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1
MASON COUNTY PERMIT NO.
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
On the web www.co.mason.wa.us .
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address Mailing Address
City State Zip Code City - -. State Zip Code
Phone Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # n "Exp.
E mail address E Mail Address Drivers Lic. # DOB
Drivers Lic.# DOB -t
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic--. Existing Septic
Connect to Water System Name of Water System��
Well Sewer System Name of Sewer System _
PARCEL INFORMATION - 12 Digit Parcel No 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 - New Add `Alt .,:,:. Repair Other PRIMARY RESIDENCE ❑ SEASONAL
Use of Building bescribe Work j
No. of Bedrooms No. of Bathrooms Square Footage t1st Floor 2nd Floor'
3rd Floor Basement (Dec k I a Covered Deck Other
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
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from 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. The owner 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 work or authorized construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION.
X Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted byt'" r' ' Date t�; i t
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department F fev7 O6
Planning Department
Environmental Health Department AIJ t:,
Fire Marshal
FEES
Building Permit Fee _ Site Inspection-,-"
Plan Review Fee .3 7°I- EH Review Fee
Plumbing & Base Fee 0- Planning Review Fee
Mechanical & Base fee Other
Wood /Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. ,--�
PLEASE PRESS HARD
PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar- P.O. Box 186, Shelton,WA 98584 12-& 5
Shelton (360) 427-9670-Belfair(360) 275-4467- Elma(360) 482-5269
On the web www.co.mason.wa.us
APPLICAN INFORMATION n CONTRACTOR INFORM TION
Owner IMA�J / t Eo(ry Lc�rL n
Company Name J4� 11J �'""_^' /�eJDarli es
MailingAddress P.D- Loy 13R Mailin Ad ress 9D l iy.oN �ri"L
Cit _► State Zip Code City ect State Zip Code 595` E
Phon Other Ph. Phone 3 6D-1129,5393 Other Ph.
Lien/Title Holder Contractor Reg.# NANDyd*7457 p 44-28'-D V
E mail address1"o_rUNej1 norm E Mail Address
Drivers Lic.# DOB Drivers Lic.#L'A17�eYel°,S�3s3 Ak DOB Z-/2 - V 9
SEPTIC INFORMATION - Connect to New Septic Existing Septic < Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. -5n Fire District
Legal Description - /
Site Address (Please include street name, street number and city) u zj.cq
Directions to site a w,'..� rgoo 2Vc A;// ,v �.
A LJ: e
Is property within 200'of Salt ter Lake -River/Creek Pon
Wetland Seasonal noff Stream Slopes or Bluffs > 15% A60-L-
TYPE OF JOB - New Add Alt JF3epair Other Use of Building
Location of Fixtures/Units - 1 st Floor_.&:=::::: 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric,_&_'_�LPC Natural Gas_ Heat Pump_
Toilets �_ Type of Unit No. of Units Fees
Bathroom Sink f Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/PelletStove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other OtherA'fA-jV f- 3
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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 that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from 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. The owner 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.
PROOF OF QONTINUA 10 OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: e2k32) 8�
Owner/Owners& sentative/Contractor (indicate which one)
r
FOR OFFICIAL USE BEYOND THIS POINT
Accepted Planning Pd Ck# Date 0-1*�j'01,e Bld P " Receipt No.
DEPAR TAL REVIEW APPROVED DENIED INOTES
Building Department
Occ Group-Type Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST
Owner's Name: Id o 1 VY d,IA Date: 10- :3( - O Ca -Reviewed By: 2 f 1�-
Documents.*
�' uilding Permit Application Completed t
✓Planning Intake Checklist ed,,� l� no i
—Site plan includes: llowable building ea,roof overhangs deck etc.
—Fire Apparatus Access o o required? Yes No
—Energy Code Application Form-•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:
Mechanical/Plum ing Application-WATER HEATER FUEL TYPE
Engineering? es (Need 2 sets of calculations)No Geotechnical report or assessment? Yes No
Snow load: 25 Seismic Zone(circle one): D 1 r DLJtl
I ! n J
n� v�
Construction Plans:�3 COMPLETE SETS � _
Plans Legible recognized Scale Elevation Views _Crdss Section
�/ Foundation Plan _Zl�oof 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:
oof Taming details,truss lay-out may be needed,truss or stick framed? a x 1
JaL)Vall Framing-Does bearing-wall height exceed 10'?(, ngineering may be required)
✓Floor framing: Floor joists: Q X I a �Q �,rroor beams:
v">Vindow 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 K t w t Yl
Heated By Furnace-Location of Furnace
e? � 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-Stery-C�. (Engineering may be required) R602.10.1, 1"story of a two-story D 145%,D2-55%
COMMENTS:
ENGINEERING REQUIRED:
Braced wall panels/braced wall lines are not marked on plans(R602.10)
ArnWnt and location of bracing does not meet minimum required in Table R602.10.1
IRREGULAR DINGS(Irregular Shape)R301.2.2.2.2
Irregular portions of s tares shall be designed in accordan�taccepted engineering practice. A portion of a building shall be
considered to be irregular w one or more of the f9jle<1ng conditions occur:
1)Exterior braced wall I r BWP cAWflevered or offset by more than 4'
2)Roof or floor is not laterall orted on all edges
2A)Portion of roof or flo extend mo an 6 ft.beyond the braced wall line.
3)End of BWP ext s more than 1 ft.over ening more than 8 ft in width below.
4)Opening i oor or roof exceed the lesser of 1 or 50%of the least floor or roof dimension.
5)Portio of floor level are offset vertically
6)S ar wall lines do not occur in two perpendicular directions.
hen a story above grade is includes masonry or concrete constructi exc: fireplaces,chimneys,and veneer).
When this applies the entire story shall be designed.In accordance with acc ted engineering practice.
DESIGN CRITERIA:Wind 85 mph exp B(unless proven otherwise), Seismic Zone: Snow: psf
2003 IRC Plans submittal checklist simplified/WORD
Mason County Planning Intake Checklist
Owners Name: Date:
Project: vt Reviewed By:
Commercialdevelopment: YE - Co ents:
PLANNER: GBM TSC CMM6!v
PBC RDH k : / �� arc-
Sit Plan: �1ie card �� Ado. nobs Loa-i-, b-Q-
orth Arrow 4ve-4-i ►'1
a� Property Dimensions: X _4_E),i Id ' V u — AppY F2.
Streets and Driveways Shown. Road name: Mye
i� All Existing Structures shown with setbacks - Mo b,k-- vvvge WL'0 A- be_ namb acL
Well Location, Septic and Drain-field Shown with setbacks - LLICL_tvu
N( Identify all surface water (streams, ponds, shoreline, wetlands, natural or historic drainage,
defined drainage ditches)
X Topography (slopes) IC) - G-Al"?o `o in�ab - t-�o m G
p� Proposed Structure Setbacks (Direction/Setback): J 0
F: �J� R: c! I / 1: CI t l i=. S2: q� / y
Utility and Drainage Easements: Yes 90if yes enter condition #5022)
Other Easements
Accessory Appurtenances: Pr ane / Heatpump no
o Variance applied for: Yes / No parking spaces allotted? Yes No
C
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?
non E
—b
Is the site clearly marked? How? Address o rf rl 6,U&k�y f6i
❑ Named
Critical Areas: ❑ Other:
Setbacks: Shoreline: Slo e: to
N _ .
Shoreline Designation: Comprehensive Plan: Rural Zoning: U`
❑ Not Applicable ❑ Agricultural X RR 2.5 �10 20 v
❑ Urban ❑ In-holding ❑ RMF
❑ Rural ❑ LTCFL ❑ RC 1 2 3
❑ Conservancy ❑ Rural ❑ RI
❑ Natural ❑ RAC ❑ RNR
Ct-
0 Unknown ❑ RCC-Hamlet ❑ RT
❑ Urban Growth Area ❑ MPR '
❑ Unknown ❑ Unknown
Water Body a of water if unnamed):
SEPA: Yes/ No Unknown, Flood Plain: YES NO Unknown Map#
Aquifer Recharge: YE /�NO�Unknown Map#
Tags/Cases:
RLC/SPI Case: 6-Year Dev. Moratorium: YES/NO
Eagle Nest Tag: YES/NO Other YES/NO
Revised: 09-29-2006
THIS PARC EL
INCLUDES
PLANS, BLUEPRINTS
01R. - OVERSI,Z.E
IMAGES
LARGE FORMAT
IMAGES HAVE .BEEN. STORED IN
FILE CABINETS) UNDER
PA RGE- L NUMBER
PARCEL # 3aM�
CASE u &..b aoM- o iqa7
PLDT_
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General/Specialty Contractor
A business registered as a construction contractor with LEtl to perform construction work within the scope
of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment
of account and carry general liability insurance.
License Information
License HANDYR'965P8
Licensee Name HANDYMAN REPAIRS
Licensee Type CONSTRUCTION CONTRACTOR
602441378 Verify Workers Comp Premium_
UBI Status
Ind. Ins. Account
Id
Business Type LIMITED LIABILITY COMPANY
Address 1 90 N UNION DR
Address 2
City HOODSPORT
County MASON
State WA
Zip 98548
Phone 3608775393
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 10/28/2004
Expiration Date 10/28/2008
Suspend Date
Separation Date
Parent Company
Previous License HANDYR"012MB
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License
https://fortress.wa.gov/lni/bbip/Detail.aspx?License=HANDYR*965P8 12/13/2006