HomeMy WebLinkAboutBLD2020-00583 Final MFG Home - BLD Permit / Conditions - 3/9/2021 3
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
BLD2020-00583 MANUFACTURED HOME
PROJECT DESCRIPTION: NEW MFG HOME ISSUED: 017/08/2020
SITE ADDRESS: 50 NE RHODY LN TAHUYA
EXPIRES: 01/04/2021
PARCEL: 223205000052
APPLICANT: JAN OOSTERVELD OWNER:
PO BOX 1709
PORT ORCHARD,WA98366
1.360.443.6937
GENERAL CONTRACTOR'S LICENSE: MAPLEWOOD CONSTLICTION INC License: MAPLECI014136
10007 86TH AVE NW Expires: 01/26/2021
GIG HARBOR,WA98332
1.253.858.2991
FEES: Paid Due
Planning Review Fee $240.00 $0.00
Modular/Manufactured Home $275.00 $0.00
Fee- 1st half collected at
submittal
State Fee-Residential $6.50
Modular/Manufactured Home $275.00
Fee-2nd half collected at ready
to issue
Building Plan Review/Change of $110.00 $0.00
Use-Onsite Sewage
Technology Surcharge $11.00
Totals : $625.00 $292.50
REQUIRED INSPECTIONS
Setback Inspection Set-Up Inspection
._ . . .. .
Footing Inspection BLD-Final Inspection
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Page 1 of 5
Mason County
Mason County - Division of Community Development
s;
615 W.Alder St. Bldg.8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
MANUFACTURED HOME BLD2020-00583
CONDITIONS
* 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).
* 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.
* 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 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.
* 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 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.
* 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.
* 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.
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Page 2 of 5
t 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 BLD2020-00583
* 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.
11* 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.
* The foundation/footing must be placed on undisturbed, firm-native soil.
* Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the
structure.
ED REQUIR INSPECTIONS (Footing Inspection-prior to pour(set-up manual must be* v _ 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 ER/CONTRACTOR(indicate which)
* 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.
Pressure treated wood manufactured
* actured 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.
* 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.
* 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.
* 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).
* When parcel development requires direct access to state road(s), a Road Access Permit or Approval must be granted and
approved by the Washington State Department of Transportation. For more information contact Washington State
Department of Transportation, at(206)357-2620, ext 630.
* 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 building permits shall have a final inspection performed. a ,. a _._. _ ..
* 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.
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Page 3 of 5
i Mason County
x
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 BLD2020-00583
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.
* 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 install
ation.WAC365-210
' 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.
* 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.
* 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.
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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 BLD2020-00583
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 provisions of any other state/local law regulating construction or the performance of construction.
Issued By:
Contractor or Autho ze Agent: ate Date.
Printed by:Genie Warland on:07/08/2020 08:13 AM
Page 5 of 5
` 615 W.Alder St.Bldg 8,SHELTON,WA 98584
MASON COUNTY SHELTON:360-427-9670,EXT 352
COMMUNITY SERIES BELFAIR:360-275-4467,EXT 352
Buildln%Plannarg,Environmental Health,Cornmunity Health ELMA:360-482-5269,EXT 352
www.co.mason.wa.us
INSPECTION CARD AND CERTIFICATE OF OCCUPANCY**
To schedule an Inspection call or visit hftp:/Avww.co.mason.wa.us/community-serAces/bid-inspecUon.php
Permit Number BLD2020-00583 Date Issued 07/08/2020 Issued By
Project NEW MFG HOME
Site Address 50 NE Rhody Ln
Applicant JAN OOSTERVELD
Contractor MAPLEWOOD CONSTUCTION INC
Contractor Phone 1.253.858.2991
Primary Code UPC IBC,IRC,IFC,IEC,IMC,& Type
Permit Type MANUFACTURED HOME Occupancy
-APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS.
-DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVAL IS GRANTED.
-THIS CARD MUST BE POSTED IN A CONSPICUOUS LOCATION,FRONT OF THE PREMISES IS BEST FOR MAKING ENTRY.
-ALL PERMITS EXPIRE 180 DAYS AFTER THE PERMIT IS ISSUED OR 180 DAYS AFTER DATE OF LAST INSPECTION.
OWNER/AGENT IS RESPONSIBLE FOR REQUESTING ALL INSPECTIONS THROUGH FINAL INSPECTION.
""THIS STRUCTURE MAY NOT BE USED OR OCCUPIED UNTIL ALL APPROVALS ARE GRANTED.'"
PRIOR TO CALLING FOR FINAL INSPECTION,ALL CONDITIONS OF THE PERMIT MUST BE MET
Public Works Access/Driveway Other
Health Septic Well
Deptartment
Planning Site Inspection
Department
Fire Marshall Fire Apparatus Access Fire Sprinkler
Auto Fire Alarm Hood and Duct
Other Final
Building Building Official: Community Services Designee
Department
Concrete Setbacks JW�,jy2,D f 7Z Slab
Footing Perimeter Point load Footing
Footing Interior Footing Decks/Porches
Foundation Stem Walls Other
Rough-In Groundwork Plumbing Framing
Groundwork Mechanical Plumbing
Groundwork Gas Pipe Mechanical
Gas Piping Shear Wall Nailing
Underfloor
Other
Insulation Slab Ceiling
Floor Vaulted Ceiling
Walls Vapor Barrier
Other
Wallboard Interior Wall Brace Panels Fire Walls
Nailing
Other
Final Building
Manufactured Setbacks Setup
Home - 1J
Concrete Foot/Runners p_/-ZoZp ,>14 c�inaal�`�r-Opp. �\ a
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28563L
CRANING TITLE
NOTES:
CUSTOMER APPROVAL 1. RECEPT SHALL NOT BE INSTALLED WITHIN 30" OF TUB/SHOWER SPACE, CUSTOM
111E CUSFON F T AND ORDER CON FAIAOON ARE A FNAI AND ACOJRATT RE^RESENTArO�
( UTl SPEOIA REWESTS ANO OPTIONS ON WS HONES FUEFRWD ASSUMES NO 2. ELECTRICAL WALLP PLATES SHALL NOT BE INSTALLED WITHIN 6" OF A FLOOR PLAN
HESPON515UTV FOR ITEMS NOT DV ME FRNRT ON CONFIRMARON. THIS VERSCN SUF'EITSCVf
ANY PRIWWS GATED rFA90N9 RANGE OR COOKTO .
nnrE___._ INTE DAZE. ____. 3. ROOM TITLES INCLUDING (N) INDICATES SQUARE FOOTAGE HAS BEEN THIS APPROVAL EXPIRES 90 DAYS FROM DAPIA APPROVAL DAANN en
COMBINED FOR GLAZING/VENTING REQUIREMENTS. STAMPED DATE. Harper J.
.FrAIEER_.______._._FLELTWDB W3TLNNER_._._....____._ 4. FOR PLUMBING E HEATING SYSTEM NOT PROVIDED, REFER BACK DATE,
TO STANDARD APPROVAL SET. CUSTOMER: HAMMON
THIS FLOOR PLAN AND ATTACHED OPTION DETAILS (IF APPLICABLE) 5. THE MAXIMUM TRAVEL DISTANCE FROM ANY BEDROOM DOORWAY TO AN O: SHT
IS DESIGNED TO MEET THE FOLLOWING STRUCTURAL REQUIREMENTS: ENTRY DOOR IS IF. N 9 0 6 4 3 0
WIND ZONE p ORDER S) 1 ROOF LOAD(S) 30 Les. PERIMETER PIERING REQUIRED WHEN ROOF LIVE LOAD > 20 sfFP.is
21YC2B563L906430
RECEIVED
J U N 10 2020
PLANNING 615 W. Alder Street
Name !✓ i-� Parcel# BLDN
Mason County
Department of Community Development RECEIVED
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. J U N 10 2020
Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater 615 W. Alder Street
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
htta//www co mason wa—us/code%ommissioners/index.htm
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
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,77re Small Parcel Stormwater Site Plan
on the pages that begin with"Handout" aaa�
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE rM
A)A
The relevant details from Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan will be installed s
inentirety AND the system will be located as not to adversely affect any septic systems on this or arty other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the .,•
xws
system will be located as not to adversely affect any septic systems on this,or any other,parcels
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 i ormation provided is accurate and employees of Mason County are granted access to the above-
descri�ed pro for revie and inspection as may be required.
X Owne Agen ontractor(circle one)Date:
Page 2 of 2
NameJ�N Parcel#22'321) BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet(page I 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
do installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
including construction,
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'Common 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 Typ2 Len X Width = Area 'All dimensions In feet
Buildings X
X = Measurements for buildings are taken at the
perimeter of the farthest projections(example:
X = eaves/gutters)
X =
0, 4,n
= �O
= Length of drive begins at the right of way
=
Arry paved,gravel or packed area per definition
= above table
=
Any paved,gravel or packed area per definition
above table
a
If the total impervious area of the proposed site
f development is greater than 2000 square feet a
X I Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas) L
If the Total Impervious Surface Area is LESS THAN 2000 Sauare 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-
desed property for review and inspection as may be required.
or 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
SMALL PARCEL STORMWATER SITE PLAN
WRITTEN DESCRIPTION
Jan Oosterveld
Mason County Tax Parcel No. 22320-50-0052
Proposal is to develop an 0.46 acre parcel, located in Section 20,T23N, R2W,W.M., approximately 410
feet west of the wet shoreline of Lake Christine.The parcel is forested and relatively flat, with a
maximum slope of approximately 4%. Approximately one-third of the site will be cleared. Native
vegetation and trees will remain in the northerly one-third of the parcel and along the east,west and
south borders of the parcel. Development of the lot consists of installation of a 58' x 26.75'
manufactured home (60' x 28.75' inclusive of eaves), 1,725 square feet of impervious surface; a 28' x 8'
covered porch, 224 square feet of impervious area; a 20'x 24' carport,480 square feet of impervious
surface; approximate 10'x SO' driveway, SOO square feet of impervious surface; and 20' x 20' parking
area, 400 square feet of impervious surface.The total proposed impervious surface area is 3,329 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 vegetation 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 easterly through native vegetation. See Residential Site Improvement 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 at where the driveway intersects the road
• Mulch will be spread over all cleared and exposed areas of the site,when not being worked
MASON COUNTY COMMUNITY SERVICES Permit No: I L1 1
PERMIT ASSISTANCE CENTER: C D
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL G
615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 PhoneGOO U N 10 2020
Belfair(360)275-4467•Phone Elma:(360)482-5269 '
BUILDING PERMIT APPLICATION HP
Ai�ipStreet `
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NAME: le G
rss MA1LI G ADDRESS: MAILING A DRESS:
CITY: . STATJE: ZIP. CITY:IE
ZIP:
PHONE#1: ^(p PHON PHONE#2: EMAIEMAIL: L&I # Fc��/1,/8� EXP.L/2�/2y�J
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OT KR
NAME EMAIL /I r e of
rV3 MAILINGADDRESS CITY STATE UJA ZIP
PHONE r-- CELL
PARCEL INFORMATION: j�
PARCEL NUMBER(12 Digit Number) ' "r P d09d ZONING ZrOl
LEGAL DESCRIPTION bbreviated) e ° IRE DISTRICT l�s
SITE ADDRESS CITY
DIRE TIONS TO SITE ADDRESS M O—
S H PIO�J C WITWN FI— SLOPES)GREATER THAN 14%: YES[] NO SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check altthat apple):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Eic.) �j 1'1b VYV G
IS USE: PRIMARY N/SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(WholeBldg)x YES(Pariftl n(Bldg)❑ NO❑
DESCRIBE WORK 1 t''
gAy-
SQUARE FOOTAGE:(proposed)
1 ST FLOOR 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 F� ►�t MODEL �(D3� YEAR .ICOLO LENGTH 55
WIDTH BEDROOMS_ BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC I- SEWER❑ / NEW,K EXISTING
PLUMBING IN STRUCTURE? YES J6, NO❑ Ijyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOg EXISTING SQ.,FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOM
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 1 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 8 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-
PERMIT APPLION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 611-01`Zo
re of OWNER(Must be signed by the OWNER) D to
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT (r
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH