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HomeMy WebLinkAboutBLD2005-00240 Final Detached Pole Bldg - BLD Permit / Conditions - 10/26/2005 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 spi$ c RESIDENTIAL BUILDING PERMIT BLD2005-00240 OWNER: ANDREW MANDJIKOV RECEIVED: 2/17/2005 CONTRACTOR: TOWN & COUNTRY 800-824-9552 LICENSE: TOWNCPF099LT EXP.. 6/30/2005 ISSUED: 3/10/2005 SITE ADDRESS: 5310 NE ELFENDAHL PASS RD BELFAIR EXPIRES: 9/10/2005 PARCEL NUMBER: 223157500040 LEGAL DESCRIPTION: TR 4 OF SURVEY 2/12 5310 NE ELFENDAHL PASS RD BELFAIR PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW DETACHED POLE BARN OLD BELFAIR HIGHWAY TURN LEFT ONTO SR 300, TURN RIGHT ONTO SAND HILL, TURN LEFT TURN SLIGHT LEFT ONTO GOAT RANCH ROAD. General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: Type of Constr.: VB Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: U-1 Lot Size: Deck: Type of Work: ACC Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building: Garage-Detached 1,728 Valuation: Building Height: 21 Occ. Status: Primary Basement: Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft. Front: N 419.0 Ft. Shoreline: Ft. Water Body: POND SEPA?: No Model: Width: Ft. Rear: S 185.0 Ft. Slope: Ft. Shoreline Desi Side 1: W 115.0 Ft. 9-'. Not Applicable Year: Serial No.: Side 2: E 53.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Plan Check Fee CMH 2/17/2005 $365.92 B12005 Planning Review Fee CMH 2/17/2005 $155.00 612005 Building State Fee ARC 2/24/2005 $4.50 612005 Building Permit Fee ARC 2/24/2005 $562.95 B12005 EH Plan Review CEW 2/28/2005 $35.00 B12005 Total $1,123.37 BLD2005-00240 Please refer to the following pages for conditions of this permit. 1 of 4 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 w, RESIDENTIAL BUILDING PERMIT BLD2005-00240 OWNER: ANDREW MANDJIKOV RECEIVED: 2/17/2005 CONTRACTOR: TOWN & COUNTRY 800-824-9552 LICENSE: TOWNCPF099LT EXP: 6/30/2005 ISSUED: 3/10/2005 SITE ADDRESS: FENDAHL PASS RD BELFAIR EXPIRES: 9/10/2005 PARCEL NUMBE 2231575000 LEGAL DESCRIPTION: Y 2/12 5310 NE ELFENDAHL PASS RD BELFAIR PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW DETACHED POLE BARN OLD BELFAIR HIGHWAY TURN LEFT ONTO SR 300, TURN RIGHT ONTO SAND HILL, TURN LEFT TURN SLIGHT LEFT ONTO GOAT RANCH ROAD. General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: Type of Constr.: VB Type of Use: SF Insp. Area: No. of Bathrooms: Occ. Group: U-1 Lot Size: Deck: Type of Work: ACC Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building: Garage-Detached 1,728 Valuation: Building Height: 21 Occ. Status: Primary Basement: Manufactured Home Information Setback Information Shoreline& Planning Information Make: Length: Ft. Front: N 419.0 Ft. Shoreline: Ft. Water Body: POND SEPA?: No Model: Width: Ft. Rear: S 185.0 Ft. Slope: Ft. Shoreline Desi Side 1: W 115.0 Ft. 9.: Not Applicable Year: Serial No.: Side 2: E 53.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Plan Check Fee CMH 2/17/2005 $365.92 B12005 Planning Review Fee CMH 2/17/2005 $155.00 612005 Building State Fee ARC 2/24/2005 $4.50 B12005 Building Permit Fee ARC 2/24/2005 $562.95 612005 EH Plan Review CEW 2/28/2005 $35.00 B12005 Total $1,123.37 BLD2005-00240 Please refer to the following pages for conditions of this permit. 1 of 4 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2005-00240 OWNER: ANDREW MANDJIKOV RECEIVED: 2/17/2005 CONTRACTOR: TOWN & COUNTRY 800-824-9552 LICENSE: TOWNCPF099LT EXP: 6/30/2005 ISSUED: 3/10/2005 SITE ADDRESS: 5310 NE ELFENDAHL PASS RD BELFAIR EXPIRES: 9/10/2005 PARCEL NUMBER: 223157500040 LEGAL DESCRIPTION: TR 4 OF SURVEY 2/12 5310 NE ELFENDAHL PASS RD BELFAIR PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW DETACHED POLE BARN OLD BELFAIR HIGHWAY TURN LEFT ONTO SR 300, TURN RIGHT ONTO SAND HILL, TURN LEFT TURN SLIGHT LEFT ONTO GOAT RANCH ROAD. General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: Type of Constr.: VB Type of Use: SF Insp. Area: No. of Bathrooms: Occ. Group: U-1 Lot Size: Deck: Type of Work: ACC Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building: Garage-Detached 1,728 Valuation: Building Height: 21 Occ. Status: Primary Basement: Manufactured Home Information Setback Information Shoreline & Planning Information Make: Length: Ft. Front: N 400.0 Ft. Shoreline: Ft. Water Body: POND SEPA?: No Model: Width: Ft. Rear: S 1 .0 Ft. Slope: Ft. Shoreline Desi Side 1: W 115.0 Ft. 9.: Not Applicable Year: Serial No.: Side 2: E 50.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Plan Check Fee CMH 2/17/2005 $365.92 B12005 Planning Review Fee CMH 2/17/2005 $155.00 612005 Building State Fee ARC 2/24/2005 $4.50 612005 Building Permit Fee ARC 2/24/2005 $562.95 612005 EH Plan Review CEW 2/28/2005 $35.00 612005 Total $1,123.37 BLD2005-00240 Please referto the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR • BLD2005-00240 CONDITIONS FOR BLD2005-00240 1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-092Y ?e person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Department prior toordfurther inspections being performed or approvals granted. X 3) In accordance with international codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus Access Roads," all new structures that require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from the access road. The numbers shall also be plainly visible and legible from the street or road fronting the property and shall contrast with their background. 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 international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting inspections.X 4) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal of approve y,(/cuments will result in failure of required building inspections. X xJ 5) This structure is approved as un-heated space. If at any time this building is to be used for anything other than what it is approved for, a change of use permit shall be appl Jar, reviewed and approved prior to the change. X {W 6) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site 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 Depart . r to any further inspections being performed or approvals granted. X BLD2005-00240 Please refer to the following pages for conditions of this permit. 2 of 4 L - 7) The internatioanl code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150' from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such rood nect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X 8) This structure is limited to U-occupancy use only (private garages, carports, sheds, and agricultural buildings.) Any other use will be in violation of the international cod�es and Mason County Regulations unless a "Change of Use" permit is applied for, reviewed and approved. X , 9) 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 (refer to current fee schedule, minimum 1 hour) will be charged and e collected by the Building Department prior to any further inspections being performed or approvals granted. X 10) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocation X 11) 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 5' 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 12) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or re ul must be reviewed and approved by Mason County prior to construction. X �, 13) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international c des as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall r e prior to requesting additional inspections. X 14) All property lines shall be clearly identified at the time of foundation inspection. X 15) 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 insp coon or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County .ices and building regulations. X BLD2005-00240 Please referto the following pages for conditions of this permit. 3 of 4 16) 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 of exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder have p ted action from being taken. No more than one extension may be granted. X JJ�� 17) Pressure treated woo manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and g. Install metal connectors approved for contact with the new types of pressure treated material. X 0m- 18) Water quality is be degraded to the detriment of the aquatic environment as a result of this project. X 19) Prior to final approval, all upland areas disturbed or newl�d by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 20) All construction and demolition debris must be removed after project completion. Proper disposa�struction debris must be on land in such a manner that debris cannot enter or cause water quality degredation of State waters. X 21) Approved p9jgftensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 22) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are r ired for this proposed development and construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of work is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and s ctur for re wan inspection. r OWNER OR� DATE: l l 01Of f7 / BLD2005-00240 Please refer to the following pages for conditions of this permit. 4 of 4 co r 0 o CONCRETE MECHANICAL MANUFACTURED HOME 0 v' Footings / Setbacks Date By Ribbons 0 CD N) Date By i l!, Gas Piping Date By o Foun a 'on 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 10 (o D By Lam— Date By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILING D.W.V. Date By Date By FINAL INSPECTION Water Line Date B ytAt,- Date By Date By � 1 / 1 1SfP� � ("�SS �ll�('l08' ���7/0� tJ0/L t" y�ceot.� o f S� '��f � o 0 0 bd � FtZAME Fl/llA L 10 P, D G &-HN61fo o � Cn 8 ,✓ O d o- Ir[sv►.f. /—('u+� �a S /0�2)/O fS� �0��ly�06� L.IDJ�- �G o.ti � O `I xo m ►Oy►'o o— 7aEl f 1pnd fvf,c� .: d 0 Site Plan Suite B•16521 Highway 99•Lynnwood,WA 98037-3199 P ase Check After Doing Site Plan: Septic and drainfield {p`ot size Draw North Arrow in Circle TOWIl &Country Everett: (425)258.4171 Puyallup: (253)840-9552 Property dimensions fE Sewer lines d Elevation of property POST FRAME BUILDINGS Administrative Headquarters: (425)743-1555 xisting buildings EI Setbacks of proposed&existing buildings ❑Bodies of water FAX: (425)742-4378 Toll Free: 1-800-824-9552 Contractor's Lk.1t:TOWNCPF099LT Proposed building Jvlain road with name ❑Floorplan LIMMr— (9 CCBN: 129311 ❑Easements (Access to proposed building 4?1 Slopes&Contours(5'Increments) QuaWy:Ow Future Depends On It^' t- Job Name: AND SZE W PA N 41 K CIV Job Site Address:S 310 a LF Legal Description: r Tax Account 4" 123 iS 7S U A -1 D r SJ L I + _ &C A. I j i 1 1 1 - 4 0. 0 it 1 : j Is, 77, -t 1 I i , O c9 it i t_a - _ 4 t 3 ) j � IP V t 1 0 Cl) a4'// (' ISr, i v*tLA �, � ©A - e S�� I ' fma i i I i 1 I M,q . S�soN oU R p _ ' Ty , , VlR I SU 7,0 /vj� AppRO SATE �j E "Cr T84- IFES to V C �� { �._ F4/R i i 1I , f I1 : 1 II DO NOT SIGN INCOMPLETE SITE PLAN! Customer has verified and approved the location of the building,orientation of the buildin to the North,an v rifles al 11 / white-Customer Copy Canary-Office Copy Pink-Accounting Goldenrod-Production utilities are shown on this drawing in the correct location. 2 Customer Signature: < Iti Lead#: ®1995 PermaBilt Industries Flt#34 SI98 T0Wli1 Country" Suito B•16521 Highway 99•Lynnwood,WA 98037-3161 POST FRAME BUILDINGS Everett Line. (425)258-4171 Toll Free: 1-800-824-8552 A� ■ ■ Admipistrative Headquarters: (425)743-1555 �► DIVISION of ■ Quality:Our Future Depends On It.� Number 5312 CHANGE ORDER PHONE DAB JOB NAMEILOCAnON TO: _ Andrew xr► tyrna bdandlikov Same SZ10 *tF nlfendahl Pass Rd Rplfa'r WA JOB NUMBER Belfair, WA 98528 LEAD# JOB PHONE 41621 EXISTING CONTRACT NO. DATE OF EXISTING CONTRACT WE HEREBY AGREE TO MAKE THE CHANGE(S)SPECIFIED BELOW: Per Customer's Request, make the Following Changes to the Building specified in the Contract signed on 1/]7/2005: RECEIVED 1. Rotate the Building so the 12'X12' and the 5'x4' Split Sliding Doors APR 0 6 2005 Face the Driveway and Round Pen. BELFAIR OFFICE 2. Replace the Two 10' Artis Ridge Vents with Two PermaBilt Cupolas with Horse Weathervanes. 3. Add a 3'X6'8" PermaBilt Steel Walk-in Door. .4 These Changes are Shown on the enclosed revised Building Design �4 ONt�fto and Site Plan Drawings. All other Terms and Conditions of the aak 4¢6T Contract remain Unchanged ��10ete�C i "PLEASE SIGN AND RETURN ORIGINAL COPY OF CHANGE ORDER­ Contract Amounts Shown Below Do Not Reflect Any Payments Received NOTE: This Change Order becomes part of and in conformance with the existing contract&does not reflect any payments received. WE AGREE hereby to make the change(s) specified above at this price =? $ 1,1 86.00 DATE I ADJUSTED TAX $ 98.44 © �0 SIGNATUR OR) PREVIOUS CONTRACT AMOUNT $ 36,1 73.28 T REVISED CONTRACT TOTAL $ 37,457.72 ACCEPTED—The above prices a d-specifications of this Change Order are satisfactory and re he accepted. All DATE OF ACCEPTANCE r work to be performed under same erms and conditions as specified in original contract unless otherwise stipulated. SIGNATURE i OWNER) I r b1990 Perma-Bilt industnes FR-40 9/99 OWII t11111' Suite B-16521 Highway 99•Lynnwood,WA 98037-3161 T M I D Everett(425)256-dqu ers: 25(253)840-9552 Building Design FAX:(suative Headquarters: (425) 00-82 -9 • ��' �� � � � � FAX:(425)742�378 TdlFree: 1-800-824-9552 Depcn&O„Ie Quality Orr Futr *' Conaaaore Lk,r.TOWNCPF099LT �OO PLEASE CHECK FLOOR PLAN ❑Roll-up doors fit in Bays Wind MPH Dra• )rth At.ow in Circle ❑Roll-up doors will not hit Truss ? Wind Exposure 12 Roof Pitch �. Eave Height Snow Load I I t Minimum Clearance I 4 i t ` ! =( Imo' t _ Auto � Door- ; � i � _... t- i R i1.'Y.�C 1�: � 1} � `pif2 I - '`•f� t .__ ��__�r� } } ; f . _Pi;WIT 14K • -1>tir AA i �- :Ft•rtt t�r1X S 1�1XI� GfiI111G , i IbFR t3 Rh + j { t t _ 2. ._.c.. _ i 1 L I z I ..' ' . f. '.1 a�• i ) 1 i , f t� Vlt'F,�. .1. _.�. . _E ' i ' ._ _ 4fr :l. f4� i. .� I • t E .Z 1 F 't'One I k-C4�� l l 4 I C . ; I : , _. •. . , I•+.,rce 'last f .__ ,,�A�® ' I BUILDING ELEVATION Customer has verified and approved the orientation of the building to the North and verifies that all items specified in Paragraph B of the contract are shown on this drawing and vice versa. Customer Name: 1Y V Lead# i- z Customer Signature i White-Customer Copy Canary-Office Copy fink-Accounting 01995 Perma-Bift Industries FR-85 0&03 PERMABILT ;. • .r. h 16abluorki-- MEN MEN MEN' ' dznmwfim ENOo! . .... .-�.. .� a,....r— 1t�■■■ a 1 FW 113, 11118MER Oman W.1wmcwffv ■i� i�■■■■■ ■1"iiia■'�i ■�ii®r■■'"`i ■■►►pis'■■i■■■ ■■■■■■■■■■■ ■■■■■r■■i!■ ■■■■■■■■ENO■■■■■■■■■i■■■■mommoomm ■■■ ■ MEN ■■■■■■■■■■ ml ®F-�1�R\m■■1■ I��■����>•r■�r•��I•rlr i® I�iir• �>•i s Ir��1.� ` MMI aim■"!!■ '' ■■ ■■!!t'S loom!■■' III III ■ Town & Country® Suite B•16521 Highway 99•Lynnwood,WA 98037-3161 POST FRAME BUILDINGS Everett:(425)258-4171 Puyallup:(253)840-9552 Administrative Headquarters: (425)743-1555 _ ■ _ FA FAX: (425)742-4378 Toll Free: 1-800-824-9552 '111111, DIVIsIONOF Contractor's Lic.#:TOWNCPF099LT Quality: Our Future Depends On It.' DIRECTIONS TO SITE JOB NAME: k\\IAAA A A"Y MANIN t kT— SHIP TO ADDRESS: 5-31 O Ej.._FEN`D&RL. PASS KI) Mci..tr4 l K. UU A TELEPHONE#AT JOB DROP: fo O'�7S'7�t50 THOMAS GUIDE Can a semi' turn around at the job drop? ❑Yes E No ❑ Back-in Only ❑Other Can a two tone get into the job drop? [Yes ❑No ❑Other Can a concrete truck get into the drop? VYes ❑No ❑Other Will a 4 wheel drive vehicle be required for deliveries? ❑Yes VNo ❑Other Directions F71:AR C flMK—VV-1VAATTO P OAP DIRECTION 5310 t"'Vftp 0 Ur S I(DNS nN AA iL,%o)c S r� G PAvZt 0 -ORI Utltrr+) GoA-r R,r,Nc RoA h Q '4 U Ys1 �Y AA �pRp 0A� L P': 'Truck Dimensions:65'long,8'wide, 121/2'high,and it weighs 35,000 lbs.empty. 'Truck Dimensions:30'long,8'wide, 121/2'high,and it weighs 18,000 lbs. empty. I • a t[„ }k. �' ►, ' .t ` ,tit• 'a 1 t-j. .•is1F41 1 a �.f I i�,"1 ,� r• °�_ ., t I l-•} tir a} {',�}t f� Nr t���a>►,1"1.�1�'� ;1� 1, �, ,` ' }• t"+ • ' -•,t� '�j��'R���:1 a} ' w y.L �� tt r• ri jo • �Y`. �lt},,�. ��''�K. .�r - Z d'4 .�;�• �. jf:� 1!a +- >•r '-�.1G�► � a�• p � r-C � � i 'i!L•� � ..�f ' 7.,L�y' � - .�' 's,G� �� +•r. 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Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ' 'U^i Company Name Tt; ir', 1,tjrN Mailing Address Mailing Address City , .1 r state jAi A Zip Code 6067-Q City State 4-- Zip Code Phone Xf'$Q Other Ph. Phone"',',-" '!!? 1!51- - Other Ph. Lien/Title Holder Contractor Reg.# j=.nrlp"Ci 14 Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. _ ,����;.. Yf{� Fire District Legal Description - Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - �Iew--*—Add Alt Repair Other P IMARY RESIDENCE Q SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No.of Bathrooms Square Footage- 1st Floor � �. 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make 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. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare thatI otit give.this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessr� ii�5iion is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,repre=thht a i{ gr�nation provided is accurate and grants employees of Mason County access to the above described property and structure for revi d s� PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date• "2- I�"* �n S 6ELFAIR OFFICE Owner/Owners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department i6- 110 L Planning Department IF Environmental Health Department Public Works Department Fire Marshal r FEES Building Permit Fee eL Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee • 5 d Violation Fee Pre-Paid at Submittal Valuation $ // 3 S �—- TOTAL FEES