HomeMy WebLinkAboutBLD2021-00369 Final Detached Garage - BLD Permit / Conditions - 12/15/2021 r
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 DD2021-00369 GARAGE/ STORAGE
PROJECT DESCRIPTION: NEW DETACHED GARAGE ISSUED: 06/18/2021
SITE ADDRESS: 1830 NE BLACKSMITH DR BELFAIR
EXPIRES: 12/15/2021
PARCEL: 223097500300
APPLICANT: BISSER RAYMOND A&JIMI L OWNER: BISSER RAYMOND A&JIMI L
260 NE LAKE RIDGE DR 260 NE LAKE RIDGE DR
BELFAIR,WA98528 BELFAIR,WA98528
360-277-8296
VALUATIONS: FEES: Paid Due
U VB Utility, miscellaneous 960.00 $46,838.40 State Fee-Residential $6.50 $0.00
Plan Check Fee $431.39 $0.00
Building Permit Fee $663.68 $0.00
Technology Surcharge $21.90 $0.00
Total: $46,838.40 Totals : $1,123.47 $0.00
REQUIRED INSPECTIONS
Setback Inspection Framing Inspection
Footing Inspection BLD-Final Inspection
Foundation Wall-Pre-Pour Inspection
CONDITIONS
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.
* 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 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.
Printed by:Kate Campbell on:06/18/2021 08:21 AM
Page 1 of 4
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 BLD2021-00369
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.
* 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 foundation/footing must be placed on undisturbed, firm-native soil.
* 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.
* 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.
* 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 (I RC Table R402.2).
* 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.
* 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 building permits shall have a final inspection performed and approved by Mason County Building Department prior to
permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property
records on file with Mason County as being non-compliant with Mason County ordinances and building regulations.
* All 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.
* 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.
Printed by:Kate Campbell on:06/18/2021 08:21 AM
Page 2 of 4
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 BLD2021-00369
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 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 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.
* 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.
* 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.
* 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.
* 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.
* All property lines shall be clearly identified at the time of foundation inspection.
* 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.
Printed by:Kate Campbell on:06/18/2021 08:21 AM
Page 3 of 4
� 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 BLD2021-00369
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.
" 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.
* 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.
" 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.
* 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.
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 er does not presume to give authority to violate or cancel
the provis' ns ny o e state/local I ulating construction or the performance of construction.
Issued By:
Contractor or Authorized Agent: c Date: 611
Printed by:Kate Campbell on:06/18/2021 08:21 AM
Page 4 of 4
615 W.Alder St.Bldg 8,SHELTON,WA 98584
'/ MASON COUNTY SHELTON:360-427-9670,EXT 352
COMMUNITY SERVICES BELFAIR:360-275 a467,EXT 352
Building,Planninq,Enviro mental Health,Coaimunity 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 BLD2021-00369 Date Issued 06/18/2021 Issued
Project NEW DETACHED GARAGE
40—
Site Address 1830 NE Blacksmith Dr
Applicant BISSER RAYMOND A&JIMI L
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 Building Official: Community Services Designee
Department
Concrete Setbacks '1-�,\-Z,\ Slab
Footing Perimeter 4� Point load Footing
Footing Interior Footing Decks/Porches
Foundation Stem Walls �/vl .-(� -�j 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
Concrete Foot/Runners Final
Other
fWA1 011 �411I 7-U-21 CI,M . set 40,
MASON COUNTY 360-427-9670 Shelton ext.352
Belfair COMMUNITY SERVICES 36 60 482 52 0-275-4467 9 Elma e t.352
Building, Planning,Environmental Health,Community Health
615 W.Alder St.Bldg.8 - Shelton,WA 98584 www.co.mason.wa.us
CORRECTIONANSPECTION REPORT
PERMIT/CASE NUMBER: 2021 - 0 o3(,q
ADDRESS/LOCATION: l $ 3o N E- 6lcLc ksm if-►, Dr-
FINDINGS:
i e 01-7ce-
1GOrr�,rP{�� r r yi QW
Q n r e Le ce i ve 2 ca.? a,Q ve slem wf 6/ in.ro C¢�
-�rx� �h g C� r'c P a 11 o�,✓in�, u o u 4-n Po v r .
Senc_ Pho4-
Qs -fi My S6 0 "5
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.
X OK to .S� LQ s
Date: 'Z ❑ Please contact our office regarding possible
Department: Bt structural damage incurred by recent
Inspector: C IM i i I per' "natural/man made"disasters.This is NOT a
CORRECTION NOTICE.
DO NOT REMOVE THIS TAG
MCC14.12
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MASON COUNTY L±C� PLANN� - _ _
SITE PLAN REQ't�l�r TO BE OLq in
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P OJECTiO
Site Plan Scale: 11 = 60' 0a
- --- =_���
- 5740
Set sack Lines - Site Address: 1830 NE. Blacksmith Dr.
Scale: 1 " - 20' Property Line
Parcel #22309-
75-00300
DESIGN FOR: � Bisser Date February 1,2021 DESIGNED BY:
� & Jimi
y 1•=20' SFL BY DE5/GN, LTD. 1
•Name n S Parcel# 2�ydG( ' I S-- UC)30d BLD#��" b
{`G�.`'1 �� ��
. . , L ptNG s�
J t Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 o,f 2�
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
s
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 Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area *All dimensions in feet
Buildings X = 1101,
l�
_ ��,7 Measurements for buildings are taken at the
X ` j _ perimeter of the farthest projections(example:
X r� _ (l, eaves/gutters)
X =
Driveways X
X = Length of drive begins at the right of way
X =
Parking Areas `:{ X ,. _ ? -
X = Any paved gravel packed area per definition
above table
X =
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) 616 b
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 property for review and inspection as may be required.
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
Name 1�. �� _ Parcel# c� !~ �? r' 00,('�6 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:
http//www.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)�tY 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
100 W. Public Works Dr
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 400
415 N. 6th St—Bldg#8 lower level
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-
describe erty for review and inspection as may be required.
X +� Owner/Agent/Contractor(circle one)Date:
Page 2 of 2
Raymond A. &Jimi L. Bisser
Mason County Tax Parcel number 22309-75-00300
The lot is north Belfair on 5.2 acres.The lot is forested with wetlands at the northwest corner of the lot.
The lot is mostly flat and slightly slopes east away from the buildings.The lot will be cleared to
accommodate building sites,driveway, and drain field area.All will be completely surrounded with
forest and vegetation.
The driveway will be approx. 12' X 140'—and graveled,total 1,680 ft2;The parking area will be approx.
1,500 ft2; the building roofs will total 2,980 ft2.The total impervious surface of 6,160 ft2 which fall
within the limits for Small Parcel Drainage Review.
The roof stormwater will be dispursed with downspouts and splash blocks and grass vegetation. Further
sheet runoff will dispurse into undisturbed natural vegetation and forest.All parcel drainage will have
no affect on drain field area.
The driveway is fairly flat and slightly sloped near the entrance where it will be rocked,the rest of the
driveway will be graveled and sloped to runoff into natural forest and vegetation.
During construction there will be a silt fence installed on the eastside of the building sites.The driveway
will be graveled and the parts of the driveway that are no graveled will be seeded.
MASON COUNTY COMMUNITY SERVICES Permit No: fbI uv'Q�,
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 r
Belfair. (360)275-4467•Phone Elma:(360)482-5269 "' °`
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: 94 w l NAME:
MAILING A RESS: 2le0 W6 L Dw'' MAILING ADDRESS:
CITY:;'C.V-r. STATE:�A4& ZIP: t5 CITY: STATE: ZIP:
PHONE#I: I Ira. _ 15?--q C,, PHONE: CELL:
PHONE#2: 3L.,-a- $2 lev• D EMAIL
EMAIL: m V:2 {�7 5,!a I i V'� v-1 L&I REG# EXP.
PRIMARY CONTACT: OWNER 2 CONTRACTOR❑ OTHER❑
NAME K94amnnA1� EMAIL (1`llle--Cp
MAILING AD ESS V CO � LG-�Lr�'7L 4� D^ CITY - f STATE�_ ZIP ��
PHONE CELL Y1&-2'J -152—D-
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) - �-- 00,320 ZONING P--f-s-
LEGAL DESCRIPTION(Abbreviated) (L-21J QZ+J ck Lfi `1' FIRE DISTRICT
SITE ADDRESS 053D t-E 6IaCaSML�t-, Q112 CITY &6- 'Z ✓' r Lt/I4 `70516
DIRECTIONS TO SITE ADDRESS - .-I i L0.
Law rn,,. -rIWC�
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ❑ n- 1N
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 2 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) 0i&�
IS USE: PRIMARY❑ SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS _
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES(part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK
SQUARE FOOTAGE: (propose+existing)
1 ST FLOOF, sq.ft. 2ND FLOOR_sq.ft. 3RD FLOOR sq.ft. BASEMENT _sq. ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE lPr sq.ft. OTHER sq. ft.
4.GARAGE 10 b sq.ft. Attached❑ Detached E� CARPORT0sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: W`A *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 9 SEWER❑ / NEW� EXISTING ❑
PLUMBING IN STRUCTURE? YES ❑ NO If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOg EXISTING SQ.FT. �S
EXISTING BEDROOMS Iv�A PROPOSED BEDROOMS__A/�A — 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 permittapplication 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 APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
X
ignature f OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT S Z �'•�t.1•
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH