HomeMy WebLinkAboutBLD2015-00608 - BLD Permit / Conditions - 7/22/2015 >
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ao MASON COUNTY PERMIT NO.. I
DEPARTMENT OF COMMUNITY DEVELOPMENT
4
'i BUILDING•PLANNING•FIRE MARSHAL DD 0)
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
f Mason County Bldg, III,426 West Cedar Street (360)275-4467 Belfair ext.352
1 J PO Box 279,Shelton,WA 98584 (360)482-5269 Elma ext.352
PLUMBING & MECHANICAL PERMIT APPLICA7ifO� �
f
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NAME: l r an7
MAILING ADDRESS:( k' M10111ri PL MAILING ADDRESS: sj2[ UlJ Ma SE
CITY: STATE:M_ZIP: qpq CITY:WU STATE:k)(( ZIP: q950'�
PHONE:,�fiDr- CELL: ' PHONE: _ (Q�CELL:
EMAIL: T EMAIL:E- 1��1�►��3?f C(r(i (oWl
L&I RI # S�,l.i�',SPL-k )-W Crq EXP.
PARCEL INFORMIATION:
PARCEL NUMBER(12 DIGIT NUMBER): H'a
LEGAL DESCRIPTION(ABBREPA7'ED); O lQ
SITE ADDRESS;V V���. �ml n� CITY:
DIRECTIONS TO SITE ADDRESS:
TYPE OF JOB
NEW ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF F6C_I R S/UNITS-lsT FLOOR 2No FLOOR BASEMENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL AJYITS
I: !Y2e of Fixture No.ofsixtures Fees -duel T-ype.Electr_ic);,,,LP_G Natur-aI Gas—Heat P-ump—
i Toilets Tv-De of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpump
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood _�
Hosobibs Dryer Vent G_
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
rOWN RLELU[LDEf_�adknewledges�submissionmf-inaccurateinformation-nay=result=in-a--stop--workzrderor-permikrevocation- ---
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
I accurate and grants employees of Mason County access to the above described property and structures)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 A LI ATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X
Signa ur Applicant Date
X NOwner/Owners Representative/Contractor
Print Ramc (indicate which one)
DEPRT1VIElYTA`L'xtE't?I)�'Wb_� A�P�tliltrJ T1iA IS� D` Iy� .l� �`�txS/N`��: ���bl�`
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIl2E MARSHAL
MASON COUNTY (360)427-9670 Shelton ext.352
T EDIT C} 1 T ' DEVELOPMENT (360)275-4467 Belfair ext. 352
t
t $UILI3.tING.PL4NN.tNG-FIRE MARSHAL (360)482-5269 Eima ext:352
j 1
Mason County Bldg. SIi,426 West Cedar Street
Shelton, WA 98564 www.co.rnason.wams
L11 -S6—OOa��
May 21, 2015
Ms.Jessica Tanurnihardja
Northwest Water Systems
Post Office Box 123
Port Orchard, WA 98366
Re: DDR2015--00047
Latvian Village Water system Plan
Dear Ms.7anumihardja,
We have reviewed the materials you submitted and have completed the Local Government
Consistency Review Checklists you provided. The completed Checklist is enclosed for your records.
if you have questions or concerns regarding this matter,please contact me at(360)427-9670 ext.
286.
Sites ,
Barbara A.Adkins,AICP
Director
Enclosure
Local Government Consistency Review Checklist
Water System Fume: Latvian Village Water System PWS ID: 7636-7
Planning/Engineering Document Title: Water System Plan Flan Date: February 2015
Local Government with Jurisdiction: Mason County
WAC 246-290-108 Consistency with local plans and regulations:
Consistency with local plans and regulations applies to planning and engineering documents under WAC 246-290
106,246-290-107,and 246-290-110(4)(b)(ii).
1)Municipal crater suppliers must include a consistency review and supporting documentation in its planning or
engineering document describing how it has addressed consistency with local plans and regulations. This review
must include specific elements of local plans and regulations, This review must include specific elements of local
plans and regulations,as they reasonable relate to water service as determined by Department of Health(DOH).
Complete the table below and see instructions on back.
LocalGovernment'CotlSiSteracy Statement Page(s)in yes-we of
Planning Applicable
Document
a)The water system service area is consistent with the adopted land use and Section 1.2 and
zoning within the applicable service area. attached maps
b)The six-year growth proiection used to forecast water demand is consistent
with the adopted city/county's population growth projections. If a different Section 1.2,2.5,
growth project is used,provide an explanation of the alternative growth and 2.8
projection and methodology.
c)Applies to cities and towns that provide water service: All water service
area policies of the city or town are consistent with the utility service Not applicable q
extension ordinances of the city or town.
d)Service area policies for new service connections are consistent with the Sections 1.2 and
adopted local plans and adopted development regulations of all jurisdictions 1:3
with authority over the service area{City(ies),County(`ies)j.
e)Other relevant elements related to water supply are addressed in the water
system plan,if applicable: Coordinated Water System plans, Regional
Section 1.2
Wastewater plans,Reclaimed Water plans,Groundwater Area Management
plans,and Capital Facilities Element of Comprehensive plans.
I certify that the above statements are true to the best of my knowledge and that these specific
elements af�7consistent with adopted local plans and development regulations.
Signa, r Date
Printed Dame,Title and lunsdictGn
F
iY .}
4ia
RECEIVED
APR 0 9 2015
426 W. CEDAR STII
�10 C.-261 5- cw47
Planning•Management•Engineering
P.O.Box 123•Port Orchard,WA 98366•888-881-0958•360-876-0958
April 2, 2015
Mason County Community Development, MS-36
c/o Barbara Adkins, Director
PO Box 279
Shelton, WA 98584
Re: Latvian Village—Water System Plan
Local Government Consistency Review Checklist
Dear Ms. Adkins:
The Latvian Village Water System (DOH System ID 47636-7) has completed a Water System Plan.
Northwest Water Systems prepared the planning document on behalf of Latvian HOA and seeks your
review and concurrence in regard to the required Local Government Consistency Review Checklist. The
Small Water System Management Program is used as the basis for the Water System Plan document as
suggested by Department of Health.
Please find enclosed relevant portions of the Water System Plan for your review. A copy of the DOH's
Local Government Consistency Review Checklist is also enclosed. If you have any questions or need any
other information, please call me at 360-876-0958, extension 110, or email
jessica@nwwatersystems.com. Any invoice shall be directed to the water system HOA President,John
Zommers.
Sincerely
I�
Jessica Tanumihardja
NORTHWEST WATER SYSTEMS, INC.
Enclosure:
Local Government Consistency Review Checklist
Water System Plan Excerpt