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B ._Point Load f isolated Footings INSULATION . . Date �( " �S� By Lv"l( BG P SLAB INSULATION t � � m Cute: By Date By FIRE DEPARTMENT 0 foundation Walls Ft Date UY Date By Data BY DECKS FRAMING Walls Date By Date y Date By PROPAN E TA K PLUMBING vault Date By Date By OTHER Groundwork . Attic TYPO, Date By Date By Date By DRYWALL i°•yp - o .v o0 It,Brace Wan Clare By Date By Oa lff By FINAL INSPECTION � -D v Water Line Fire Saporation p i3ai ByDatei3y a<e � ��` BY(�N�� CD 00 Pass or Request Inspect. b 0 Type of Insp. Fail Date Date Dane By Comments 4 o V m p o C ls� 717161 7146C 1 P� a 8 oz Cn N 0 CD 0 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION Cf-D-7 E,�E 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 - Belfair(360) 275-4467 - Elma (360) 482-5269 On the web www.Co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Eck D-)Grouloeq - Company Name 4—M Mailing Address (0/ Da!4dA Mailing Address 3f(,P �'acleav�t 4- City 6kel" —State U-X Zip Code W29y City p_�Xt"N-:� State S01A Zip Code Phone 22 -11,76 Other Ph. Phonel(oq- Other Ph, Lien/Title Holder Contractor Reg. #_QD_fZ� Exp. A( E mail address E Mail Address Drivers Lic.# DOB Drivers Lic,.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic-- Existing Septic LZ_1__ Connect to Water System —Name of Water System Well--V---,- Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 41,V —Fire District Legal Description Site Address (Pleas q include street name, street number and city) A1�4p( 4-&i Directions to site 6) - LO c5kc( " Will timber be cut and sold in parcel preparation?Ye<LN- S�) Is property within 200' of Saltwater —Lake River/Creek Pond Wetland SeasonalRunoff Stream Slopes or iBluffs -57-15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No —R-- TYPE OF JOB New Add Alt— Repair Other PRIMARY RESIDENCE SEASONAL ❑ Describe e-L L'..-) 5-6 Use of Building V'Srjl"-( e Work we A-e No. of BedrooriL,; Z . -No. of Bathrooms &IL Square Footage- 1st Floor A2 - _2nd Floor 3rd Floor—Basement— Deck--Covered Deck OtherSq. ft. Garage— Attached —Detached — Carport— Attached Detached MANUFACTURED HOME INFORMATION - Make Kqf-57v7 —Model _V —Year— Length_Zi�Wiclth_ Serial No. --l—L-0 No. of Bedrooms iz2, No. of Bathrooms Type of Heat _E-Lec- Purchase Price $ �ccnc' Replacement Unit? Q1 No Installer Name Certification 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 the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure 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 M= PE TION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X $17 Date:1,o -t(,p-U3 LOwner!Owners Repreikntative/Contractor (indicate which one) h FOR OFFICIAL USE BEYOND THIS POINT Accepted byi C � D2t DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department ITVF Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fe _ Site Inspection Plan Review Fee EH Reviely Fee Plumbing & Base Fee Planning�Review Fee Mechanical & Base fee Other Wood /Gas / Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal lValuation $ TOTAL FEES s o U/ z Z — G) i O� O r y 0z > `rr- m Z Z L� , y' �eAS s e WAS C0� cis — c ) V -- U-pr PC rr-w-�� op Jelk,l G�b 4q eX��(�g V ENSc�ess AT 1 Sq Pt Per 150 Sq Ft (:e:i MAST MEN" ALI ' RENT WASH NGT NI STA-fL CODES J �v _ U) (D C) y . ----- ---------- JIM M i N I J .,a- I I I I _ I r I � I I J hn -" t •d 9EI TSt+E09ET es awoH t e-i.iadw i� d9t,:z0�60 9 T +�n me ��oU Parcel# 'y — 7J 000/6 BLD,#s r- t. Mason County a�a 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. G :.;.::Surface Type Length X Width = Area *All dimensions in feet Buildin s S(p X a7 X _ Measurements for buildings are taken at the X = perimeter of the farthest projections (example: eaves/gutters) X = Driveways fda X /,2 /yyp 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 X r above table Others X = X — ::: erulrrus.: . U. <: J�t :..:::. :..........:::.:::::::::::::::.........:......:.::.::::::.::::::...:.........�.....,. :n::::::::::::::.f.,:.::_:::::..:......::......:.......,...................,.........::... 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. Oixner/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- descr roperty for rev' and inspection as may be required. X Owner/Agent/ ontract ircle one)Date: ' «-CZ If the Total Impervious Sur ace Area is GREATER THAN 2000 Square Feet,please read, acknowledge and sign the information provided on page 2 of 2. Page 1 of 2 ArlieParcel# Ypoog- cl(5'" Cr'»/y 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//vn"v.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 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 revie d inspection as may be required. 1 Owner/Agen ontracto (circle one)Date: Ca-((-o-a r� Page 2 of 2