HomeMy WebLinkAboutBLD2009-00969 FInal Carport with 2nd Floor Storage - BLD Permit / Conditions - 8/18/2010 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext. 352
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Mason Count Bldg. III 426 W. Cedar P.O. Box 186
Shelton. WA 98584
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RESIDENTIAL BUILDING PERMIT BLD2009-00969
OWNER: JUDY SCOTT
CONTRACTOR: LICENSE: EXP:
RECEIVED: 11/4/2009
SITE ADDRESS: 131 NE MCKNIGHT RD BELFAIR
ISSUED: 12/8/2009
PARCEL NUMBER: 123204400100
EXPIRES: 6/8/2010
LEGAL DESCRIPTION: TR 10 SE SE
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW DETACHED CARPORT WITH 2ND FLOOR STORAGE ST RT 3, L ON ST RT 300 AT 4-WAY STOP GO STRAIGHT TO OLD BELFAIR
HWY, R ON MCKNIGHT RD TO SITE ADDRESS ON THE LEFT SIDE
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.: VB
Type of Use SF Insp. Area: No. of Bathrooms: 1 Occ. Group: U Lot Size: Deck:
Type of Work: ACC Fire Dist.: 2 No. of Stories: 2 Occ. Load: Building: Garage-Detached 1,296
Valuation: Building Height: 27 Occ. Status: Primary Basement: STORAGE 901
Manufactured Home Information Setback Information Shoreline& Planning Information
Make Length: Ft. Front: S 274.0 Ft. Shoreline: Ft. Water Body:
Rear: N 596.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: E 60.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No Side 2: W 415.0 Ft. Comp. Plan Desig.: Urban Growth Area
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty Type Qty Type By Date Amount Receipt
Lavatories 1 Ventilation Fan 1 Plan Check Fee GMM 11/4/2009 $468.49 S12009000
Water Closets (Toilets) 1 Planning Review Fee GMM 11/4/2009 $205.00 S12009000
Water Heaters 1 EH Plan Review GMM 11/4/2009 $103.00 S12o09000
Additional Plan Check Fee LDK 11/17/200 $104.65 S12009000
Building State Fee LDK 11/17/200 $4.50 S12009000
Building Permit Fee LDK 11/17/200 $881.75 S12009000
Mechanical Permit Fee LDK 11/17/200 $9.o0 S120090o0
Mechanical Base Fee LDK 11/17/200 $28.50 S12o09000
Plumbing Permit Fee LDK 11/17/200 $26.10 S12009000
Plumbing Base Fee LDK 11/17/200 $24 70 S1200900o
Total $1,855.69
BLD2009-00969 Please refer to the following pages for conditions of this permit. 1 of 5
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CASE NOTES FOR
' BLD2009-00969
CONDITIONS FOR
BLD2009-00969
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 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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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"jb�ic5r to\any further inspections being performed or approvals granted.
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3) Owner/Ageflt\tis ponsible 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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4) 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 apRrgvk.documents will result in failure of required building inspections.
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5) This structure is apptprrovvfed as un-heated space. If at any time this building is to be used for anything other than what.it is approved for, a change of use
permit shall be a�. 1 for, reviewed and approved prior to the change.
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6) All slabs within the heated space shall be insulated t a ' um R-10 for at least 24". Monolithic slabs shall be insulated around the perimeter from the
top of the slab to the bottom of the footing X
7) THE FOUNDATION SYSTEM SHALL BE PLACED O�UNDISTURBED, NATIVE SOIL. X
8) 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
Build"int,' Irtment prior to any further inspections being performed or approvals granted.
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BLD2009-00969 Please referto the following pages for conditions of this permit. 2 Of 5
Per IRC -SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
accord Wi` the applicable provisions of this section and the manufacturer's installation instructions.
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10) 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`Nc nowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
11) This structure has NOT been reviewed or approved as an Accessory Dwelling Unit(ADU): A second dwelling unit detached from an existing single-family
dwelling for use as a completely independent or semi-independent unit with provisions for cobki�4,,ating, sanitation and sleeping. ADUs are required to
meet the requirements under Mason County Development Regulations 17.03.029. X ,r-`
12) 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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13) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150' from an approved
access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such roads cor Nct with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
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14) 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
internationa)codes and Mason County Regulations unless a"Change of Use" permit is applied for, reviewed and approved.
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15) 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 ah6Z; llbe collected by the Building Department prior to any further inspections being performed or approvals granted.
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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 Wa�hin�gton. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revo +`
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BLD2009-00969 Please referto the following pages for conditions of this permit. 3 of 5
_) 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.
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18) 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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19) 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 be made prior to requesting additional inspections.
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20) All property lines shall be clearly identified at the time of foundation inspection. X
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21) 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 Couv,ordinances and building regulations.
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22) 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 re vented action from being taken. No more than one extension may be granted.
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23) Pressure"treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connector�s,� d flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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24) Retaining walls needed to support a surcharg4_�� as structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
25) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan" to ensure
these structures meet the setback conditions listed.
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BLD2009-00969 Please refer to the following pages for conditions of this permit. 4 of 5
40) 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 Sfie P gb"to ensure these structures are shown and meet the setback conditions listed.
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27) 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 found $ion drains within 30ft, down gradient of drainfield/reserve area.
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28) Approved)%r dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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29) Prior to final approval, all upland areas disturbed or newly creaib d�by_construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X `, ->
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 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 a-d structure fo' reyieN"nd inspection.
OWN ER OR AGENT: tom" l'l DATE: I
BLD2009-00969 Please referto the following pages for conditions of this permit. 5 of 5
o CONCRETE MECHANICAL MANUFACTURED HOME n
O _ Date �'��7_�v By // _--- O
Footings/setbacks Gas Piping - Ribbons
o Interior Date By Interior- Date By Dais By
o _ L
0) Exteror Date _ By Exterior-Date B S*t.ul) C
INSULATION v
Point Load/isolated Footings Date By
BG!SLAB INSULATION
Date By Data By FIRE DEPARTMENT
Foundation Walls Floors I Date By
Date 7 ,/ 7-(O By Data 110 By DECKS
FRAMING Walls Date By
Date ,r-L7-60 By ZH Data PROPANE TANKS
PLUMBING gly Date t3y
Date By _-
OTHER
Groundwork Attic
Type
Date r4 By Date By Date / 'a � By t
D.W.v DRYWALL TYpe-
� c O Int Brace Wall Date By
Date By oats By FINAL INSPECTION
v Water Line Fire Separation
Date By Date By Date �LS '<� By 0
Pass or Request Inspect. c
s Type of Insp. Fail Date Date Done By ' Comments
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RECEIVED
PLANNING - -a� Scorr NOV ' A
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wfill
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ALL SETBACKS ARE MEASURC
FROM THE FURTHEST \\�
PROJECTION OF THE BUILDING 8p -Z
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APPROVED .T `.
MASON COUNTY DGb PUA.&NING
SITE PLAN REQUIRED f0 BQN SITE 116
CH4NGE5 SUBJECT f0 APiFQ�Vk
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Name Parcel# I a�' -�`t 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 =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
54 eaves/gutters)
(� X =
Drivewa s 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) �aCj(p ,
If the Total Impervious Surface Are is LESS THAN 2000 Square Feet, ease read,acknowledge and sign below.
Based Upon the information you have prove d orm r Site 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.1
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for eview inspection as may be required.
X Owne/Agent/Contractor(circle one)Date:
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If th otal I pervious 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/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
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:
Page 2 of 2
MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST
Owner's Name: Date: 1 L4 Reviewed By:
Documents: � ,�
�uilding Permit A pplication Completed V tormwater Checkli(tj
_ �lanning Intake Checklist Completed,
�V Site plan includes: Allowable building area,roof ov rhangs,decks, etc.
re Apparatus Access Road info required? Yes/
energy Code Application Form- 0 Electric wall heater 0 Electric central furnace 0 LPG Furnace
0 Heat pump with electric furnace 0 Heat pump with LPG furnace 0 Boiler(heat type )
0 Other: Specify:
V Mechanical/Plpaaking Application - WATER HEATER FUEL TYPE/LOCATION
Engineering. Ye o Snow load: _%3Q Seismi 5+OAAS .
Stock Plan—approved snow load: Seismic: L�Z
M u acture Ho es—4 FLOOR P
oundat n Type: A I/Manu cture metho Engineered m ndatio Basement
Decks: C eered? Uncove d ove x 6 and over Construction plans req ' end.
Construction laps:_✓3 COMPLETE SETS
_ lans Legible _Recognized Scale _Elevation Views _Cross Section
foundation Plan _Roof Framing Plan _Floor Plan-Use of rooms noted(all floors)
_Floor Framing Plan-all floor levels including loft,crawlspace,etc. (<200 S.F. ??—stairs?)
.Dock Framin plan ;nr��pV porch framine
Plan Details:
Roof framing details,truss lay-out may be needed (Hip and girder location shown) AnQ i YlzQi1.. 4&—Fru,5,j
(D ✓ all Framing-Does bearing-wall height exceed 10'?(Engineering may be required)
✓Floor framing: Floor joists(size&spacing): r�.P�or beams:
v/�Vindow headers. Typical header: A-1 l y—2X t 6 ✓P�f"►
foundation: footing size, reinforcement JJJJJ U)/TrU�iS M
Y)Q Concrete Walls-Does Concrete Wall Height Exceed 8'?(Engineering may be required, see details)
v Landings at all exits?Less than 30"above grade` N
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Location(s):
indow Sizes Marked on Plans
raced wall panels(shear walls)marked on plans or lateral engineering? ( Q�j_/�q
2-story garage? (Engineering may be required) I"story of two story D1 —45%, D2 55%
COMM NTS: n + on
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+� be.. hpc, ,cd
ENGINEERING REQUIRED � iS
Braced wall panelsibrace wall lines are not marked on plans(R602.10)
Amount and location of bracing does not meet minimum required in Table R602.10.1
DESIGN CRITERIA: All notes and details required as a result of-the engineered analysis shall be transferred onto proposed
building plans. Wind 85 MPH, Exposure B (unless proven otherwise). Seismic Zone: Snow___psf.
IRREGULAR BUILDINGS R301.2.2.2.2
Irregular portions of structures shall be designed in accordance with accepted engineering practice. A portion of a building shall be
considered to be irregular when one or more of the following conditions occur:
1)Exterior braced wall line or BWP cantilevered or offset by more than 4'
2)Roof or floor is not laterally supported on all edges
2A)Portion of roof or floor extend more than 6 ft. beyond the braced wall line.
3)End of BWP extends more than I ft. over an opening more than 8 ft in width below.
4)Opening 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
MASON COUNTY PERMIT NO.?)1d;;k00q
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 �-�Q �
On the web www.co.mason.wa.us
APPLICANT�II FORMAzION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address AI k 1 31 M(,J<µ 1614 T- 1 ra Mailing Address
City State Zip Code ` 0`-Z 6— City State Zip Code
Phone 36,0.2751 2,55- ether Ph. Phone Other Ph.
Lien/Title Holder — C%— Contractor Reg. # Exp.
E mail address 55CQ V1(A- 'UC1 )blo 1'YlG%�1, . C0-ol E Mail Address
Drivers Lic.# 0T5".S6N7L - DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Conne t Water System Name of Water System
Well A Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No -oo In= Fire District C 2
Legal Description
Site Address(Please include street name street number and city) I i E-1 - 7Z
V1 Directions to site BW 1 3 N -To Bt LFAiZ , L- • Ou C-�I E 0M L►O tZ n,v "D 6i LpgI V_
4Owc r aSS
� Will timber be cut and sold in parcel preparation?Yes No
Is property within 200'of Saltwater 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 N
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ® SAS NAL ❑
Use of Building CARt'OR Describe Work C"7_6^ �
rQ No. of Bedrooms No.of Bathrooms_I Square Footage-1 st loor_ _ 2nd Floor—'
T 3rd Floor Basement D Covered Deck Other S .ft.
Attached tache rpo _ 1a%0 Attached etache
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.
PROOF CONTINU O F WORK IS BY MEANS OF A PROGRESS INSPECTION.
Xa 0 tZ Date:
Owner Owners Representative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date y
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department t4
Planning Department C�
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planninq Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES
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.# 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. t - 001 UU Fire District
Legal Description
Site Address (Please include street name, street number and city) 17;In dgn. K n i-- r
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 - 1 st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric— LPC-- Natural Gas_ Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs Heatpumps
Showers Spot Vent Fan Z
Water Heater i Propane Tank
Clothes Washer Gas Outlets
Kithen 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 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 Date: 11 1,4 O`I
! wner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYON 7T S POINT
Accepted by: Planning Pd Ck# Date L7` Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department '`17/01 Wit
Occ Grou Jdr--T e Constr.-U-15-
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