Loading...
HomeMy WebLinkAboutBLD2006-01794 Final SFR - BLD Permit / Conditions - 2/5/2008 r r 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 186 Shelton,WA 98584 RESIDENTIAL BUILDING PERMIT BLD2006-01794 OWNER: BRIAN DRAKE RECEIVED: 10/3/2006 CONTRACTOR: HILINE HOMES 360-598-1849 LICENSE: HILINH981 BT EXP: 2/10/2008 ISSUED: 12/14/2006 SITE ADDRESS: 161 E PEEBLES CT SHELTON EXPIRES: 12/14/207 PARCEL NUMBER: 321275400117 LEGAL DESCRIPTION: LAKE LIMERICK 5 TR 117 PROJECT DESCRIPTION: DIRECTIONS TO SITE: New SFR Mason Lk. Rd. to right on Old Lyme Rd. Left on Peeble Ct. to 160 E. Pebble Ct. STOCK#2003-0006 on left. General Information Construction &Occupancy Information Square Footage Information No.of Bedrooms: 3 Type of Constr.: VB Type of Use: SF Insp.Area: No. of Bathrooms: 3 Occ. Group: R-3 Lot Size: Deck: Type of Work: NEW Fire Dist.: No.of Stories: 2 Occ. Load: Building:1,768 None 0 Valuation: Building Height: 22 Occ. Status: Primary Basement: COVPCRyM 198 Manufactured Home Information Setback Information Shoreline&Planning Inform Make: Length: Ft. Front: S 50.0 Ft. Shoreline: Ft. Water Body: Rear: N 50.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Side 1: E 36.0 Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: W 10.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Plan Check Fee KKK 10/3/2006 $222.27 S22006000 Hosebibs 3 Ventilation Fan 4 Planning Review Fee KKK 10/3/2006 $155.00 S22006000 Kitchen Sink 1 Dryer Vent 1 Building State Fee ARC 10/10/200 $4.50 Si2006000 Lavatories 3 Building Permit Fee ARC 10/10/200 $1,111.35 S12006000 Water Closets (Toilets) 3 Mechanical Fee ARC 10/10/200 $46.90 sl2bbsbbo Water Heaters 1 Mechanical Base Fee ARC 10/10/200 $23.50 S12006000 Bath Tubs 2 Plumbing Fee ARC 1 011 0/2 0 0 $89.00 S12006000 Clothes Washer 1 Plumbing Base Fee ARC 10/10/200 $20.00 S12006000 Planning Dept. Permit RDH 12/5/2006 $50.00 S12006000 EH Plan Review ADR 12/8/2006 $75.00 S12006000 EH Permit Revision CMH 12/14/200 $35.00 S12006000 Total $1,832.52 BLD2006-01794 Please refer to the following pages for conditions of this permit. 1 of 5 —r CASE NOTES FOR BLD2006-01794 CONDITIONS FOR BLD2006-01794 1) This p rc�I is located in a smoke management zone. Please contact a fire warden at(360)427-9670 ext. 459 for further information. X 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 1-800-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 0 /a d4 3 The international code requires a fire ap paratus pparatus 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 r gonnect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X j 4) Approve per limensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 5) 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 'or o any further inspections being performed or approvals granted. X_ 6) In accordance with international codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus Access Roads," all new structures that require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from the access road. The numbers shall also be plainly visible and legible from the street or road fronting the property and shall contrast with their background. Mason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted by the jurisdiction and the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting inspectio ,} 7 X ,,��''yy 7) 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 removpf " roved documents will result in failure of required building inspections. X BLD2006-01794 Please referto the following pages for conditions of this permit. 2 of 5 9) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X ' 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 4tm nt prior to any further inspections being performed or approvals granted. 10) Washington State Energy Code Compliance has been approved using the following: Heat Type: Electric or other fuels, Compliance Method: IV, Window(Max U-Factor):0.40, Skylight(Max U-Factor):0.58, Doors (Type/Ma U-Factor):0.40 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38,Vault Insulation R-30, Slab Insulation R-10. X h7 11) Per 2003 IRC - SECTION 1609 -WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609 BASIC WINQ SPEED (3-SECOND GUST)the wind speed for Mason County is 85 MPH. 12) Per 2003 IRC - SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in accordan�?ygth the applicable provisions of this section and the manufacturer's installation instructions. X 13) Stock Plan Identification number: 2003-0006 This project is approved subject to the provisions identified the Mason County Stock Plan Policy. The site plan approved by the Planning Department, original building plans, and all attachments approved by the Mason County Building Department shall be available for the Mason County Building Inspector at etch required inspection. X 14) 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). X 1`� 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 9�� e collected by the Building Department prior to any further inspections being performed or approvals granted. X 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 Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocation. X BLD2006-01794 Please refer to the following pages for conditions of this permit. 3 of 5 y i 17), Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact ` .1djacent 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, R is suggested to contact that office to review future planned work which may affect your projec X 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,r ul * n, must be reviewed and approved by Mason County prior to construction. it X 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& Ibe made prior to requesting additional inspections. X ` 20) All property lines shall be clearly identified at the time of foundation inspection. X 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 Maso C ordinances and building regulations. X 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 a evented action from being taken. No more than one extension may be granted. X 23) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, conne rs, flashing. Install metal connectors approved for contact with the new types of pressure treated material. X 24) 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. X 25) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X - BLD2006-01794 Please referto the following pages for conditions of this permit. 4 of 5 26)• _Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your • 'Approve S'. Plan"to ensure these structures are shown and meet the setback conditions listed. 27) • A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at (360)427-9670, a :- 50. The building permit will not be "finaled" until the permit holder can show proof that the access permit from Public Works has been "fi d" proved. 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 an str re or r - and inspection. /� OWN ER OR AGENT: DATE: �� l / Leo BLD2006-01794 Please refer to the following pages for conditions of this permit. 5 of 5 1 W o - CONCRETE ,D, MECHANICAL G,4 ow MANUFACTURED HOME o pate L�/ Footin !3etb 0 7 BY L� Ribbons rn Gas Piping InteriotDateZ - By� interior-Data By Date By rT1 Exterior Date 6Y Exterior pate B Wit- W INSULATION u Point Load!Isolated Footings pate By D Date By BG!SLAB INSULATION Z Data By FIRE DEPARTMENT Foundation Wails Floors Date By Date p- By Z Bye, DECKS FRAMING Walls Date By Dates•Z Byf7> yi °ata5'L - By PROPANE TANKS PLUMBING vault Date t3y Date BY OTHER Groundwork Attic Date By Date /40-7 BY Type:Date By o.w. 5 a v DR AL Type: Int Brace Wall Date By W Date S• BY BY-Lww. - �7 Date FINAL INSPEcnoN v 2 Water Line Fire Separation N 8 Date !. ? By ZW Date By Data Jam- By�3,,� Pass or Request inspect. c Type of Insp. Fall Date Date ©one By Comments i CD �• �� G�ri/� �ll�y CD o 1 8 5- -0 = -D7 L J vice- a o? � / 1/340-7 RM67 -S A— 1� A�V ,Ilk If 0 PLANNING , S / n 1$... I& -ni-4; L"-- L... t 1, wK' � i� vrr, � X Vl Jl x rl L" L",x �i *' r JLn �Ln a Clo a M lb S y � � � 2 � a � 3 � ✓ (/Lr L �, -- -- QUA 14 ()LC5 �AL-v��L 4 i o --a9 S LCAy To ru L GG L(N� U OJ R a Q' 9 S-LCAh 06/4 Do � � r/',�o °St�� � �rP( M p � 3,f' co �� 3c� APPROVED ASON COUNTY DCD PLANNING SITE PLAN REQUIRED TO BE ON SITE CHANGES SUBJECT TO APPROVAL BY Date r n MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT WSEC/VIAQ Compliance Application Telephone: 7 Z _ 67v Parcel#: 3ZIZ ,5�� 00IZ7 Type of project (%1 New Residence ( )Addition ( ) Remodel Total Sq. Ft. �/ 1S Floor: L 2 floor. , Heated Basement: of heated area:: Heating System Type: b Electric wall heater O Electric Central Furnace O LPG Furnace O Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type: O Other: Specify Glazing O Prescriptive Option see reverse side circle one: 1 II IV Percentage: Compliance z� Method O Component Performance , Chapter 5— Calculation worksheets required Check one:. �% O Systems analysis, Chapter 4 Whole House Ventilation system O Whole House Ventilation using a Heat Ventilation using exhaust fans&window or wall fresh air System vents (VIAQ 303.4.1) Recovery Ventilation System (VIAQ 303.4.4) Check one O Whole House Ventilation Integrated O Whole House Ventilation using an inline with a Forced Air System (VIAQ 303.4.2) supply fan. VIAQ 303.4.3> Window & Door Schedule (If needed, attach an additional sheet) Total Manufacturer Room/location U-Factor Size Quantity Square Tot of Feet Windows: ar e 3 S '0 x Wo i t ct.r a 35 h'D x WO I 2 y Ad i NAcc r �a Eh 3 3'O x 'D f I AaA 'C 3 5 'o x so -' L a� K I 35 'D X3' '0 x S '6 1 �0 ; [ SJ 3 `b x 5`o -'s 0 l 11AaA UViV., � 35 ("oV 51O 100 5 '0 x Windows: Total Sq. ft. 2 Doors: Doors: Total Sq. Ft Total window and door area Total window & door area 2-N /(divided by)total sq. ft of heated area 1 —1&8 = �� %of glazing MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Assistance Center SHELTON (360) 427-9670 BELFAIR(360)275-4467 Elma (360)482-5269 FAx: (360) 427-7798 WEB SITE: www.co.mason.wa.us P.O. Box 186, SHELTON 98584 2004 Washington State Energy Code (WSEC) 2003 Ventilation and Indoor Air Quality Code (VIAQ) effective July 1, 2004 Code Compliance Application Form The following information will be required for the WSEC and VIAQ plan review: 1. Complete the Washington State Energy Code/Ventilation and Indoor Air Quality Code (WSEC/VIAQ)application located on the reverse side. 2. Complete the window and door schedule on the reverse side. Include all windows, skylights, sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening dimensions of the windows and doors. Information about the U-factor of the window will also help to expedite the energy code review. If you are complying with the WSEC by prescriptive path and are using the area weighted average method you must include your calculations. 3. On your building plans note the location and fuel type of water heater, location of exhaust fans (bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and slabs, 4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 352. Additional WSEC and VIAQ compliance information is available on the internet at: http://www.energy.wsu.edu/code/ Prescriptive Requirements "for Group R Occupancy Climate Zone 1, Table 6-1 Glazing Glazing U-factor Door Wall Wall Wall Area %of U- Vaulted Above interior° exterior Slab° Option Floor Vertical Overhead" Factors Ceiling Ceiling3 Grade below 4 Below Floors on 10 2 iz grade Grade Grade I 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10 II* 15%* .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10 IV Unlimited Single Family Res .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10 (R-3)Only *Reference Case/Call (360)427-9670 ext. 352 for footnote information. Log&solid timber wall with a min.avg.thickness of 3.5"are exempt from the above grade wall insulation requirements. HiL ICE Window Schedule for H O M E S" Plan 1768 Manufacturer: Milgard Windows Inc. Type: Vinyl Model: Style Line Series U-Value = .35 Window SIZE GLAZING TOTAL LOCATION -Quantity widthxhei ht AREA SQUARE FT. 1 4'Ox4'0 16 16 Bedroom #3 1 6'Ox4'0 24 24 Bedroom #2 1 6'Ox4'0 24 24 Master Bedroom 1 3'Ox3'0 9 9 Master Bathroom 2 1'0x5'0 5 10 Entry 1 4'Ox3'6 14 14 Kitchen 1 6'Ox5'0 30 30 Dining Room `1 6'Ox5'0 30 30 Family Room 1 6'Ox5'0 30 30 Living Room 1 6'Ox6'10"SGD 41 41 Nook Total Window Area = 228 SQ.FT. otal Glazing Area = 228 SQ.FT. (228 / 1768) 0.13 x 100 = 13% (Glazing Area / Conditioned Floor Area) x 100 = Glazing Percentage If a sliding glass door option was chosen, switch the appropriate window with he slidinq lass door and use the calculation below. 1 'Ox6'10 SG 41 41 Ippropriate Room (239 / 1768) 0.14 x 100 = 14% Glazi ig Area / Conditioned Floor Area x 100 = Glazing Percentage All other doors,windows and skylights do not need to be calculated because they meet all minimum requirements Updated 5/5/05 Request To Revise An Approved Plan Permit Number: BLD200-tk---Q Ljcl L4 Name Parcel Number 31;.1 Project Address l �- — Phone Number daytime `4. tP Mailing Address iea E WA ----1 110 Please provide a complete,detailed description of the proposed revisions to the approved plans: . ► �.-tom , 56 1 L) - r n ° 5 CA-)�+- E=4a2 r � Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No Are the approved site plans included? D Yes 11 No Are the revisions clearly and accurately identified on the plans or addendum? ❑ Yes o No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes ❑ No If Yes,Has the engineer or architect approved this revision? ❑ Yes ❑ No Is a stamped and signed approval included with this request? ❑ Yes ❑ No (Note:No structural changes to a"designed"plan will be approved without the mitten consent of the engineer and/or architect of record.) Does the proposed revision modify the footprint or location of the structure? Yes ❑ No If Yes, Is a revised site plan,.with all new setback dimensions included with this request? Yes ❑ No Additional Information: Applicant's signature (; Date: Z Office use Only Received by. Date Sent Assigned To _Approved By Date ginal Valuation: $ Additional Valuation: $ 10('0 Sq.Ft. x$ $ H. !t)to U?-5 - Sq.Ft. x S s i6/p � Total New Valuation $ Additional Fees: —' Additional Planning Dept. S 5 New setbacks: Front Rear Additional Plan Review $ Additional Building Permit $ Side1_ �C / Side2 �/ Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. $ ' Other $ Total Amount Due: S Amount To Be Paid Up-Front$ Tah ieti.l Revised SRG i^t2/20M MASON COUNTY PERMIT NO BUILDING PERMIT APPLICATION eblece-A 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 PF_ Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 0 -00clo(D On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFQtM�1TION ` �Vh PS f vtq t Owner I o o D V` ` F Company Name t" I � T' Li� Mailing Address 'L' F '� F C- ' Mailing Address - City 0 F Ift'✓1 tate Zip Code City tate - Zip Code--e -r-t Phone' they Ph. Phone Othe�-rPh. ' 6 5'I Lien/Title Holder Ian /'K> 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 INFORM TI - 12 digit Parcel No. ► Fire Dis t Legal Description - L :Llmer I c IS/ ') O O 4 PG -L Site Address (Plea include treet name, ggtreet nuVff and city) P ' - P Directions to site include �' 'Qr 1 LG��e K c4 t U y I 0I I C, l ni Q .tt,P� `-e -T i F > f e U 1 0V1 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 Bluff/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 ❑ �i( Use of Building Y i � " ( t Descri4 Aprk No. of Bedrooms No. of Bathrooms Square Footage - 1st F 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME FORMATION - Make —Model h oms Year Length Width ,/ Ser al No. No. of Bedrooms _` No. of Bat 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 OF OGr__ NSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WI INVALIDATE THE APPLICATION. X_ U AA6 . Date: / 0j 0 2,1 Z-0(),(n Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Q_ Date DEPARTMENTAL REVIEW APP DENIED NOTES Building Department Planning Department Environmental Health Department a Fire Marshal r"7-- e 3 FEES Building Permit Fee 3 Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee i Planninq Review Fee Mechanical & Base fee Other Wood / Gas/ Pellet Stove Fee State Fee Violation Fee A10 G-k)F Pre-Paid at Submittal Valuation $ YZ 8 S 7 3. 4 TOTAL FEES ,. PERMIT N ,.. , MASON COUNTY �W# y PLUMBING/MECHANICAL ox PESheRMIT on,WA APPLICATION a.'�^. — !�^;^ (� Shelton (360) 427-9670 •Belfair(360) 275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMAPON CONTRACTOR INFORItAATION Owner I ' Company Name i i kt c H C01 f Mailing Address Mailing Address 2 City A Q �� �'' State Zip Code City _ �u State Zip Code Phone `L "I Other Ph. Phone D Other-Ph. Lien/Title Holder Contractor Reg. IS 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. G ' Fire District Legal Description Site Address (Please include street n me, streei numper and city) Directions to site ovi 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_ LPCa_ Natural Gas_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace 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 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 F CONT ATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: ner Owners Representative/Contractor (indicate which one) FORFOFFICIAL USE BEYOND THIS POINT Accepted by: P' Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department 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