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HomeMy WebLinkAboutBLD2020-00675 Final MFG Home - BLD Permit / Conditions - 3/4/2021 Mason County Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton,WA 98584 360-427-9670 ext 352 www.co.mason.wa.us B DD2020-00675 MANUFACTURED HOME PROJECT DESCRIPTION: NEW MFG HOME ISSUED: 08/14/2020 SITE ADDRESS: 60 NE RHODY LN TAHUYA EXPIRES: 02/10/2021 PARCEL: 223205000053 APPLICANT: OOSTERVELD JAN&THERESA OWNER: OOSTERVELD JAN&THERESA PO BOX 1709 PO BOX 1709 PORT ORCHARD,WA98366 PORT ORCHARD,WA 98366 1.206.954.4082 CONTACT: BRAD LANSING 3216 SE PARAKEET LN PORT ORCHARD,WA98367 1.206.954.4082 GENERAL CONTRACTOR'S LICENSE: MAPLEWOOD CONSTUCTION INC License: MAPLEC101466 10007 86TH AVE NW Expires: 01/26/2021 GIG HARBOR,WA98332 1.253.858.2991 FEES: Paid Due Modular/Manufactured Home $275.00 $0.00 Fee- 1 st half collected at submittal Technology Surcharge $11.00 Building Plan Review/Change of $110.00 $0.00 Use-Onsite Sewage Modular/Manufactured Home $275.00 Fee-2nd half collected at ready to issue State Fee-Residential $6.50 Planning Review Fee $240.00 $0.00 Totals : $625.00 $292.50 REQUIRED INSPECTIONS Setback Inspection Set-Up Inspection Printed by:Ariane Paysse on:08/14/2020 11:45 AM Page 1 of 5 Mason County Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us MANUFACTURED HOME BLD2020-00675 Footing Inspection BLD-Final Inspection CONDITIONS * Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State Installation code,chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified installer responsible for each major part of the installation. RCW43-63B.090 An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily located in plain site within three feet of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each installer performed or installed. Certification number and signature of the certified installer responsible for each major part of the installation.WAC365-210 * All property lines shall be clearly identified at the time of foundation inspection. When parcel development requires direct access to county road(s), a Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at(360)427-9670, ext.450 or 100 W Public Works Dr. Shelton. The building permit will not be finaled until the permit holder can show proof that the access permit from Public Works has been finaled and approved. " All changes to"approved"building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction. The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility of the applicant,owner or contractor to make the required 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 approved documents will result in failure of required building inspections. * By definition, propane tanks and heatpumps are structures,which must meet setback conditions. Please check your "Approved Site Plan"to ensure these structures meet the setback conditions listed. * This permit is for the placement and installation of the manufactured home only and does not imply approval or review for any other items indicated on the plot plan. " CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. 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 codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting additional inspections. * REQUIRED INSPECTIONS (Footing Inspection-prior to pour(set-up manual must be on-site), Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved)by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. Until resolution of any/all problems no occupancy(Final Inspection)will be granted for the residence. OWN E R/CONTRACTOR(ind icate which) Printed by:Ariane Paysse on:08/14/2020 11:45 AM Page 2 of 5 Mason County Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us MANUFACTURED HOME BLD2020-00675 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. * Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28 and 14.17. " The stamped 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, 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 Department prior to any further inspections being performed or approvals granted. " Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. Retaining walls needed to support a surcharge such as structures, roads,or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. " If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American National Standards Institute(NCSBCS/ANSI A225.1). Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. * A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement of any development activities. "NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater Management Application/Worksheet the document entitled"Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan"constitutes an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are responsible for contacting 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. By calling for a final inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. 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 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. " The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including installation instructions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be clearly marked in the installation instructions. Printed by:Ariane Paysse on:08/14/2020 11:45 AM Page 3 of 5 Mason County Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us MANUFACTURED HOME BLD2020-00675 * All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may grant a one time extention of 180 days, upon the receipt of a written extension request prior to permit expiration. Letter must indicating that circumstances beyond the control of the permit holder preventing action from being taken. No more than one extension may be granted. " All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor increase the velocity flow entering or abutting to any state or county culverting/ditching system or road way. " All building permits shall have a final inspection performed and approved by Mason County Building Department prior to permit expiration.The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordinances and building regulations. * All construction must meet or exceed all local and state ordinances in addition to 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. " 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 1-800-647-0982.The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. " All RED stamped 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 to any further inspections being performed or approvals granted. The foundation/footing must be placed on undisturbed,firm-native soil. Concrete used for basement walls,foundation walls, exterior walls, porches, carport slabs,steps exposed to the weather, garage floor slabs and other vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). " Application acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. RR20 " On-site Septic System final installation approval required prior to temporary/final occupancy of the residence. " Horizontal setbacks per WAC246-272A-0210 must be maintained, unless prior approval is obtained " Applicant/Owner assumes all responsibility if On-site Sewage Components are encumbered. A.) Drainfield/Reserve requires a 1 Oft setback from all footing/foundations. B.)Septic tank(s)requires 5ft setback from all footing/foundations. C.) No foundation/Perimeter Drains within 30ft, down gradient of Drainfield/Reserve area. D.) No Cut Bank(s) (greater than 5ft and over 45 degrees)within 50ft, down gradient of Drainfield/Reserve area. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of Laws and Ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisioilR of any other state/local law regulating construction or the performance of construction. Issued By: Contractor or Authorized Agent: C% Date: Printed by:Ariane Paysse on:08/14/2020 11:45 AM Page 4 of 5 Mason County Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton,WA 98584 360-427-9670 ext 352 www.co.mason.wa.us MANUFACTURED HOME BLD2020-00675 Printed by:Ariane Paysse on:08/1412020 11:45 AM Page 5 of 5 t r o 0 ° ° O v m © ° z z z � � T c'c -'I -1 m 0 3 M m p! y n n c M m M > > � N co Z z -0 ° N o 0 _ m cn o m O m o 0 D 0 w m a d e � z z CA C, 0 CD go A c- m v rn 0 M 4 1 m Z D z n V 0 CF) 3 m v vT V Ul mo o m m L. (- D Z co y 0 0 CECl) -i -q W (D MT G O M o m co � e , 0 22 °D �X ran O v W U) 0 cm co) cc ` -0D CO O Oo 3 m Z O 0 (n0 O y — m Z (p =r C Z o wow ♦ ♦ Z -n m = D G = o co 0 O - OD < cn �j 00 m z ai C v m 00 cn i _ = 000 0 O O z z M m 3 Cn o 3 w 0 cn 9 A IV �, O O (O Qp N S(ftvf wcjfcr'I;rw wi4-I v► 10 ' oj� fah OoS4Cryeld comvo►u,ntS Zo- -00 23 So 05 2 'ParG�e( �#Z 3 co►fV0rt ---® NF� p— h ody (.h y rriftcc a w _(' W � tee* y g � R � 5 min U 1O 1 5, shod Lv� _... s5 ,--N E . y o Is ' ' 30 us tso titi° � �r3 � C? 28' � 0 a-Te Sf Rol e 30 no lom�h #1-t#2N23 5CAn locAvn t i roo fS +0 f`I' ( qoo SF / 3 -' 20 `t SaPld 10a wl 4- 'Dc 19 J Q/ Ito r 00 f S +o -f-. #q--#5 ov • —J�1d2o2o - ougrI5 RECEIVED • 2620 - 6015 �;k JUN 3 0 2020 615 W. Alder Street ill III PANNING; ALL SETBACKS ARE MEASURE© FROM THE FURTHEST s _ PR ECTION OF THE BUILDING ��� MASON CO�UNTR OVED APF�. Y DCD PLANNING Nd' NI COUNTY SITE PLAN REQUIRED TO BE ON SITE 1N REQUIRED 10 C SUBJECT TO APP OV L SUBJECT TO API By Dated !� Date FOODY L� ALL UPIIJSED SOILS -FIML L 'q` SE 1lfCILcA25;5 klN,EI+! NOT � P t ! N AlorE,• N14soAj 00WrY NIAPPIMG Silo ors SlTL� 15 ViKrui4�.�Y �LR7'/�7'�2�' E1.FVAT/DiV,' dr J ji ,510AI AhLD .SL'D/ML117- CollrROL RAt1 APPLIC 7-. JAN L00s-rERVELD pRr�GE� � 22 3 20 -50-06o53 sCAL : o -50 45 GD 7 JW qE 20M (3G0)440-547D cdrd mur5elMp2i(. PLANNING- --u ure om Zd of Bremerton 60'-0" FT_ 0 C� g I ® OPI.GARDEN NB � 1 ,1 �`, BATH KITCHEN _ V`t i #Za DININ6 cirri �3ED - I AREA 1 g�OAR If uni rrir, orr i MASTER 12'-2"X 12'-10° I 8'-9'X 12'-10° II WAR WOR I AAM I 0 L31rH 0 I' II UTILITY MASTER O d x I Z.'� 0 I 20-8" On GLAMOUR ------------ BATH LIVING ROOM MASTER BEDROOM =L1 19'-OI X BEDROOM#2 BEDROOM#3 11'-e"X 10'-10° OPT.PANTRY 11'-6"X 10'-10° i I ENTRANCE` � I � DORMER RECEIVED O BATH #Z 3 0 2020 � OPT.DEN 615 W. Alder Street 14-VX18.0" 0 EAGLE 4 Bedroom 2 Bath 1 ,599 Square Feet ------------ ------------ 4021 State Hwy 16 W I Bremerton, WA 98312 1360.479.4663 1 Mon-Sat 9a-Sp Sun 12p-Sp www.futurehomesbremerton.com Namek _ Parcel#223��` C)"Ot��:S BLD# 2o, r lS! Mason County RECEIVED Department of Community Development Small Parcel Stormwater Management Application/Worksheet(page 2 of 2) JUN 3 0 2020 Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity. 15 W. Alder Street Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website: htro//www co mason.wa us/code/commissioners/indexhtm Please follow the links to"Title 14,Chapter 14.48 Stormwater Management"_ Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan (Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document UILDING 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 Stornnvater Site Plan on the pages that begin with"Handout" PLEASK INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A) The relevant derails 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 Cotmty'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/drain6eld 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 consult with the se design involved with the project.Mason p tic desi any other,parcel.You may also wish to co p g 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 pen- nit-Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such it by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I further acknowledge that information provided is accurate and employees of Mason County are granted access to the above- des bed pr rty for a and inspection as may be required. e X __Owne Agent/Qontractor(circle one)Date:t!J 2of2 /`Page JUb�m 1.f�e�1 � �U' GV(.t/ Name KN �),S-tEC&LD Parcel BLI?lt -- — 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=. '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 'Common impmious 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 I Width = Area 'All dimensions in feet Buildings G X ,, - 1782,5 X ,�, = Measurements for buildings are taken at the X _ perimeter of the farthest projections(example: eavesigutters) X Driveways X 0 = 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 = PatioslWalks 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) 1 3,113 If the Total Impervious Surface Area is LESS THA 2000 uare 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,owners legal representative,or the contractor.I further acknowledge that the in rmat]on provided is accurate and employees of Mason County are granted access to the above- descK.pbed pr perty for rev w d inspection as may be required. n^ �r A ' Owne Agent/Oontractor(circle one)Date: - ��L' - 0 - .- i If the Total Impervious Surf a rea is GREATER THAN 2000 Square Feet,please read,acknowledge and sign the information provided on page 2 of 2. Pagel of 2 SMALL PARCEL STORMWATER SITE PLAN WRITTEN DESCRIPTION Jan Oosterveld Mason County Tax Parcel No. 22320-50-0053 Proposal is to develop an 0.37 acre parcel, located in Section 20,T23N, R2W, W.M., approximately 435 feet west of the west shoreline of Lake Christine.The parcel is forested and flat. Approximately one- third of the site will be cleared. Native vegetation and trees will remain in the southerly on-third of the parcel and along the east,west and north borders of the parcel. Development of the lot consists of installation of a 60' x 26.75' manufactured home (62'x 28.75' inclusive of eaves), 1,782.5 square feet of impervious surface; a 20' x 24' carport,480 square feet of impervious surface; approximate 10' x 45' driveway,450 square feet of impervious surface; and 20'x 20' parking area,400 square feet of impervious surface.The total proposed impervious surface area is 3,113 square feet, meeting the threshold to require a Small Parcel Drainage Review. All stormwater flows will be dispersed through native vegetation. Roof runoff will be directed to splashblocks and the site will be graded to ensure positive drainage away from the foundations and toward vegetated flow paths.An onsite septic system is proposed. Drainage flowpath for the roof runoff will be downslope from the septic tanks and drainfield areas; runoff from the driveway will sheet flow northerly through native vegetation. See Residential Site Improvements Plan. Measures to prevent erosion and maintain sedimentation control will include the following Best Management Practices, as shown on the Erosion and Sediment Control Plan: • Clearing limits will be marked on the ground with fencing or other method (flagging) • The driveway will be constructed and graveled immediately;Areas accepting sheet flow from the driveway will be left in native vegetation or seeded and mulched • Silt fencing will be placed at the downslope side of the clearing area, as needed to prevent the transport of sediments • A rock construction entrance will be installed where the driveway intersects the road • Mulch will be spread over all cleared and exposed areas of the site,when not being worked RECEIVED . MASON COUNTY COMMUNITY SERVICES Permit No: 1314 2oZO'OC7{Q'i y PERMIT ASSISTANCE CENTER: J�N �U4� •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL • 615 W.Alder Street,Shelton,WA 98584 Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone 615 W. Alder .S t r e.e t Belfair.(360)275-4467•Phone Elms:(360)482-5269 BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: i NAME: I-, NAME: j G MAILING ADDRESS MAILING ADDRESS: nAve- CITY: STATE: ZIP. CITY STATE: ZIP: PHONE#I: .- q _6 PHON CELL: PHONE#2: EMAIL: E i EMAIL: L&I REG# eiM/ _EXP. t'/ PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ o 11 Icy /. NAME EMAI 6/bNLPS opmj,'� MAILING ADDRESS O CITY STATE L414 ZIP PHONE CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number)2 -40 06-3 . ZONING k$ LEGAL DESCRIPTION(Abbreviat d) l" G f t! RE DISTRICT SITE ADDRESS CITY 7-AM-1911 It DIRECTIONS TO SITE ADDRES a ` - got 9 �5� /� L TU R T O WIT1 0 --PE(S)GREATER THAN 14%: YES[] O`� SNOW LOAD:_psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that opplv): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW['ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Erc.) #?Pig L de KL-e IS USE: PRIMARY F—SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS,_ HEATED STRUCTURE? YES(Whole Bldg) YES Ouri,b]al aldg)❑ NO❑ DESCRIBE WORK U L U 7- \V SQUARE FOOTAGE:(proposed) 1ST FLOOR _600 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached,❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE films(i(�DO(Y MODEL YEAR ZQ D LENGTH WIDTH BEDROOMS_ BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC R--' SEWER❑ / NEW❑ EXISTING❑ PLUMBING IN STRUCTURE? YES 4]--- NO❑ ljyes,attach completed Water Adequacy Farm PERIMETERNOUNDATION DRAINS PROPOSED? YES❑ NOR— EXISTING SQ.FT. EXISTING BEDROOMS O PROPOSED BEDROOMS_ •TOTAL BEDROOMS_ 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 OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PER PPLICATIO"F 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON c" COUNTY CODE 14.08.42) rJ mrni✓ttzd X _ gnature of OWNER(Must be sinned by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT .7-1— PLANNING DEPARTMENT x FIRE MARSHAL PUBLIC HEALTH