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Road name: L 4451 4v.y All Existing Structures shown with setbacks Idoe . &5, Well Location, Septic and Drain-field Shown with setbacks �Identify all surface water (streams, ponds, shoreline, wetlands, natural or historic drainage, defined drainage ditches) Topography (slopes) 5.1opaf�- dowyi VW_t-j LaJ(4 o ,"ProposedJ&ructure Setbacks (Direction/Setback): w Me- F: 10, / E R: _J vJ Sl: 5 n S2: or,"Utility and Drainage Easements: Yes No (if yes enter condition #5022) at/Other Easements r�Accessory Appurtenances: Propane / Heatpump o/Variance applied for:4idy(add No - parking spaces allotted? (YeDs / No County Access Permit condition #0010) Standard Conditions to be added to all Building permits that planning reviews: #5019 and #0700 Site Access: Are there any impediments (dogs/gates) that my restrict access to your site? hone Is the site clearly marked? How? ddress r1u cX.box ❑ Name Critical Areas: ❑ Other: Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: ❑ Not Applicable ❑ Agricultural 0 RR 2.5 10 20 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy ❑ Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR ❑ Unknown ❑ Unknown Water Body pe of water if unnamed): SEPA: Yes/ o Unknown Flood Plain: YES 0 nknown Map# Aquifer Recharge: YE NO Unknown Map# Tags/Cases: RLC/SPI Case: n/4 6-Year Dev. Moratorium: YES 0 Eagle Nest Tag: YES O Other YES 0 Revised: 09-29-2006 MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST Owner's Name: VI e-.rej A Date: Reviewed By: Documents:: V ]3uilding Permit Application Completed ✓ Planning Intake Checklist Completed, Site plan includes:Allowable building area,roof overhangs,decks,etc. ✓F' a Apparatus Access Road info required? Ye No ergy Code Application Form-O Electric wall heater O Electric central furnace O LPG Furnace O Heat pump with electric furnace O Heat pump with LPG furnace O Boiler(heat type O Other:Specify: n i-'Z ;5�Q lq-cQ ti' Nechanical/Plumbing Application-WATER HEATER FUEL TYPE Engineering? Yes (Need 2 sets of calculatio No _ Geotechnical report or assessment? Yes No Snow load: Seismic Zone(circle one): D i o D2 Construction Plans: ✓ 3 COMPLETE SETS f _Plans Legible ✓Recognized Scale _Elevation Views _✓Cross Section Foundation Plan _ZICoof Framing Plan _Floor Plan—Use of rooms noted(all floor levels) Floor Framing Plan-all floor levels represented? Loft,crawlspace,etc. Deck Framing Plan,including covered.porch framing Plan Details: _Roof framing details,truss lay-out may be needed,truss or stick framed? Wall Framing-Does bearing-wall height exceed 10'?(Engineering may be required) _Floor framing: Floor joists: ,Floor beams: _Window headers marked on plans: Typical header: Foundation:footing size,reinforcement _Concrete Walls-Does Concrete Wall Height Exceed 9'?(Engineering may be required) —Landings at all exits? Less than 30"above grade? Y N —Heated By Furnace-Location of Furnace t)h kr, —Fireplace/Stove Information Shown-Fuel Type? Location(s): —Window Sizes Marked on Plans _ Braced wall panels(shear walls)marked on plans or lateral engineering? (Plans may not be approved if not provided.) — 2-Story Garage? (Engineering may be required) R602.10.1, l'story of a two-story D1-45%,D2—55% COMMENTS: ENGINEERING REQUIRED: Braced wall panels/braced wall lines are not marked on plans(R602.10) Amount and location of bracing does not meet minimum required in Table R602.10.1 IRREGULAR BUILDINGS(Irregular Shape)R301.2.2.2.2 Irregular portions of structures shall be designed in accordance with accepted engineering practice. A portion of a building shall be considered to be irregular when one or more of the following conditions occur: 1)Exterior braced wall line or BWP cantilevered or offset by more than 4' 2)Roof or floor is not laterally supported on all edges 2A)Portion of roof or floor extend more than 6 ft.beyond the braced wall line. 3)End of BWP extends more than 1 ft.over an opening more than 8 ft in width below. 4) Opening in a floor or roof exceed the lesser of 12 ft.or 50%of the least floor or roof dimension. 5)Portions of floor level are offset vertically 6) Shear wall lines do not occur in two perpendicular directions. 7)When a story above grade is includes masonry or concrete construction(exc: fireplaces,chimneys,and veneer). When this applies the entire story shall be designed.In accordance with accepted engineering practice. DESIGN CRITERIA:Wind 85 mph exp B(unless proven otherwise), Seismic Zone: Snow: psf 2003 IRC Plans submittal checklist simplified/WORD I', MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 4 i L k 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 p;i- Shelton (360) 427-9670 • Belfair(360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICAIJZ INFORMATION CONTRACTOR INFORMATION Owner ,4 U,L (5L, i` G.r Company Name Mailing Address AgY Aj& WAVLV Wif Mailing Address City " � Y1" d State &JA Code City State Zip Code Phone -^?Go-.277 03A7 Other Ph=?' 21P4 9y�"7 Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address AiaL Vti7"14A (Q ZM-22,eVA1 E Mail Address Drivers Lic.# r- DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic /vim Existing Septic N/A Connect to Water System AY—Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description A Site Address (Please include street name, street number and cit v Directions to site zA1,( S,,P. et 47 h N Al /t_ �C ' Will timber be cut dnd sold in parcldl preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond I Wetland Seasonal Runoff Stream Slopes or Bluff—T/o Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ELSEASONAL ❑ Use of Building_j94Rn °- Describe Work.3C XV4 JP/Mid s'i©IeK iJ.UsfFA772) No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor i;aM 2nd Floor !!!� 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage— Attached Detached __X_ 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 Z'permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or r W jl lare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have r i m all the necessary parties. If permission 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. Jhe"'per or ( agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.This permit/application becomes null &void if wor r o izedAconstr�uction is not commenced within 180 day or if construction work is suspended for a period of 180 days. PROOF OF, A-I� T16 BY J ME�p18t7F PROGRESS INSP CTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. i X v Date: /01/G`e,00 Owner wnersIke-presentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date IIto-24 �( DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Yp " r 'c100o2, Environmental Health Department Fire Marshal i FEES Building Permit Fee 3 _ G,J� Site Inspection Plan Review Fee -S EH Review Fee Plumbing & Base Fee PlanningReview Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee �-- Violation Fee �/- 3ar O^� Pre-Paid at Submittal V ation $ TOTAL FEES I