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ENTRANCE PROPONENT/ L❑CATI❑N:
'{2f
PROPOSED WELL IT VEITCH
NE MOUNTAIN VIEW DRIVE
PARCEL 22319-50-00906
MASON COUNTY, WASHINGTON
PROPOSED
WATER LINE ENGINEERt
6 7 0± ENVIROTECH ENGINEERING
PO BOX 2�0 984 BELFAIR, WASHINGTON 98528
360-275-9374
EXISTING DRIVEWAY
SITE PLAN
Name VGtACh Parcel# . W N-5b—000 6 BLD# 2611 — W-311 D
Mason County �� ' L
D '
Department of Community Develop N G
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requiremen�� ere��
Management in this jurisdiction.A complete copy of the ordinance can be found on the Masas
http//www.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to"Title 14,Chapter 14.48 Stormwater Management". MAY 0 12017
Regulated activities shall be conducted only after Mason County Public Works approves a stkAllivAr Noffat9treet
(Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document
entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan".This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details*are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system(see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) /The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
Mail:P 0 Box 1850,Shelton WA 98584
Physical:415 N 6th St, Shelton WA 98584
If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other,parcel.You may also wish to consult with the septic design professional involved with the project.Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT.352
Mail:P 0 Box 1666,Shelton WA 98584
Physical:426 W Cedar St,Shelton WA 98584
A condition will be added to the building permit that states,in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
describ p erty for revi w and i ectio�be required.,...
X Owne" gent/Contractor(circle one)Date:
Page 2 of 2
NameA�� U0. Parcel# 223 j 9— 5_&-U O 9 O(o BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code, Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment',with more than 2,000 square feet of impervious surface 2.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction, installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area All dimensions in feet
Buildings X =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parking Areas X =
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area (sum of all areas)
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
WSEC/Ventilation Code Compliance ApplicBUILDING
Submit with heating/cooling system size worksheet (see instructions #4)
X Owner: Parcel#: Type of project: aa
Total Sq. Ft. fir, 1 It Floor: 2nd floor: Heated Basement:
of heated area:: TM
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
Y 1 2017
• Heat Pump with electric furnace O Heat pump with gas furnace O Ductless Heat Pump
O Boiler, specify fuel type: O Other: Specify: 615 VV. Alder Street
■ Prescriptive Option Table R402.1.1 (see table on previous page)
Compliance Method ❑ Component Performance, R402.1.3 — Calculation worksheets required
Must Check one::
❑ Other (Specify):
Check one ❑ Whole House Ventilation system Whole House Ventilation
Ventilation using exhaust fans&window or wall Integrated with a Forced Air ❑ Other,describe:
fresh air vents(101507.3.4). If using System (1141507.3.5)
System window vents be sure to order
windows with vents.
Referencing Table R406.2, "Additional Residential Energy Efficiency Requirements,"all residential units
must develop credits as specified in Table 406.2. Identify and describe which option(s)will be used to
comply. If the table is not attached to this form you can access the table on our website at:
http://www.co.mason.wa.us/forms/Community Dev/iecc wsec.pdf
a) Description: Small dwelling units: less than 1,500 sq. feet of heated or cooled floor
Additional area and less than 300 sq. ft fenestration area (skylights, doors, windows, etc).
Energy "Including additions to existing building that are greater than 500 sq. ft. of heated floor
Efficiency but less than 1,500 sq ft of floor area. Requires 1.6 credits
Requirements b) Medium dwelling units that are not included in (a) above(small dwelling), OR (c) below
Energy credits (large dwelling} Requires 3.5 credits
required: EXCEPTION: Dwelling units serving R-2 occupancies shall require. Requires 2.5
3.5 credits. See page two for description.
c) Large dwelling unit is a dwelling unit that exceeds 5,000 sq. ft. of heated or cooled
floor area. Requires 4.5 credits
d) Additions less than 500 sq feet. Requires .5 credits
(Fenestration is defined in the IECC as skylights, roof windows, vertical windows, opaque
doors, lazed-doors that include products with glass and non-glass glazing materials.
Describe Energy Credit Option(s):
Using Option number(s): -'
2A . 45A . C
3
f
FENESTRATION'SCHEDULE
USE FOR ENERGY CREDIT, a) SMALL DWELLING OPTION & COMPONENT PERFORMANCE COMPLIANCE
List all windows, doors, skylights. (if needed, attach an additional sheet)
'Fenestration is defined in IECC Chapter 2 as skylights, roof windows, vertical windows, opaque doors, glazed-doors that
include products with glass and non-glass glazin materials.
Manufacturer Location U-Factor Size Quantity Total
rough opening) Square Feet
Total Fenestration: windows, skylights and door area
4
Simple 1�-eatin System Size: Washington State
This heating system sizing calculator is based on the Prescriptive Requirements of the 2015 Washington State Energy Code(WSEC)and ACCA
Manuals J and S.This calculator will calculate heating loads only.ACCA procedures for sizing cooling systems should be used to determine cooling
loads.
The glazing(window)and door portion of this calculator assumes the installed glazing and door products have an area weighted average U-factor of
0.30. The incorporated insulation requirements are the minimum prescriptive amounts specified by the 2015 WSEC.
Please fill out all of the green drop-downs and boxes that are applicable to your project.As you make selections in the drop-downs for each section,
some values will be calculated for you.If you do not see the selection you need in the drop-down options,please call the WSU Energy Extension
Program at(360)956-2042 for assistance.
Project Information Contact Information
Veitch Bennett
560 NE Mountain View Dr
Tahula,WA 98588 Plan 2734
Heating System Type: *11 Other Systems ()Heat Pump
To see detailed instructions for each section,place your cursor on the word'Instructions".
Design Temperature
Design Temperature Difference(AT) 47
Shelton
A=Indoor(70 degrees)-Outdoor Design Tamp
Area of Building
Conditioned Floor Area
Instructions Conditioned Floor Area(sq ft) 2,734
Average Ceiling Height Conditioned Volume
nstruc.nons Average Ceiling Height(ft) 8.1 22,173
Glazing and Doors U-Factor X Area = UA
Instructions
0.30 348 104.48
Skylights U-Factor X Area = UA
Instructions 0.50 ---
Insulation
Attic U-Factor X Area = UA
Instructions R-49 0.026 2,734 71.08
Single Rafter or Joist Vaulted Collings U-Factor X Area UA
Instructions
SeledR-value No selection ---
Above Grade Walls iaee Figure 1) U-Factor X Area UA
Instructions
R-2t intermediate ;,,,Iglj� 0.056 F-1—.76i—I 98.60
Floors U-Factor X Area UA
Instructions 0.029 2,734 79.29
R-30
Below Grade Walls Ime Figure 1) U-Factor X Area UA
Instructions Select R-value No selection ---
MA
Slab Below Grade ism Figure v F-Factor X Len4th UA
Instructions111 III
Select conditioning c�'I No selection ---
Slab on Grade(am Figure 1) F-Factor X LeL h UA
Instructions Select R-Value til{ No selection ---
Location of Ducts
Instructions �1,, Duct Leakage Coefficient
Unconditioned Space 1.10
Sum of UA 353.45
Envelope Heat Load 16,612 Btu/Hour
Figure 1. Sumof UAXAT
Air Leakage Heat Load 11,255 Btu/Hour
VolumeX 0.6XATX.018
Above Grade Building Design Heat Load 27,867 Btu/Hour
Air Leakage+Envelope Heat Loss
Building and Duct Heat Load 30,654 Btu/Hour
Ducts in unconditioned space:Sum or Building Heat Loss X 1.10
Ducts in conditioned space:Sum of Building Heat Loss X 1
Maximum Heat Equipment Output 42,916 Btu/Hour
Building and Duct Heat Loss X 1.40 for Forced Air Furnace
Building and Duct Heat Loss X 1.25 for Heat Pump
(07101113)
Prescriptive Energy Code Compliance for All Climate Zones in Washington
Projact Information Contact Information
s
Veitch Bennett
560 NE Mountain View Dr
Tahula, WA 98588 Plan
This project will use the requirements of the Prescriptive Path below and incorporate the
the minimum values listed. In addition, based on the size of the structure,the appropriate
number of additional credits are checked as chosen by the permit applicant.
Authorized Representative Date
All Climate Zones
R-Valuea U-Factors
Fenestration U-Factorb n/a 0.30
Skylight U-Factor n/a 0.50
Glazed Fenestration SHGCb.e n/a n/a
Ceilingk 44 0.026
• Wood Frame Wallg7n 21 int 0.056
Mass Wall R-Value' 21/21' 0.056
Floor 309 0.029
Below Grade Wall``" 10/15/21 int+TB 0.042
Slab R-Value& Depth 10, 2 ft n/a
*Table R402.1.1 and Table R402.1.3 Footnotes included on Page 2.
Each dwelling unit in a residential building shall comply with sufficient options from Table R406.2 so as to achieve
the following minimum number of credits:
1.Small Dwelling Unit: 1.5 credits
❑ Dwelling units less than 1500 square feet in conditioned floor area with less than 300 square feet of fenestration
area. Additions to existing building that are greater than 500 square feet of heated floor area but less than
1500 square feet.
P12. Medium Dwelling Unit: 3.5 credits
All dwelling units that are not included in#1 or#3. Exception: Dwelling units serving R-2 occupancies shall
require 2.5 credits.
❑3. Large Dwelling Unit: 4.5 credits
Dwelling units exceeding 5000 square feet of conditioned floor area.
❑4. Additions less than 500 square feet: .5 credits
Table R406.2 Summary
Option Description Credit(s)
1a Efficient Building Envelope 1a 0.5 ❑
1b Efficient Building Envelope 1b 1.0 ❑
1c Efficient Building Envelope 1c 2.0 ❑
1d Efficient Building Envelope 1d 0.5 ❑
2a Air Leakage Control and Efficient Ventilation 2a 0.5 0 0.5
2b Air Leakage Control and Efficient Ventilation 2b 1.0 ❑
2c Air Leakage Control and Efficient Ventilation 2c 1.5 ❑
3a High Efficiency HVAC 3a 1.0 0 1.0
3b High Efficiency HVAC 3b 1.0 ❑
3c High Efficiency HVAC 3c 1.5 ❑
3d High Efficiency HVAC 3d 1.0 ❑
4 High Efficiency HVAC Distribution System 1.0 ❑
5a Efficient Water Heating 5a 0.5 0 0.5
5b Efficient Water Heating 5b 1.0 ❑
5c Efficient Water Heating 5c 1.5 121 1.5
5d Efficient Water Heating 5d 0.5 ❑
6 Renewable Electric Energy 0.5 *1200 kwh 0.0
Total Credits 3.50
*Please refer to Table R406.2 for complete option descriptions
Table R402.1.1 Footnotes
For SI: 1 foot .= 304.8 mm, ci .=continuous insulation, int .= intermediate framing.
a R-values are minimums. U-factors and SHGC are maximums. When insulation is installed in a cavity which is
less than the label or design thickness of the insulation,the compressed R-value of the insulation from
Appendix Table A101.4 shall not be less than the R-value specified in the table.
b The fenestration U-factor column excludes skylights.The SHGC column applies to all glazed fenestration.
"10/15/21.+TB" means R-10 continuous insulation on the exterior of the wall, or R-15 on the continuous
insulation on the interior of the wall, or R-21 cavity insulation plus a thermal break between the slab and the
basement wall at the interior of the basement wall. "10/15/21.+TB" shall be permitted to be met with R-13
cavity insulation on the interior of the basement wall plus R-5 continuous insulation on the interior or exterior
of the wall. "10/13" means R-10 continuous insulation on the interior or exterior of the home or R-13 cavity
insulation at the interior of the basement wall. "TB" means thermal break between floor slab and basement
wall.
d R-10 continuous insulation is required under heated slab on grade floors. See R402.2.9.1.
e There are no SHGC requirements in the Marine Zone.
t Reserved. '
' Reserved.
h Reserved.
The second R-value applies when more than half the insulation is on the interior of the mass wall.
Reserved.
k For single rafter-or joist-vaulted ceilings,the insulation may be reduced to R-38.
Reserved.
M Int. (intermediate framing) denotes standard framing 16 inches on center with headers insulated with a
minimum of R-10 insulation.
Table R402.1.3 Footnote
j a Nonfenestration U-factors shall be obtained from measurement, calculation or an approved source or as
specified in Section R402.1.3.
MASON COUNTY RESIDENTIAL PLANTS SUBMITTAL CHECKLIST
Owner's Name: / - ate:Jr-1- ( � Project description: ITV F�- .
Documents: BUILDING
RECEIVED
✓Building Permit Application Completed.
_Mechanical/Plumbing Application Completed. MAY 0 2017
/ Planning Intake Checklist Completed.
// Site plan includes: Allowable building area, roof overh s, decks, etc. 615 W. Alder Street
Fire Apparatus &Access Road info required? Yes CLO
Ptormwater Checklist Completed.
Energy Code Application Form - O Electric wall heater O Electric central furnace O LPG Furnace
10 Heat pump with electric furnace O Heat pump with LPG furnace O Boiler(heat type )
O Ductless Heat Pump O Other. Specify:
Construction Plans:
/3 Sets ( 2 full size sets w/engineered calculation�-& 1 reduced sized set 1X17 min.(no calculation needed )
✓plans Legible Recognized Scale ✓Elevation Views _Cross Section
Foundation Plan _Roof Framing Plan Yz-floor Plan-Use of rooms labeled (all floors)
Zfloor Framing Plan -all floor levels including loft, crawlspace, etc.
Deck Framing Plan including covered porch, carports
Plan Details: ou
✓Roof framing details, truss fay-out may be needed (Hip and girder to ation shown)
✓ Wall Framing- Does bearing-wall height exceed 10'?(Engineering y be required) 0 W x
_✓Floor framing: Floor joists (size & spacing): ,S":E100e_ Floor beams: on
✓Window headers. Typical header. c}Y 8 Garage header. `4 X I.-A X 1
-7 Foundation: footing size, reinforcement
/Concrete Walls - Does Concrete Wall Height Excee B'? (Engineering may be required, see details)
Landings at all exits? Less than 30'above rade Y N (must be shown on site plan)
✓Water Heater. Location: l Type:
✓Heated By Furnace- Location of Furnace Fuel type:__VJ pu+Y-)C_,
— �+rlace/Stove Information Shown- Fuel Type? 0 Location(s):
✓ endow Sizes Marked on Plans.
I4�aced walla_ (shear walls) MUST be markedfindicated on plans�2.2, Iakk_r-1 0G�
— Engineered Yes/ No Snow load: 2!S Seismic: D2 Design Code:2- ( Are plans stan(Jd
Mgaufactured Homes:
_4 Floor ooms &areas must be labeled)
Foundation Type:
ANSI/Manufacture method Engine oting/foundation Basement
Decks*: 44 min. landings required at each entrance (must e n on site/plot plan)
*Covered decks and/or any decks greater than a 4'x4' that exceed 30' from prade es a permit and
construction plans.
COMMENTS:
intake review (initial Date:
H:\permit tech building checldist2015.doc Revised 8.5.2016
If any of the items fisted below are either indicated or missing within the construction
documer-its; the plans must be engineered or returned to the applicant for resolution.
ENGINEERING REQUIRED:
Braced v✓all panels/brace wall lines are not marked on plans (R602.10)
Amount and location of bracing does not meet minimum required in Table R602.10.1
DESIGN CRITERIA:
All notes and details required as a result of the engineered analysis shall be transferred onto proposed building plans.
Wind 85 MPH, Exposure B (unless proven otherwise). Seismic Zone: D2, Snow_psf.
IRREGULAR BUI LDINGS R301.2.2.2.5 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 shear wall or braced wall fine are not in one plane vertically from the foundation to the uppermost
story in which they are required. See exceptions.
2) Roof or floor is not laterally supported by shear walls or brace walls lines on all edges.
3) Portion of roof or floor extend more than 6 ft. beyond the braced wall line.
4) End of BWP extends more than 1 ft. over an opening more than 8 ft in width below.
5) Opening in a floor or roof exceed the lesser of 12 ft. or 50% of the least floor or roof dimension.
6) Portions of floor level are offset vertically
7) Shear wall lines do not occur in two perpendicular directions.
8) If a story above grade includes masonry or concrete construction*When this applies the entire story shall be
designed. In accordance with accepted engineering practice. -(exception: fireplaces, chimneys, and veneer as
permitted by the code).
***Applicant must take plans to a design professional to address items indicated above***
Notes/Comments for design professional:
1\permit tech building checklist2015.doc Revised 8.5.2016
pvta cVU ,. MASON COUNTY COMMUNITY SERVICES
PERMIT ASSISTANCE CENTER: Permit No::& a,b l I - 00'5,10
.BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584 Shelton: RECEIVED
- Phone elton:(360)427-9670 ext. 352-Fax:(360)427-7798 Phone
Ifair. (360)275-4467-Phone Elms:(360)482-5269
[Nbi
MAY 012017
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
7t► NAME: ` v Q t NAME:
MAIL G ADDRESS: 3 MAILING ADDRESS:
CITY:Va4N STATE: (emu. ZIP: j CITY: ST ZIP: -
PIONE#I: PHONE: CELL:
PHONE 112:3 (j- U{- 3 �7 EMAIL :
EMAIL: i U 1. o L&I REG,# EXP.
PRIMARY CONTACTi. OWNER CONTRACTOR❑ OTHER[]
NAME _1 I rY1L,, EMAIL
MAILING A RESS CITY STATE ZIP
PILONEo1��`72[7 ` (ELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) o9 o23 I ZONING 7 I
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT oZ
SITE ADDRESS (p() n C n�I/)t JKL EU { t t 1/i= CITY
DIRECTIONS TO SITE ADDRESS '
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER TITAN 14%: YES[] NOI
1S PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVEWCREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Eric) Fe,
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS c;l•S
HEATED STRUCTURE? YES(Whole Bid ❑ YES(Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK Yl E I,-)
,SOUARE, FOOTAGE: (propose+existing)
1ST FLOOR sq. 11. 2ND FLOOR sq. it. 3RD FLOOR sq.ft. BASEMENT sq. It.
DECK sq. ft. COVERED DECKA,5a sq.ft. STORAGE sq.ft. OTHER sq. [t.
GARAGE 1J A sq,ft. Attached Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
—
TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER (3 / NEW/ EXISTING ❑
PLUMBING IN STRUCTURE? YES ❑ NO ❑ Ijyes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES'x NO[] EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 4 TOTAL BEDROOMS L
OWNER acknowledges that 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 and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,Including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)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 O CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PER ICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
U TY CODE 14.00.42)
Signs ure of OW Must be sl ned b the OWNER Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
MASON COUNTY RECEIVED
COMMUNITY SERVICES
®� Building,Planning,Environmental Health,Community Health MAY 012017= BUILDING
Physical and Mailing Address: 615 W Alder St.,Bldg 8, Shelton, WA 98584 615 W. Alder Street
Shelton Phone: (360)427-9670 ext 352 •: Fax (360)427-7798
PLUMBING & MECHANICAL PERMIT APPLICATION Permit#:'6 1((�U! I -O. Mo
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NAME:
MAILING ADDRESSIFF 3-1 ', z , 'rc i= Rcl MAILING ADDRESS:
CITY:':r+ 0(-LL'0.r-ck S T A'�T E A ZIP,i1L—4 CITY: ST ZIP:
1st PHONE: ZS3 �2a-AA 1 y PHONE: CELL:
2nd PHONE: EMAIL :
EMAIL:a 1 U w•a MC"I -L 0, L&I REG# EXP. 1 1
-PARCEL INFORMATION:
PARCEL NUMBER (12 Digit Number): 2 I cl—TD — ^ 7CID(0 Zoning:
LEGAL DESCRIPTION (Abbreviates!):
SITE ADDRESS: �C) NI Mtn; .;� ���+' Vtt-:-J ibc- CITY:
DIRECTIONS TO SITE ADDRESS:
TYPE OF JOB/WORK: NEW ADD ALT REPAIR OTHER
USE OF BUILDING
PLUMBING FIXTURES MECHANICAL UNITS [] Electric in-wall heaters (nolee)
Type of Fixture No. of Fixtures Fuel Type Fees Type of Unit No. of Units Fuel TyDe Fees
Toilet(s) Furnace I G/LPG]
Bathroom Sink(s) Heat Pump 1 G/LPG]
Bath Tub(s) o Ductless H.P. [E/G/LPG]
Shower(s) —� Spot Vent Fan 5
Water Heater(s) I �G/LPG] Propane Tank _gal.]
Clothes Washer(s) I G/LPG] Gas Outlet(s)
Kitchen Sink(s) L Heat Stove [E/G/LPG/W]
Dishwasher(s) i Kitchen Exhaust Hood 1
Hose bib(s) Z Dryer Vent I
Other Solar Panel
Other Other
Plumbing Subtotal Mechanical Subtotal
Plumbing Base Fee Mechanical Base Fee
Final Inspection Fee Final Inspection 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 contractor. I further declare that I am entitled to receive this permit and to
do the work as proposed. I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this
project.The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure(s)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 OF
INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
Signature of Applicant D
x_N P,}C (Owner/Owners Representative/Contractor
Print Name ( rr�one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
O Building
O Fire Marshal
O Permit Tech (OTC permit only)
`r7
s;, http:J/WWW.Co.mason.wa.us/Community_dev/ Rev 3/08,12017