HomeMy WebLinkAboutBLD2021-01021 Final Garage - BLD Inspections - 11/5/2021 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
BLD2021-01021 GARAGE/ STORAGE
PROJECT DESCRIPTION: INSTALLING 30X50 METAL GARAGE ISSUED: 07/29/2021
SITE ADDRESS: 792 E JENSEN RD SHELTON
EXPIRES: 01/25/2022
PARCEL: 321322390032
APPLICANT: MIKE MCGEE OWNER: JENSEN INVESTMENTS IRREVOCABLE
792 E JENSEN RD TRUST
SHELTON,WA 98584 DAVID D REED TRUSTEE
SHELTON,WA 98584
CONTACT: DAVE YOUNG-D.B&R Inc
1149 RUSH RD
CHEHALIS,WA98532
360-269-3877
GENERAL CONTRACTOR'S LICENSE: IMPERIAL HOMES SALES INC License: IMPERHS952JN
17096 SEQUOIA ST#104HESPERIA, CA 92345 Expires: 04/15/2023
360-345-1132
VALUATIONS: FEES: Paid Due
U VB Utility, miscellaneous 1500.00 $73,185.00 Technology Surcharge $29.21 $0.00
Plan Check Fee $575.39 $0.00
Building Permit Fee $885.22 $0.00
State Fee-Residential $6.50 $0.00
Planning Review Fee $240.00 $0.00
Total: $73,185.00 Totals : $1,736.32 $0.00
REQUIRED INSPECTIONS
Setback Inspection Framing Inspection
Footing Inspection BLD-Final Inspection
CONDITIONS
Printed by:Genie Mcfarland on:07/29/2021 01:10 PM
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
GARAGE/ STORAGE BLD2021-01021
" The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons is not
allowed without the approval of the Mason County Fire Marshal.
* All property lines shall be clearly identified at the time of foundation inspection.
* 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).
* Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site
plan. Please check your"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
* REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable
provisions of the current code and the manufacturer's installation instructions.
A drip edge shall be provided at eaves and gables of shingle roofs.
* 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.
* 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.
* Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the
structure.
* 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.
* Concrete encased grounding electrodes must be installed and used at each new building or structure that is built upon a
permanent concrete foundation. In Mason County the electrical code is regulated by Washington State Department of Labor
& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-
4000.
* 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 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.
* 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.
* 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.
Printed by:Genie Mcfarland on:07/29/2021 01:10 PM
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
GARAGE/ STORAGE BLD2021-01021
* 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.
* 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.
* 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.
* 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.
* The foundation/footing must be placed on undisturbed, firm-native soil.
* 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.
Printed by:Genie Mcfarland on:07/29/2021 01:10 PM
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
GARAGE/ STORAGE BLD2021-01021
* 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.
* 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 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.
* 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.
* 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.
* WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind
speed for Mason County is 85 MPH.
* 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.
* 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 applicant acknowledges that the structure is only permitted for use consistent with the current zoning of the parcel.
* 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.
* 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.
* This structure is limited to U-occupancy use only(private garages, carports, sheds, and agricultural buildings.) Any other
use will be in violation of the international codes and Mason County Regulations unless a "Change of Use" permit is applied
for, reviewed and approved.
Printed by:Genie Mcfarland on:07/29/2021 01:10 PM
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
GARAGE/ STORAGE BLD2021-01021
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 Au'hor zed Agent: Date:
Printed by:Genie Mcfarland on:07/29/2021 01:10 PM Page 5 of 5
4
MASON COUNTY 615 W.Alder St.Bldg 8,SHELTON,WA 98584
COMMUNITY SERVICES SHELTON:360-427-9670,EXT 352
BELFAIR:360-275-4467,EXT 352
ISO Building,Planning,Environmental Wealth,Community 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 http://www.co.mason.wa.us/community-services/bid-inspection.php
Permit Number BLD2021-01021 Date Issued 07/29/2021 Issued By
Project INSTALLING 30X50 METAL GARAGE
Site Address 792 E Jensen Rd
Applicant MIKE MCGEE
Contractor IMPERIAL HOMES SALES INC
Contractor Phone 360-345-1132
Primary Code UPC IBC,IRC,IFC,IEC,IMC,& Type
Permit Type GARAGE/STORAGE 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
Department Building Official: Community Services Designee
Concrete Setbacks -l(-Z 1 G 41 Slab p ,,t c�rce 7 - c. f"';C-5
Footing Perimeter $- 1C7'-Z! D6c c- Point load Footing
Footing Interior Footing Decks/Porches
Foundation Stem Walls Other
Rough-In Groundwork Plumbing Framing 11- -214M
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 Z ( GLM Setup
Home
Concrete Foot/Runners Final
n Other
g-fl-21 Cih . $ee A4++. -Final fay I q-20 21 C04. See ll
MASON COUNTY 360-427-9670 Shelton ext.352
COMMUNITY SERVICES 36 60-482-52 Be lm ext.352
360-482-5269 Elma ext.352
Building,Planning, Environmental Health,Community Health
615 W.Alder St. Bldg.8 - Shelton,WA 98584 www.co.mason.wa.us
CORRECTION/INSPECTION REPORT
PERMIT/CASE NUMBER: 0LPW 21 - 010 Z l
ADDRESS/LOCATION: 122 E— Tensen 94
FINDINGS:
I L XPansiOn anchors- 960 bt ins+af a ifwl -fie
To bQ Ghe c ked 0 =Gm m I rA
Conc�e slab Porrery,ent oe_f- 3 S oAck 6-Q
ld tend oil tr ►�✓!I I -Fo 1(ow J(- W t f� �n -f G�o r
Ck l r► �Fer' � - i ti S ?� •. l..o 1 be end
All
correct-log,
Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
❑ Call for re-inspection when corrections are made before proceeding with any further work.
® Make corrections, items will be checked on the next inspection.
OKto f4Ke plwfo3 or' slab felhArcerrr.2r1-�. Zey-dA i-t5-2t bcc- .
Date: I '2 ❑ Please contact our office regarding possible
Department: �� structuraI damage incurred by recent
"natural/man made"disasters.This is NOT a
Inspector: CkriS�i" f'►'I.(..I I 1p_r
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
MASON COUNTY 360-427-9670 Shelton ext.352
COMMUNITY SERVICES 36 60-482-52 Be lm ext.352
360-482-5269 Elma ext.352
Building,Planning,Environmental Health,Community Health
615 W.Alder St.Bldg.8 - Shelton,WA 98584 www.co.mason.wa.us
CORRECTIOWINSPECTION REPORT
PERMIT/CASE NUMBER: lam-D 2.o Z ( - of D 21
ADDRESS/LOCATION: 7 12 E Ten n �aI She I+o n
FINDINGS:
+ eri V ire- r'ai e.
as !�
Ok 4m Sena P64Ts of +his once :Hnesorcer-fi6n is rnad
Q i ( am i 11,er WGLSnnCQ(Jh•1V(A1a - ADV
�inc_,cl a germ i 1 4A fill P41192 i
Items listed above must be corrected to gain compliance.
❑ THIS IS NOT A COMPLETE INSPECTION
❑ This structure has been inspected by Mason County Building Department and the items listed
above are in VIOLATION of Mason County laws and/or ordinances.
❑ Call for re-inspection when corrections are made before proceeding with any further work.
❑ Make corrections, items will be checked on the next inspection.
® OK to ,2 p
Date: 1-20 -21 ❑ Please contact our office regarding possible
Department: structural damage incurred by recent
Inspector: r i'V1 e( "natural/man made"disasters.This is NOT a
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
`f RECEIVED
PLAN IN G. JUN 01 2021
ALL.SETBACKS RE NIEP SURD
FROM THE FURTHEST 615 W. Alder Stre t
" l u PRO)ECTION O THE BL ILDINO
PLANNING
old 202 l -61 oZ I
if
lob
�j
j,
APPROVE
MA80N COURlTY DCD A s , =rA
SrTt P1Ak I~eE!�t1IRE3 TO E
Cw�• � SU ET TO PR
�{o �.,
Name Parcel# �. ,, ?�E7— Bra 2 -D b 2
Mason County
JI,N 01 2021
Department of Community Development 615 W. Alder Street
Small Parcel Stormwater Management Application/Worksheet(page 2 of 2)
Based Upon the information you have provided a Stonwi ater Site Ptah IS Required for this development activity.
Title 14,Chapter 14.48 of the Mason County Cods(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
httpl/www.co.mason.waves/codatcommissionerWindex.htm BUILDING
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, The Small Parcel Stormwater Site Plait
on the pages that begin with"Handout'
PLEASES INITIAL,BELOW T'O INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS Sff E
A)—ZL 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/BuildedAgent 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
fwther acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
descn for and inspection as may be required
X JgL . [.� )TI ,CKmer/Agent/Contiaetor(circle one)Date: / 30
r—:
Page 2 of 2
Name ger Parcel# _ v' N _ 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.
'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 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 Cai'culate Impervious Surfaces Tease Comp to 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 —
Pahos/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 o development is greater than 2000 square feet a
Small Parcel Stormwater Site Purl is Required
Total lmpervious Surface Area(sum of all areas}
If the Toted Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below.
Based Upon the information you have provided a Sformwamr 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 reprusentative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
desc cd propert for reJn � inspection as may be required.
X 1 OwneS(Agent/Contractor(circle one)Date: _ Z 6
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 I of 2
MASON COUNTY COMMUNITY SERVICES Permit No: 2W]- D 1021
PERMIT ASSISTANCE CENTER: RECEIVED
.BUILDING•PLANNING-PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 exit 352•Fax:(360)427-7798 Phone
Belfalr.(360)275-4467•Phone Elms:(360)482-5269 J U N 01 2021
BUILDING PERMIT APPLICATION5 W. Alder Street
PROPERT-Y1 OWNER INFORMATION• CONTRACTOR INFORMATION:
NAME: F 1 1) }"�)C NAME: p6'1 cr 1 L o►M ?--,-
MAIL DRESS: MAIL DRESS: ).16� Q ¢�
CITY: 5 ATE. ZIP• CITY: 1 I STATE: q ZIP:
PHONE#1: PHONE: &v .r 9?7 CELL:
PHONE#2: EMAIL
EMAIL: L&I REG# 'yYnj�f 5 EXP..�Z/16
_/ _
PRIM Y CONT T: OWNER❑ CONTRACTOR❑ THE
NAME EMAIL '4 (24M ) ,
MAILING ADDRESS Cy CITY t3 SATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)_,,?C Z3--- 9Q73 :L ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS to ispyZ CITY
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO[''SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER[] LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW a ADDITION❑ ALTERATION❑ REPAIR❑ OTHER El-
USE OF STRUCTURE(Residence Garage,Commercial Bldg,Etc.
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s]of Bldg)❑ NO a--'
DESCRIBE WORK '1 '1)
SQUARE FOOTAGE: (proposed)
1ST FLOOR tM 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 °3W sq.ft. Attached❑ Detached Q/ 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❑ NO R Ifyes,attach completed Water Adequacy Form
PERRVMTER/FOUNDATION DRAINS PROPOSED? YES ❑ N09-- 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 permitlapplication becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is for a period of 180 days.
f3 Lam) irisuspended
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