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HomeMy WebLinkAboutBLD2002-01278 SFR and Deck - BLD Permit / Conditions - 5/28/2004 Inspection Line(36 0)4 27-726 2 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 o Shelton,WA 98584 1 RESIDENTIAL BUILDING PERMIT BLD2002-01278 OWNER: NICK GAGLIARDI CONTRACTOR: CASCADE CUSTOM BUILDERS 360-701-9601 360-867-4116 LICENSE: CASCACB980LJ E RECEIVED: 9/24/2002 SITE ADDRESS: 461 NE MOUNTAIN VIEW DR TAHUYA ISSUED: 3/31/2003EXPIRES: 9/30/2003 PARCEL NUMBER: 223195000025 LEGAL DESCRIPTION: WOOTEN LAKE TRACTS TRS 25-26 PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESIDENCE,AND DECK NORTHSHORE RD R BELFAIR TAHUYA RD R MTN VIEW General Information Construction&Occupancy Information Square Footage Information No.o e rooms: 3 Type of Constr.: V-N Type of Use: SF Insp.Area: No.of Bathrooms: 3 Occ. Group: R-3 Lot Size: Deck: 757 Type of Work: NEW Fire Dist.: 2 No.of Stories: 2 Occ. Load: Building:2,086 Valuation: Building Height: 33 Occ. Status: Unknown Basement:1,743 Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft. Front: S 236.0 Ft. Shoreline: 40.0 Ft. Water Body: WOOTEN LAKE Rear: N 40.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: E 10.0 Ft. Shoreline Desig.: Urban Year: Serial No.: Side 2: W 18.0 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 KLW 9/24/2002 $860.70 60626 Hosebibs 3 Furnace<100K 1 EH Plan Review CEW 9/25/2002 $75.00 2720 Kitchen Sink 1 Gas Outlets 2 Planning Site Inspection RAM 10/2/2002 $70.00 2720 Laundry Tray 1 Propane Tank 1 Adjust Plan Check Fee JRN 11/7/2002 $3.64 2720 Lavatories 6 Ventilation Fan 7 Building State Fee JRN 11/7/2002 $4.50 2720 Showers 2 Heat Pump 1 Building Permit Fee JRN 11/7/2002$1,329.75 2720 Water Closets Toilets 5 Mechanical Fee JRN 11/7/2002 $167.70 2720 Propane Stove 1 Water Heaters 1 Dryer Vent 1 Mechanical Base Fee JRN 11/7/2002 $23.50 2720 Bath Tubs 3 Plumbing Fee JRN 11/7/2002 $147.00 2720 Clothes Washer 1 Plumbing Base Fee JRN 11/7/2002 $20.00 2720 Total $2,701.79 BLD2002-01278 Please referto the following pages for conditions of this permit. 1 of 5 CASE NOTES FOR BLD2002-01278 CONDITIONS FOR BLD2002-01278 1) This application is subjptTlt uffer and Landscaping requirements as established under Mason County Ordinance 1.03.036.X 2) Contractor registration laws 4re governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potentia s and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-0982( he son signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 3) The use, handling and storage of hazardous(at ials 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 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) The shoreline setback for this parcel is 40' he Ordinary High Water Mark(OHWM)of the lake. No portion of the structure over 30" in height may project into that setback. X 6) The proposed project must be consistent wi licable policies and other provisions of the Shoreline Management Act, its rules, and the Mason County Shoreline Master Program.X 7) Water quality is oft a degraded to the detriment of the aquatic environment as a result of this project. X 8) All upland areas disturbed or newly d by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 9) Approved per dimensions and setbacks on submitted site plan. X zz BLD2002-01278 Please refer to the following pages for oonditions of this permit. 2 of 5 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 (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department pr' to y 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 fail st the address on site prior to requesting inspections. X 12) The plan review the k 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 chan ed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on ! ite for o h d X ation of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. 13) THE FOUNDATIO SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X 14) The"approved"plot plan is required to be on-site for inspection purposes. If an inspection is requested and t "approved" plot plan is not 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 shall be collected by the Building De nt prior to any further inspections being performed or approvals granted. X r7A 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 docu is are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged an all a collected by the Building Department prior to any further inspections being performed or approvals granted. X 16) All construction mus(meet or exceed all local ordinances and the 1997 Uniform Building Code requirements as adopted and amended by Mason County and the State of Vaoington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in perm' evo n. X 17) 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, st a reviewed and approved by Mason County prior to construction. X 18) The construction of th 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 Inspectors a ade prior to requesting additional inspections. X BLD2002-01278 Please referto the following pages for conditions of this permit. 3 of 5 19) , All propane tanks must be installed in accordance with the Uniform Fire Code and all applicable Mason County ordinances. All propane tanks filled on ' site must be located a minimum of 10'from any possible source of ignition (electrical outlets, electrical fixtures, compressors, etc), mechanical system air • intake (direct vent appliance, ventilation air intake, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. Propane tanks less than 125 gallons must also be located a minimum of 5'from any building opening (foundation vents,windows, doors etc), property line or easement. If a propane to exposed to probable vehicular damage, protective bollards must be installed. X 20) All propane tanks must be installed in accordance with the Uniform Fire Code and all applicable Mason County ordinances. All Propane tanks between 125 and 500 gallons must be located a minimum of 10'from any building, property line, public way, possible source of ignition (electrical outlets, electrical fixtures, compressors, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. If a propane tank is exposed to probable vehicular damage tective bollards must be installed. X 21) All propane tanks m t be installed in accordance with the Uniform Fire Code and all applicable Mason County ordinances. All propane tanks must meet the installation r uir ments and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks. X 22) Fuel piping shall be inspected after the installation of gas piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the time of inspectio the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall not be used i the final inspection has been performed and approved by a Mason County building inspector. X 23) The placement of small propane tanks are not normally subject to a permit review by the Planning Department; however, propane tanks are subject to Planning Department regulations. Such regula imarily consist of setbacks from shorelines and features considered to be critical areas (streams, wetlands, slopes, etc.) If you think such featutio r s ex' t on r nearby your property, please contact the Planning Department so that exact setback requirements can be determined. X 24) All property lines shall be clearly identified at the time of foundation inspection. X _ 4 25) All building permits shall have a final inspection performed and approved by the Mason Count Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property rec( rds on file with Mason County as being non-compliant with Mason Count inances and building regulations. X 26) All permits expire 80 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 t exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder have pr nt d ction from being taken.-No more than one extension may be granted. X BLD2002-01278 Please referto the following pages for conditions of this permit. 4 of 5 This permit becomes null and vo rk orconstr n uth 'zed 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 tinuatio of work ro nspection within the 180 day period. Final inspection must be approved before building can be occupied. OWNER 0 GENT- _ DATE: BLD2002-01278 Please refer to the following pages for conditions of this permit. 5 of 5 a ' o CONCRETE MECHANICAL MANUFACTURED HOME 0 ^� Footings / Setbacks Date B y Ribbons 0 Date Z U3 By Gas Piping Date B y 00 Foundti aon Walls GOA Date B y Set-up Date ' ZS O--,> By -r2 INSULATION Date By B G / Slab Insulation Floors Final Date By Date By Date By FRAMING Walls FIRE DEPT DatelZ L i S By440il-- Dates ' O3 By Date By PLUMBING Attic OTHER Groundwork Date j Z v 3 By i,01t-- Date •30-04y �2. WALLBOARD NAILING D.W.V. Date _ r? By / Date %Z B FINAL INSPECTION Water Line Date Vjf�5- i4 B y t-01L Date BY Date By 1 61k ovp- .ptZe- 8 GS ✓1'f_ r /> . C4 G N � d- �i-iv-o> �-e>-3 P�f' �i�/L sir_' �9i� 00 t. T� L4 01 IY43 1k'&L k z..e d S a'1 cjvm- t ow. Lod"d u ]—/ Pj5s' SQL/ BULKHEAD/OHWM A10-30- GSL 30"+TILL ' 0-38"GSL t14' 38"+TILL WOOTEN LAKE /// // COMMON LINE / / 35' J / / J U t20' 50, !/ / 3 BDRM HOME d 1'r . NO WELLS WITHIN 100'OF THIS TANKS \ PROPERTY LINE TRANSPORT LINE GARAG REC ROOM �p V0 J 'o 00 /DRIVE/PARKIN 00 WATER/SEWER XING: SEWER LINE 18"DEEPER i &DOUBLE ENCASED IN 4" \ SCH 40 W/IN 10'OF XING +� z i WATERLINE 75. R \ EXISTING WELL � I SITE PLAN: �63° FOR: GAGLIARDI JOB#: m o goo' PARCEL* 22319-50-00025 DATE: 05 JULY 02 ' BY: TJS DESIGN PAGE OF o 0 ,+ c������� NORTH ARROW: SCALE: 1" =40' NEoo� Oof 80, m © TAHJA-OYRETT OE NO G O Ri c 0 E 3 J 1 7-1 "T2AnISPe2� ; X 4N til/kTE/1-/SEwtl2 X�N�7 � 0 EE/Z ScN Yo ti�r /� "r- Ul 4 O b J 1 • � G c � G - L N U� FORM MUST BE COMPLETED IN INK PERMIT NO BLD at 1a-78 PLEASE PRESS HARD MASON COUNTY BUILDING 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 APPLICANT INFORMATION CONTRACTOR INR RMATION Owner-N t C.l� E�AG,i. i AgY -b i . �- Contractor Name Mailing Addresses ?U r2N_3 1i:Z Mailing Address'- �-!G Cit O i D •DF '0,AL, State Zip-Code. 9 ZL� CityC�1:,!!J# P,A} State VJh- Zip Code ) b 5DZ- Phone(9q`7 ) '-7l,,;L, _2)5 t rPh.( Ph. C� ?�r!-`7��'i Other Ph.(: t.;1�:)_ (4�- ylttc Lien/Title Holder Contractor Reg. # CA-S C E%i, J Address Expirations /_LL_/ (1 '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. 7 Z 31 e) /Sb / OG 2 Fire District Legal Descriptions VQ_n LP,�c Site Address(Please include street name, street numbers city) 4- 6- MAVA)r,*V VI6 -v ) TA Jy/{ Directions to site �G'i-�Z-\-Si#� Cl l'-D (%�-� �y ZF/�-+/L �arf.� � �c(� `) M7-j Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water (Name) VO 00-1re,>J t_AK3 Saltwater Lake_ River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE I] TYPE OF JOB New Add Alt Repair Other Use of Building a F I? 2 Describe Work G-S+ 01?-.41ri -/tiL_ 'F(Z No. of Bedrooms Z No. of Bathrooms 3 SQUARE FOOTAGE-1st Floor/ 7+-13 2nd Floor 3y I 3rd Floor Loft Basement !7'-I 3 Deck 703 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. 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 conformanc herewith. N changes shall be made without approval. first obtaini proval. X Date X _ Date -/ _d Z FOR OFFICIAL USE BEYONP THIS I �0 Accepted by Date b Submittal Amount Due Receipt No. i DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group - Type Constr. b 5 0d r A S Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee 7S � Plumbing&Base Fee Planning Review Fee Mechanical &Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO.: BLD MASON COUNTY BUILDING 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 APPLICANT INFORMATION CONTRACTOR IN ORMATION Owner t C44 IA2� J2 Contractor Name I�/ ekbE CV STOM Mailing Address 612N OTJ DIZ Mailing Address HO V C4-A!Ii Citf State CA Zip Code CityC"M101A- State�[k Zip Code SW_ Phone(9�-19 -7(a(* 3S�t r Ph.( Ph.(3cv0 )'701-91#01 Other Ph.(Z?J,�U) 13ts-7- yel 110 Lien/Title Holder Contractor Reg. # C94.5 CA C.& 9 An 1 -1 Address Expiration( q SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic . Existing Septic Connect to Sewer System Name of Sewer System Well Y Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Z'Z 3)Cl /5-o / U O Fire District Legal Description �'� .� 6�� 'F' -1 �2`�1 G�- -2- Site Address(Please include street name, street number city) E I" r Vr 7 Directions to site 0 04a"1*S PON L ('_ILN L) /t.0Cr—) AfN Will timber be cut and sold in parcel preparation? (Yes/No) ` Is your property within 200' of the following: Body of Water (Name) W 00'tL'vJ L-At a; , �allwatdr Lake ?C River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Other Use of Building 15F rZ Describe Work R..rs, Ocart AL- 4SF (;L No. of Bedrooms Z No. of Bathrooms 3 SQUARE FOOTAGE-1st Floor 1*714.3 2nd Floor 3�_ 3rd Floor Loft Basement /744 3 Deck 7)3 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 8,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 ex�gpt 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 conformanc herewith. N changes shall be made without approval. first obtain' )roval. X Date X Date�/-/�"0z FOR OFFICIALt -7USE BEYON THIS'06ittr Accepted byfe� "'` Date t D(r Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED'' CONDITION CODES Building Department C� t \ Occ Grou k T e Constr. �5 fV�, A C -�y Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation FEES Building Permit Fee '115 Site Inspection Plan Review Fee G q -0-4 EH Review Fee Plumbing& Base Fee 00 Planning Review Fee Mechanical&Base Fee�co1.10 Ro— Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( '10 ) TOTAL FEES PERMIT NO.. MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 j Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner " I C IL C,A 4 -1/-k 2 C1 , Contractor NameCASCAOr Mailing Address Mailing Address '5"10 IN :c P`z,4 1, r City,�,,� -l,t R State Zip Code .-6 City OL` MA, State )A Zip Code O Phone( .35'OOther Ph.( Ph.( ') )7b j_ %t n I Other Ph.(-�ieD ) f3(b'7-Hll L, Lien/Title Holder Contractor Reg.# r'A f-�L.AC;; C)DSO L J Address Expiration O (o /_It / SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 digit Tax Parcel No. 2 7 J 9 / / Fire District Legal Description Site Address (Please include street name,street n mber and city) AJ MOW TAiar J )3,140 Directions to siteVhl Is your property within 200'of the following: Body of Water (Name) A)LK.l 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 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 Bathroom Sink Furnace Bath Tubs Heatpumps U Showers -{- Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove f , " Dishwasher 1 Kitchen Exhaust Hood ` Hosebibs Dryer Vent Others, 5,411 1 , _1_ 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-]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 obtain in approv . X Date X L Date FOR OFFICIAL USE BEYO D THIS POINT Accepted by Date Submittal Amount Due Receipt No. £3EPARTtVEFtVTAtREVIEW '.< APPROVED DENIED ItI0I.GL1l1E5 Building Department — - Occ Grou 3Type Constr. " =-a c Planning Department Other Other ... �_._ ES ::::::::::: ............ ... . .... 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