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HomeMy WebLinkAboutCOM2004-00181 Laundry, Condos - COM Permit / Conditions - 12/6/2004 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 COMMERCIAL BUILDING PERMIT COM2004-00181 OWNER: RICK KRUEGER RECEIVED: 9/17/2004 CONTRACTOR: STEPHEN JOHNSON INC. 3\275-6711 LICENSE: STEPHJ*199LW EXP: 6/1/2005 ISSUED: 12/6/2004 SITE ADDRESS: 381 NE ROMANCE HILL RD UNITS A-E BELFAIR EXPIRES: 6/6/2005 PARCEL NUMBER: 1233252QW030-- lqw A LEGAL DESCRIPTION: CLIFTON RIDGE LOT: F PROJECT DESCRIPTION: DIRECTIONS TO SITE: 5 UNIT CONDO HWY 3 TO BELFAIR EAST ON ROMACE HILL RD APPROX 3/10 MILE ON LEFT General Information Construction &Occupancy Information Type of Use: MULTI FAMILY Insp. Area: No. of Units: 4 Type of Constr.: V-B No. of Bathrooms: 10 Occ. Group: R-3/ U Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: 0 Valuation: $ 604,050.00 Building Height: 25 Pre-Manufactured Unit Information Square Footage Information Make: Length: Lot Size: garage: 1,761 Model: Width: Building: 8,207 Year: Serial No.: Basement: Parking Spaces: Setback Information Shoreline& Planning Information Front: S 19.00 Ft. Shoreline: Ft. Rear: N 210.00 Ft. Slope: 15.00 Ft. Water Body: Shoreline Desig.: Not Applicable Side 1: W 130.00 Ft. SEPA?:No Comp.Plan Desig.: Urban Growth Area Side 2: E 180.00 Ft. Fire Protection System Information Auto Fire Alarm System?: Y Emergency Key Box?: Y Standpipe?: N Auto Fire Sprinkler System?: Y NFPA 13 Access Road?: Y Fire Extinguishers?: N Fixed Fire Suppression System?: N Fire Hydrants?: Y Fire Lanes?: Y iNkM2004-00181 Please refer to the following pages for conditions of this permit. 1 of 5 ' . I Plumbing Fixtures Mechanical Fixtures FEES T,fpR ` Qty. Type Qty. Type By Date Amount Receipt Dishwasher 5 Exhaust Hood 5 Plan Check Fee Tw Qi17i90na 09 a,)F 1� gignndnn 'Hosebibs 5 Furnace<100K 5 Planning Review Fee Tw Qn7/9nna ,zgr.r,nn q»nnAnn Kitchen Sink 5 Gas Outlets 10 Address Fee Qiginnna clan nn ci?nnAnn Lavatories 15 Ventilation Fan 15 Building State Fee nnRr, inngi,?nn ea c;n e1gnnann Showers 10 Nat. Gas Stove 5 Building Permit Fee NARr. inngi9nn (Za 7.19 rn cignnAnn Water Closets (Toilets) 10 Dreyer Mechanical Fee nnR(: 'IM1919nR riri ar, gignninn Water Heaters 5 Ven 5 Mechanical Base Fee nnRr, Inn919nn d.9.�r,n cignnaon Bath Tubs 5 Plumbing Fee NARr inn*2i9nn. 0�qn nn gignnann Clothes Washer 5 Plumbing Base Fee nnRr inn9i9nn. .09n no g1gnnann EH Plan Review nnR 11/gaignn. �7�;nn g1gonAnn UFC Plan Check Fee CAR 11/gQi9nn �1 91,1 na C1?nnAnn Total $8,371.34 CASE NOTES FOR COM2004-00181 CONDITIONS FOR COM2004-00181 1) 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 potenti sks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-09 he person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) All approved plans are requ ed to be on-site for inspection purposes. If inspection is called for plans are not on site, Approval WILL NOT be granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour it charged and collected by the Mason County Building Department prior to any further inspections being performed or approvals granted. X 3) PURSUANT TO INTERNATIONAL CODE, ALL SITES MUST HAVE APPROVED NUMBERS 6R A DRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE, BAS ON RATES AS ADOPTED BY THE JURISDICTION AND THE INTERNATIONAL CODE WILL BE ASSESSED IF OWNER/ O TRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS. X 4) Any Chan es In construction shall be reviewed by engineer of record and submitted in writing to the Mason County Building Department prior to construction. All engineering documents are a part of the approved set of plans and must remain attached thereto. If engineering documents are removed roval will not be granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour will be charged and collected he Mason County Building Department prior to any further inspections being performed or approvals granted. X �OM2004-00181 2 of 5 5) ' ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND THE INTERNATIONAL CODE IREMENTS AND OCCUPANCY IS LIMITED TO THE PERMITTED AND APPROVED CLASSIFICATI N. ANY CHANGE OF U E R OCCUPANCY WOULD RESULT IN PERMIT REVOCATION. CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE. x 6) Changes jo-approved building plans that affect compliance to the current Washington State Energy Code (WS ), ventilation and Indoor Air Quality C d X \\e�v Q), Building/Plumbing/Mechanical Codes and/or Mason County Regulations shall be approved prior to construction. 7)' CONST TIO PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOP E BjJILDING CODE. X 8) All pro ty lines shall be clearly identified at the time of foundation inspection. X 9) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure tq-r"est a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant ith Mason County ordinances and building regulations. X ` � 10) The app val of this project is subject to the recommendations and specifications outlined in the at d geotechnical report or assessment. Structures and /or land modifications (grading, cuts, fills, etc.) required in the geotechnical report/ s e sment, may require a seperate permit. The geotechincal report/assessment shall remain attached to the approved building plans. X 11) Pressure ed wood manufactured after January 1, 2004 may contain high concentrations of co4er which could quickly corrode metal fasteners co ctors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. X 12) Approve r dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 13) Parking shall be sufficient for 10 normal parking stalls including garag feet by 20 feet) and 1 handicap parking stall (12.5 feet by 20 feet)with sufficient maneuvering aisles. Handicap stalls shall be of a smooth s ce,at level or ramped to entry, located closest to the building entry, and shall be signed with the International Symbol of Access. X 14) Provide fire apparatus access to within 150'of all exterior walls. X Provide an additional fire hydrant in an approved location. X Fire lanes shall be marked/posted in an approved manner. X Fire sprinkler and alarm systems need seperate plan review and permits. X 15) Prior to final approval, all upland areas disturbed or newly cr�t ted by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X Z� � 16) This application is subject to Buffer and Landscaping requirements as est=is 'under Mason County Ordinance 1.03.036. The provisions in the site landscape plan shall be implemented prior to final approval. X � M2004-00181 3 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 any time after work is commenced. Evidence of co inuation 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 progres$ inspection.The owneror the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to .he above described property'and struct re for review and inspection. OWNER OR AGENT: DATE: OL 004-00181 4 of 5 a o CONCRETE MECHANICAL MANUFACTURED HOME o Date By C? Footings!Setbacks Ribbons Gas Piping interiorDats By Interior-Date By Date By Exterior Date By Exterior-Date By Set-tQ Point Load I Isolated Footings INSULATION Date !ey BG!SLAB INSULATION' Date By Data By FIRE DEPARTMENT Foundation Wails Flood Date By Date By Date By DECKS FRAMING walls Date By Date By Data By PROPANE TANKS PLUMBING vault Date By Data By OTHER Groundwork Attic -- Data By Date By Type: Date By n.W.V DRYWALL Type: Int.Brace wall Date By Date By Date By -0 FIB INSPECTION Water Une Fire Separation �D Date By Data By Date ' By m Pass or Request Inspect. 5 Type of Insp. Pail Date Date Done By Comments CD One'? �7 5 LI—I A 5 r�l�0 5� � BLS tilt fis 13 E E. 9� WL-r 1 G F,o.tc , 51Z,3(0& 5121 l46 KUS g 0(L AOUk�e- 1 8 CC C n 0 Foo a N PttL,& CONCRETE MECHANICAL MANUFACTURED HQIF, o Footings i Sethacks , Date / —//—d G By Ribbons b Date ByM Gas Piping Date By Foundation Walls Date B T1 Set.-up Date S`/Z-v5' By 7i2 INSULATION Date By B G 1 Slah Insulation Floors Final Date By Date B y Date B FRAMING _ NValls FIRE DEPT Date ! r By Date 1, b6 By (.I JL Date By PLUMBING Attic � �—.3 0 l� _ OTHER Groundwork Date B v Date By ANALLBOARD NAILING D.W.V. Date By Date AWr— By FINAL INSPECTION AlVater Line Date B v Date By Date By f L Ve ZG —oS /=�bT/a✓G, Di9c�S C��O_ 72L 222 / 2 . S�,�i-7 erg« d- I(I'�>brrf O /�s�—a✓ - �=i3 --o�-- ���,��i,n/ice?s ,o�s`.r /�� � � / Z. — /L /z j %r �Y O Cn / s 045vGr --s��� /12 WG l( J.1/�Sv► �t�fcsS 1�I7//!)(o 113/IJC� �p a33� - 5a - �IQOiO qoow �j 0036 MASON COUNTY PERMIT ASSISTANCE CENTER Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shelton,WA 98W (360) 427-9670 Belfair(360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 January 22, 2001 Jack Johnson P.O. Box 1119 Belfair, WA. 95828 Re; COM2000-00005 To Whom It May Concern: Dear applicant the permit submitted 1-20-2000 for the construction of a laundry mat has been canceled due to lack of activity. See 1997 Uniform Building Code, Section 107.4 Expiration of Plan Review. It appears that the building construction, location and design had changed and the project has been replaced with a substitute structure under a different permit number. The plans for the canceled permit have been included with this letter. Please call me if you have any further questions. Thank You. Kelly Mayo Mason County Building Department Plans Examining Ph(360)427-9670 Extension 595 Attached Project plans(2-sets) (DC 0_/ , - 0 ) 6q Case ber:MIS 9 MASON COUNTY PRE-SUBMISSION CONFERENCE REQUEST FORM The purpose of the pre�ubrnissiou application is to identify and/or eliminate as many potential problems as possible in order for the project to be processed widwut delay- Representatives from the Building Deparw=t, Fire Marshal's office, Fnvironmeatal Health, Planning, and Public Works departments may attend the meeting to discuss rules and regulations applicable to the proposed project. Topics covered during the meting will include the comprehensive plan, shoreline program, zoning, availability of sewer and potable water, developmarit concepts, building construction, fire protection and life safety of the pr,oposod project. By providing the most accurate and detailed information on the application and sit©plan your pro-submission conference will be more informative. Pr—Submission conferences are hold every Wednesday and last approximately one hour. To schedule a mewing complete the application on both side and return 7 copies of the site plan to the Mason County Permit Assistance Center, attn. M. MacSems. if you have questions call(360)427-9670 end_ 281. Date: _ y c1 Site Plan Applicant: Submit 7 copies Nazar otcrk tti�S� 1� /? nn/� -,� Include thefollawing Address information err site pions: Oay me telephone 6 2 5 — 4 �� •/ Property lines,easements.and right- of-ways. The location of all existing and Representative pr%cd sulfa ass include bquuc Name footage of eadatulg and proposcd - ^— buildings. Address s� Daytime telephone—_-- � - ��-� " °�- _ � Setback distmtce,in feet,fructt alI 1 property lines and buildings. Parcel Number: 12 digits J E)dsting and propowA rind access to , and from the site. T ./ Parking sites Description of Project: / Location of pn-site sewage t=ks and drairifields. lncludc square footage of structure, use of buildings i.c.office,warehouse, etc, occupancy classification(UBC, Tablc 3-A),and construction type. Provide one set ✓ Location of drinking water supply of prvposad site and surrounding sites. of pttatty, if available. � �40 � ���ti!�C �-- + ,SQ �Py P_ <<✓ L�,c.�nc? �__ s�!'� •/ Steep bluffs,wetlands,romans, end bodies of water QtoP L"A ✓ Location of fire hydrants and -- emergtncy vehicle access roads, including grade- ✓ surface and storm water run-off routes- Con!lnued on reverse side D � U H JUN 3 01999 PERMIT ASSISTANCE CENTER 13602 756400 J. JOHNSON CONST. I NC 637 P02 JUN 30 1 ti Fins this project bo discussed dunng a previous Pre-Submission Conference?If yes, please indicate date - —--- Will the building have employees? If yes, how many? What is the water availability of the proposed project? If there is an existing well, what is the name of the system?_ -�3e� .v �'J. 4e c C What is planned for an on-site sewage system? If you aru proposing a now on-site system provide detail an the required site plan. U A lAa AhQ a 5 Ad Q10A2 r i p ADDITIONAL COM RENTS: A,PPLICA.BLE BUTLDING CODES. 1997 Uniform Building Code -WAC 51-40 1997 Uniform Mechanical Code-WAC 51-42 1997 Llniform Plumbing Coda-WAC 51-46/51-47 1994 Non-Residontial Energy Code/Ventilation and Indoor Air Quality Code Masan County Ordinance Date and Time Conference Scheduled: Location: ` l� S 9q :00 �rc s_ �rNrat. ------— a• - Sel�' Sev�.c cam,. < <n+x L_ E) --- --- �Injet l q, - -- e yam o Y,V-- ---AtL c'a Z)a4-- QOL.,.t-4•r LLCA 1-01" S+o. tc-,.s �f S�}e s P c c��� etiq�ti, e e r•v,�_s��_���u.��.� _ r r 10 A. i Y1��GY.aY btu osA� 1$=11( /c 7-3 I`Iec meanocd�_ �(4r-,-uc W7 s�pe , — �x� a.. pi. V c� �a rs4 e,' tx....f �.•D.t.•\_ S.'7,C ��!'.�[.r►t_ u�l Sayle rciz c 5 i4 .6e—red T S r r,-- NAtj o,n tZ/a A i4ccctr�'6/e ��c,�, d C�aP r �/ /9r7 ul3C L UMC-) . K-e�r} v�L►- � deck � Dy �ouv� ✓��c,u�_ c�Z,Z • 1cj �� (,�v�;{'or S. y Coe4,e -16 r s.Ipoef. �d war/� any - �i nhrw�uur�t�t urau ccc Gie 5 lD N S s - �, +900 A to u IA h TAN K S ZO 4yN N 1 ,233 2- SAM B . THELERS HOME AND GARDEN TRACTS s 14124 W m S 10146 m VOLUME 4 , PAGE 20 w_ Ul TRACT I EX S -r90 i u' 9) 1 30 00004 A by 00001 S /Oi m 2 m .50 00003 L£^loe>> l40 Mf-J Ki.v:J 8 +60' OF TRACT I 50 00002.. y 1 0 J0vvt,15us) N2 OF )RRCT q I 5O 00008 Pr 6 12332 50 000id7 4.p1R�ti( (�♦� SO 0 p0007 Z 30 00009 W2-SF OF TRACT-4 n .��RRY oLDlRetJ 0 Z 90 00010 S4 OF TRACT 4 (� NASaN�C Twmpi . N2 OF TRACT 6 N /40' OF TRACT .5 Z 50 00013 50 00012 n 90 00089 SZ OF rRAc r 6 3110 TRAC r 8 EX N 140' �:1200 50 00014 , 010 50 00011 T —• Cu aa ta�c m SP 165) I��). 0 90 OOQ17--J, oa)4 Li e J�o 50 00015 S 0 0001 y C Z 570 00 0 W SQ 00088 TRACT 10 EX 5 100' � • 50 00022 ~ 50 OU020 N I O SP 1891 50 00021 13602756400 J. JOHNSON CONST_ I NC 637 Po3 JUN 30' 99 12: 15 NON RESIDENTIAL DEVELOPMENT# INITIAL REVIEW QUESTIONNAIRE In accordance with Washington States Growth Management Act, the Mason County Comprehensive Plan regulates the placement, expansion or modification of commercial, industrial and public facilities to certain areas of the county. In the interest of saving you time and money the Department of Community Development requires this initial review check list to be completed and reviewed by this department prior to the submission of any building permits. Applicant Name —f( 00 �,vkSnl Phone # (3W) 2'7 Mailing Address PO �b X <«�' [��p�-�` Site Address Directions to Site b Septic or Sewer Water Supply Y ( . it-�e}' G Tax Parcel #_ l 2 325, Q Legal Description VI S cL L4C4 Type of Development ,� �n �M�.��� � ���� .�/1 ? (lLn, 141C.SII Applicant's Signature . (11VV1, OFFICIAL USE *1[}#####*i#F##}!##f•t4t#####f iE#iAF F•4 f # Fabf#iP 1t-if�F 6# i#f.l4 err*#1F it#! IUOA Approved Sy _Exiating commeroiel Qate HHERE JUN 1 0 1999 PERMIT ASSISTANCE CENTER GARY YANDO,DI SECTOR STq 0 A U DEPARTMENT OF COMMUNITY DEVELOPMENT ~ o T z PLANNING -SOLID WASTE -UTILITIES Z� N Y y BLDG. I • 411 N. 5TH ST. • P.O. BOX 578 1864 SHELTON,WA 98584 • (360) 427-9670 July 6, 1999 Jack Johnson P.O. Box 1119 Belfair, WA 98528 Dear Mr. Johnson, This letter is in response to your Initial Review Questionnaire (IRQ) . You are proposing to re-establish an existing laundry mat and construct a car wash at 23381 NE HWY 3 in Belfair. According to the Mason County Comprehensive Plan your facility is located in a portion of the county that has been designated as laying in - the Belfair Urban Growth Area. Mason County land use matrix (Development Regulations figure 1 . 03 . 020) your proposal would be classified as a conforming land use. I understand that you have already scheduled a Pre-Submission meeting for your project . At that meeting, representatives of the various county departments will explain their regulations to you. After the meeting, you may submit your permit application. Sincerely, X�L Gary Yando, Director Dept . of Community Development Recycled 1/22/01 Activities for Case #: COM2000-00005 10:26:58 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes COMB009 Fire Marshal Review 1/20/00 No Hold KLW 1/20/00 COMB110 Building Plan Review 1/20/00 1/27/00 SKM SKM HOLD No Hold SKM 1/27/00 as per applicants request, location may switch.see notes. COMB130 Planning Review 1/25/00 AHB PEND No Hold GBM 3/3/00 APPLICANT HAS TO DETERMINE WHETHER PROPOSAL WILL PROCEED COMB120 WSEC Compliance Review 1/20/00 No Hold KLW 1/20/00 ON THIS SITE. AHB COMB135 Addressing 1/20/00 1/24/00 GMM DONE No Hold GMM 1/24/00 COMB138 Planning Pre-Review 1/24/00 1/25/00 MMS DONE No Hold MMS 1/25/00 COMB200 Environmental Health Review 1/20/00 1/24/00 CEB HOLD No Hold CEB 1/24/00 need approved septic design COMB210 Water Adequacy 1/20/00 1/24/00 CEB HOLD No Hold CEB 1/24/00 waiting for water adequacy from doh COMA915 Existing Records-See Case 1/20/00 KLW DONE No Hold KLW 1/20/00 need signed water adequacy app COMB210 Water Adequacy 1/31/00 1/31/00 CEB DONE No Hold CEB 1/31/00 received water adequacy from doh COMA960 Cancellation-Expiration 1/22/01 SKM DONE No Hold SKM 1122101 permit has expired and letter and plans have been sent to applicnat. File has been sent to case mgr for refile. Page 1 of 1 ��MM 00005 PERMIT NO.:6OW MASON COUNTY (,Z BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone( Other Ph.(_) Ph.( );> 7 r�KT�Other Ph.( ) Lien/Title Holder Contractor Reg. # 4,ddress Expiration / "? / SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. _I7-:Z 3? /$:TjZ/ Q00n C,,� Fire District Legal Descriptions R c 1��,� �{� ��`7'ur. AZ 2 �,C T✓G^�•4r-- — Site Address(Please include street name, street number and city) Directions to site Cs Will timber be cut and sod in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water (Name) V r ) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Describe Work 4-6;i4- -10ldc , 4 No. of Bedrooms No. o Baf throoms SQUARE FOOTAGE-1st Floor Jo 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that lie warf��the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this�e t is4gl;t d and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. CJ first ob 'ning approv / X Date I — 1 L —0o X A Date /U FOR OFFICIAL USE BE D THIS''' OINT ccepted by Date Submittal Amount Due Receipt No. c DEPARTMENTAL'; EVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ .................................................. FEES Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) . ........... ..........................::::::::::::: TOTAL FEES PERMIT NO.: MASON COUNTY 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 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address Mailing Address City State Zip Code _ City fx. State Zip Code Phone( Other Ph.( 7lo Ph.( r-40) Other Ph.( 5 ) 7 Lien/Title Holder Contractor Reg. # 1 Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. / / Fire District Legal Description s -0- — Site Address(Please include street name, street number a d city) 1 , v- Directions to site c`, o S W "' 44z' I Is your property within 200' of the following: Body of Water (Name) v J Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 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 Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural GasHeatpump Toilets Type of Unit No. of Units Fees Bath Basins Furnace _ Bath Tubs Heatpumps Showers Vent Fans Water Heater Propane Tank Laundry Wsher Gas Outlets Sinks Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other Other Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that 1 am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. (� X Qv,,4, / Date — " W X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTM"TAL.P. .S1t1l DENIED Building Department tati It ill CdD>w5 Occ Group Type Constr. Planning Department Other Other Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES MASON COUNTY PROJECT SITE INFORMATION Case No. Name PARCEL NUMBER Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line4 I I E-adjacent property line I I I I I I I I I " I � I I I � I I I I I I I I I I I I I I I I I 1 I I I I I 1 I I I I I I I I I adjacent property line4 ' I E-adjacent property line SAMPLE SITE PLAN adjacent property line4 azo' _ _ f-ddjacent property line � I D 30' rti�SCRvAL- E gel I a CREEK \ I \ 1 HOM L. i Gnatn y \ I j Prao Po�tn 1 bc' —/So'---�I � R I VAG n,T I crnrtAae \ I I go' I i P0.oPo�CD � �\ A&R=LLL1ruJX 50 I 1 I I I I 80, � I I \ i /00, r" -cLL I I � I x� /00. `� I I adjacent property lined \; <—adjacent ro ert' line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dtstar.cm to ruttL,a,Y� dca't�.,c� ro Siopa •}-c¢ dis+anaa 40 a- Signature Date