HomeMy WebLinkAboutBLD2012-00802 SFR - BLD Permit / Conditions - 12/14/2012 (2) 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 279
1r Shelton, WA 98584
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RESIDENTIAL BUILDING PERMIT BLD2012-00802
OWNER: DAVID NAVARRO RECEIVED: 10/18/2012
CONTRACTOR: ADAIR HOMES INC (360) 352-8571 LICENSE: ADAIRH`262RZ EXP: 1/9/2013 ISSUED: 12/14/2012
SITE ADDRESS: 3937 NE OLD BELFAIR HWY BELFAIR EXPIRES: 6/14/2013
PARCEL NUMBER: 123091400010
LEGAL DESCRIPTION: TR 1 OF SE NE
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR ST RT 3 TO BELFAIR, L ON ST RT 300/ FOLLOW TO OLD BELFAIR HWY,
THEN TO SITE ADDRESS ON THE LEFT, SHARED DRIVEWAY WITH
3931,3933,3935
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.:
Type of Use: SF Insp. Area: No. of Bathrooms: Occ. Group: Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No. of Stories: Occ. Load: Building:
Valuation: $ 365,788.60 Building Height: Occ. Status: Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft, Front: N 215.0 Ft. Shoreline: Ft. Water Body:
Rear: S 180.0 Ft. Slope: Ft. SEPA?:
Model: Width: Ft, Side 1: E 565.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: W 690.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 4 Ventilation Fan 5 Plan Check Fee GMM 10/18/201 $ 1,509.78 S120120000000i
Lavatories 7 Exhaust Hood 1 Plan Check Fee GMM 10/18/201 $ 68.00 S220120000000(
Bath Tubs 3 Dryer Vent 1 Planning Review Fee GMM 10/18/201 $205.00 S220120000000i
Showers 2 Fire Warden Review GMM 10/18/201 $73.00 S220120000000i
Water Heaters 1 EH Plan Review KKK 10/18/201 $ 103.00 S620120000000t
Clothes Washer 1 Water Adequacy Plan Revi KKK 10/18/201 $ 103.00 S120120000000i
Kitchen Sink 1 Building State Fee DLC 11/16/201, $4.50 S2201200000001
Dishwasher 1 Building Permit Fee DLC 11/16/201. $ 99.50 S2201200000001
Hosebibs 2 Building Permit Fee DLC 11/16/201: $2,383.85 S120120000000i
Laundry Tray 1 ADJUST--Plan Check Fee DLC 11/16/201: $ 36.40 S120120000000i
Mechanical Permit Fee DLC 11/16/201, $67.20 S120120000000(
Mechanical Base Fee DLC 11/16/201: $ 2&50 S120120000000(
Plumbing Permit Fee DLC 11/16/201: $ 188.90 S120120000000i
Plumbing Base Fee DLC 11/16/201 $ 2470 S120120000000t
Total $4,895.33
BLD2012-00802 Please refer to the following pages for conditions of this permit. Page 1 of 5
CASE NOTES FOR
BLD2012-00802
CONDITIONS FOR
BLD2012-00802
1) PER TITLE 14 MASON COUNTY BUILDING CODE- CHAPTER 14.17, STANDARDS FOR FIRE APPARATUS ACCESS ROADS- 14.17.110:
A fire apparatus access road in excess of 14% grade and more than 150'to new residential or commercial structures will require an automatic
fire sprinkler system installed. Contact the Mason County Fire Marshal at(360)427-9670, extension 352, for further information.
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2) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800/4,7-Q982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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3) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour) will be charged and must be collected by the Building
Xepa� for to any further inspections being performed or approvals granted.
4) Own
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is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
5) 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 mo a f pproved documents will result in failure of required building inspections.
6) 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
Buildi egartment prior to any further inspections being performed or approvals granted.
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BLD2012-00802 Please refer to the following pages for conditions of this permit. Page 2 of 5
7) Washington State Energy Code Compliance has been approved as follows:
Heat Type: Electric wall mount heaters, Compliance Method: Prescriptive option III, with table 3A upgrades:
Window(Max U-Factor):0.28, Skylight(Max U-Factor):0.50, Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-38, Ceiling
Insulation R-38 advanced or R-49 standard..
In addition the following credit from Table 9-1 shall be completed:
Option 3A: insulation upgrades listed above, and
Option 55fA::/Water heating, Electric min. EF 0.93
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8) A permanent certificate, completed by the builder or registered design professional, shall be posted within three feet of the electrical distribution panel.
The certificate shall list the predominant R-values of insulation installed in or on ceiling/roof, walls, foundation (slab, basement wall, crawlspace wall
and/or floor), and ducts outside the conditioned spaces; U-factors for fenestration; and the solar heat gain coefficient(SHGC) of fenestration. Where there
is more than one value for each component, the certificate shall list the value covering the largest area. The certificate shall list the type and efficiency of
heating, cooling, and service water heating equipment, duct leakage rates including test conditions as specified in WSEC Section 503.10.2, and air
leakage results if a blower door test was conducted.
Building envelope air leakage control shall be considered acceptable when tested to have an air leakage less than 0.00030 Specific Leakage Area (SLA)
when tested with a blower door at a press of 50 Pascals (0.2 inch w.g.). Testing shall occur at any time after rough in and after installation of penetrations
of the building envelope, including penetrations for utilities, plumbing,electrical, ventilation, and combustion appliances and sealing thereof. The blower
door test results shall be recorded on the permanent certificate required located near the electrical distribution panel. Air leakage testing is not required
for additions less than 750 square feet. Reference WSEC 105.4 Certificate and 502.4.5 Building Air Leakage Testing.
Compliance certificates are available online at the WSU Energy program website titled, "WSEC 2009 Certificate" and are available in %4 or'/sheets. The
Mason County Permit Center will also have some available.
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9) A minimum of 50 percent of all luminaires shall be high efficacy luminaries unless lighting compliance was approved using the options available in WSEC
Section 1520 or 1530. Luminaires providing outdoor lighting and permanently mounted to a residential building or to other buildings on the same lot shall
be high efficacy luminaries unless permanently installed outdoor luminaires are controlled by a motion sensor(s)with integral photocontrol photosensor or
installed in or around swimming pools or water features. All fluorescent fixtures must be fitted with T-8 or smaller lamps (but not T-10 or T-12 lamps).
Xefere C 505.
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10) WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85
MPH.
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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.
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BLD2012-00802 Please refer to the following pages for conditions of this permit. Page 3 of 5
12) 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/age nt/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 i��k wledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X �� ,
13) 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 !VZlb collected by the Building Department prior to any further inspections being performed or approvals granted.
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14) 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 atio .
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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.
16) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance u ion, must be reviewed and approved by Mason County prior to construction.
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17) 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
Inspec 'all e made prior to requesting additional inspections.
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18) All property lines shall be clearly identified at the time of foundation inspection. X
BLD2012-00802 Please refer to the following pages for conditions of this permit. Page 4 of 5
19) 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
Maso ordinances and building regulations.
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20) 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
hold7N/1__r
vented action from being taken. No more than one extension may be granted.
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21) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR� AY.
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22) Approved er dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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23) Prior to final approval, all upland areas disturbed or newly err tad by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
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24) Temporary erosion control measures must be implemented to prevent water quaff¢'eg�adation of adjacent waters or properties. Silt fencing must be
installed and maintained until upland vegetation has become established. X .jam/
25) All construction and demolition debris must be removed from the site after project completion. Prop sposal of construction debris must be on land in
such a manner that debris cannot enter or cause water quality degradation of State waters. X
26) Xppli �ac, nowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Residential 5 zone.
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 a5 pess to e above described property and structure for review d inspection.
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OWNER OR AGENT: DATE:
BLD2012-00802 Please refer to the following pages for conditions of this permit. Page 5 of 5
1 N
Name r � Parcel# �Z�j�l _ILA( 1('���8 u I tBI® A' d�O�
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 2.
'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.
ZCommon 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
r
Buildin s X _ (71
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X L
co, X 101 = w4p 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) o
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-
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.
Pagel of 2
Name �1C 1�� Parcel# 12�jM J L'—QOO J U 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)�e 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 dAf 6L4 Owner/Age ontractor rcle one)Date:
Page 2 of 2
PLANNING:
ALL SETBACKS ARE MEASURED LANNING
FROM THE FURTHEST
PROJECTION OF THE BUILDING
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AP JROVED
MASON COU 4TIIY DC D PLANNING
SITE PLAN RE UIRED TO BE ON SITE
CHA GES S BJECT TO APPROVAL
By Date
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PLANNINGPlanner: Grace (A"D-Haniebecca
MASON COUNTY PLANNING INTAI E CHECKLIST
Owners Nam Date:
Project: n F kk) Commercial ?: yes Eo
Site Plan:
North Arrow ,I / � -1�
''Property Dimensions: `�5d x aq 5 Irregular Shape ? yes no
,,e''Streets and Driveways shown . 11 V, a)
Road Frontage Name:
All Existing Structures Shown with setbacks and use. - r-,6unt4 L►►1aJ
-Well Location, Septic and Drain-field show with setbacks own
—��rrtified Surface water(stream ,ponds,shoreline,wetlands,natural/historic drainage, defined drainage)
,,E'ropography(slopes) -Fro rY-) 40rn E
❑ Minimum Structure Setbacks (direction/setback):
F Y R. J / ( / Si 1,51o5 S2 VJ
till and Drainage Easements: yes C�J (if yes enter condition 45022)
�� ty
,,2-Other Easements
'Accessory Appurtenances� pv)paffe-
,,,Er Does site plan show landings at ll exits ?
no Parking spaces allotted: yes no
❑ Variance applied for: yes
tCounty Access Permit Needed (add condition 900 10
ate Access Permit needed (add condition #0020) Pr t Ve a -'
a-Standard Planning conditions: 95019 and 4700
❑ Are there any impediments (dogs/gates) that may restrict access to your site? yes io
❑ If yes, do we need appo' en . es no wU,,e-- POS-f--A,:JI&1ss
❑ Is site clearly marked? Address J Name Other A5 4
UGA'S L�
ALLYNBELFAIR/SHELTON ur LAND DESIGNATIONS
) GC ) PF ) R-1 ) R 1P ) RC 1 ) 5 ) AGRICULTURAL
POS ) FR ) R-2 ) R-1R ) RC 2 5 ) LTCFL
) BI ) GC-CI ) R-3 ) RI ) RC 3 ) 10 ) IN-HOLDING
HC ) LTA R-5 ) RT ) RMF ) RR 20 ) TRIBAL
) T ) MII I ) R-10 ) RT/RTC ) RNR
MHe ) BP I ) VC ) RAC
Critical Areas: (streams, on , shoreline,wetlands &steep slopes)
Shoreline Designation: /A ❑ Urban ❑ Rural ❑ Conservancy ❑ Natural
Water Body:
SEPA: yes no �,� Flood Plain: yes no o Map #
Aquifer Recharge: yes no w�wn Map#
Tads/Cases:
RLC/SPI: 6 year Reforestation: yes no
Eagle Nest Tag: yes no Other/North Bay Sewer: ye. no
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BUILDING �{
MASON COUNTY PERMIT NO., C IC I -CXL
BUILDING PERMIT APPLICATION ���
426-W.-C-edar• P.O. Box 186; SheltorT, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 .-r
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner sli i tolP V)alLIDM Company Name ADAt R H OM ES 1 N G
Mailing Address?.L?� t\c-- (M 3fIfair Ht Mailing Address 2 O KD A,lE Svc
City State �A A-- Zip Code City 0L`Q-1PtA State A Zip Code 512
Phone' (c -9'+-+-(` ,151 Other Ph. Phone_'3G0. 352. 165-7 1 Other Ph.
Lien/Title Holder Contractor Reg. # 2 ?-RZExp.aF2 1201
E mail address _li1tn1n11n,t t°,ill'-411% C9 1• l E Mail Address rc� hot�tnrtc cay'-)
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic � Existing Septic
Connect t9 Water System ` Name of Water System
Well Water System Name of Water System 1
PARCEL INFORMATION- 12 Digit Parcel No -I -000 Fire District
Legal Description SC L a J 3 1— 01 `\1
Site Address (Please include street name, street number and city) 1 I O =11�j
V&
Directions to site ti`��` v- - -A--�r1 1( 1 Gt/l
Will timber be cut and sold in parcel preparation?Yes -
Is property within 200'of SaltwaterLake River/Creek N,, Pond .. 1Lh
Wetland �Seasonal Runoff 1170 Stream M,, Slopes or Bluffs > 15%_ Nn
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 RE IDENCE N SEASONAL
Use of Building Describe Work eat In4�1A' S �C�IC.�il� S�� riyi <<i f�
No. of Bedrooms No. of Bathrooms 3-C-,) Square Footage- 1 st loor A(p_L(o 2nd Floor 1!�23 n
3rd Floor B ent Deck overed Deck 2 Other Sq. ft. _
Garage Attached Detached Carport i7X 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 n
Installer Name Certification No.
OWNER/BIALDER 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 J
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained v
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 accu to and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF C NUATI N F WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date :Id'Al
O ner/O ners Re r entativ /Co indicate which one
FOR OFFICI L USE BEYOND THIS POINT Accepted b I Date I
DEPARTMENTAL REVIEW APP OVED DENIED NOTES
Building Department - cu.bi +V Fifes Save.—
Planning Department r j P-Al ,&7 It �r_ 1
Environmental Health Department
Public Works Department
Fire Marshal
FEES
BuildingPermit Fee Site Inspection
Plan Review Fee 6 49 /&1 tr/• /P EH Review Fee
Plumbing & Base Fee 8'90 Planning Review Fee
Mechanical& Base fee Rf sv t (o 7 Other
Wood/Gas/Pellet tove Fee V State Fee �!_
Violation Fee Mt-- Pre-Paid at Submittal /$]
Valuation$ _3 Ce 5 78$. fvU TOTAL FEES
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� 4-1�
COUNTY PERMIT NO.�)PLa11-DINIGASON
-HANICAL- 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 \ � r\iGQ le, Company Name S 14C-
Mailin Address 2055 N 9— O�G I Y t ^ 1 Mailing Address
City State LA A- Zip Code 119`2 City Ol M PI fl State h _ Zi Code SI 2
Phone`1a0-Ll�--0' 5f p
Other Ph. Phone�O'�Z• � Other Ph.
Lien/Title Holder Contractor Reg. #A AI —ZH*26Zp� p
E mail address I-Tw- Li 1411 ci rn `� t CGVt� E Mail Address Lxp.
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 - I -n Fire District
Legal Description 23 j
Site Address (Please include treet name, street number and city) 150 Vv r
Directions to site. 1 fit
Is property within 200'of Saltwater Lake R' er/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New—C _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 LPG_Natural Gas_Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs " 3 Heatpumps
Showers 2-. Spot Vent Fan
Water Heater I Propane Tank
Clothes Washer I Gas Outlets
Kithen Sinks I Wood/Gas/Pellet Stove
Dishwasher I Kitchen Exhaust Hood i
Hosebibs 2- Dryer Vent I
Other f �Prxr- 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 CONTI UATION OF.WORK IS BY MEANS OF A PROGRESS INSPECTION. `
X vl Date:fir/ fh`
Owner/Own e Repres tative ontr (indicate which one)
FOR OFFICIAL USE BEYQNQ THI POINT
Accepted b Planning Pd Ck# Date L e t� $Id Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Grou Type Consir.
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