HomeMy WebLinkAboutBLD2020-00854 Final Detached Garage,Shop with Unheated Storage - BLD Permit / Conditions - 5/20/2022 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 DD2020-00854 GARAGE/ STORAGE
PROJECT DESCRIPTION: DETACHED GARAGE/SHOP WITH ISSUED: 12/28/2020
UNHEATED STORAGE
SITE ADDRESS: 146 NE MAKELA RD BELFAIR EXPIRES: 06/26/2021
PARCEL: 123202192060
APPLICANT: YOUNG JAKOB &SAMANTHA OWNER: YOUNG JAKOB&SAMANTHA
146 NE MAKELA RD 146 NE MAKELA RD
BELFAIR,WA 98528 BELFAIR, WA98528
360.801.9194
CONTRACTOR: LMS DESIGNS LLC
po box 813Belfair, WA 98528
3602279861
VALUATIONS: FEES: Paid Due
U VB Utility, miscellaneous 1600.00 $77,280.00 Planning Review Fee $240.00 $0.00
U VB Utility, miscellaneous 520.00 $25,116.00 Technology Surcharge $36.48
Building Permit Fee $1,105.44
Change in Tenant- Minor EH $110.00 $0.00
Plan Review
Plan Check Fee $718.54 $0.00
State Fee-Residential $6.50
Total: $102,396.00 Totals : $1,068.54 $1,148.42
REQUIRED INSPECTIONS
Setback Inspection Shearwall Inspection
Footing Inspection Framing Inspection
Foundation Wall-Pre-Pour Inspection BLD-Final Inspection
CONDITIONS
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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 BLD2020-00854
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/d itch ing system or road way.
* 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).
* 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.
* All property lines shall be clearly identified at the time of foundation inspection.
* 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.
* The foundation/footing must be placed on undisturbed, firm-native soil.
* 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.
* 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.
* 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.
* 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.
* 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.
* 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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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 BLD2020-00854
* 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.
* 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 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.
* 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.
* 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.
* 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 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.
* 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 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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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 BLD2020-00854
* 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.
* 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.
* 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.
* Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the
structure.
* 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.
* 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.
* 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.
* 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.
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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 BLD2020-00854
A separate inspection in addition to the inspections required in the IBC, Section 110 shall be required in accordance with
the 2015 IBC, Section 1705.12.2 and Section 1707.1. The additional inspection is required when shear wall fastener
spacing is required to be 4 inches or less. The shear wall schedule shown on sheet S3 designate GARAGE PORTAL
WALLS (501)with fastener spacing 4 inches or less.
The required inspection may be performed by the Mason County Building Department, a WABO certified inspector, certified
to inspect lateral connections, the Engineer of record (EOR), or an authorized representative of the (EOR). The special
inspectors duties and responsibilities shall be as specified in Chapter 17. When a third party inspector is used to perform the
inspection, special inspection reports shall be submitted to the Mason County Building Department, 615 W Alder St, Shelton,
WA 98584 and also available on site for review by the Building Official. Inspection reports shall be completed and submitted
to the Mason County Building Department in a timely manner and shall be submitted prior to the framing inspection of said
project.
Do not remove additional vegetation within the buffer adjacent to the stream.
" Application acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel.
" Applicant/Owner assumes all responsibility if On-site Sewage Components are encumbered.
A.) Drainfield/ Reserve requires a 1Oft 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 t. The granting of a permit does not presume to give authority to violate or cancel
the provisi n an othersta)te/local law regulating construction or the performance of construction.
Issued By:
Contractor or Authorized Agent: - Date:
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615 W.Alder St.Bldg 8,SHELTON,WA 98584
MASON COUNTY SHELTON:360-427-9670,EXT 352
COMMUNITY SERVICES
BELFAIR:360-275-4467,EXT 352
Building,Planning.Environmental Health CommunityHeailh 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:/Iwww.co.mason.wa.us/community-services/bid-inspection.php
Permit Number BLD2020-00854 Date Issued 12/28/2020 Issued
Project DETACHED GARAGE/SHOP WITH UNHEATED STORAGE
Site Address 146 NE Makela Rd
Applicant YOUNG JAKOB&SAMANTHA
Contractor
Contractor Phone
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 y -Z I cl-MSlab
Footing Perimeter t1.f2_-Z( CtA Point load Footing
Footing Interior T_t-t-2( J%Z Footing Decks/Porches
Foundation Stem Walls LAA(A-WJA M A Other
Rough-In Groundwork Plumbing Framing .Z0
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
Concrete Foot/Runners Final
Other
Melrior fo -� d (.00 f W1 it1�n. J" en r le}ker for 566 nip
Name Parcel# BLD45i_1
.. r� County
it-�, Mason Coun AUG 0 5 Department of Community Development 2020
Small Parcel Stormwater Management Application/Worksh9goOkAliftf
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 surface2.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
2Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area ' All dimensions in feet
Buildings X 43
X = Measurements for buildings are taken at the
perimeter of the farthest projections (example:
X = 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
X _ above table
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area (sum of all areas) L
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read,acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described pro for r ins ection as m d. L n
X er/ gent/Contractor(circle one)Date:
If t� otal Im �ious Surface ea is GREAT THAN 2000 Square Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Pagel of 2
Name c k'-C' Parcel# 1�-� d cJ�—1 �(D BLD�#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14,Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
bMiLwww.co.mason.wa—us/code/commissioners/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, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in thdiir�entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) WA—An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
syste will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions, guidance and examples.(Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
Mail:P 0 Box 1850, Shelton WA 98584
Physical:415 N 6th St, Shelton WA 98584
If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other,parcel.You may also wish to consult with the septic design professional involved with the project.Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT.352
Mail:P 0 Box 1666, Shelton WA 98584
Physical: 426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X er/ gent/Contractor(circle one)Date: A
IA-
Page 2 of
U\b
PLANNING: oozo
ALL SETBACKS ARE MEASURED
FROM THE FURTHEST Mason County WA GIs web Map o
PR0J,-'..T1QN OF THE BUILDING
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— 28' county Boundary - -
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80N COUNTY MD PtANt�IHt�rcels(loom in to 1:30,000)
SITE PLA Id REOYIRED TO SIE ON SITE
141"4OX 0SWW /� CM8 SJIET TO APPROVAL
67
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Ground Snow Load: 25
/ Ultimate Design 110 MPH 3 SECOND GUST
Wind Speed(MPH): 85 a
Topographic Effects: NONE �4
Special Wind Region NONE
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i qt sc_/�,+ Wind-Borne Debris Zone NO v u
lC, Seismic Design Category: D2 q E
GALE: Soil Bearing Load: 1,500 LBS.ASSUMED
az
71
Subject to Damage From: o
�11 _ 51 Weathering MODERATE J ti
Frost Line Depth: 12 INCHES a mS .
Termite: SLIGHT TO MODERATE
Winter Design Temperature: 22 DEG.F
Ice Shield Underlayment NO DATE:
- — 300, Requirement: 6/13/2020
- Flood Hazards: CALL FOR INFORMATION
Air Freezing Index: 1170
SITE PLAN Mean Annual Temperature: 151 DEG.F wens
_ I
SHEET:
PG# of
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SCALE: -
{ MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER:
•
•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 �: •j„�
Belfair(360)2754467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION 6'JS UG�S20
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: Qf 20
MAII, RESS: NAME:
6ajKADDRE , PLI OWA � er`Street
CITY: t' STATE:v/ ZIP; CTfY: STATE: ZIP:
PHONE#I: 31t0 1 g19g PHONE: CELL:
PHONE#2: 10 ?j4O '7�i 14 EMAIL:
EMAIL: L&I REG# EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER)( P&f_10Pzr P11J.
NAME 44r)f SMLVIAN EMAIL 1!'tIS�GSr`4.\�IfC�.GtW'�.f rNt
MAILINGADDRESSr CITY STATE ZIP
PHONE CELL sco
PARCEL INFORMATION: v
PARCEL NUMBER(12 Digit Number) 0 '5,0'M a,hcO(ao ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
srmADDREss II+�i i�/,�L (��RA. CITY
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOX SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cheek all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEWX ADDITION ALTERATION❑ REPAIR[] OTHER ❑
USE OF STRUCTURE(Residence.Garage,eonvnerdal Bldg,Etc.) TSt{'11O
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS 0_NUMBER OF BATHROOMS O
HEATED STRUCTURE? YES(IPhol m40❑ YES(PartA1 qfB1dg) N3ro
DESCRIBE WORK r�
SQUARE FOOTAGE:(proposed) (Lk^V4
1 ST FLOOR sq.13 2ND FLOOR 6�6 N.ft. 3RD FLOOR N.ft. BASEMENT N ft.
DECK_sq.ft. COVERED DECK-ff&- sq.ft. STORAGE_hLk N.ft. OTHER&_sq.ft.
GARAGE_M_A_-sq.ft. Attached❑ Detached❑ CARPORT-W A---sq.& Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: D*
: *4 COPIES OF THE FLOOR PLAN REQUIRE
MAKE I V MODEL V A= YEAR _LENGTH
WIDTH—U_&- BEDROOMS—&j;!�7- BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC bt SEWER❑ / NEW❑ EXISTING W-
PLUMBING IN STRUCTURE? YES❑ NOK If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NCM- EXISTING SQ.FT.
EXISTING BEDROOMS V 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 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 APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
x h/5/-9-0 d__U
ignature OWNER t be signed by the OVMER I I Date
DEPARTMENTALREVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT Z,-)
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH