$cw requverneM. lo-W denolee an AFUE of 0.74.
10.or on haw interior toevesame levd r walk abo.a grade. Exts ax Rwula(ion Wed'denotes m AFUE of 0.78. 'Hph'denote-an AFUE d 0.8a.
iwta86d on below grads wars shah be a water resistant met",rrwnufadured for
to irisnded w,snd irwtsied aocordirp to the nwm ladurees apecFcdiona. See
section 8022
ELECTRIC RESISTANCE HEAT
Gwzic9 wail wall fnt' Waif ext' Slabs
%Floor Glazing Doors Vaullad Above Below Below on
Option Area U-Value U-Value Ceiling= QW509" Grade Grade Grade Floor Grade
I. 10% 0.46 0.40 R-38 R-30 R-21 R-21 R-10 R-30 R-10
I1. 12% 0.43 020 R 38 R-30 R-19 R-19 R-10 R-30 R-10
III. 12% 0.40 0.40 R-38 R-30 R-21 R-21 R-10
:......``. �vCv...;.t�.C:. .::: :`.>•...yv.v:.......,J:.`.,n,.w....r..: `��•ay.......:vv�iv�k:'• .::^:!uYMY>?:N:Cw•>`Y 30 R—
t0
Reference case
V. 18% 0.39 020 R-38 R-30 R-21 R-21 R-10 R-30 R-10
VI- 21% 0.36 020 R-38 R-30 R-21 R-21 R-10 R-30 R-10
V11•7 25% 0.35 020 R-38 R-30 R-19+R-5' R-21 8-10 R-30 R-10
V111.7 30% 0.32 020 R-38 R-30 R-19+8-5' R-21 R-10 R-30 R-10
1 Mtwrrawn-* -nwnb kv each aptm awed. For urarrpie.if a proposed desWn has 5 F1oar-aver crawl apaoee or emosed to anbienf air cored tiom.a giaxvp ratio to the oww1itiorwd lr{ a cot are I M t shall oonply with ap of lha
nquirenwrks of t-21%g—rg option(or hghter)• proposed desigm which carvot 8 Requ sob p.ri W nsulabon shall be a water resatanl material rrvnuladwed
I the speafo nqurerrwr6s d a listed option above,nwy caloulate oorrp"a for*A"orded use,and inets8ed e000rdvV to nwrxAadurees sp.cifioatarx. See
by Chapters 4 or 6 a(this oode. section 4.n 602
2 ' derwhs Advaroed m 064 Cot xospt arngte rafter a pint V"&d o.Arnga. 7 Theae optawhah s be eppk"to bwlfings toss than three stories.
r%
8 Th-w&X—U abon requir-rtwnl denotes R-19 wall cavity inwlation plus R•5 loam
ROqurertwnt alp k&We only to single rafter or joist v"ad ceifi". sh
4 Bebw grade wak"be wauW*d sttw on the-xterior to a mininrwn level of R-
10-Or on ON uN-nor to Uw sartw level as walk above grade. Exterior nuAatan
iwtNied m below grade wage shall be it water minaret nvienai.n+anufadurad for
do intended we,and irrtased aoowd-v to taw n- utedw e.pc/"..m. See
section Ab22
I + 1
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND INDOOR AIR QUALITY CODE
RESIDENTIAL REQUIREMENTS (NEW CONSTRUCTION, ADDITIONS, &REMODELS)
THE PROCESSING OF YOUR APPLICATION CAN BE EXPEDITED IF YOU PROVIDE
COMPLETE AND DETAILED INFORMATION.
YOU ARE ENCOURAGED TO COMPLY TO THE 1991 WSEC BY UTILIZING THE
APPROPRIATE PRESCRIPTIVE PATH FOR YOUR PROJECT. THIS WILL ALSO
HELP EXPEDITE MATTERS.
THE FOLLOWING INFORMATION MUST BE PROVIDED:
1) A complete window schedule must be submitted with your WSEC compliance
information, even if a window schedule is included on your building plans. Note that
sliding glass doors (patio), french doors, and any door with 50% or more glass in it is
considered a window with the area (sq.ft.) being the entire units rough opening
dimensions. 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.
This window schedule must minimally show the dimensions of the rough openings of
each window, the model (casement, horizontal slider, single hung, awning, picture,
etc...), and the units tested U-value.
2) If you are complying to the WSEC by prescriptive path and are using the area weighted
averaging method you must include your calculations (worksheet).
3) Indicate type of hot water heater, location of exhaust fans (bathrooms, laundry,
kitchen), the location of your whole house fan, and all insulation levels (walls, floors,
ceilings, and slab) on your building plans.
4) Indicate how you will comply with the requirement for introducing fresh air to each
habitable room on your building plans (window frame vents, through the wall ports, or
an integrated system with your furnace).
5) Using electric heat or a heat pump??? If so, you may be eligible for an incentive from,
from your local utility. For more information contact PUD #3 at 426-0777 or PUD #1
at 877-5249.
6) Questions? Call Debbera Coker at the Mason County Building Department at
(360) 427-9670 ext. 284.
w
MASON COUNTY BUILDING DEPARTMENT
1991 WASHINGTON STATE ENERGY CODE
AND
VENTILATION AND IlVDOOR AIR QUALITY CODE
OWNER / - j( /X7 AE-L1-4 S TELEPHONE 360 —37 z- 2 SG
COMPLIANCE INFORMATION
TYPE OF PROJECT: O NEW RESIDENCE( ADDITION O REMODEL O OTHER
AREA(SQ.FT.) 1ST FLOOR 2ND FLOOR HEATED BASEMENT
Note: Heated basements must be insulated and finished to meet minimum energy code requirements.
TOTAL SQUARE FOOTAGE OF CONDITIONED (DATED) AREA 563
COMPLIANCE METHOD: /056
PRESCRIPTIVE PATH -- circle option -- 1 11 111 IV !V,lVl VII VIII
Glazing percentage 47 y n (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
NA--
WATER HEATER
O Electric water heater (y-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
O Other O Boiler System (indicate type)
Make
��---- //�� Model
Sized AFUE HSPF
VENTILATION SYSTEM:
M Spot and Whole House ( ) Central Ducted System ( ) 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.
GARY YANDO,DIRECTOR
y�N.S TA
c A DEPARTMENT OF COMMUNITY DEVELOPMENT
u
o T = PLANNING - SOLID WASTE - UTILITIES
N Y y BLDG. I • 411 N. 5TH ST. • P.O. BOX 578
of 1864 ao SHELTON, WA 98584 • (360) 427-9670
DISCLAIMER/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 Hearing Board's Order of October 2, 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 attributable 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)
4ropperty owner's signature otarized)
(or the County may acce the signature of the owner's authorized agent upon proper proof of authorization)
ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL)
STATE OF
COUNTY OF Crg �41�h
On this'day of 6 _, in the yearlq�e , before me{ } ; 1/1 Notary Public,
personally appeared k),ubrA WJL1 ! 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-
E \, Review d b applicant on
ON00
lU
i lJ \�• �;� � Date
Notary's signature
My Commission Expires: _• NOTARY ;.—A Staff Initial:
PUBLIC
Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION a�
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT
#1 Owner 'b E. u L 1 S Phone# S7
ite Address (/, E . Q U 1-A ez W�ti a N E Serif Fire District# 49
City AFL F,4,.►e- St 1J 4 , Zip A 3
Directions to Job Site BGD A& ry Aeqe-
'e d 77
Owner Mailing Address Q , cg- I g 4-3
t
City D F'(,-FA j rz-' St L.)e zip $S�
Lien/Title Holder S ftme. A-s e-w fis le 5
Address
City St Zip
#2 Contractor Name rn 'W-& R IJ k ,r m A P.s,1+ (sj-,q a Fo rn oB,L 0 Contractor Reg#w if r nee ram -v
Addre s .2 8g q- e, 6 R tiE- Expiration Date 7. l A Y l 77
city St ^ A, Zip q?3- b Phone# 37b - 49a3
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#46� ar No. aa�l b - 7 9 - 9c'1�f'a
egal Description to Sb wrrt y;, 'os T+r£ S e wT*E P5 i Q to'A-&T Ex, &F MC S&- rO EAST !c c�,v-e-T&e— , Sdre e.1) 3-'
A ev Tld� fJeGTtF Ya n F TtfE /Jec�T��e+sr �t� weer!✓ e She-rioa 10� e, �-�-�',� 7aea,usK p
Ie A N R LJ FIST ) Lie M , ;N Miss
#5 BuildiMg Square Footage: (existing/proposed)
1st FI_!,05-6 / 2nd FI / 3rd FI / Loft ---f-
Basement Deck / #bedrooms / #bathrooms _/
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft. /
#6 Use of building Describe work
#7 Type of Job: ew Add Alt Repair Other
D
W1
L�
#8 MOBILE/MANUFACTURED HOME INFORMATION D
Model Year s Mak96&&fi,,p Model �- Q
Length !!5�f Width_Serial No.
# Bedrooms_ #Bathrooms �7, Type of Heat
Purchase Price$ 90 l aoo LTH
F�1/IC�,
9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland ake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions✓ Flood Zones
Existing Structures Ive ie Fences lelU)e-
Structure Setbacks Bieways��
Water Lines lY
Drainage Plan Topography
Septic Systemsl✓- Wells ✓
-Pro-p-b—sed Improvements—
Indicate Directional by (N, S, E, W)
in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
0400
n,
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i
Plumbing Fixtures ($3 each) F�,g Mechanical Fixtures ($6 each)
No.,Toilets CIRCLE FUEL TYPE: Gas Electric,
Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
j_Showers Furn BTU
J_Hot Water Htr _ Heatpumps
Laundry Washer _ Vent Systems
2 Sinks Spot Vent Fans
Floor Drains No. Boilers/Compressors
0 Laundry Basins HP
QDishwasher 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
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 15.00
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 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 DE RTMENT DEPARTMENT.
X OWNER X BY
DATE LX DATE
i
FOR OFFICIAL USE ONLY:Accepted by. v Date: `� �4
i
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning:
746N .
�z31
Environmental Health:/
-i'7
Building Plan Review
5
�o-
Occupancy Group: Type of Const:
Fire Marshal:
•
Other:
Special Conditions: FEES
Building Permit
Plan Check
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Others-� �
Other
Building Valuation: TOTAL FEE