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HomeMy WebLinkAboutCOM2019-00049 Final Paint Booth see TPN 419240000010 Alta Facitily - COM Inspections - 1/9/2020 1 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 F 9-00049 NEW COMMERCIAL PERMIT ESCRIPTION: INSTALL A PAINT BOOTH FOR WATER ISSUED: 09/17/2019 DE THE PULL CHAIN BUILDINGESS: 780 W STATE ROUTE 108 SHELTON EXPIRES: 03/15/2020 PARCEL: 419240000000 APPLICANT: ALTA FOREST PRODUCTS OWNER: ALTA FOREST PRODUCTS 810 NW ALTA WAY 810 NW ALTA WAY CHEHALIS,WA 98532 CHEHALIS,WA 98532 1.360.871.1985 VALUATIONS: FEES: Paid Due Project Valuation (BID, 60233.00 $60,233.00 IFC Plan Check Fee $255.17 $0.00 ESTIMATION..) Planning Commercial Review $380.00 $0.00 Fee State Fee-Commercial $25.00 $0.00 Building Permit Fee $785.12 $0.00 Plan Check Fee $510.33 $0.00 Total: $60,233.00 Totals : $1,955.62 $0.00 REQUIRED INSPECTIONS 3rd Party Inspection Report Mechanical Inspection Framing Inspection BLD-Final Inspection CONDITIONS " 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. 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. Printed by:Nicole Norris on:09/17/2019 12:52 PM Page 1 of 3 Mason County i 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 NEW COMMERCIAL PERMIT COM2019-00049 " 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 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. * 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. * 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. * 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. * The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. * 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. * 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. * Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. * Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached thereto. If documents are removed, 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. * Epoxy grout required and specified on the approved building plans shall require a special inspection. The special inspector shall be the engineer of record or their authorized representative, a WABO Certified special inspector, or certified testing laboratory. In addition a Mason County Building Inspector may perform the inspection provided holes are prepared in accordance to manufacturer specifications that are available on-site during inspection. Special inspectors shall inspect the installation of grouted construction anchors as stated in the manufacturers specifications. An inspection report shall be prepared and submitted to the Mason County Building Department prior to the framing inspection of the project. Printed by:Nicole Norris on:09/17/2019 12:52 PM Page 2 of 3 1 R Mason County I s 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 NEW COMMERCIAL PERMIT COM2019-00049 Lever hardware is required at doors. The unlatching of any door shall not require more than ONE operation. Hardware with locks must open with a single action from the egress side of the door. Door hardware shall allow egress doors to be readily open able from the egress side without the use of a key or special knowledge or effort. Handles, pulls, latches, locks and other operable parts on accessible doors shall have a shape that is easy to grasp with one hand and does not require tight- grasping, pinching, or twisting of the wrist to operate. X " Compliance with an approved Storm Water Plan shall be subject to an on site inspection, or inspections, by the engineer of record or an authorized representative. Said inspection(s)shall be performed in accordance with the approved plan, and prior to any modification that would make a determination of compliance impossible. Inspection reports and as-built drawings shall be submitted to verify all engineering requirements have been completed in accordance with the approved storm water plan. Reports shall be submitted to the Mason County Department of Community Development prior to each corresponding inspection and final permit approval. Copies of all special inspection reports shall be made available at time of inspection. In addition to the inspections required in IBC, Section 110,the owner,the engineer or architect of record acting as the owner's agent shall employ one or more special inspectors who shall provide inspections during construction on the types of work listed under Chapter 17 and as specified by the design professional. The special inspectors duties& responsibilities shall be as specified in Chapter 17. Special inspection reports shall be submitted to the Mason County Building Department, 615 W Alder St, Shelton WA 98584 and available for inspection. Inspection reports shall be completed and submitted to the dept. in a timely manner and shall be submitted prior to the framing and final occupancy inspections. " This structure is approved as unheated space. To be considered unheated space the area may be provided with a heating system that does not exceed maxium output of 1 watt per square foot., or 3.4 Btu/h per square foot. A permit and approval is required prior to installation of any heating system. When a heating system exceeds 1 watt per sq. ft(or 3.4 btu/h per sq.ft)the heated space shall be insulated in accordance with the energy code in effect at the time of permit application. " All MSDS Sheets must be onsite in available location. * The plan for application of water-based stains is approved. If the the use changes to application of petroleum based products at any time,this application may be revoked and be reconsidered for additional restrictions or prohibited from use. Feby certify that I have read and examined this application and know the same to be true and correct. rovisions of Laws and Ordinances governing this type of work will be complied with whether ified heren or not. The granting of a permit does not presume to give authority to violate or cancel provisi f an other tate/local law regulating construction or the performance of construction. ed By: Contractor or Authorized Agent: Date: Printed by:Nicole Norris on:09/17/2019 12:52 PM Page 3 of 3 n o p -0 -0 ®. ` z z z � .� X X m m D D r �.. 0 z O O m X Z1 7 n z Z D tj N N T 0 m O o o m O C° 0 N e n 1 U) o U) m � m ^0 nl 0 rn 3 r D D cn L. Z X N cca m m D CA Q N n n Cl) > CD W D M7 � v o � rn o m v c 0 m o N) U) n a: O co n o 3 cn 3 cD� 2 y D O to v 00 n O N F � � � z o o � p� Z m � c _ X m �_ CD a m N o C Cn .�� 0 0 v C cn IV O z a D 0 m OD Cil °o O OD c M m _ v CO C/) m m O N z CD z z m D N m m o 0C 00 a OD w v M o n an s a.. ANNEX N AWS D1.1/D1.1M:2010 WELDING PROCEDURE SPECIFICATION (WPS) Yes❑■ PREQUALIFIED QUALIFIED BY TESTING or PROCEDU�RE�^QUALIFICATION.RECORDS(PQR) Yes❑ Identification# Revision.,-, Date By (� Company Name Alta Forest Products Authorized by Date Welding Process(es) sMAw Type—Manual❑■ Semiautomatic Supporting PQR No.(s) Mechanized❑ Automatic❑ JOINT DESIGN USED POSITION _ Type:. Position of Groove:3- Fillet: Single ■ , Double Weld Vertical Pro ression: U Down I'I 9 ❑. . 9 Backing: Yes❑ No Back ELECTRICAL ELECTRICAL CHARACTERISTICS Root.Opening W Root Face.Dimension Groove Angle: adius(J-U). �� Transfer Mode(GMAW) Short-Circuiting❑ Back Gouging: Yes❑ No Method /1,. Globular < Spray❑ 9 9_ � ❑ R Y Current:AC❑ DCEP K DCEN❑ Pulsed El BASE METALS Power Source:CC❑ CV❑ Material Spec. ASTM A 36 Other Type or Grade A3s Tungsten Electrode(GTAW) Thickness:` Groove Fillet ci Size: N/A Diameter(Pipe) - Type: N/A FILLER METALS: TECHNIQUE AWS Specification A5.1 Stringer or Weave Bead: AWS Classification E7018 Multi-pass or Single Pass(per side) Number of Electrodes Electrode Spacing Longitudinal NIA SHIELDING Lateral N/A Flux N/A Gas NIA > Angle N/A Composition NSA Contact Tube to Work Distance N/A Electrode-Flux(Class)NIA Flow Rate N/A Peening N/A Gas Cup Size NSA Interpass Cleaning: NSA PREHEAT POSTWELD HEAT TREATMENT Preheat Temp., Min. 50 Degrees Temp. N/A Interpass Temp.,Min. Max.: Time N/A WELDING PROCEDURE Pass or Filler Metals Current Weld Type& Amps or Wire Travel Laye(s) Process Class Diam. Polarity Feed Speed Volts Speed Joint Details SMAW E7018 1/8 DCEP 105-110 N/A � 5d 3- r �x y Form N-1 (Front) 354 ANNEX N 1© .6E 1 ""Ux5a As .5,�Wiu AWS D1.1/D1.1 M:2010 WELDING PROCEDURE SPECIFICATION(WPS) Yes ■❑ PREQUALIFIED QUALIFIED BY TESTING or PROCEDURE QUALIFICATION RECORDS(PQR) Yes❑ Identification# I�IMp+ CfG G� CU� Revision Date / By Company Name Alta Forest Products Authorized by Date:: Welding Process(es) SMAw Type—Manual Semiautomatic❑ Supporting PQR No.(s) Mechanized❑ Automatic JOINT DESIGN USED POSITION' Type: Up Position of Groove: Fillet: Single Double Weld❑ Vertical Progression: Up❑ Down❑ Backing: Yes❑, No RE Back��ing��M, ateriak ELECTRICAL CHARACTERISTICS Root Opening s-- Root Face,Dimension All Groove Angle 11 Radius(J-U) Transfer Mode(GMAW) Short-Circuiting El Back Gouging: Yes El No� Method Globular❑ Spray El Current:AC❑ DCEP ■❑ DCEN❑ Pulsed El BASE METALS Power Source:CC❑ CV Material Spec. ASTm Ass Other Type or Grade A136. Tungsten Electrode(GTAW) Thickness: Groove Fillet y Size: NIA Diameter(Pipe) Type: N/A FILLER METALS TECHNIQUE AWS Specification A5.1 Stringer or Weave Bead: s'TiKlri` AWS Classification E7018 Multi-pass or Single Pass(per side)` S Number of Electrodes Electrode Spacing Longitudinal NIA SHIELDING Lateral NIA Flux NiA Gas NIA - Angle. N/A Composition N/A Contact Tube to Work Distance NIA Electrode-Flux(Class)NIA Flow Rate NIA Peening NIA Gas Cup Size N/A Interpass Cleaning`: N/A PREHEAT POSTWELD HEAT TREATMENT Preheat Temp., Min. 50 Degrees Temp. NIA Interpass Temp.;Min. Max. Time NIA WELDING PROCEDURE Pass or Filler Metals Current Weld Type,& Amps or Wire Travel Layer(s) Process Class Diam. Polarity Feed Speed volts Speed Joint Details 1 SMAW E7018 1/8 DCEP 105-110 N/A y 0(L5Tj:*& y II Form N 1 (Front) WZS, N r�-Ti[� 7Y1 # - • - .To ,� / GCS F nGi _5#MV41 ,a)€354 70 '�_T -SCAqW—/�%6 7&' J C—�.� T1' ,��t� b ANNEX N rE A AWS D1.1/D1.iM:2010 WELDING PROCEDURE SPECIFICATION(WPS) Yes❑■ PREQUALIFIED QUALIFIED BY TESTING or PROCEDURE QUALIFICATION RECORDS(PQR) Yes❑ rV7�T VL Identification# Revision_ Date / By }G(/ lld Company Name Aita Forest Products Authorized by Date Welding Process(es) MAW Type—Manual❑■ Semiautomatic Supporting PQR No.(s) Mechanized❑ Automatic JOINT DESIGN USED POSITION 7 z Type: TES" Position of Groove: 3— Fillet: Single FE] Double.Weld❑ Vertical Progression: Up ' Down❑ Backing: Yes❑ No N Backing Material: fU ELECTRICAL CHARACTERISTICS Root Op eningMA Root Face Dimension Groove Angle: 1 Radius 07U) 1l Transfer Mode(GMAW) Short-Circuiting❑ Back Gouging Yes❑ No Method 11 Globular❑ Spray El Current:AC❑ DCEP Q DCEN❑ Pulsed❑ BASE METALS Power Source:CC❑ CV❑ Material Spec. ASTM A 36 Other Type or Grade A36 Tungsten Electrode(GTAW) Thickness: Groove Fillet y Size: NSA Diameter(Pipe), Type: N/A FILLER METALS TECHNIQUE AWS Specification A5.1 Stringer or Weave Bead: ST AWS Classification E7018 Multi-pass or Single Pass(per side) Number of Electrodes Electrode Spacing Longitudinal NIA SHIELDING Lateral NIA Flux NIA. Gas N/A Angle NSA Composition NIA Contact Tube to Work Distance N/A Electrode-Flux(Class)NSA Flow Rate NIA Peening N/A Gas Cup Size N/A Interpass Cleaning: N/A PREHEAT POSTWELD HEAT TREATMENT Preheat Temp.,Min. 50 Degrees Temp; N/A Interpass Temp:; Min. Max. Time N/A WELDING PROCEDURE Pass or Filler Metals Current Weld Type& Amps or Wire Travel L ayers). Process Class Diam. Polarity Feed Speed Volts Speed Joint Details SMAW E7018 1/8 DCEP 105-110 N/A If (WWI) III i d ,/ Form N-1 (Front) Nl r d LA, Va /7 X s 0054 ?/ $ t(164WCV1�' . /IRAV T>yY Rmy NTH#Z -Tcxt� rn t Z 6W r w 7# l )"TF/VT-4w To AW . l.-I ANNEX N AWS D1.1/D1.1M:2010 WELDING PROCEDURE SPECIFICATION(WPS) .Yes PREQUALIFIED QUALIFIED BY TESTING or PROCEDURE QUALIFICATION RECORDS(PQR) Yes❑ ��: ��� �► j Identification# Revision Date / By Company Name. Alta Forest Products Authorized by Date' Welding Proces (es) sMAw Type—Manual❑■ Semiautomatic❑ Supporting PQR No.(s) Mechanized❑' Automatic El JOINT DESIGN USED POSITION /_, a� Type: T Position of Groove: F 'F Fillet: Single X Double Weld El Vertical Progression: Upn Down❑ Backing: ,Yes❑ No 0 - Backin Material: ELECTRICAL CHARACTERISTICS Root Opening Root Face Dimension Groove Angle. Radius(J—U) Transfer Mode(GMAW) Short-Circuiting❑ Back Gouging: Yes❑ Now, Method Globular❑ Spray❑ Current:AC❑ DCEP❑■ DCEN❑ Pulsed El BASE METALS Power Source:CC❑ CV❑ Material Spec. ASTM A 36 Other Type or Grade A36 Tungsten Electrode(GTAW) Thickness: Groove Fillet Size: N/A Diameter(Pipe) Type: N/A FILLER METALS TECHNIQUE AWS Specification A5.1 Stringer or Weave Bead: 'ham AWS Classification E7018 Multi-pass or Single Pass(per side) Number of Electrodes Electrode Spacing Longitudinal NSA SHIELDING Lateral NSA Flux NIA Gas N/A Angle N/A Composition NSA Contact Tube to Work Distance N/A Electrode-Flux(Class)NSA Flow Rate N/A Peening NSA Gas Cup Size NSA Interpass Cleaning: NSA PREHEAT POSTWELD HEAT TREATMENT Preheat Temp.,Min. 50 Degrees Temp. NIA Interpass Temp., Min. Max. WR Time NSA WELDING PROCEDURE Pass or Filler Metals Current Weld Type& Amps or Wire Travel r Layer(s) Process Class Diam. Polarity Feed Speed Volts Speed Joint Details SMAW E7018 1/8 DCEP 105-110 N/A HS (ykyX , Q i yF �I -� ca, yxyx Form N 1 (Front) �,�y t� K�.� sS f' ii/ ill % ��`T/r� �f THIS' Sfg W*V WO EG 7MV MA/R-0ek R,AW A104 70 MEW Ck£ Kaman Industrial �' � Teohnologles Corp. Industrial Technologies 5102 20th street East Suite 100 Fle,WA 95424 P 253.896.2543 F 253.896.0573 O www.kamandirect.com 14 . W-4 ~� J j_ • i 5 , 3z i TO B� KEPTINTHE } _-. -- PAR,R,CELFI LE f i • t + 1 A LTA FOREST PRODUCTS November 26, 2018 Trish Woolett 615 W Alder St Shelton,WA 98584 Re:Alta Forest Products'Stain Booth Project To Whom It May Concern: This proposal letter is a request to establish a variance for running the oil stain booth in The Upper Shed at Alta Forest Products'Shelton Washington mill. This variance request will enable us to run the equipment using 24-hour security until sprinkler protection for the building is installed. The sprinklers have been approved and will be installed as soon as the permit and contractors can install the system. At this time, we have added one hydrant to code at the sheds that serves as protection in case of a fire. Due to the urgent nature of this project,the timeline has been shortened. With this new timeline we expect the full sprinkler system to be installed as soon as everything is approved and the project can be completed. If this step goes according to plan,we expect the sprinklers to be installed as early as this year, or at the latest, before March in 2019. We request that since this timeframe has been shortened, that we would not be required to use a temporary, remote monitored, UL listed system. In lieu of this temporary system,we are requesting that 24-hour on site security monitoring will satisfy the requirements until the full sprinkler system can be installed. Sincerely, Dan Florek Operations Manager Alta Forest Products Shelton Operations CC: Jeromy Hicks Deputy Fire Marshal 615 W Alder St Bldg 8 Shelton,WA 98584 Shelton Sawmill 780 W State Route 108 Shelton, WA 98584 t MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT FIRE MARSHAL Mason County Bldg. 111, 426 West Cedar Street, Shelton, WA 98584 www.co.mason.waus Shelton (360)427-9670 Belfair(360)275-4467 Elma (360)482-5269 December 10,2018 Alta Forest Products C/o Dan Florek ` Re:Request for variance f S Mr.Florek, HA L I have received your letter dated November 261, 2018 requesting a variance for the addition of fire sprinklers in a building. Per your request and conversations, we have had, Alta Forest Products is requesting to proceed with installing a small self-contained roll coating operation in one of your storage facilities. During the permit process it was identified that the building in which this operation would be performed met the requirement for fire sprinklers due to the size and lack of fire flow in the area. As a result, Alta Forest Products is installing two fire hydrants to decrease the distance from the building. Both hydrants will be installed according to NFPA 20 and NFPA 25, permitted and inspected by acceptable codes. Additionally, a fire watch will be posted 24 hours a day in the storage/roll coating building until a fire sprinkler system can be installed. You have indicated that the fire sprinkler system will be installed in early 2019 but not to exceed the time frame of March 2019. If a fully approved NFPA 13 fire sprinkler system is installed a fire alarm system will not be required, however water flow indication and notification will need to be installed as outlined per NFPA 13 and NFPA 72. Your request for variance has been discussed with the local fire chief, myself and the Director of Mason County Development. At this time,you request is approved under the following conditions: 1. The fire hydrants are installed and inspected. 2. The fire pump has a current test record. 3. A bond is obtained in the amount of the fire sprinkler system total cost of install. This must be provided to our office prior to any permit approval. 4. The understanding that in March of 2019 that if the system is not installed that the building will need to be vacated and completely sealed as outlined in the IFC under "abandoned building" until a fire sprinkler system is installed using the bond in which you have obtained. If you have any further questions,please feel free to contact me at 360427-6970 x 282. Sinc a y, Jero Hi M avid Windom,Director Fire arshals Office Community Development Masq County Mason County f Page 1 of 1 Grace Miller - FNvd: SEPA inquiry for Mason Count' facility ............... From: Michael MacSems To: Miller, Grace Date: 8/25/2014 4:43 PM Subject: Fwd: SEPA inquiry for Mason County facility >>>Aaron Manley<aaron.manley@orcaa.org> 8/25/2014 1:50 PM>>> Hello,Michael. I'm not sure who the lead SEPA contact is with Mason County and I'm hoping you can forward this to the correct party, or put me in contact with them. I'm an air quality engineer with the Olympic Region Clean Air Agency (ORCAA) and I'm currently working on an after-the-fact permitting case for a project in your jurisdiction. Alta Forest Products (previously Welco Lumber Company and Skookum Lumber) located at 708 W HWY 108 Shelton, WA 98584 has a small spray tunnel for applying fungicides, stains, and paints to their fencing. The mill has been in operation since at least 1988, and I'm hoping to get a copy of their SEPA determination. ORCAA requires a SEPA determination, DNS, MDNS, or a letter of exemption from the lead agency before we can finalize one of our air permits. Is this something you have, or can you redirect me to the appropriate party? Thank you, Aaron Manley ORCAA Engineer I (360) 539-7610 Ext.104 aaron.manley@orcaa.org Please take notice that any records or communications with ORCAA are subject to public disclosure under the Public Records Act, (RCW 42.56)unless exempt under applicable law. file:///C:/Users/gbm/AppData/Local/Temp/XPgrpwise/5 3 FB67AAMasonmai1100 l 673 76E... 8/26/2014 MASON COUNTY COMMUNITY SERVICES �..�� PERMIT ASSISTANCE CENTER: Permit No: BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL �� tl vQ D 615 W.Alder Street, Shelton,WA 98584 i - — Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Phone= Belfair. (360)275-4467•Phone Elma:(360)482-5269 I 854 MAY 0 ' 201 BUILDING PERMIT APPLICATION 615 W. Alder Street PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: NAME: MAIL,IN DD MAILING ADDRESS: CITY: ' TATE: ZIP: CITY: STATE: ZIP: PHONE#1:-3 6,0 .�(�{ �,5 PHONE: CELL: PHONE#2: EMAIL : EMAIL: G{& L&I REG# EXP. PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER NAME tad EMAIL MAILING ADDRESS C 61,1 ,g4TY STATE ZIP PHONE CELL PARCEL INFORMATION: ' PARCEL NUMBER(12 Digit Number) LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT SITE ADDRESS 7Q0 W )RT I a? CITY_S- La l 0f q DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] N01H_ IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE ❑ RIVEFJCREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF E- STREAM❑ TYPE OF WORK: NEW/V ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc)/Vg) r Sk Ll bMC6, (,0VY\1A'1C1r CO IS USE: PRIMARY ❑ SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES (Whole Bldg) ❑ YES(Part[s]of Bldg) [IfNOX �Y�I ?Wkk C-�r,,, ( t DESCRIBE WORK S ry4or-Q. � �VS¢ aL[1C�Q� v��� Sc�S Y�4 SQUARE FOOTAGE: (propose+existing) IST FLOOR__t��sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. ft. BASEMENT sq. ft. DECIC 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 MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW ❑ EXISTING ❑ PLUMBING IN STRUCTURE? YES ❑ NOX If yes, attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO� EXISTING SQ.FT. EXISTING BEDROOMS 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 PERMIT APPLICA ION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42) Signature of OWNER(Must be signed by the OWNER) T— ate DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT - PLANNING DEPARTMENT FIRE MARSHAL -t PUBLIC HEALTH