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O '• O
ILDING
MASON GOUNTY �,NO
BUILDING PERMIT APPLICATION �1 ��a���.
426 W. Cedar• P.O. Box 186, Shelton,WA 93534
Shelton(360) 427-9670•Belfair(360)275-4467•Enna(360) 482-52692
C"51
x�
On the web www.co.rnasorl.wa.us i
APPLICANT INFORMATION
INFORMATION
r Company Name 1 "
Owner Pa` r roC �, i�. p Y - n
{� c Gi�C i� MarTrng Address Ts Code
Marking d iress_ r ,j,t State gy, p
City ' City
,11r � State_Zip Code �%
Phoner ` c� Other Ph. Phone of C. t•y Other Ph. •�>G.
Contractor Reg. ;' ,'`PO4-z`e s Exp. y
Lien/1-rle Holder E Mail Address
E mail address Drivers Lic.# DOB
Drivers Lic.# DOB
SEPTIC I WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Water System Name of Water System
Fire>.��e-� �-f (�Q�P`/ re District
PARCEL INFORMATION-12 Digit P l No - ,.
�^ �.C! .��t� 1.��7`t.:�,/
Legal Description L f e-
Site Address(Please include street name,street number and city)
Directions to site vr?N� �` * re - _
Will timber be cut and sold in parcel preparation?Yes a
Is property within 200'of Saltwater C1 .2 �� River/S _lopes or Bluffs > 15%Ponce -��.�
Wetland yo Seasonal Runoff AZO Stream
is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y o
TYPE OF JOB-New Add " Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑
Use of Building tel�'P,� Describ-`NorTr
No.of Bedrooms_ —No.of Bathrpoms Squa
re Footage-1st Floor— —2nd Floor S4
3rd Floor---_ —Basement- Deck Covered Deck Other Sq.
Garage_ _ Attached_ Detached .Carport Attached Detached
MANUF ED HO MATION-Make Model Year r"'�
Lea Nr Serial Na. No.of Bedrooms of Bathrooms
of Heat Purchase Price Replacern Yes/No
Installer Name on No.
OW[�IER/BIJQ D A�mowledges submission a ¢�a irilanna ion may result in a slop work order or p.smit reran.Admowfedgeemerlt of
such is by signatzae below.I declare that I am the owners owners legal rapresert�live,or .the oontactor.i furfier declare that I am arced th re slue this
Pa rrd and to do the work as proposed in the application.I declare that I have obtained the permsm n from all the necessary pardees.If permission is
raged from arty easement hoider,or airy other parry in irileres+regarding this applicahm orthe work proposed in the appfraabon,I have obtained
pe<r zsnn from them to apply for ttms porn-k and condur i the work proposed. The owner or agrrf on owners bR.half,repreEarts t iat the information
C
provided i;au w and employees of Mason or srty ama_z tD the above described proper and struclure for review and hsP�ion.
PROOF JF CO WORK is BY MEANS OF A PROGRESS INSPECT101%
Date-
Owner/ ers Representative/ niracto Cmdcate which one
OR OFFICIAL USE BEYOND THIS POINT Accepted by. - Date
DEPARTMENTAL REVIEW APPROVED DENIED MOTES
Building Department # /K /Z
Planning Department
Errvironmental Health Department
Public Works Department
Fire Marshal
FEES
Bulidinq Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical €z Base fee Other
Wood/Gas/Petlet Stove Fee State Fee
Violation Fee Pre-Paid at Submi"ual
Valuation$ TOTAL FEES
PERMIT NO.1 d C2NLJ � CU-- --
MASON COUNTY
PLUMBING 6MECHA ICBA ox 8 PERMI`T APPLICATION
Shelton(360)427-9967 0 eB if irw(3w0)2
75-4467- Elma(360)482-5269
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner P '��.::�'...��,s�,l, �
R r s �Y ri- Company Name �e'0,55
�.. m Mailin ddress `
Mailin ddres� �` ��� � �1
p e S !� State �� Zip Coder r
City gar Ls<l! State tr1L Zip Code � ' City p
Phone.ar. 47-P (-C-6 0 Other Ph. ___ Phone
a G Other Ph. � s°?C
� ' ?�iA
Lien/Title Holder Contractor Reg.#�� Ex
E mail address
E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION -Connect to New Septic Existing Septic. , Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No 14LO . ga i/ ' Fire District
Legal Description �'J6` !/ C"a � S,i '� 3e s ! 71,a�' r�L �r� •)ir�4
Site Address(Please include street'name, street number and city) /7 f`rrr � c �
Directions to site-L` ")' 6`/� T 'a✓ c� �llc r L,°--'� 1Z'�2� al
Is property within 200'of Saltwater AL3 Lake IA River/Creek /-fi Pond er
Wetland ''-f� Seasonal Runoff Stream A-0 Slopes or Bluffs > 15%_ //:1
TYPE OF JOB- New Add_< Alt Repair Other Use of Building
Location of Fixtures/Units- 1 st Floors— 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electdc_.LPG_Natural Gas_Heat Pump_
Toilets Fype of urnace
No. of Units Fees
Bathroom Sink
Bath Tubs Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets 1
Kithen Sinks Wood/Gas/PelletStove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
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.
PROOF OF O ON OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
-.. Date: fc�' "�'
Owned/owners Representative/ ontracto (indicate which one)
FOR OFFICIAL USE BEYOND THI OINT
Accepted tanning Pd Ck# Date Bid Pd Receipt No.
DEPARTIAtNTAL REVIEW APPROVED DENIED NOTES
Building Department
Doc Group Toe Constr.- ifliqlIz, 1,0,/
Planning Department
Environmental Health Department
FEES
Plumbing& Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMEh Yi �0 ®) ( !
WSEC/Ventilation Code Compliance Application
Owner: Parcel#: Type of project:
Total Sq. Ft. /1 S ' Jx, V`-tiv 15 Floor: 2n floor: Heated Basement:
of heated area:: A#01 ti5 /1 L A�W&joj
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
O Heat Pump with electric furnace O Heat pump with gas furnace O Ductless Heat Pump
O Boiler, specify fuel type: O Other: Specify: ,{JA 1'&,4
Glazing Compliance O Prescriptive Option (see reverse side) circle one: I II III
Percentage: Method O Component Performance , Chapter 5— Calculation worksheets required
1j `1 % Check one::
� '— O Other (Specify):
Check one O Whole House Ventilation system O Whole House Ventilation O Other,
Ventilation using exhaust fans &window or Integrated with a Forced Air describe:
System Fall fresh air vents (M1508.4) System (M1508.5)
Referencing WSEC Section 901, "Additional Residential Energy Efficiency Requirements," all
NEW residential units must develop 1 credit from Table 9-1. Identify and describe which option(s)will be used
ENERGY to comply. If the table is not attached to this form you can access the table on our website at:
CREDITS hftp://www.co.mason.wa.us/forms/Community Dev/index. h .
Option: Description:
Table 9-1
Window & Door Schedule (If needed, attach an additional sheet)
Total
Manufacturer Room/location U-Factor Size Quantity Square Feet
Windows:
�u, �e
Windows: Total Sq. ft.
Doors:
0� 1 A0
Doors: Total Sq. Ft
Total window and door area
Total window&door area_ i /(divided by)total sq. ft of heated area 1` _ %of glazing
G
Name Parcel .! - sf (� BLD# 2-&
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.
'Redev0gRment 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.
e:Com re.te;Thhf Ta61
T�-calculate-7mperv��S1-Wi'`aces..Pleas ... .
P
Surface Type Length X Width = Area All dimensions in feet
Buildings X =
`, �-� ld � X = `.� c 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
above table
X =
Patios=alks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X :the tota(impervious area-of the proposed-site
X = %developmeniis.greter than.2000.square.fleet a-
.
Small Pamel:Stormwater.SO.Plan.is Required.;.
Total:mpewiou§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.
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 operly for revie, inspection as may be required.
X Owner/Agent/ ontractor(circle one)Date: -L-
I e 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
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APRP0vE.D
MASON CU►v fY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
CHANGES SU JE 'T TO APPROVAL
By Date
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