HomeMy WebLinkAboutBLD2012-00082 Caroport, Storage - BLD Permit / Conditions - 3/7/2012 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext.352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2012-00082
OWNER: RICK KRUEGER
CONTRACTOR: STEPHEN JOHNSON, INC 1.360.275.6734 LICENSE: STEPHJ*199LW EXP: 6/16/2012 RECEIVED: 2/15/2012
SITE ADDRESS: 22021 E STATE ROUTE 3 BELFAIR ISSUED: 3/7/2012EXPIRES: 9/7/2012
PARCEL NUMBER: 122057690150
LEGAL DESCRIPTION: TR 12 & 15 OF NW NW S 7/26 PCL 1 OF BLA#01-38 S 26/239
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
CARPORT WITH STORAGE NEXT TO DECK& MANUF HOME SOUTH OF BELFAIR MILE TO MILE AND HALF TO INTERSECTION OF HWY
3 AND HWY 106 GO UP HILL 1/3 MILE ON LEFT BOBBLE STONE/CAST
IRON GATE
General Information Construction &Occupancy Information Square Footage Information
No.of Bedrooms: Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: U Lot Size: Deck:
Type of Work: ACC Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building: Carport-Detached 392
Valuation: $ 12,008.56 Building Height: 16 Occ. Status: Primary Basement: STORAGE 104
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: N 110.0 Ft. Shoreline: Ft. Water Body: na
SEPA?: No
E 1
Model: Width: Ft. Rear: 90.0 Ft. Slope: Ft. Shoreline Desi
Side 1: 90.0 Ft. 9.: Not Applicable
Year: Serial No.: Side 2: W 65.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Plan Check Fee TW 2/15/2012 $ 145.11 S1201200000001
Planning Review Fee TW 2/15/2012 $205.00 S1201200000001
EH Plan Review KKK 2/15/2012 $ 103.00 S6201200000001
Building State Fee LDK 3/5/2012 $4.50 S1201200000001
Building Permit Fee LDK 3/5/2012 $223.25 S1201200000001
Total $680.86
BLD2012-00082 Please refer to the following pages for conditions of this permit. Page 1 of 5
CASE NOTES FOR
BLD2012-00082
CONDITIONS FOR
BLD2012-00082
1) 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
1-800-64 82 The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state l
- aw.
X
2) Owner/Ag t is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
3) Prior to final approval, all upland areas disturbed or new cr a d by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
4) Approved a dirnensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
5) Applica *o nowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Residential 5.
X
6) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTI NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROA W Y
X
7) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/Reserve requires a 1 Oft setback from all footing/foundations.
B. Sep � tank(s) requires 5ft setback from all footing/foundations.
C. No o nd on drains within 30ft, down gradient of drainfield/reserve area.
X
8) All 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 ted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Depa t rior to any further inspections being performed or approvals granted.
X
BLD2012-00082 Please refer to the following pages for conditions of this permit. Page 2 of 5
The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. 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 p oved documents will result in failure of required building inspections.
X
10) This structure is approved as un-heated space. If at any time this building is to be used for anything other than what it is approved for, a change of use
permit sha a plied for, reviewed and approved prior to the change.
X
11) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
12) The"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, then
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 D p �n�prior to any further inspections being performed or approvals granted.
X
13) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufa er's installation instructions.
X
14) 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 nsult with the septic design professional involved with the project. By calling for a final
inspection of the building permit the owner/agent/contra to is acknowledging that all components of the stormwater management system have been
installed as approved on the stormwater site plan. X
15) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical c to work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
X
16) 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 cuments are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charge a shal be collected by the Building Department prior to any further inspections being performed or approvals granted.
X
BLD2012-00082 Please refer to the following pages for conditions of this permit. Page 3 of 5
17) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
State of W gton. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revo at
X
18) 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 to ted 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.
X
19) PlacemJL_IZ�11
stre must comply with standards set forth per the international codes regarding descending and/or ascending slopes.
X
20) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinanc or re lation, must be reviewed and approved by Mason County prior to construction.
X
21) 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 in ational codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector kVI be made prior to requesting additional inspections.
X
22) All property lines shall be clearly identified at the time of foundation inspection. X
23) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to request a f inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with
Mason Cou ty rdinances and building regulations.
X
24) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for
action fo eriod not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holder h v pr vented action from being taken. No more than one extension may be granted.
X
25) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connector , a flashing. Install metal connectors approved for contact with the new types of pressure treated material.
X
BLD2012-00082 Please refer to the following pages for conditions of this permit. Page 4 of 5
:76) Retaining walls needed to support a surch rg s ich as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X.
27) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these str ur s meet the setback conditions listed.
X
28) Landings stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approv d e "to ensure these structures are shown and meet the setback conditions listed.
X
This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period of 180 days at any
time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be
occupied. Proof of continuati o ork is by means of a progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate
and grants employees of M son ounty acce s to the above described property and structure for review and inspection.
OWNER OR AGENT: DATE:
BLD2012-00082 Please refer to the following pages for conditions of this permit. Page 5 of 5
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April 18, 2012
Rick Krueger
PO Box 584
Belfair, Washington 98528
RE: Structural Evaluation for Proposed Carport/ Shed Located at 22021 E State Route 3,
Belfair, Washington
Dear Mr. Krueger
Envirotech Engineering (Envirotech) has recently completed plans and a structural report dated
January 23, 2012 for the above referenced project. The original report, Envirotech Project#1205,
utilized a combination of shear walls and deep poles for the wind and seismic design of the
structure. Therefore, soffits or any other under-sheathing components may be omitted during
construction with relation to the lateral design and integrity of the structure.
Please call Michael Staten at 360-275-9374 if you have any questions or require additional
information.
Sincerely,
Envirotech Engineering
PtiV CLYDF rT
F WASy�� 9T 1
�o kF 43045 Ea ��c4
t CISTVR [�
FSS�CNALtiNG`
Michael Staten, P.E.
Project Director
po gox984
gelfa%r, wastiLwgtow98528
D f f. 360-2759374
C U: 360-689-6045
FAX: 360-275--4.789
ewvLrotech@geoteckvUcaLLv fo.cowv.
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April 18, 2012
Rick Krueger
PO Box 584
Belfair, Washington 98528
RE: Structural Evaluation for Proposed Carport/Shed Located at 22021 E State Route 3,
Belfair, Washington
Dear Mr. Krueger
Envirotech Engineering (Envirotech) has recently completed plans and a structural report dated
January 23, 2012 for the above referenced project. The original report, Envirotech Project#1205,
utilized a combination of shear walls and deep poles for the wind and seismic design of the
structure. Therefore, soffits or any other under-sheathing components may be omitted during
construction with relation to the lateral design and integrity of the structure.
Please call Michael Staten at 360-275-9374 if you have any questions or require additional
information.
Sincerely,
Envirotech Engineering
CLYDF S
`G`T� E WASy�h T9),
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o Fc�s�Re° s,�v
SSrONALE�G`
Michael Staten,P.E.
Project Director
PO$ox9s4
ge�faCr, wasHCwgtow98528
Off: 360-2�593�4
ULL: 360-609-6045
Fax: 360-275--4'-89
evi.vLrotech@geotechwLcaL�w fo.cont
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GENERAL NOTES
1. ANY DISCREPENCIES BETWEEN THE STRUCTUAL DRAWINGS/ NOTES, AND THE ARCHITECTURAL DOWN ri• DATE'
DRAWINGS SHALL BE REPORTED TO THE ENGINEER OF RECORD. Hcs vzula
2. EXCEPT WHERE NOTED BY AN ENGINEER, ALL BUILDING METHODS, MATERIALS, AND WORKMANSHIP acauD ri, DATG
SHALL BE IN ACCORDANCE WITH THE INTERNATIONAL BUILDING CODE (IBC) 2009 EDITION.3, THE CONTRACTOR IS RESPONSIBLE FOR IMPLEMENTING SAFE WORK PRACTICES AND CONFORMING HkMN stAtw,M. /iasne
TO ALL SAFETY ORDINANCES,
DESIGN CRITERIA ZT��
1, ROOF, 25 PSF LIVE LOAD (SNOW)I 15 PSF DEAD LOAD.
2. WALLS, 10 PSF DEAD LOAD. -
2'x6' DOUBLE 3, WIND 85 MPHI EXPOSURE 'B'
TOP PLATE" 4. SEISMIC, CATEGORY DI.
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SHEATHING. jQTH I WITHIN 12' OF' ALL ENDS. ANCHOR BOLTS SHALL BE EMBEDDED AT LEAST 7' 1N CONCRETE. ALL. byrara4
FFASTEN WITId D NA L ANCHOR BOLTS SHALL USE 3' SQUARE X d' THICK STEEL PLATE WASHERS.
® 4' O.C. AT EDGES' AND 2. 'NAIL TOP SILL SPLICE (4' MINIMUM) AT THE END OF A SHEAR WALL THAT CONTINUES WITH A
t / f 12' O.C. IN FIELD• NON-SHEAR WALL WITH A MINIMUM OF (12) 16D NAILS EQUALLY SPACED.
3. ALL STUDS SHALL BE 2X6 DOUGLAS FIR, AND SPACED A MINIMUM OF 16' O.C.
4• INTERMEDIATE FRAMING SHALL BE A MINIMUM OF 2X WOOD MEMBERS WITH 8D NAIL SPACING Q
- 2'x6' STUDS 8 16' O.C. l2' ELC,
/� (DOUBLE AT ENDS) 5. WALL SHEATHING SHALL BE ' CDX PLYWOOD, &' DSB, OR r TI-11 SIDING,
/ FASTEN WITH (2) 16D 6, SHEATHING MAY BE INSTALLED HORIZONTALLY OR VERTICALLY.
f NAILS AT EACH END 7, FASTEN SHEATHING TO STUDS WITH 8D NAILS SPACED 2 4' D.C, ALONG EDGES, AND 12' D.C. IN
# PANEL FIELD.
:4 1 *� • S. BLOCKING IS REQUIRED AT ALL SHEATHING EDGES. THE SPECIFIED EDGE NAILING IS REQUIRED A
�'• ALL HOLD-DOWN POSTS.
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MANUFACTURERS SPECIFICATTONS,
UNLESS OTHERWISE 10• ALL DOUBLE AND TRIPLE STUDS SHALL BE NAILED TOGETHER WITH TWO ROWS OF IN NAILS
Ekt.Do,THIN NOTED ON PLANS, STAGGERED AT 4' D.C. FOR EACH ROW AND EACH STUD.
SIMPSON HDU8-SDS2.5 HOLD-DOWN AND TIEc_
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1. INSTALL ALL HOLD-DOWNS AND TIES PER MANUFACTURERS SPECIFICATIONS. T
2, ALL METAL C13NNECTORS IN CONTACT WITH PRESSURE TREATED WOOD SHALL BE SIMPSON Z-MAX, 2
�.T,S. TRIPLE ZINC COATED OR HOT DIPPED GALVANIZED FOR CORROSION PROTECTION.
.[*"
Name FV-t-L V R--Le&0YZ_ Parcel# 10 (s-O 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.
'RedeveloRment 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 Irnpecuious surfaces P/ease Complete Thls Table
Surface Type Length X Width = Area All dimensions in feet
Buildings ;L-7 I�� X
ILO { 14 X = O 4 Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X =
jA,r.0 X = Length of drive begins at the right of way
X =
Parking Areas w X =
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks via X =
X = Any paved, gravel or packed area per definition
above table
X =
Others N 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 1.
Total'Im.pervious Surface Area(sum.of all areas)
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.
ATtheotaole���ervious
ment of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
fowledge that the information provided is accurate and employees of Mason County are granted access to the above-
deperty fo review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If 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 Parcel# 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 SUE
A) 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/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:
Page 2 of 2
MASON COUNTY PERMrr NO.6L.)ND12 "82
BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360)427-9670•Belb (360)275-4467•Elma(360) 482-5269
On the web www.co.mason.wa us
APPLICW INFORMATION CONTRACTOR INFORM,%-N
Owner I�i U� � -- Company Name ^"� �-
MafFin A dr ss . •O • MaiGn Add ess P.D.
City i t S e�=Tip Code Z City ( l r' State w Tip Code 5 Z
Phone 0_ `3 - C 1 Other Ph. Phone� �215- Other Ph-
Lien Title Holder ►ti f a Contractor Reg.#5-TV IS'l Li#1 Exp.
E mail address E Mail Address
Drivers Lic.#iC(ZAZU?,A-f b-�>C. DOB 1 Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic
Connect t�CNater System Name of Water System
Well 1/ Water System Name of Water System
PARCEL INFORMATION-12 Digit Parcel No 1 12-C) - b G 1 Fire District
Legal Description 12-f I S OP NW ►v(wC, -70.fel PG` 1 42 (3 - 61 39_
Site Address(Please include street name,street number and city) La V 2' gE �k1Q WA.
Directions to site U` ��'R l'- "1 I E -70 N i. OP I.�IfI 4 1 O6. CC L11P
Will timber be cut and sold in parcel pr paration?Yes
Is property within 200'of Saltwater +1 LP e River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
Is this permit submittal th result of a Stop Work Notice,Correction Notice or other enforcement action?Y Mi4j
TYPE OF JOB -New Add Aft Repair Other PRIMARY RESIDENCE SONAL ❑ (2�� -a£
Use of Buildng ".QT P a Describe Work (' ►.ART 7C1511NC& 1`-i0E311.E
No.of Bedrooms No.of Bathrooms Square Foo �etag -1st Floor Am 2nd Floor
3rd Floor Basement Deck Covered Deck r Sq.ft.
Garage Attached Detached Carport ' S� Attached Detached
MANUFACTURED HOME INFORMATION -Make Model Year
Length Width Serial No. No.of Bedrooms No.of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/No
Installer Name Cartification No.
OV44 SL/13ULDER Ada-�owledges submission of r a=xate information may result in a stop work order or permit revocation.Admowfedgement of
such is by dgnatae below.I dew tl-ed I am the owner,owners legal representative,or the contractor.I further declare that I am engfied to receive this
permt and to do the work as proposed in the application.I declare that I have obtained the permission from all the neoessary parties.I pan fission is
required from any easement hofder,or any other party in nterest regarding this application or the work proposed in the appkafiort,l have obtained
them in apply for this p�and conduct the work proposed. The owner or agent on owners behalf,represents that the irbrmsdon
P is and grans employees of Mason County access to the above descbed property and structure for review and won.
OIMNUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Qate
Owner Own epresentafim/Contractor (mdcate which one)
FO OFFICIAL USE BEYOND THIS POINT Accepted by. Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department 3 Z L m
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical &Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES