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HomeMy WebLinkAboutCOM2005-00087 Restrooms, Concessions - COM Permit / Conditions - 9/20/2005 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360)427-7262 go Y Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427 9670,ext. 352 Shelton, WA 98584 COMMERCIAL BUILDING PERMIT COM2005-00087 OWNER: MASON COUNTY PARKS DEPARTMENT RECEIVED: 7/14/2005 CONTRACTOR: LICENSE: EXP: ISSUED: 9/20/2005 SITE ADDRESS: Qlo� E SAND HILL RD BELFAIR EXPIRES: 3/20/2006 PARCEL NUMBER: 14644Ot) r LEGAL DESCRIPTION: N 3/4 OF NE EX PROJECT DESCRIPTION: DIRECTIONS TO SITE: Restroom / Concession Stand. Sandhill Rd. to Sandhill Park. General Information Construction &Occupancy Information No. of Units: Type of Constr.: V-B Type of Use: Insp. Area:Type of Work: ACC Fire Dist.: 2 No. of Bathrooms: 2 Occ. Group: U Valuation: $ 48,492.00 No. of Stories: 1 Occ. Load: Building Height: 12 Pre-Manufactured Unit Information Square Footage Information Make: Length: Lot Size: Model: Width: Building: 900 Year: Serial No.: Basement: Parking Spaces: Setback Information Shoreline& Planning Information Front: Ft. Shoreline: Ft. Rear: Ft. Slope: Ft. Waier Body: Shoreline Desig.: Not Applicable Side 1: Ft. SEPA?:Yes Comp.Plan Desig.: Rural Side 2: Ft. Fire Protection System Information Auto Fire Alarm System?: Emergency Key Box?: Standpipe?: Auto Fire Sprinkler System?: Access Road?: Fire Extinguishers?: Fixed Fire Suppression System?: Fire Hydrants?: Fire Lanes?: COM2005-00087 Please refer to the following pages for conditions of this permit. 1 of 5 Plumbing Fixtures Mechanical Fixtures FEES rype Qty. Type Qty. Type By Date Amount Receipt Hosebibs 1 Ventilation Fan 2 Ki�ohen Sink 3 Total Laundry Tray 1 Lavatories 3 Water Closets (Toilets) 6 Water Heaters 1 Drinking Fountain 1 CASE NOTES FOR COM2005-00087 CONDITIONS FOR COM2005-00087 1) MUST OBTAIN FULL APPROVAL OF GROUP A PUBLIC WATER SYSTEM FROM DOH PRIOR TO FINAL OCCUPANCY. MUST SUBMIT APPR ,V LETTER FROM DOH AS PROOF OF APPROVAL. X= 2) PU SUANT TO INTERNATIONAL CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEGIBLE FROM THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY BUILDING DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS. A REINSPECTION FEE, BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE INTERNATIONAL CODE WILL BE ASSESSED IF O ONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS. X 3) T u ture is approved as semi-heated space as identified in the Washington State Energy Code section 1310.2. 4) he approved site plan is required to be on-site for inspection purposes. If inspection is called for and the site plan is not on site, Approval WILL NOT be granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour will be charged and collected by the Mason C ing Department prior to any further inspections being performed or approvals granted. 5) 3 00 PSI CONCRETE WILL REQUIRE SPECIAL INSPECTION IF THE QUANTITY EXCEEDS 50 CUBIC YARDS< LESSER AMOUNTS WILL REQUIRE AN APPROVED CONCRETE SUPPLIER TO PROVIDE YOU WITH A BATCH TIC WILL BE REQUIRED TO BE SUBMITTED TO THE SITE INSPECTOR FOR THE VERIFICATION OF MATERIAL USED 6) International Buildig Code CHAPTER 17: IN ADDITION TO THE INSPECTION REQUIRED I IBC, SECTION 109, THE OWNER OR THE ENGINEER OR ARCHITECT OF RECORD ACTING AS THE OWNER'S AGENT SHALL EMPLOY ONE OR MORE SPECIAL INSPECTORS WHO SHALL PROVIDE INSPECTIONS DURING CONSTRUCTION ON THE TYPES OF WORK LISTED UNDER CHAPTER 17. THE SPECIAL I DUTIES & RESPONSIBILITIES SHALL BE AS SPECIFIED IN CHAPTER 17. 1� COM2005-00087 2 of 5 7; _ Any changes in construction shall be reviewed by engineer of record and submitted in writing to the Mason County Building Department prior to construction. All engineering documents are a part of the approved set of plans and must remain attached thereto. If engineering documents are removed, approval will not be granted. In addition, a reinspection fee, based on the current fee schedule, minimum one-hour will be charged and Goffetf y the Mason County Building Department prior to any further inspections being performed or approvals granted. 8) an t approved building plans that affect compliance to the current Washington State Energy Code (WSEC), ventilation and Indoor Air u lity o (VIAQ), Building/Plumbing/Mechanical Codes and/or Mason County Regulations shall be approved prior to construction. 9) C NSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE A OPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in c ith the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mas n C u Building Inspector shall be made prior to requesting additional inspections. 10) Al building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The que t a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being ith Mason County ordinances and building regulations. X 11) ea d wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal st e onnectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. ecycla rials Solid Waste Storage: Space shall be provided for the storage of recycled materials and solid waste. The storage area hall be des n t eet the needs of the occupancy, efficiency of pick-up, and shall be available to occupants and h ulers 13) All appr ed plans are required to be on-site for inspection purposes. If inspection is called for and plans are not on site, Approval WILL NOT be granted In addi ion, a reinspection fee, based on the current fee schedule, minimum one-hour will be charged and collected by the Mason County Buildin 'artm nt prior to any further inspections being performed or approvals granted. X 14) Water qual t i of to be degraded to the detriment of the aquatic environment as a result of this project. Pri r to final approval, all upland areas disturbed or newt i "r ate y construction activities shall be seeded, vegetated or given an equivalent type o ction (silt fencing or straw matting . 16) _ Appr ed per mensions and setbacks on submitte(ite plan. Setbacks are measured from the furthest projection of the structure. 17) T e approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment. uctures and /or land modifications (grading, cuts, fills, etc.) required in the geotechnical report/assessment, may require a seperate permit. The geotechincal report/assessment shall remain attached to the approved building plans. X COM2005-00087 3 of 5 This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at anytime after work is Commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of work is by means of a progress ins ectio .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 pr a struct e for review and inspection. OWNER OR A-G _ DATE: 2 U — C S COM2005-00087 4 of 5 �� FI4ornwUion RECEIVED CR 54388 iN N To Build On as co.m.am as sbe„rw DEC 0 5 2005 ❑ 111 702DMADMCOM �!6o-h)d Reckord SION ❑ POR7LAXD DIVISION 241356THAVEW 602 NO.CUT-TER CR.SUITE 460 MOUNTLAKE TERRACE,WA 98043 TACOMA.WA 98499 PORTLAND,OR 97217 (425)248-2400'FAX(425)248-2401 (253)589-1804-FAX(253)585-2136 (503)289-1778•FAX(503)289.1918 CLIfN:T : ::'::::::: Macleod Reckord RRf3:iEC':NO::: ::::::= 742-50214 DATE October 26,2005 :L111E88 231 Summit Ave East PERMfF:;`20: W.O, _ 76502 Seattle,WA 98122 M,UNICIPLtCCfY:::;';':::>:>::>:>: Mason Coun Park Department A,i26NT40N:::::..........:Mr. Ed Macleod AFtCFIFFE T -- .........::::::::::.:.:::::: irO1dTRAGTOF PRCJJECT Sand Hill Paris Phase I PROJECT ADDRESS:»::>: 1000 NE Sand Hill Rd-Be)fair SAMPLE 1,0, SIZE(IN.) AREA(SO.IN.) DATE TESTED AGE AT ULTIMATE STRENGTH CHECKED FRACTURE TEST LES. PSI TYPE A 4 X 8 12.56 ill02105 7 61170 4870 DD D B 4 X 8 12.56 11123/05 28 90130 7160 DD D C 4 X 8 12.56 1 11t23/05 1 28 90190 1 7180 1 DD I D D 4 X 8 12.56 HOLD H DISCARD SAMPLE AND TESTED FIELOSPECIMENS SLUMP SAMPLING AIR TEMP BREAK NEOCAP OTHER IN ACCORDANCE WrTH: ASTM ASTM ASTM ASTM ASTM ASTM ASTM ASTM C-31 B C-143 0 C-172 0 C•231 ❑ C-1064 E3 C-39 H C-1231 0 TIME,TEMP.8 12:40 PM HOF DATE MIXING DESIGN SAMPLE WEATHER PARTLY CAST 26-OCt-05 PLANT HARD ROCK STRENGTH 3000 TYPE CYLINDER CLOUDY PROPORTIONS: CEMENT C'SE AGG. FINE AGG. WATER ADDED ADMIXTURE ADMIXTURE ADMIXTURE 520 1830 1450 0 N/A N/A N/A TYPE OF CEMENT I it CONC.TEMP. 70eF SLUMP 4 ins. AIR N/A % QUANTITY 3 OF 17 C..Yd TRUCK 10 TICKET 207346 SUPER PLASTICIZED SLUMP N/A MIX if 51N2SKB POUR LOCATION AND NOTES: FOOTINGS FOR CONCESSION BUILDING PERIMETER DATE RECEIVED: October 27,2005 PSI ON SITE FOR REINFORCING STEEL AND CONCRETE SAMPLING AND TESTING AS REQUESTED. REINFORCING STEEL WAS VERIFIED FOR PROPER SIZE,GRADE,SPACING AND CLEARANCES AS PER APPROVED PROJECT PLANS. CONCRETE WAS PLACED BY PUMP TRUCK AND MECHANICAL VIBRATOR. MADE 7 SETS OF FOUR CYLINDERS FOR TESTS. TO THE BEST OF THE INSPECTOR'S KNOWLEDGE.WORK PERFORMED WAS TO PLANS,CODE AND SPECIFICATIONS. EQUIPMENT IDENTIFICATION AND S/N#: COPIES TO: INSPECTOR: DATE: I7EjVIS INSt?LCTED�?:CS:�:�:�:�:�:�:�:�: x CLIENT CONTRACTOR BRUCE RIDGLEY October26, 2005 APP.f�O�FED":PIATIS1CRE ENGINEER x BUILDING DEPT, FIELD CONTACT: DATE: ARCHITECT SUPPLIER :::CONE MMWG::i: ::;::;x.: .•. . .-.:•.. N0.NC0NFQF'mING:::: : _._. 'r Ns fePod Is Pfov4ed for the IW0,Tn21f n of the citent only. The reproduction of Otis report,by any motnod,and Its tmm N tal to a third party,by any NAME ON OFF ST OT MILES m Cu .esow;n No,v ghovt the hill P—ssion of Profesymal Service industries,Inc.,Is proNbted.' 'T1us cenlraeon 811 s to the sceuracy of the r"Oft obtained from the actual last performed andbr observaaom made w%Nn me defined swpe of EI.R IDG LEY 10:00 2:30 1T Oro—k.Ceibf1=b n shed not be construed to repfesera an Inspection,*Wmsl a ax Vonc*of other assoogled v 04 a a Mnenty of design of ty Of Ine spedfiaeon repulrements' TOTAL HOURS Certified Report by Professional Service Industries: Deane H.Ramsdell I Date (November 30, 2005 TS-98-1 Mason County Parks P.O. Box 2286 Shelton, WA 98584 June 15, 2006 _ Mr.William Beisley Beisley, Inc. P.O. Box 2355 Belfair,WA 98538 Dear Mr. Beisley, Yesterday, a meeting conducted at Sandhill Park including you, County staff, and Ed MacLeod to review additional details of the Sandhill Park development project. During the meeting, you mentioned that the Fire Inspector required a letter from the County explaining our plans for the concession building relating to the fire suppression system and the type of stove that will be included in the building. As you know, the project specifications did not include a stove for installation in the building during the project. The County intends to contract the concession operation out to a private concessionaire. The concessionaire will provide the stove for the concession operation and once that process is completed, the County would contact the Fire Inspector for a building inspection to obtain the final approval. In conclusion, I am sending you this letter at your request and I hope this will satisfy the needs of the Fire Inspector? If more information is required contact me at your convenience, My telephone number is (360)427-9670, ext. 535. Sincerely, John Keates Parks Department Director CONCRETE MECHANICAL MANUFACTURED HOME �✓'� N - FoatirW I Setbacks Date By Ribbons o Die �� �`�y--By��'� Gas Piping Date By wFoundation Wald Date By Set-up Dace By INSULATION Date BY BG I slab Insulation doors FINAL I NSPECTION Date By Date By Gate By FRAMING Sj-L' RL5g z'10,rwaiis FIRE DEPARTMENT Date By Date By Date By PLUMBING Attic OTHER G Date By f}•�f} 1?6"Y f J Groundwork Gate yI T By WALLBOARD NAILING o.w.v Date By 1^'- DateO4'%k By?;C�, Water Line FINAL INSPECTION Date \�%A# By KLS Date i3`c�,CBY Dste BY Type of Insp. Pass/Fail Request Date Inspect. Date Done By Comments O D fk,,v6(:j,4 I zyox- /I j V&fr 06 0 CD CDz (inn o O c c =emu &) tl �o� v5 �l t"_ bS fSt>iA milstro) - o� AM � MW id kVX Ak 4-F � D y tilo 5 a k viv - t v M D v�°� gs. I zl b� I I Za10 s LS z u' ]- 0, cn cD T 5ut,: All �tS v F� oY l0 tiro oY t(I& S R=5, Mkt t F/ ryl� iL -Z6 ps cf -z7-c;,G Page No. 1 CASE HISTORY FOR CASE NO.: BLD97-1411 MASON COUNTY PARKS NE1000 SAND HILL RD BELFAIR 03/31/00 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By BLDA010 Application received 12/18/97 / / 12/19/97 DONE TMJ 12/19/97 TMJ BLDA500 (F) Issue building permit / / / / 07/22/99 DONE KS 07/22/99 KS BLDA560 Permit cancelled / / / / 01/21/00 DONE KW 01/21/00 KW BLDA910 Meeting / / / / 01/20/98 Spoke with Mike Byrne. They are in TLG 01/22/99 TLG process of doing the things EH required. This permit should still be considered active as the MH is there on a storage permit. BLDB110 Structural Plan Review 12/31/97 / / 01/02/98 DONE TLG 10/09/98 TW BLDB130 Planning Review 12/22/97 / / 12/30/97 REVISED SITE PLAN NEEDED; PLANS TURNED DONE AHB 10/09/98 TW IN LATE ON 12-23-97. AHB BLDB134 RLC Review / / / / 12/30/97 SITE ALREADY USED FOR RESIDENCE. AHB N/A AHB 12/30/97 AHB BLDB135 Addressing 12/19/97 / / 12/19/97 DONE GMM 12/19/97 GMM BLDB138 Planning Pre-Review 12/19/97 / / 12 7 DONE MMS 12/22/97 MMS BLDB200 Environmental Health Review 01/02/98 / 1/0 eed to show�jlot pla with reserve HOLD CAJ 01/09/98 CAJ ddrayr/q/rea and ha the septic tank pump i ed. BLDB200 Environmental Health Review 02/ /99 / �0 / Rec of plan with reserve area and DONE CEB 02/10/99 CEB n��e i pumpers report. BLDB210 Water Adequacy O1/ 9/98 / / 01/09 ' j oved wate system HOLD CAJ 01/09/96 CAJ BLDB210 Water Adequacy 04/2 /98 / / 04/28/ ` v REQUEST ISSUE BUILDING PERMIT HOLD CAJ 04/28/98 CAJ BEFORE APP EAL OF THE WTER SY;STEM WAS SUBMI TO DR. TRUCKESS ON 4/11/98. . Truckess wanted a list of what was needed for approval of the water system before he would make a decision. I talked with Mike Byrnes and told him what was needed. BLDB210 Water Adequacy 07/16/99 / / 07/16/99 see condition DONE CEB 07/16/99 CEB BLDC200 MH Setup inspection 07&/99 07/28/99 07t28/9 POST ADDRESS AS PER CONDITION #5 ON FAIL TR 07/29/99 KW � IT. 2 2SUPPORT AT 4' O.C. _ IN. 0 INSTALL WATER LINE AND INSULATE W / INSTALL"DRYER-vExT. INSTALL WATER HEATER TEMP PRESSURE RELIEF INE TO EXT AND TURN DOWN W/90 v DEGREE ELL 6" TO 24" ABOVE GRADE. TOP OF SKIRTING JOINT W/WALL CAULK M F LENGTH 7 EPAIR ALL RIPS IN BELLY WRAP. NSTALL HEAT CROSSOVER DUCT. INSTALL TRIM AT MARRIAGE LINE. 10. ESPREAD VISQUEEN O 2 G MASON COUNTY PERMIT NO. ' 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 n(�(-) On the web www.co.mason.wa.us APPLICANT INFORMATION E1Ae>04 CC)UNT'r cry CONTRACTOR INFORMATION Owner 'Nu, PARKS DIR Company Name Mailing Address 3S:-X r7 h Mailing Address City State AT 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 /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site ' Will timber be cut and sold in parcel preparation?Yes/No Is property within 200' of Saltwater Lake` t�?,! River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs �/o Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building ,., Describe Work ` No. of Bedrooms No. of Bathrooms—s—Square Footage- 1st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/ No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X <� .7 C 6))WA!:h MAC.Lrx_1') Date: Owner/~Owners R60resentafi_ /Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW AEMVED D NIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning 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 MICHEAU PARKS Company Name Mailing Address 7 t Mailing Address City TVA"'ll State VIA Zip Code City State Zip Code Phone 4Z7_` Other Ph. Phone Other Ph. Lien/Title Holder bkv-- Contractor Reg. # Exp. E mail address UA)CtI" 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. I Fire District Legal Description l f= Ai -HI"'1E1yT) Site Address (Please include street name, street number and city) 1�113 HILA, li-.0.. Directions to site r'"-,'�s1%fir 1 �1�' +-�U{2h' IUM 5TA,T1k_"RC0115 ' -0 T l^LI%, i.); 6 SAPI0 HILA.- cc'P-M1 IiorU 3 w ,,I) Ic SA►-IofalU,_ )l1r;1 ptc};:1, Is property within 200'of Saltwater No Lake 'A C River/Creek 'L Pond Wetland Seasonal Runoff No Stream Slopes or Bluffs > 15% 'rc TYPE OF JOB - New Add Alt Repair Other Use of Building FU15L i r,,i±L 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— LPCL___ Natural Gas Heat Pump_ Toilets 4 Type of Unit No. of Units Fees Bathroom Sink Furnace rlL-tNe,HEAL Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other tWe504114- Other cc�i` '1 ►►�1t�T I +dNc,fwH17,1 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 5-"/! 1-1 L_ ( E ARO F' +-Fot7 Date: 7/1 le,S Owner Owners Re resentativ✓e Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW AP OVED DENIED NOTES Building Department %-� i t ao Occ Group—Type Constr. ' Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES MASON COUNTY PERMIT NO. 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 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 /WATER SYSTEM I[NFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site 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 Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - Newer Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/ No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative, or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. r X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee 07� 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 Building Permit Application Sand Hill Park Attachment Legal Description: All of the north three quarters of the northeast quarter of the northeast quarter of Section 30, Township 23 North, Range 1 West, W.M., together with all improvements, containing 30 acres, more or less, according to the government survey thereof. Plumbing and Mechanical Permit Application Sand Hill Park Attachment Legal Description: All of the north three quarters of the northeast quarter of the northeast quarter of Section 30, Township 23 North, Range 1 West, W.M., together with all improvements, containing 30 acres, more or less, according to the government survey thereof.