HomeMy WebLinkAboutBLD2015-00973 Change Use Garage to Rec Room - BLD Permit / Conditions - 5/24/2016 Inspection Line(360)427-7262
�6aN cop MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County
615 W Alder St
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT
BLD2015-00973
OWNER: TERRA SOWINSKI RECEIVED: 11/17/2015
CONTRACTOR: ASHBY HOMES (360)427-1207 LICENSE: ASH BYH1036RW EXP: 5/11/2017 ISSUED: 5/24/2016
SITE ADDRESS: 530 E LAKESHORE DR ALLYN EXPIRES: 11/24/2016
PARCEL NUMBER: 122205400048
LEGAL DESCRIPTION: LAKELAND VILLAGE 5 TRACT 48
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
CHANGE OF USE GARAGE TO ENTERTAINMENT SPACE/BONUS LOCATED IN LAKELAND VILLAGE:
ROOM WA ST RT 3 N, LEFT ONTO E LAKELAND DR, LEFT ONTO E LAKESHORE
DR, SITE ON RIGHT
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: R-3 Lot Size: Deck:
Type of Work: ALT Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building:500
Valuation: $ 49,518.56 Building Height: Occ. Status: Unknown Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: Ft. Shoreline: Ft. Water Body: LAKE ANDERSON
Rear: Ft. Slope: Ft. SEPA?: Unkn
Model: Width: Ft. Side 1: Ft. Shoreline Desig.: bloben
Year: Serial No.: Side 2: Ft. Comp. Plan Desig.: Urban Growth Area
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Heaters 2 Ventilation Fan 1 Plan Check Fee JBN 11/17/201: $319.96 S2201500000001
Kitchen Sink 1 Planning Review Fee JBN 11/17/201: $205.00 S2201500000001
EH Minor Plan Review JBN 11/17/201: $ 100.00 S2201500000001
Building State Fee TW 1/15/2016 $4.50 S1201600000001
Mechanical Permit Fee TW 1/15/2016 $9.00 S1201600000001
Mechanical Base Fee TW 1/15/2016 $28.50 S1201600000001
Plumbing Permit Fee TW 1/15/2016 $26.10 S1201600000001
Plumbing Base Fee TW 1/15/2016 $24.70 S1201600000001
Building Permit Fee JTL 5/5/2016 $643.75 S1201600000001
ADJUST--Plan Check Fee JTL 5/5/2016 $98.48 S1201600000001
Total $ 1,459.99
BLD2015-00973 Please refer to the following pages for conditions of this permit. Page 1 of 4
CASE NOTES FOR
BLD2015-00973
CONDITIONS FOR
BLD2015-00973
1
1) Install BC fire extinguishers so that the maximum dlstanee_of veI does not exceed 75 feet in any direction and mo ed no more than
6 ' ches above the floor.
A ox(knox box)is required to be installed per section 506 of the 2012 Inter de. Please contact th ire district for more
formation and in
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2) 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.
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3) 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 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
Departmenttpprior to any further inspections being performed or approvals granted.
4) 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.
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5) All replacement windows shall be installed per manufacturer's specifications and be flashed per IRC section R703.8. All installations shall meet
requirements for guards per R613 and safety glazing per R308.4. WSEC requires a U-factor of.30 or less in all heated spaces. Existing,
non-conforming, egress window openings are not required to be enlarged, but it is highly recommended. Egress windows replaced in an existing opening
shall be brought into compliance with current codes if a product is available for this application. Building plans/permit are required for windows in new,
enlarged or relocated openings these installations must meet all current codes.
Windows and doors shall be installed in accordance with the manufacturer's written installation instructions and shall be available during inspections.
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BLD2015-00973 Please refer to the following pages for conditions of this permit. Page 2 of 4
6) 2012 IECC/Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric or other than electric, Compliance Method: Prescriptive option Marine-4C, Window(Max U-Factor):0.30, Skylight (Max
U-Factor):0.50, Doors (Type/Max U-Factor):0.30 or less, Wall insulation R-21, Floor insulation R-0, Ceiling Insulation min. R-60, Slab Insulation R-0.
In addition the following credits from R406.2 shall be completed as follows: 5A Efficient Water Heating must be a .93 or better
X 41,
7) A minimum of 75 percent of all permanently installed lamps in lighting fixtures shall be high efficacy lamps in accordance with IECC/WSEC Section
R404.1.
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8) Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer specifications and in accordance with IRC
Section R315.
Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level of the dwelling.
EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of fuel burning appliances),
repairs, or additions requiring a permit occur, or when one or more sleeping rooms are added or created.
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9) 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 Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocation.
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10) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or reguI tion, must be reviewed and approved by Mason County prior to construction.
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11) 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 b�made prior to requesting additional inspections.
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12) 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 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 or finances and building regulations.
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BLD2015-00973 Please refer to the following pages for conditions of this permit. Page 3 of 4
13) 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 for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
' (older haveprevented action from being taken. No more than one extension may be granted.
14) 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.
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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.
Signat re Date
Cdht l C AUSC- T-4 OWNER - REPRESENTATIVE - C &TRACTOR '
Print Name (Circle one to indicate) ----- f
BLD2015-00973 Please refer to the following pages for conditions of this permit. Page 4 of 4
aN MASON COUNTY Permit No: 6LD��, '(1iJ 13
DEPARTMENT OF COMMUNITY DEVEL6PMEN'P
BUILDING• PLANNING• FIRE MARSHAL (360) 427-9670 Shelton ext. 352
http://ww.-.°c6.mason.wa.us/community dev/ (360) 275-4467 Belfair ext. 352
1Rs4 �' 426 W Cedar Street, Shelton WA 98584 (360) 482-5269 Elipa ext. 352
RECEIVED
'�p��� BUILDING PERMIT APPLICATION Jal
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:426 W. CEDAR ST.
NAME:- Vi�,Zc=-& Sew%m S y-► NAME: Mlnzwl 16 M'rc S I tie—
MAILING ADDRESS: S'So E iN:Z MAILING A— D�S: Fwo V&or-
CITY: ,,l STATE: w& ZIP:gV5Z CITY: "—>+Ltx0r4 STATE: 'yw A, ZIl': 8,Y9
PHONE:,36b 40g3$o CELL: PIIONS:31,6 `I0 93 00 CELL:
EMAIL: ; EMAII. :
L&I RE,G#. Ir► }- 6%fZW EXP. / / r10
CONTACT : OWNER ❑ CONTRACTORS BELOW ❑
NAME: Nsi+iuA kpvf,S I%x, MAILING ADDRESS:-J>6 9,oyC 2 too•L.
CITY: S STATE: w& ZIP: gs PHONE:3xo y��cELL: RECEIVED
EMAIL: M14-atj JVv ti_ AgoL-- LCJM
PARCEL INFORMATION: APR i 2016
PARCEL NUMBER(12 DIGIT NUMBER) .�Z 5-14 FIRE.DISTRICT `N AId f 5 �1
LEGAL DESCRIPTION(ABBREVIATED) : L l�t,�1 Nb V ltl.�6vp S T2�LT L-e
SITE ADDRESS 5 3 o F_ J,-N 4Z CITY t-'-M-Q
DIRECTIONS TO SITE ADDRESS twist 3 LtLrK a (>17. L-- a r1
P.- 1-&itr`Si.ba.rt 6(L-. sit m tC� o, 4 1Zn6Wr
IS PROPERTY WITI-IIN 200 FT:
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF�OJECT-GREATER TITAN 14% YES❑ NO ❑
TYPE OF JOB: NEW ❑ ADDITION ALTERATION PAIR❑ OTHER
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) EV�' +t —
IS USE: PRIMARY A- SEASONAL❑' NUMBER OF BEDROOMS b NUMBER OF BATHROOMS_
DESCRIBE WORK "tN 11,1 Sv ira:-TrOt�l -M AwTl C- > t T►ST-6-U.- t4 r,-;w WA Nfla vS r
V, ai. u
SQUARE F00 AGE:
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq. ft.
DECK sq.ft. COVERED DECK sq.ft.STORAGE sq.ft. OTHER sq.ft.
GARAGE sq. ft. ATTACHED ❑ DETACHED ❑ CARPORT sq.ft. ATTACHED ❑ DETACHED ❑
MANUFACT E INFORMATION: S OF THE FLOOR PLAN REQUIRED
MAKE MODEL YE LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
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 or owner's legal representative. 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 permit/application becornes 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 CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42)
Signature o OWNER Date
DEPARTMENTAL REVIEW APPROVE DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT 5E IGf 2603- 00(.0 ta0
PLANNING DEPARTMENT n
FIRE MARSHAL
.'.FE'DTO'TAL'iyAl,UATIOl�T,:„:; ti .+ hif �i :•
`t 1 rt�bT.p e} raLv t�
BUILDING PERMIT FEE FIRE ACCESS AND GRADE
PLAN REVIEW GEO-TECH REVIEW
PLUMBING &BASE FEE STORMWATER REVIEW
MECHANICAL&BASE FEE TOTAL FEES
WOOD/GAS/PELLET STOVE VIOLATION INVESTIGATION FEE
PLANNING REVIEW FEE I VIOLATION FEE
5�r CpU�
MASON COUNTY PERMIT NO. LD D�a73
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING• PLANNING•FIRE MARSHAL
_ WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. 111,426 West Cedar Street (360)275-4467 Belfair ext. 352
1Xsa Shelton,WA 98584 (360)482-5269 Elma ext. 352 RE C E I V E D
B U I L D I N PLUMBING & MECHANICAL PERMIT APPLICATION NOV 17 2015
OWNER INFORMATION: CONTRACTOR INFORMATION: 426 W. CEDAR ST.
NAME:—['"Ztto. Scw►N5w4-I NAME: CAai5 Ayz+;-r-nt-
MAILING ADDRESS: '53o E b(L- MAILING ADDRESS: Pu fWA 2,192-
CITY: AdA=4rJ STATE: VV d ZIP:°13s2- CITY: So,abr4 STATE: wA ZIP: 19sv
PHONE: 360 `f9 b 9 5 too CELL: PHONE:3bo yqo 4 3 fto CELL:
EMAIL: EMAIL :
L&I REG# MI±!a ,4 t1 t 0'3 6 R W EXP. D! t/
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER): J 2'ZZO r 5`F—nab S
LEGAL DESCRIPTION(ABBREVUTED): \h AIE- Tit& 48
SITE ADDRESS: '53o savz& bP- CITY: �J
DIRECTIONS TO SITE ADDRESS ow
OH DX
TYPE OF JOB
NEW ADD ALT REPAIR OTHER USE OF BUILDING V"'�4T A-T- -D
LOCATION OF FIXTURES/UNITS—1 sr FLOOR 2ND FLOOR BASEMENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UN WS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric ,/ LPG Natural Gas Ductless_
Toilets Exis 41 n ci,, Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heat Pump
Showers ,,�" � Spot Vent Fan
Water Heater oZT � Wl:rI�YY Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Extlw►?oor,n t .�-. Solar Panel
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 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.
X06�� 11 1(111b
� •Signature of Appl cant Efate
X c4t7tA S AUSr, "M 14-i ►`iz^ Owner/Owners Representative/Contractor
Print Name I (indicate which one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
A�oN coUN MASON COUNTY COMMUNITY SERVICES Permit No: �-Obq
�` rA PERMIT ASSISTANCE CENTER:
Recv'd:
• BUILDING•PLANNING. FIRE MARSHAL RECEIVED
615 W. Alder St- Shelton, WA 98584
Phone Shelton:(360)427-9670 ext. 352 Fax.(360)427-7798
Phone Be/fair:(360)275-4467 Phone E/ma:(360)482-5269 APR 19 2016
�xsa httrx//www.co.mason.wa.us/community dev/
B U I L D I N GLUMBING & MECHANICAL PERMIT APPLICATION615 W. Aider Street
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NAME: h-, 4 Jam,
MAILING ADDRESS: p 7Aq?- MAILING ADDDI ESS: o %oR ZI°lZ
CITY: SllkAWyA STATE: WX ZIP: 98SO CITY: SlW-L-,U 4 STATE: y4 ► zip:1 SS8
I" PHONE: 'U,0 Z 1 4467 PHONE: '36,o 42Z t d CELL: 'ieo 4i0 013go
2", PHONE: EMAIL : Ik A4?-, SC Z ,mac-. 6vA-1
EMAIL: l A&4Lt e5 r-?f(,A A-o L • boP\ L&I REG# Arq-1g4}tl 0J 6r2 W EXP. /_/Ab
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): ( ZZy-O —S-4 -00048 8 Zoning:
LEGAL DESCRIPTION(Abbreviared): L-A vLr,"mb \( iLLnbl` S TR-4eT- If
SITE ADDRESS: 530 IE bR- CITY: rl
DIRECTIONS TO SITE ADDRESS: Av-y1 tl Ltti lrr auto
La."SAo&cr- ILL-. Sri is on► (441' 'r.
TYPE OF JOB
NEW ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS— I IT FLOOR ,/ 2ND FLOOR BASEMENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Tyne of Fixture No. of Fixtures Fees Fuel Type:Electric LPG Natural Gas Ductless_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heat Pump
Showers l Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Solar Panel
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 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.
ignature of Appli ant Date
X G+yu" &L-r/ru Owner/Owners Representative/Contractor
Print Name (indicate which one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
l. . CaU - W2c�� _ 3
�a MASON COUNTY Permit No:
DEPARTMENT OF COMMUNITY'DEVELOPMENT
A BUILDING• PLANNING• FIRE MARShAL. (360) 427-9670 Shelton ext. 352
_-— h#tp://www,co.mason.wa.us/community dev/ (360)275-4467 Belfair ext. 352
1854 426 W Cedar Street, Shelton WA 98584 (360) 482-5269 Ehna ext. 352
RECEIVED
BUILDING BUILDING PERMIT APPLICATION - �,,,
NOV
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:426 W. CEDAR ST.
NAME:-T6q�t=-& Sraw t N S►L-t NAME: M,fc S I r te—
MAILING ADDRESS: Sao E DR- MAILING ADD SS:FG L3c c Z.192�
CITY. ►v STATE: wA ZIP:q CITY: '5"*A br4 STATE: w A- ZIP: 8S8
PHONE:'3(6� 48a CELL: PHONE:3bD no 93 so CELL:
EMAIL: ; EMAIL :
L&I REG# 0-%fLvJ EXP.
CONTACT : OWNER ❑ CONTRACTORA BELOW ❑
NAME: ASWI-44 MAILING ADDRESS: e a g' K
CITY: S 1 E�.ta�tJ STATE: W A ZIP: 9 m t PHONE:-JJ o y%o 3%OCELL:
EMAIL: MItnH IL►—C-10k A-oL• GoA-A
PARCEL INFORMATION
PARCEL NUMBER(12 IT NUMBER) ZZZa" 4} —O-Ub IS FIRE DISTRICT___
LEGAL DESCRIPTIO BREVIATED) V t�.lA. c- 5 'TfLA c.T- S _
SITE ADDRESS $; L,a-9madoo rZre-- 6/Z CITY !:.
DIRECTIONS TO S ADD t wvt 3 LAR-K a tJ L&, res d� D R.,
IS PROPERTY WITHIN 200 FT:
SALTW TER❑ LAKE❑ RII R/CREEI POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑
DOES P TY HAVE SLOPE( 00 F THE PROJECT-GREATER THAN 14% YES❑ NO❑
TYPE OF JO NEW ❑ ADDITION ALTE REPAIR❑ OTHER
USE OF STRUCTURE( CE,GARAGE ET . —0A 6R-- nF�wE_
IS USE: PRI SE AL❑' F B13DROOM[JJ NUMBER OF BATHROOMS_
DESCRIBE WORK A 1 M w1 mbawS,
SQUARE FOOTAGE:
1ST FLOOR sq.ft. 2ND FLOOR ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. ATTACHED ❑ DETACHED ❑ CARPORT sq.ft. ATTACHED ❑ DETACHED❑
MANUFACTU INFORMATION: S OF THE FLOOR PLAN RE LIMED
MAKE MODEL YE LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
OW'N-ER 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 or owner's legal representative. 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 IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42)
Sig-nature of OWNER Date
DEPARTMENTAL REVIEW APPROVE PATri, DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT IJ ` 02603- OO(O&O
PLANNING DEPARTMENT 4bn
FIRE MARSHAL
�FE'I}A : '
BUILDING' , �'.. , ,• .-
PERMIT FEE FIRE ACCESS AND GRADE
PLAN REVIEW GEO-TECH REVIEW
PLUMBING&BASE FEE STORMWATER REVIEW
MECHANICAL&BASE FEE TOTAL FEES
WOOD/GAS/PELLET STOVE VIOLATION INVESTIGATION FEE
PLANNING REVIEW FEE VIOLATION FEE
„; ,