HomeMy WebLinkAboutBLD2005-00860 Final SFR - BLD Permit / Conditions - 1/20/2006 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. 3 426 W. Cedar P.O. Box 186
i
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2005-00860
OWNER: ARTHUR LAMBSON RECEIVED: 5/24/2005
CONTRACTOR: HILINE HOMES LICENSE: HILINH981 BI EXP: 2/10/2006 ISSUED: 6/28/2005
SITE ADDRESS: 1580 E JENSEN RD SHELTON EXPIRES: 12/28/2005
PARCEL NUMBER: 321307590143
LEGAL DESCRIPTION: TR 14-C OF SURVEY 4/74 TR C OF SP#800 SURVEY 30/139
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
SFR, STOCK PLAN #2003-0022 Brockdale Rd. onto E Jansen Rd. Proceed for 1.5 miles to site on right.
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 3 Type of Constr.: V-B
Type of Use: SF Insp.Area: No.of Bathrooms: 2 Occ. Group: R-3, U Lot Size: Deck:
Type of Work: NEW Fire Dist.: 9 No. of Stories: 1 Occ. Load: Building:2,152 Garage-Attached 576
Valuation: Building Height: Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: N 85.0 Ft. Shoreline: Ft. Water Body:
Rear: S 290.0 Ft. Slope: 80.0 Ft. SEPA?: No
Model: Width: Ft. Side 1: W 22.0 Ft. Shoreline Desig.: Not Applicable
Year: Sedal No.: I Side 2: E 30.0 Ft. I 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 5/24/2005 $262.59 S22005
Hoseblbs 1 Ventilation Fan 3 Planning Review Fee KKK 5/24/2005 $155.00 s22005
Kitchen Sink 1 Dryer Vent 1 Building State Fee JRN 6/3/2005 $4.50 S12005
Lavatories 3 Building Permit Fee JRN 6/3/2005 $1,312.95 S12005
Showers 1 Plumbing Fee JRN 6/3/2005 $89.00 S12005
Water Closets (Toilets) 2 Plumbing Base Fee JRN 6/3/2005 $20.00 S12005
Water Heaters 1 Mechanical Fee JRN 6/3/2005 $39.65 s12005
Bath Tubs 2 Mechanical Base Fee JRN 6/3/2005 $23.50 S12005
Clothes Washer 1 Additional Plan Check Fee JRN 6/3/2005 $58.00 S12005
EH Plan Review ADR 6/3/2005 $75.00 S12005
Public Works Review AT 6/9/2005 $39.22 S12005
Total $2,079.41
BLD2005-00860 Please referto the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2005-00860
CONDITIONS FOR
BLD2005-00860
1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-800-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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2) 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. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such roads connect 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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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
Depaf t prior to any further inspections being performed or approvals granted.
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4) 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
inspectil
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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
remgvaI of approved documents will result in failure of required building inspections.
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6) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X �-
BLD2005-00860 Please referto the following pages for conditions of this permit. 2 of 5
7) 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/Max 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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8) Stock Plan Identification number:2003-0022
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
IIns�cto�each required inspection.
9) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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10) 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
char ed and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
11) 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 revtion.
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12) 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 pro. t.l I L
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13) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
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BLD2005-00860 Please referto the following pages for conditions of this permit. 3 of 5
14) 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
Inspe t all be made prior to requesting additional inspections.
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1 ) All property lines shall be clearly identified at the time of foundation inspection. X
16) 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
Xasgn County ordinances and building regulations.
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17) 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
jooldar���prevented action from being taken. No more than one extension may be granted.
18) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
conn c , and flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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19) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment. Structures
and/or land modifications (grading, cuts, fills, etc.) required in the geotechnical egort/assessment, may require a seperate permit. The geotechincal
report/assessment shall remain attached to the approved building plans. X. ,r /t�
20) The geotechnical engineer has recommeded minimum footing dimensions of 18"wide and 10"deep. X 4#
2�) Prior to final approval, all upland areas disturbed or newly reated by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X ,6 L
22) Temporary erosion control measures must be implemented to prevent water qua_ity degradation of adjacent waters or wetlands. Silt fencing must be
installed and maintained until upland vegetation has become established. X �{,L
23) Xpprgved�er dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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24) Per the eotechnical report, the minimum building setback from the crest of the southern slope shall be 80'.
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BLD2005-00860 Please referto the following pages for conditions of this permit. 4 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 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 ownero-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 and str ture for reviewd insption.
OWN ER OR AGENT:
✓/G / DATE:
BLD2005-00860 Please referto the following pages for conditions of this permit.
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o CONCRETE MECHANICAL MANUFACTURED HOME
Footings/setbacks ' Date to j/? !JS136� Ribbons .
o Date r�v; By Gas Piping Date By
00
o Foundation Walls Oate BY Set-ap
Datv�: 1 INSULATION gate By
BG 1 Slab Insulation - floors FINAL I NSPECTION
Date B y Date o/ �8 y Data BY
FRAMING Wadi$ FIRE DEPARTMENT
Date By Date 10 �0� �/' Date By
PLUMBING Attic OTHER
Date d l9 try
Groundwork
Date By WALLBOARD NAILING
a.w.v
Date A q o t- By
Date i 0`,- U j B D-V
Water Line FINAL �S E
Date I o / 0'S B Date / �D/&,y Date By
s Type of Insp. PassfFail Request Date Inspect. Date Done By Comments
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Window Schedule
HiL I%E for 2152 plan
H O M E S
Manufacturer: Milgard Windows Inc. Model: Classic Series
Type: Vinyl U-Value = .36
Windows
Quantity Size/ Handing Glazing area Total S . Ft. Location
width x heighth
1 6'0 x 5'0 30 30 Den
1 SO x 5'0 25 25 Bedroom 2
'1 6'0 x 4'0 24 24 Mstr. Bedrm
1 3'0 x 3'0 9 9 Mstr. Bath
1 TO x 5'0 35 35 Great Rm.
2 2'0 x b'0 10 20 Break. Nook
1 3'0 x 5'0 15 15 Break. Nook
2 3'0 x 3'6 10.5 21 Kitchen
1 6'0 x SO 30 30 Dining Rm
1 6'0 x 5'0 30 30 Bonus Room
1 1'8 x 5'0 8.3 8.3 Entry
Total glazing area 247.3 sq. ft.
247.3 - 2152 = .114 X 100 = 11%
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
264.3 - 2152 = .122 X 100 = 12%
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.
MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/VIAQ Compliance Application
Owner: is" TeIephon o 7 Is' Parcel#: a O f
Y` cc f rl
Type of project (✓rNew Residence ( ) Addition ( ) Remodel
Heated Basement:
Total Sq. Ft. 15 Floor : 2" floor:
of heated area:: d
Heating System: e e ter s
Glazing Prescriptive Option see reverse side circle one: I II III
Percentage: Compliance
Method O Component Performance , Chapter 5— Calculation worksheets required
Check ate::
�% O Systems 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)
System vents (VIAQ 303.4.1
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 2fpL4. I(divided by) total sq. ft of heated area 2-462— = « %of glazing
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELTON (360) 427-9670 BELFAIR (360)275-4467 SEATTLE (206)464-6968
ELMA (360)482-5269 FAx: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 186, SHELTON 98584
2001 Washington State Energy Code (WSEC)
effective July 1, 2002
2000 Ventilation and Indoor Air Quality Code (VIAQ)
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 our calculations.
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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:
www.energy.wsu.edu/buildings/
Prescriptive Requirements 0,1for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Door Wall Wall 4 Wall 4
Area /o of
Option Floor „ Ll_ Ceiling Vaulted Above interior exterior Slab
9 2 Ceiling3 Grade below 4 Below Floors on
10 Vertical Overhead Factor 12 grade Grade Grade
1 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10
11* 15%' .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
III 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.
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�P c Irr_ DEPARTMENT OF COMMUNITY DEVELOPMENT
4 MO �
o N 2 Planning Division
7 N Y y P O Box 279, Shelton, WA 98584
(360)427-9670
1864
REQUEST FOR ADDITIONAL INFORMATION
June 10, 2005
ARTHUR LAMBSON
2041 E BROCKDALE RD
SHELTON WA 98584
Parcel No.: 321307590143
Project Description: SFR, STOCK PLAN #2003-0022
Dear Applicant:
You have submitted a permit application (case no. BLD2005-00860) for proposed
construction or development in the county. Upon review of your application, I require
additional information to complete the permit review process.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360) 427-9670, ext. 295 if you have questions.
Since ly,
Tammi Clark
Land Use Planner
Mason County Planning Department
6/10/2005 Page 1 of 2 BLD2005-00860
REQUEST FOR ADDITIONAL INFORMATION
6/10/2005 Case No.: BLD2005-00860
Comments: Staff has received the "field report" for the proposed Art Lambson
single-family residence from Public Works. Per the enclosed
Inter-Departmental Communications from Alan Tahja, PAIV - Co. Hydr.
Engr., the information submitted does not provide enough information
to be able to recommend acceptance as meeting County geotechnical
reporting requirements. The field report is being returned for
completion in compliance with the County's Landslide Hazard Areas
reporting requirements. A copy is enclosed. Should you have further
questions regarding these comments, you may contact Alan Tah'a at
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(360) 427-9670 ext. 461.
6/10/2005 Page 2 of 2 BLD2005-00860
.... .........
�--- Detach And Display Certificate
DEPARTMENT OF LABOR AND INDUSTRIES
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REGISTERED AS PROVIDED BY LAW AS Ij
' I CONST CONT GENERAL
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j REGIST. $# EXP. DATE
CC01 HILINH*981BT 02/10/2006
EFFECTIVE DATE 01/30/2002
HILINE HOMES
11306 62ND AVE E
PUYALLUP WA 98373
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tom- ____ ;�-.�-_—�-•-•.�--------
`--- Detach And Display Certificate — s
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` MASON COUNTY PERMIT NO. t 3111J �;
BUILDING PERMIT APPLICATION OC �
S. �(up 426 W. Cedar - PO. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269
y On the web www.co.mason.wa.us
APPLICA T INFORMATION CONTRACTOR INFORMATION
Owner Company Name J411-11VAZ ,odo*tS
Mailing ddre s o w Mailin Address // 'to G " mae
City -State&M_Zip Code 12 SXY City State 1 kjA_ Zip Code8'313
Phone 160- �1J7 -1/a7 Other Ph. Phone ^��r- Yo- / gy 4 _ Other Ph.
Lien/Title Holder Soh r�� i 4Q. Contractor Reg.#Ni.0 iA;# 9213ARInExp. JJ ZO? o
E mail address dx-t!q h4dry J.. �Zmag. efina, E Mail Address
Drivers Lic.# - , DOB QM Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION - 12 Digit Parcel No..�rx o.� : -, 1 o / (4s Fire District
Legal Description nT C E 40 Sliff YV, SAe,zo. Ta//✓�,,/t��_kJ. ^'
Site Address (Please include street name, street number and city)
Directions to%site - oe% - ..
Will timber be cut and sold in parcel preparation?Yes 140
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% ✓
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB -,New Add Alt Repair Other_ PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building t, XC Describe Work 'L r
No. of Bedrooms No. of Bathrooms oZ Square Footage - 1 st Floor -9/ 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.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X /4 . - ,n. Date:
Owner/Owners Representative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by:__ Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department c,, C6
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Buildinq Permit Fee `S Site Inspection
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
I
FORM MUST BE COMPLETED IN INK PERMIT NO.:
PLEASE PRESS HARD MASON COUNTY
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 Seattle(206)464-6968
APPLICA T NFORM TION CONTRACTOR INFORMATION
Owner r Contractor Name 91 0NF F Oly rs
Mailin Addr ss "O - Mailing�ddress I/ Nb A11
City Stater Zip Code �$'S-T City UYALLUP State Zip Code
Phone 6v 'VO'7 --//F7 Other Ph.( Ph.( 2133 ) 940-IM9 Other Ph.( )
Lien/Title Holder K r Contractor Reg. # N I LI PJ R *9 fi �1 f�
Address divelo eL v JL lgiigglg2i Expiration It / a-? / oC
SEPTIC INFORMATION-Connect to New Septic_/ Existing Septic Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION- 12 digit Tax Parcel No. &-I / 3 / 97 S;-9 / 01 ,13 Fire District
Legal Description
Site Address(Please include street name,street number and city) 'SPi, e h
Directions to site Tim r n ti ><' - f
Is your property within 200'of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream
Slopes or Bluffs
TYPE OF JOB New ✓ Add Alt Repair Other Use of Building 5 :, _ s,' .,ee
Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric ✓
Type of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump
Toilets 62 Type of Unit No.of Units Fees
Bathroom Sink 3 Furnace
Bath Tubs / Heatpumps
Showers ,;Z Spot Vent Fan /
Water Heater % Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood /
Hosebibs / Dryer Vent /
Other Other 4- /./per
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith No changes shall be made without
approval. first obtai Vpr
Date � o X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
DEPARTMENTAL.REVIEW. APPROVED : >DENIED: CONDITION CODES
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
---------------
>FE ES
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES