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Home My WebLink AboutBLD2009-00835 SFR, Garage Room Final - BLD Permit / Conditions - 7/7/2010 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 P10 RESIDENTIAL BUILDING PERMIT BLD2009-00835 OWNER: TAMARA RIGGS RECEIVED: 9/23/2009 CONTRACTOR: ZIESER BUILT CONSTRUCTION INC. 360-830-5037-360-271-3715 LICENSE:ZIESEBC077P ISSUED: 11/19/2009 SITE ADDRESS: 3630 E STATE ROUTE 302 BELFAIR EXPIRES: 5/19/2010 PARCEL NUMBER: 122212400012 LEGAL DESCRIPTION: N1/2 TR 1-B OF G.L. 2 &TAX 1360-C N1/2 PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW RESIDENCE, including heated bonus room above garage PAST ALLYN ON HWY 302 PAST VICTOR CUT OFF RD ON WATER SIDE General Information Construction &Occupancy Information Square Footage Information No.of Bedrooms: 2 Type of Constr.: VB Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: R3U Lot Size: Deck: Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:2,025 Garage-Attached 352 Valuation: Building Height: Occ. Status: Primary Basement: cov porch 304 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: E 32.0 Ft. Shoreline: 35.0 Ft. Water Body: HOOD CANAL Rear: W 35.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: N 6.0 Ft. Shoreline Desig.: Urban Year: Serial No.: Side 2: S 6.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Plan Check Fee TW 9/23/2009 $908.02 S12009000 Hosebibs 2 Fireplace 1 EH Plan Review TW 9/23/2009 $103.00 S12009000 Kitchen Sink 1 Furnace<100K 1 Water Adequacy Plan Review TW 9/23/2009 $41.00 S12009000 Laundry Tray 1 Gas Outlets 4 Planning Review Fee TW 9/23/2009 $205.00 S12009000 Lavatories 2 Propane Tank 1 Building State Fee DLC 10/16/200 $4.50 si2bbb000 Showers 1 Ventilation Fan 3 Mechanical Permit Fee DLC 10/16/200 $237.90 S12009000 Water Closets (Toilets) 2 Heat Pump 1 Mechanical Base Fee DLC 10/16/200 $28.50 S12009000 Water Heaters 1 Dryer Vent 1 Plumbing Permit Fee DLC 10/16/200 $101.90 sinbbbo0 Bath Tubs 1 Plumbing Base Fee DLC 10/16/200 $24.70 S12009000 Clothes Washer 1 Building Permit Fee DLC 11/18/200 $1,665.75 S12009000 ADJUST--Plan Check Fee DLC 11/18/200 $174.72 S12009000 Total $3,494.99 BLD2009-00835 Please refer to the following pages for conditions of this permit. 1 of 5 CASE NOTES FOR BLD2009-00835 CONDITIONS FOR BLD2009-00835 1) Ow r/Age 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 Lo 2) 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 Department prior any further inspections being performed or approvals granted. X -am 3) 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. The 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 X mov�I of approved documents will result in failure of required building inspections. �- 4) 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 Department prior to any further inspections being performed or approvals granted. X 5) Washington State Energy Code Compliance has been approved using the following: Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab Insulation R-10. Exception: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the X de§ e id of the roof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation. 6) Per 2003 IRC- SECTION 1609 -WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609 BAStIWIN, =ED (3-SECOND GUST) the wind speed for Mason County is 85 MPH. X �� BLD2009-00835 Please referto the following pages for conditions of this permit. 2 of 5 7) Per IRC�- SS�ECTION R905- REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in acc!r! ��Jththeapplicable provisions of this section and the manufacturer's installation instructions. X 8) 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 to consult with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. X � rnrn �=_ _ 9) 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 (olderhaaveepprevented action from being taken. No more than one extension may be granted. 10) 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 ouunttyJ o��rdinances and building regulations. X e r( 11) All property lines shall be clearly identified at the time of foundation inspection. X �-- 12) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must meet tl�,e install t�ion requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks. X M XL--_ 13) 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 Inspectgr shall made prior to requesting additional inspections. X M 14) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordim or ulg ation, must be reviewed and approved by Mason County prior to construction. X v�y (� BLD2009-00835 Please refer to the following pages for conditions of this permit. 3 of 5 15) 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 located 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 � �--� 16) 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 rev cati\o�n. X �� 4 17) The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons is not allowed without the approval of the Mason County Fire Marshal. X i=2 rn 18) Contact utilities prior to construction for instructions on how to protect the pump and controls and for inspection and testing of grinder pump and piping upon completion. X '`� � 19) 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. y The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X G. 20) Approxedrprerr mensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X �M 21) The proposed project must be consistent with all applicable policies and other provisions of the Shoreline Management Act, its rules, and the Mason Xounty ore�I�ing,Master Program. 22) Prior to final approval, all upland areas disturbed or ne ly crea_ d by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X :1 23) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or properties. Silt fencing must be installed and maintained until upland vegetation has become established. X 24) The applicant acknowledges that this development was sited such that further shore protection measures will not be required for protection of the proposed development. X m` BLD2009-00835 Please referto the following pages for oonditions of this permit. 4 of 5 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 anytime 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 continuation of work 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 Mason County access to the above described property and structure for review and inspection., OWNER OR AGENT: DATE: 1 l O q BLD2009-00835 Please refer to the following pages for conditions of this permit. 5 of 5 r � r , CONCRETE MECHANICAL MANUFACTURED HOME o Date q_ /�Jr Y //� B �� Footings J Setbacks Gas Piping Ribbons N o Intenor Date By interior-Date �t By Date By w Exterior Date I t_23.t_� By ?- Exterior-Date By Set-up a 3 Point Load!Isolated Footings INSULATION Date By D BG 1 SLAB INSULATION Date By Data By FIRE DEPARTMENT y Foundation Walls Floors Date By Date By Data By DECKS FRAMING walls _ r Date By Date -/9'.ry By Data — lj BY PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Dale By Data By TypeDate By D.w.v DRYWALL Type- Date InL Brace wall Date By W _ _lam Qate S�3 -�� By By � FINAL INSPECTION 0 Water Line Fire Separation 1 / 7_ 7-�� o Date By Dals @v By d" Date BY O m Pass ar Request Inspect. ; c CD Type of Insp. Fail Date Date Done By Comments w .rT-a.� tr 10-46r— a _ z �l r}�SZl-lo - �o CID r ► �� 7--b-1 b 7-7-1 d v� Q Q s 0 Name 1 Parcel# v�ao�1 �`1 `V 00 11 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 surface2. '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. ,_, z ,ry To Calculate,lmpervious Surfaces Please Complete This Table Surface Type Length X Width = Area *All dimensions in feet Buildings X X = Measurements for buildings are taken at the X _ perimeter of the farthest projections(example: 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/Walks X X = Any paved, gravel or packed area per definition above table X = Others 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 Total Impervious Surface Area(sum of all areas) ^3 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- describ d property for review and inspection as may be required. Rt:, Owner/Agent/Contractor(circle one)Date: q If the 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 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/i ndex.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 th i ntirety 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/d ra infield 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. C/� X ! 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PRO MA �.� SO V G� UY .-PL f w, E sIT • ��RE D=T'0 OE QN SITE TD"ktf� VAL v. .,,. . .. �-- .°.......... ..... .............. ........{. . ........... ? ....y........S .... .....M............... ... .... ... ... .... ....... ........ ............... .......y................*........:........�............... .. .....v........:........4....... ... - [........i........:..... .....i......: .. TOPOGRAPHY PROFILE: i I Direction: Scale: Approval: for office use Building Permit number: Building: Owner/Applicant: 1 l--'o"TUT_ 2jins Date of Planning: 1 �i _ 2-L1 r —�, .�. O application: Env. Health: Pa I rcel Number. �� _...,, //........ ............... ....... ..........-......,r........ 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MASON d =✓ 0-...0 .:D:CQ, L4N.1 $ITE PLAN REQUI2ED10 BE ON SITE ��rrFV GALN �l f h.`.. .... .. .... {...................:.......:..........................:............ ....... TOPOGRAPHY PROFILE: ....... .. ------------ --------- Direction: Scale: Approval: foroffice use Building Permit number: -- ;` Building: Owner/Applicant:��;� �'�ks 1L '. 4� -- Date of Planning: application: Env. Health: Parcel Number. � 7 7-2-1 - Zi _ , ��-.. - ----- - ------ -- MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 411 N. Fifth Street/P.O. Box 186, Shelton WA 98584 360.427.9670 ext. 352 DDR 4009 - CO Rec'd ;reest Request for Administrative Variance for Reduction in the Requiredks ($115.00) For administrative review, the minimum variance on a setba is 5 feet from the side yard lot lines and 10 feet for front and rear lot lines or any access easement. Request for further reduction requires a standard variance. Setbacks are measured from the furthest projection of the structure including roof eaves. Applicant/Owners: �►: ,Q YY L 1 GG Mailing Address: T o .—i�)O x I �j Telephone : . -�(pQ Lo cP)- 6q rj r( city: I r►)c.\j - 0n State: �74 Zip: 93 �� 3 If this reduction is tied to a building permit, please give permit case number. BLD o,Q09- - OOHS Parcel Number(s): ' 1 2-q 000 10, Zoning -S Site Address: Requested variance: Front/ Re /Side Yar (please circle all that apply I noe-4+— v-Hti.k:�Ac-J-(— Requested setback variance: J ft. An illustrated site plan is required. Your site plan must show the following: north arrow, abutting street or easements, set backs to all property lines and existing buildings, slopes, surface water, wetlands, critical areas, septic, well and driveway. Show all proposed new development. The following circumstances must apply: FRONT AND OR REAR YARD REQUIREMENTS: 1) Existing lots of record as of March 5, 2002; You must meet one of the following: (Please circle all that apply) 2) One of the following exists on the lot: a) steep slopes, wetlands, or streams present; b) soils that restrict building or septic development; c) lot width at the front yard line of no more than 50 feet; d) lot size of no more than one-fourth acre; \\CLUSTERI_HOME_SERVER\HOME\COMMON\COMMUNITY DEVELOPMENWAC\VARIANCES\2009 Adminstrative.var.doc Updated: 12-15-2008 e) existi.ng improvements of buildings, septic systems, and well areas. BIDE YAR"EQUIREMENTS: 1) __FA ting lots of record as of March 5, 2002; t must meet one of the following. (Please circle all that apply) 2) One of the following exists on the lot: a) steep slopes, wetlands, or streams present; b) soils that restrict building or septic development; c) lot width at the front yard line of no more than 50 feet; d t size of no more than one-half acre; e) isting improvements of buildings, septic systems, and well areas. Explain how these circumstances preclude a reasonable development proposal from meeting the setback standard for Rural Residential 2.5, 5, 10, or 20 zones. Owner/Agent(please indicate) Signature and date --- ---Official Use Only --- - --- ----- ---------------. Approved Date Z�I to Denied Date Reason for denial: \\CLUSTERI HOME_SERVER\HOME\COMMON\COMMUNITY DEVELOPMENT\PAC\VARIANCES\2009 Adminstrative.var.doc Updated: 12-15-2008 .«s`.,e„_�• !- \ [f ` + gyp 7 ,� FORM MUST BE COMPLETED IN INK MASON'�O`UNTY PERMIT N0T-- �_`-DL1JU1- PLEASE PRESS HARD BUILDING PERMIT APPLICATION ` «. 426 W. Cedar" P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 " Belfair (360) 275-4467 " Elma ( 60) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 1.0,n-A k.6 NV K 1 Er(h 'i Company Name Mailing Address '.0 ti C 1. 1"1 Mailing Address C it City y State Zip Code `'� "� City l '..,.s. State Zip Co " U Phone A Other Ph. Phone '� - Other Ph. - ti Lien/Title Holder - t- Contractor Reg. � _j E mail address 1i -�'(yi, I E Mail Address Drivers Lic.# " t t DOB Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System +SUS v " U nq U t I Iltr PARCEL INFORMATION - 12 Digit Parcel No. I �- - - Fire District ` Legal Description L I _ f._. , w ;- .TP� Y 13 tw C G i Site Address (Please include street name, street number and city) 3i6 3 O Ir S`T<d Directions to site Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater w Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE 0 SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor ` -` 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached ' Carport 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 Certification No. 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 MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X ; Date: w Owner/Owners Representative/Contractor '(indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted A Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department EAff!Z1- Planning Department Environmental Health Department Fire Marshal FEES Buildinq Permit Fee ite inspection Plan Review Fee f �' C'J H Review Fee Plumbing & Base Fee A q 7O t' / O/•-7D Planning Review Fee Mechanical & Base fee 3 .9a Other Wood /Gas/ PeNet ove Fee State Fee S--b Violation Fee o Pre-Paid at Submittal 190 ir OCR Valuation $ / TOTAL FEES 9-1 7b �- ley C� C��. i�vrc.,►�S�We.e c e.r✓ pvk7 �� 7.S 4 MASON COUNTY PERMIT NO. PLUMBING/MECHANICAL PERMIT APPLICATION 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 < Company Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone` Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. 4 Exp. 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. Fire District Legal Description Site Address (Please include street name, streei number and city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs , 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units - 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric - LPCi_ Natural Gas_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs �_ Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent OtherLa.44� / Other r�`�/ Base Fee Base Fee UU TOTAL PLUMBING TOTAL MECHANICAL O\NER/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 CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X �(k)",1-1 Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. 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