HomeMy WebLinkAboutBLD2016-00439 DEMO Garage, Carport - BLD Permit / Conditions - 6/10/2016 Inspection Line (360)427-7262
ASOH cot"" MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext. 352
Mason County
615 W Alder St
Shelton, WA 98584
'"'° RESIDENTIAL BUILDING PERMIT
BLD2016-00439
OWNER: JERRY LIND RECEIVED: 5/17/2016
CONTRACTOR: LICENSE: EXP: ISSUED: 6/10/2016
SITE ADDRESS: 5630 E STATE ROUTE 302 BELFAIR EXPIRES: 12/10/2016
PARCEL NUMBER: 122335000020
LEGAL DESCRIPTION: OLYMPIC SHORE TR 8 W1/2 OF &T.L.
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
DEMO EXISTING 528 SQ FT GARAGE & BUILD NEW DETACHED FOLLOW ST RT 3, R ON NORTH BAY RD, FOLLOW TO ST RT 302 TO SITE
GARAGE&CARPORT WITH 2ND FLOOR STORAGE ADDRESS ON THE 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: U Lot Size: Deck: 140
Type of Work: ACC Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building: Garage-Detached 864
Valuation: $ 52,864.08 Building Height: 23 Occ. Status: Primary Basement: STORAGE 432
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: N 200.0 Ft. Shoreline: Ft. Water Body: CASE INLET
Rear: S Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: E 5.0 Ft. Shoreline Desig.: Urban
Year: Serial No.: Side 2: W 5.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Hosebibs 2 Plan Check Fee GMM 5/17/2016 $432.09 S220160000000i
EH Minor Plan Review GMM 5/17/2016 $ 100.00 S2201600000001
Planning Review Fee GMM 5/17/2016 $205.00 S220160000000i
Building State Fee SLC 6/2/2016 $4.50 S2201600000001
Building Permit Fee SLC 6/2/2016 $664.75 S220160000000i
Plumbing Permit Fee SLC 6/2/2016 $6.20 S2201600000001
Plumbing Base Fee SLC 6/2/2016 $24.70 S2201600000001
Total $1,437.24
BLD2016-00439 Please refer to the following pages for conditions of this permit. Page 1 of 6
CASE NOTES FOR
BLD2016-00439
CONDITIONS FOR
BLD2016-00439
1) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/Reserve requires a 1 Oft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. No foundation drains within 30ft, down gradient of drainfield/reserve area.
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2) Water quality is not to be degraded to the detriment of the aquatic environment as a result of this project.
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3) 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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4) 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 to any further inspections being performed or approvals granted.
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5) 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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6) 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
removal of approved documents will result in failure of required building inspections.
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BLD2016-00439 Please refer to the following pages for conditions of this permit. Page 2 of 6
7) This structure is approved as unheated space.
To be considered unheated space the area may be provided with a heating system that does not exceed energy usage of 1 watt per sq. ft., or 3.4 Btu/h
per sq. ft. A permit and approval shall be required prior to installation of any heating system.
When a heating system exceeds 1 watt per sq. ft(or 3.4 btu/h per sq. ft) the heated space shall be insulated in accordance with the energy code in effect
at the time of permit application.
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8) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
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9) 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.
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10) 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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11) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's installation instructions.
A drip edge shall be provided at eaves and gables of shingle roofs. (IRC 2012 R905.2.8.5)
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12) A concrete encased grounding electrode must be installed and used at each new building or structure that is built upon a permanent concrete foundation.
In Mason County the electrical code is regulated by Washington State Department of Labor& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-4000.
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13) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/ Reserve requires a 10ft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. N�foundation drains within 30ft, down gradient of drainfield/reserve area.
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BLD2016-00439 Please refer to the following pages for conditions of this permit. Page 3 of 6
14) A separate inspection in addition to the inspections required in IBC, Section 110 shall be required in accordance with the 2012 IBC, Section 1707.11.2.
The additional inspection is required when shear wall fastener spacing is required to be less than 4-inches.
The shear wall schedule shown on sheet P3 designate walls type PORTAL with fastener spacing less than 4-inches.
The required inspection may be performed by the Mason County Building Department, a WABO certified inspector, certified to inspect lateral
connections, the engineer of record (EOR), or an authorized representative of the EOR. The special inspectors duties & responsibilities shall be as
specified in Chapter 17. When a third party inspector is used to perform the inspection special inspection reports shall be submitted to the Mason
County Building Department, 426 West Cedar St, Shelton WA 98584 and also available for inspection.. I spection reports shall be completed and
submitted to the dept. in a timely manner and shall be submitted prior to the framing inspections. X �(�
15) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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16) 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 ��ff��
17) This structure is limited to U-occupancy use only(private garages, carports, sheds, and agricultural buildings.) Any other use will be in violation of the
intern tional codes and Mason County Regulations unless a"Change of Use" permit is applied for, reviewed and approved.
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18) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building
Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached
thereto. If documents are removed, 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.
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19) 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
perfnit revocation.
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20) The placement of buildings and structures on or adjacent to slopes steeper than one unit vertical in three units horizontal (33.3% slopes) shall conform to
the International Residential Code Section R403.1.7 for descending or ascending slopes.
Alternate setbacks may be approved subject to approval of the building official based upon the investigation and recommendations of a qualified engineer
licensed in the State of Washington. Such an investigation shall include consideration of material, height of slope, slope gradient, load intensity, and
erosion characteristics of slope material.
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21) Proposed structure(s) must maintain a minimum of a 5' setback from all property lines, easements and 25' from all County and State Road right of ways.
Setb�cl s are measured from the furthest projection of the structure.
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BLD2016-00439 Please refer to the following pages for conditions of this permit. Page 4 of 6
22) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
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23) 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
In X sp1eGtor shall be made prior to requesting additional inspections.
24) All property lines shall be clearly identified at the time of foundation inspection. X
25) 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
Masp County ordinances and building regulations.
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26) 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
holder have prevented action from being taken. No more than one extension may be granted.
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27) 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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28) Retaining walls needed to support a surc rge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X y_� —
29) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
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30) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANYADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD WAY.
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BLD2016-00439 Please refer to the following pages for conditions of this permit. Page 5 of 6
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 APPLIC TION OF 180 DAYS W L INVALIDATE THE APPLICATION.
Signature Date---�
Ll�d
OWNER REPRESENTATIVE - CONTRACTOR
Print Name (Circle one to indicate)
BLD2016-00439 Please refer to the following pages for conditions of this permit. Page 6 of 6
f BUILDING - -
Na e _ 'f Wft4, Ltad Parcel# 33 /�OALD#
Mason County "MAY 17 26"0'
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet
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/index.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 their entirety 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/drainfield 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
fu er acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
d sc 'bed property r re w andinspection ma a required.
X (9/Agent/Contractor(circle one)Date:
3 l�b
Pag of 2
Name Parcel# 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 surface'.
'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.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area *All dimensions in feet
Buildings X
!ti{uaac.� t;o X o2 tf' Measurements for buildings are taken at the
X a2 = 01� perimeter of the farthest projections(example:
eaves/gutters)
31' X 4' = 9,94
Driveways X =
.,+.cc�( ' X Length of drive begins at the right of way
X =
Parking Areas X =
c5.7 X _ p Any paved,gravel or packed area per definition
a
X _ above table
Patios/Walks X =
`t` �� X ��' = Nark Any paved, gravel or packed area per definition
above table
1°w �s a 5 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) �yb[•�
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 Stornswater 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 property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
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
PLANNING: R E V E D
ALL SETBACKS ARE MEASURED
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FROM THE FURTHEST S C�AZ r f - 50 �°�" 7 20 �
PROJECTION OF THE BUILDING PLANNING
- - 615 W. Alder Street
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SON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST
Owner's Name:raj I Yl Date:.5' 17- a j�p Reviewed By:
Documents:
✓Building Pe it Application Co J,�d� /Stormwater Checklist
lanning Intake Checklist Compl rl I L D M G .
Xte plan includes:Allowable building area;roof aVgs,fl cics,a BUILDING
Fire Apparatus Access Road info required? Yes No
Energy Code Application Form-O Electric wall heater O Electric central furnace O LPG Furnace
O Heat pump with electric furnace O Heat pump with LPG furnace O Boiler(heat type )
/ O Ductles _ t Pump • Other. Specify:
I/Mechanic 1 Application-WATER HEATER FUEL TYPE/LOCATIO
Engineering. 0 Snow load: Seismic:_D2_ Fk66 &,6f>orti
Stock Plan-ap roved snow load: Seismic: _D2_
Qx '
an act owes— O YLLAA1ivv S U
Foundation Tyre: anufac method gineered o oundation Baseme
Decks: Covered? Unc over 4 over 30"? Construe 1
onstruction Plans: ✓3 COMPLETE SETS
_Plans Legible ✓Recognized Scale _✓E vation Views _�ss Section
foundation Plan _✓toof Framing Plan ✓Floor Plan-Use of rooms noted(all floors)
Floor Framing Plan-all floor levels including loft,crawlspace,etc. (<200 S.F. ??-stairs?)
Deck Framing Plan, incl cov.porch framing
Wlan Details: fI ms --
✓Roof framing details,truss lay-out may be needed (Hip and girder location shown) M F6, A fil i rv-5,5- 5
all Framing-Does bearing-wall height exceed 10'? (Engineering may be required) 10 YYl►4 X
Floor framing: Floor joists(size&spacing): ,Floor beams:
Window headers. Typical header: Garage header:
vToundation: footing size,reinforcement
-=rrete Walls-Does Concrete Wall Height Exc 8'? (Engineering ay e r�guirec7 seriet�a�i'Is S�
_✓Landings at all exits?Less than 30"above grade Y/ -�T�I►Ch CI f !]CGK ly-rn
Htated By Furnace-Location of Furnace Fuel nape:
F-i;&place/Stove Information Shown-Fuel Type? Location(s):
endow Sizes Marked on Plans
raced wall panels(shear walls)marked on plans or lateral eng? 1 h-"-r i r-IC
COMMENTS:
ENGINEERING REQUIRED
Braced wall panels/brace wall lines are not marked on plans(R602. 0)
Amount and location of bracing does not meet minimum re ' in Table R602.10.1
DESIGN CRITERIA: All notes and details required as a re t of the engineered analysis shall be transferred onto proposed
building plans. Wind 85 MPH, Exposure B(unless en otherwise). Seismic Zone: Snow__psf.
IRREGULAR BUILDINGS R301.2.2.2.2
Irregular portions of structures shall be signed in accordance with accepted engineering practice. A portion of a building shall be
considered to be irregular when o r more of the following conditions occur.
1)Exterior braced w ' e or BV�TP cantilevered or offset by more than 4'
2)Roof or floor ' not laterally supported on all edges
2A)Portio roof or floor extend more than 6 ft.beyond the braced wall line.
3)En BWP extends more than 1 ft.over an opening more than 8 ft in width below.
4 ening in a floor or roof exceed the lesser of 12 ft. or 50%of the least floor or roof dimension.
5)Portions of floor level are offset vertically
6)Shear wall lines do not occur in two perpendicular directions.
7)When a story above grade is includes masonry or concrete construction(exc: fireplaces, chimneys,and veneer).
When this applies the entire story shall be designed.In accordance with accepted engineering practice.
H:\permit tech building checklist.doc Revised 11-29-2007
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BUILDING ` MAY 17 2
♦�°� k� MASON COUNTY aeC Qtfe`" PERMIT NOINGI A01ty•r0`}�jC►
DEPARTMENT OF COMMUNITY DEVELOPMENT a
BUILDING•PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg.III,426 West Cedar Street (360)275-4467 Belfair ext.352
Ixc.r PO Box 279,Shelton,WA 98584 (360)482-5269 Elma ext.352
BUILDING PERMIT APPLICATION I
OWNER INFORMATION:11 !! CONTRACTOR INFORMATION:
NAME •- W e A L 1 o d NAME:
MAILING RtJS S: 0 VE4 q O MAILING ADDRESS:
CITY: kY STATEW ZIP: CITY: STATE: ZIP:
PHONES b U CELL: !� S l 1 PHONE: CELL:
EMAIL: r QIJ EMAIL:
L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) V FIRE DISTRICT :7
LEGAL DESCRIPT ( ic-5 F 8 vy F T L.
SITE ADDRESS b 319 CITY )
DIRECTIONS TO SITE ADDRESS r
IS PROPERTY WITHIN 200 FT:
SALTWATER 2r LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO❑
TYPE OF JOB: NEW ® ADDITION ❑ �A''LTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) (2 a ra V::!::�
IS USE: PRIMARY K SEASONAL❑ ER OF BEDROOMS NUMBER OF BATHROOMS
DESCRIBE WORK rlrJf� O�i� Lxr�C7 lY Pi J �v'
SOUARE FOOTAGE:
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. CGE
R sq.ft. BASEMENT sq.ft.
DECK 1-k) �q.ft. COVERED DECK sq.ft.STO 'y� ✓sq.ft. OTHER sq.ft.
GARAGE 5 7G ✓sq.ft. ATTACHED❑ DETACHED® CARPORT 'ol ✓ sq.ft. ATTACHED 14 DETACHED❑
; A
0�3E71VF N: *4 COPIES OFTHEFLOOR PLMODELLEN BEDROOMS BATHS SERIAL
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 wne wners legal representative,or contractor.I further
declare that I am entitled to receive this permit and to do the work as pr osed.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 permittapplication becomes null&void if work or authorized construction is not commenced within 180
days o if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF
INSP I N.IN TIYJTY OF THIS ERMIT A PLI ATION OF 180 DAYS WILL IN LID T THE APPLICATION.
x �; 3 �l
igure of Applicant �_
x tWii1P La� COWN EPRESENTATIVE/CONTRACTOR
Print Narihe (CIRCLE TO INDICATE)
DEPARTMENTAL REVIEW. APPROVED DATE DENIED DATE TAGS/N0TES/C0NDMONS
BUILDING DEPARTMENT Z (,
PLANNING DEPARTMENT
FIRE MARSHAL
a" c MASON COUNTY PERMIT NO. RQ1 tf•co�
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL -+ �;s
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 _`�CjE"V D
Mason County Bldg. 111,426 West Cedar Street (360)275-4467 Belfair ext.352
PO Box 279,Shelton,WA 98584 (360)482-5269 Elma ext.352 fr4�1Y
1 7 2� �I
PLUMBING & MECHANICAL PERMIT APPLICATION 615 W. Alder Street
OWNER NFORMATION- J CONTRACTOR INFORMATION:
NAME: Y` Q 1 f1Gt NAME:
MAILIN D S:S 3 17 MAILING ADDRESS:
CITY: �Y' STATE: ZIP:I CITY: STATE: ZIP:
PHONE: 3- 6 U CELL:2 6 PHONE: CELL:
EMAIL: j4yj4, EMAIL:
L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER):
LEGAL DESCRIPTION ABBREV 4TED):
SITE ADDRESS: CITY: i
DIRECTIONS TO SITE ADDRESS: - I
TYPE OF JOB
NEW ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS—1 IT FLOOR 2m FLOOR BASEMENT GARAGE OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No.of Fixtures Fees Fuel Type:Electric_LPG_Natural Gas Heat Pump_
Toilets Type 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
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 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
permittapplication becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is
sus nded for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS
P T APPLIC T O F 180 DAYS WILL INVALIDATE T APPLICATION.
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Si lure jf7Applicant Date
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X Y Y 1 n Znr� L l n(� Owner/Owners Representative/Contractor
rint Name (indicate which one)
'DEPARTMENTAL REVIIEV07 APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT G z
PLANNING DEPARTMENT
FIRE MARSHAL