HomeMy WebLinkAboutBLD2005-01687 Final SFR - BLD Permit / Conditions - 6/1/2006 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 BLD2005-01687 �
OWNER: ROBERT VAN DE HEY
CONTRACTOR: HI LINE HOMES 360-482-1750 LICENSE: HILINH*981 10/25/2
ISSUED: 0/25/2 BT EXP: 2/10/2006 RECEIVED: 00
005 '
SITE ADDRESS: 121 E LUND DR SHELTON EXPIRES: 4/25/2006
PARCEL NUMBER: 321307590182
LEGAL DESCRIPTION: TR 18-B OF SURVEY 4/74 LOT: B SP#795
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New SFR Brockdale Rd. to Jensen Rd. to Lund.
Stock Plan#0004
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-3U Lot Size: Deck:
Type of Work: NEW Fire Dist.: No.of Stories: 1 Occ. Load: Building:2,320 Garage-Attached 528
Valuation: Building Height: 18 Occ. Status: Primary Basement: COVPORCH 132
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: N 125.0 Ft. Shoreline: Ft. Water Body:
Model: Width: Ft. Rear: S 151.0 Ft. Slope: 20.0 Ft. SEPA?: No
Shoreline Desi
Side 1: W 35.0 Ft. g•: Not Applicable
Year: Serial No.: Side 2: E 20.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures FEES
Mechanical Fixtures
Type Qty. Type Ul ya By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee KKK 9/26/2005 $276.03 S22005
Hosebibs 3 Ventilation Fan 5 Planning Review Fee KKK 9/26/2005 $155.00 S22005
Kitchen Sink 1 Dryer Vent 1 EH Plan Review CEW 10/3/2005 $75.00 S12005
Laundry Tray 1 Building State Fee ARC 10/18/200 $4.50 S12005
Lavatories 4 Building Permit Fee ARC 10/18/200$1,380.15 S12005
Showers 1 Mechanical Fee ARC 10/18/200 $54.15 S12005
Water Closets (Toilets) 3 Mechanical Base Fee ARC 10/18/200 $23.50 S12005
Water Heaters 1 Plumbing Fee ARC 10/18/200 $110.00 S12005
Bath Tubs 2 Plumbing Base Fee ARC 10/18/200 $20.00 S12005
Clothes Washer 1 Total $2,098.33
BLD2005-01687 Please refer to the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLD2005-01687
CONDITIONS FOR
BLD20 0 5-01 6 87
1 A ro dimensi n n setbacks n pp o s and se ba s o submitted site plan. Setbacks are measured from the furthest projection of the structure.
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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 po ial risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800- - 82. 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) The internatioanl 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. ads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such r d nnect 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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4) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will
not begrantRd. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building
Depa prior to any further inspections being performed or approvals granted.
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5) 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 thWn and the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting
inspe
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6) The plan review chec ist and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the
corrections indic d on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building
Official. The mit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or
remov proved documents will result in failure of required building inspections.
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7) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
BLD2005-01687 Please referto the following pages for conditions of this permit. 2 of 4
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 ill 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
Buildin ment prior to any further inspections being performed or approvals granted.
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9) Washington State En rgy Code Compliance has been approved using the following:
Heat Type- lectri or other fuels, Compliance Method: IV, Window(Max U-Factor):0.40, Skylight(Max U-Factor):0.58,
Doors (T 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.
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10) Stock Plan Identification number: 2003-0004
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 ns, and all attachments approved by the Mason County Building Department shall be available for the Mason County Building
Inspect h required inspection.
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11) Concrete used for basement walls,foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical c ncre work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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12) 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. I ocu (ents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
charged all be collected by the Building Department prior to any further inspections being performed or approvals granted.
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13) 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 ingto . Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit rev i
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14) 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 to ed with 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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15) All Chan o " roved" buil ing plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordina or r wed and approved by Mason County prior to construction.
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BLD2005-01687 Please referto the following pages for conditions of this permit. 3 of 4
16) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED
BUILDING CODE.
The construction of the rmitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance
with the * ernatio codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspe made prior to requesting additional inspections.
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17) All property lines shall be clearly identified at the time of foundation inspection. X
18) All building permit all have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to requ t a fi 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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19) 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 fo a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
holde prevented action from being taken. No more than one extension may be granted.
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20) Pressure ated ood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connec flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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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 t e agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to
the above described property truq1yre for review inspec'on.
OWN ER OR AGENT: DATE:
BLD2005-01687 Please refer to the following pages for conditions of this permit. 4 of 4
,
o CONCRETE MECH NI AL MANUFACTURED HOME
Footings t Setbacks Dat`v By tb _ Ribbons
C) Date �� pj B Gas Piping Date By
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w Foundation Walla Date By Set-up
Date fZ--/ By pIF INSULATION Date By
BG I slab Insulation Floors FINAL I NSPECTION
Date By pat �3106 By Date By
FRAMI G 73wbo
FIRE DEPARTMENT
Date IB Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLLBOARD NAILING
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APPROVED
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CHANGES SUBJECT TO APPROVAL
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ZIP Ua'S-Y v
MAILING ADDRESS
CITY
ZIP
PARCEL NUMBER
PHONE NUMBER H Z
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DEPARTMENT OF LABOR AND INDUSTRIES i
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REGISTERED AS PROVIDED BY LAW AS
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CONST CONT GENERAL
j REGIST. # EXP. DATE ;
CCOl HILINH*981BT 02/10/2006"
EFFECTIVE DATE 01/30/2002
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i HILINE HOMES iI
11306. 62ND AVE E
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PUYALLUP WA 98373 I `
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Detach And Display Certificate — j
Window Sc
HiL INE for 2320
H 0 M E s p��zoo
Hiline Holl�eAs 5
MM ON COUNTY
Manufacturer: Milgard Windows Inc. Model: Style Line Series
Type: Vinyl U-Value = .35
Windows
Quantity Size/ Handing Glazinq area Total S . Ft. Location
width x height
2 1'0 x 5'0 5 10 Entry
1 5'0 x 5'0 25 25 Bedroom 3
1 5'0 x 5'0 25 25 Bedroom 2
1 6'0 x 4'0 24 24 Media
*1 6'0 x 4'0 24 24 Master Bed
1 TO x 30 9 9 Master Bath
2 2'6 x 5'0 22.5 45 Great Room
1 5'0 x 5'0 25 25 Great Room
1 4'0 x 5'0 20 20 Dining Room
1 5'0 x 5'0 25 25 Dining Room
Slid. Glass Doors
1 6'0 x 6'10" sgd 41 41 Kitchen Nook
Total glazing area 273 sq. ft.
273 - 2320 = .117 X 100 = 12%
Glazing Area + Conditioned floor Area Glazing Percentage
* If a sliding glass door option was chosen, switch the appropriate window w/the sliding glass door
and use the calculation below.
1 6'0 x 6'10"sgd 41 41 Appropriate Room
290 2320 = 125 X 100 = 13%
Glazing Area + Conditioned floor Area Glazing Percentage
All other doors,windows&skylights do not need to be calculated do to the fact they meet all minimum requirements.
EILQ - Building Permit Information Form - 2320 Plan
This form contains the information you'll need to complete your building permit packet. We've included info lYn
some of it may not apply to yours. If you have any questions, please give us a call at 360-807-1849. SEP 2 6 2005'
Applicant/Owner/Contact Information: Your name,address. shone number
Contractor Information: Name: HiLine Homes of Elma MASON COUNTY
Address: 50 Enterorise Ln Ste 215
Elma WA 98541
Phone: (360)482-1750
License# HILINH*981 BT
Expiration: 01/30/06
Tax Parcel#/Assessor's Acct.#: This will be with your property information.
Job Site Address: Your new home address(example: xxx Filmore St.)
Legal Description: This will be with your property information. (example:Lot xx Large Lot Sub Division xxx in Lewis County etc.)
This will be a New Single Family Residence
Describe work/Type of Job: New Home construction
Home Information: Floor Area: (sq.footage)
Main/1st: 2320 #of stories: 1 Carports: 0
Second: 0 Bedrooms: 3 Decks: 0
Basement: 0 Bathrooms: 21/4 Porches: 132
Total: 2320
Garage: 528 (Attached)
Construction Method: Wood frame
Heating System:
Be sure to choose the information below that correlates with the heat system you have ordered.
HVAC/Mechanical Contractor is the company installing your heat system.
Cadet/Wall Mount I Zone Heaters: Standard heats stem
Installer: North Pacific Electric Contact: Bernie/Kim
License#: NORTHPE994JB Phone: 360-943-6020
Expiration: 04/01/04 Location: Olympia
Manuf: Brand:
Module#: KW: 14
WHF: AMPS: 20
On permits,for the#of wall heaters,put 1,or you'll be charged extra for every one.
Heat Pum w/furnace w/HWH:
Installer: Chehalis Sheet Metal Contact: Dave Pyles
License M CHEHASM252MH Phone: 360-748-9921
Expiration: 07/02/04 Location: Chehalis
Manuf: Trane Module: 2TWR1030A1000A KW: 10
Tonnage: 21/2 HSPF: 7.75 Seer: 10
LRA: 73 Efficiency: 100%
Natural Gas or Propane furnace w/HWH
Installer: Chehalis Sheet Metal Contact: Dave Pyles
License#: CHEHASM252MH Phone: 360-748-9921
Expiration: 07/02/03 Location: Chehalis
Manuf: Trane Module: TDE060A936 Watts: 977
BTU: 60,000 Efficiency: 80%
Spot Vent Fan:_1 Kitchen Exhaust Fan: I_ Dryer Vent:_)_ Wood/Gas/Pellet Stoves:_ Gas Outlets:_
Plumbing System: Installer: Allied Plumbing Contact: Roger
License M ALLIEP*986KC Phone: 360-289-4114
Expiration: 05/31/06 Location: Rochester
Toilets:_2 Bathroom Sinks:_2_ Bath Tubs:_ Showers: 1 Kitchen Sinks:_1 Water Heater:_
Clothes Washer:_1 Dishwasher:_ 1 Hose Bibs: I (first 4 enter quantity of 1,every home has 2)
Energy Compliance Information:
Compliance Method/Path: Always#3(Per Washington State Energy Code)
Total sq.ft of glazing(glass): Standard home: 273 . w/sliding glass door option: 290 divided by
total sq.ft.of heated area: 2320 equals a glazing percentage of 12% standard or 13% w/sliding glass door option.
Swinging doors and skylights are not counted in this configuration because they meet all requirement minimums.
Window Schedule: See attached form.
Ventilation System:
Intermittently operating Whole House Ventilation System using exhaust fans&window fresh air vents.(VIAQ 303.4.1)
House Fan Specifications: Whole house fan:Qty: 1 Manuf: NuTone QuieTTest Module#: QT130 CFM: 130
Bathroom One-Bulb Heater/Fans: Qty 3 Manuf: Solitaire Ultra Silent Model#: 162 CFM: 70
Copyright 2003 HiLine Homes
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC!VIAQ Compliance Application
(/ ,.
Type of project V New Residence ( ) Addition RE
Total Sq. Ft. 1 s Floor : 2 nd floor: S �i2ep05sement:
of heated area::
Heating System Type: 9flectric wall heater O Electric Central Furnace O LP CO
UNIY
O Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type:
O Other: S ecif
Glazing O Prescriptive Option see reverse side circle one: 1 II III
Percentage: Compliance
Method' O Component Performance , Chapter 5— Calculation worksheets required
Check one:: O S stems analysis, Chapter 4
O Whole House Ventilation system O Whole House Ventilation using a Heat
Ventilation using exhaust fans&window or wall fresh air Recovery Ventilation System (VIAQ 303.4.4)
VIAQ 303.4.1
System vents
( )
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 Roomllocation U-Factor Size Quantity Square Feet
Windows:
Windows: Total Sq. ft.
Doors:
Doors: Total Sq. Ft
Total window and door area
Total window & door area 1 (divided by) total sq. ft of heated area = %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
2003 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
(WSECNIAQ)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. 284. Additional
WSEC and VIAQ compliance information is available on the internet at :
http://www.energy.wsu.edu/code/
Prescriptive Requirements 0,1for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Wall Wall Wall
Option
Area %of Door Ceiling Vaulted Above interior4 exterior Slab'
Floor „ U s Ceihn Grade s
Vertical g below Below F 10 Overhead FBCtOr 12 loot on
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.284 for footnote information. Log&solid timber wall with a min. avg.thickness of 3.5"are
exempt from the above grade wall insulation requirements.
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION
426 W. Cedar * P.O. Box 186, Shelton, WA 98584 o bla7
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 I've
Mailin AqLftp 1112j, "Iv't /9.1' Mailing Address
City l to Zip Code Zglki? City �td —State Zip Code
Pho'ne ther P Phone ther 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 WaterSystem—Name of Water System
PARCEL INFORMATION - 12 Digit Parcel No.W FX_ 6:2, Fire District
0
Legal Description 115 A77-Al _'yR_
Site Address (Please include street name, street number and city) A
Directions to site Lk k4 44t! = 'At -2—ir-i4k>AW-1 72 -A.U,142
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater —Lake River/Creek- A Pond
Wetland SeasonalRunoff Stream —Slopes or Bluffs > 15%
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 E] SEASONAL ❑
Use of Building Describe Work
No.of Bedrooms No.of Bathrooms '% Y' Square Footage- 1 st Floor 11 X/9 _2nd Floor
3rd Floor—Basement— Deck CoveredDeck OtherSq.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.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X /* Date, e 6-
Owner/Owners Representative/Contractor (indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department rV
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee 13$C) - C> Site Ins pe tion
Plan Review Fee EH Review Fee
Plumbing & Base Fee 13 09— Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee /y.0 6;0F. Pre-Paid at Submittal
(to
_
iValuation $ 1p> -7 9 TOTAL FEES
,$ 1
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
APPLIC T I FORMATIO CONTRACTOR INFO M TIO
t) — /M
Owner. Company Name
Mailing Addres Mailing Address �� F
City o-1" 1u AP.31PA State _Zip Code City //l Stat Zip Code
Pho �- Other Ph. Phone "- `'x' r Ph.
Lien/Title Holder M t Contractor Reg. CrR Exp.
E mail address E Mail Address
Drivers Lic.# DOB t0— 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. Fire District
Legal Description 16
Site Address (Please' clude stree name, street numb d city
i
Directions to site Is property with' 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 - 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_ LPC-L— 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
01NNER/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.
XROO_+1/�� Date
T�IUATION OF WO��S BY F.A PROGRESS IECTIO II
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYONDTHIS POINT
Accepted by: 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