HomeMy WebLinkAboutBLD2007-01025 Final SFR - BLD Permit / Conditions - 12/31/2007 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
P10
RESIDENTIAL BUILDING PERMIT BLD2007-01025
OWNER: BETTY HYATT RECEIVED: 6/11/2007
CONTRACTOR: HILINE HOMES LICENSE: HILINH*981 BT EXP: 2/10/2008 ISSUED: 7/10/2007
SITE ADDRESS: 60 E TYLER LN SHELTON EXPIRES: 1/10/2008
PARCEL NUMBER: 321322290053
LEGAL DESCRIPTION: TR 5 NW NW LOT: C OF SP #884
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
New SFR Jansen Rd. toTyler Ln.
Stock Plan 2003-0022
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: 2 Occ. Group: R-3U Lot Size: Deck:
Type of Work: NEW Fire Dist.: No.of Stories: 1 Occ. Load: Building:
Valuation: Building Height: 17 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: S 25.0 Ft. Shoreline: 245.0 Ft. Water Body:
Rear: N 235.0 Ft. Slope: Ft. SEPA?:
Model: Width: Ft. Shoreline Desig.:
Side 1: W 54.0 Ft.
Year: Serial No.: Side 2: E 29.0 Ft. Comp. Plan Desig.:
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee KKK 6/11/2007 $280.51 S22007000
Hosebibs 3 Furnace<100K 1 Planning Review Fee KKK 6/11/2007 $170.00 S22007000
Kitchen Sink 1 Ventilation Fan 3 Fire Warden Review DHS 6/19/2007 $64.00 S22007000
Lavatories 3 Dryer Vent 1 Building State Fee ARC 6/29/2007 $4.50 S22bbibbb
Showers 1 Building Permit Fee ARC 6/29/2007 $1,402.55 S22007000
Water Closets (Toilets) 2 Mechanical Fee ARC 6/29/2007 $60.00 S22007000
Water Heaters 1 Mechanical Base Fee ARC 6/29/2007 $25.30 S22007000
Bath Tubs 2 Plumbing Fee ARC 6/29/2007 $97.90 S22007000
Clothes Washer 1 Plumbing Base Fee ARC 6/29/2007 $22.00 S22007000
EH Plan Review AMH 7/5/2007 $75.00 S22007000
Total $2,201.76
BLD2007-01025 Please referto the following pages for conditions of this permit. 1 of 5
9) 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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10) 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 WIND SPEED (3-SECOND GUST)the wind speed for Mason County is 85 MPH.
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11) Per 2003 IRC - SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
accordance with the applicable provisions of this section and the manufacturer's installation instructions.
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12) Stock Plan Identification number: 2007-0022
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
Inspector at each required inspection.
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13) 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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14) 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 and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
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15) 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.
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16) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the
stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which
is proposed to be located within 25'of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your project.
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BLD2007-01025 Please referto the following pages for conditions of this permit. 3 of 5
17) 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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18) 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 shall be made prior to requesting additional inspections.
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19) All property lines shall be clearly identified at the time of foundation inspection. X
20) 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
Mason County ordinances and building regulations.
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21) 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 have prevented action from being taken. No more than one extension may be granted.
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22) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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23) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
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24) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X
25) W ,ter quality is not to be degraded to the detriment of the aquatic environment as a result of this project.
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26) Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
27) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or wetlands. Silt fencing must be
installed and maintained until upland vegetation has become established. X "',i f
BLD2007-01025 Please referto the following pages for conditions of this permit. 4 of 5
28) 1. First habitable floor must be elevated at least 2 feet above surrounding grade. 2. Mobile homes must be securely anchored. 3. Foundation or skirting
vents must be within 1 foot of grade.4. An elevation certificate must be completed by a licenced land surveyor certifying the as-built elevation of the first
floor to the nearest 10th of a foot prior to final inspection. X
29) Subject to conditions of Aquifer Notification letter. X
30) 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.
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This permit becomes null and void if work o r 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 andt structure for review and inspection.
OWNERORAGENT: � "�' 2''(�� DATE: l57
BLD2007-01025 Please refer to the following pages for conditions of this permit. 5 of 5
o CONCRETE MECHANICAL MANUFACTURED HOME _
N
O Date it�kC� By � D
Footings/Setbacks Gas Piping Ribbons
Interi(x Date Ar j07 ByL Interior-Date By pate B W
iss y
Exterior Date By Exterior-Date B Set-up M
INSULATION �
Point Load I Isolated Footings Date By �
BG t SLAB INSULATION
Date By Data By FIRE DEPARTMENT
Foundation Walls Floors Date By
Date 13 07 By 1-0'(., Data -O Iqt C71 DECKS
FRAMING Walls Date By
Date/,,I. p' B a Data 1 a Ui By 1,iD1:f PROPANE TANKS
PLUMBING vault Data By
Date a OTHER
Ground+Mork Attic
Date By Type:
Date BY pate BY
D.W.V DRYWALL Type-
Int.Brace Wall Date By
Date ijoBY Date l (, By r
� �' Fire Se ion FINAL INSPECTION p
m Water tine
Date I 2 By g(k Date By Date E3y O
m y i
Pass or Request Inspect.
Type of insp. Fail Date Date Done By Comments N
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TOPOGRAPHY PROFILE:
ry.t 3 a
Direction: Scale: it I Approval: for office use
Building Permit number: ,____---------_ I Building:________
Owner/Applicant:__N YA l I (,D4 tJhL_-f!- __ Date of Planning:
Parcel Number: _ S
.-,2-; 32_2_? �00 5"S' application: Env. Health:______
NAME q�� `�- �� �; NORTH VICINITY MAP
SITE ADDRESS s
CITY �Iti
ZIP 98 3 �
MAILING ADDRESS
"3go
CITY :*ell-„N
ZIP 98 S',g)'y i
PARCEL#
PHONE NUMBER H � LlaLn-5 a 3 _ O
W 701 --79/-7
MILES FROM HILINE HOMES (o m�lcs
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��tm�les
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From: 10/23/2007 07: 12 #456 P. 002/004
From:LUWSPNENS TRUSS DIV 253 735 1128 10/18/2007 05:62 #821 P.002/004
r `
MiTek-
POWER'ra PERFI?RM."
MITek Industries, Inc.
7777 Greenback Lane
Suifa 109
Citrus Heights,CA,9561p
Telephone 9161676-1900
Re: 07-2209 - FaxMr,576-1909
HYATT
The truss drawing(s)referenced below have been prepared by MiTek Industries,Inc.under my.direct supervision
based on the parameters provided by Lumbermen's Bldg Center-Auburn, WA.
Pages or sheets covered by this seal:R26965896 thru R26965886 .
My license renewal date for the state of Washington is August 1,2008.
gP Oti WAS$ l'A
A �
P0� ,PA3 6 k4r
F G��
EX RES:O 0
October 18,2007
Tingey,Palmer
The seal on these drawings indicate acceptance of professional engineering responsibility solely for the
truss components shown-. The suitability and use of this component for any particular building is the ;
responsibility of the building designer,per ANSUTPI-2002 Chapter 2.
i
From: 10/23/2007 07: 13 #456 P. 003/004
Frew:LUFiBrRMENS TRUSS DIV 253 735 1126 10/19/2007 05:52 =1 P.003/004. ~
,bb Tnaa Tntes Type aty Ply HYATf
R2e6a6886
Ol'-220a 4TR GOMMOW
Job R gPdOnsil
Tess-Span Lkanbermww,Aubum,WA 980C1 7,010 s Sep 112007 blfrok India rl",Inc. Thu Oct 18 09:24:302007 Pape 1
I_zsa sae 1 taus I 19 e e l 25 t-it 31-7 l 37"
2-0-a 6e-a Gt-11 e-1-11 61-71 a-1-11 6S9
3.w.-1 e7.5
5X8 MR20=
5.o0 12
9
2X4 ke 20% 70�Mwo - I
3Xa 161204 5 7 330 U020
2.4 MII2D N- 4 a
DH MIQa
3 a
2 10
tUPI¢
Sa6 kaQO 13 12 11 me M120=
3te4
W20= bR MR20= am MIQO= .
I 941-7 r— 1640 I 26-2-e
9re-7 9-2-9 else ti67
LOADING(psr) SPACING 2-0-0 CS1 DEFL. in (loc) Ydefl L/d PLATES GRIP
TOLL 25.0 Plains Increase 1.15 TC 0-78 Vest(ILL) -0.27 12-13 >SW 240 101111121) 185f148
TCDL 10.0 L umber Increase 1.15 BC 0.92 Vert(rL) -0.57 12-f 3 i788 180 w
BCLL 0.0 Rep Stress Incr YES WB 0.63 Horz n) 0-18 10 hfa n/e
BCDL 10.0 Code UBCS71ANS195 (Matrix) Weight:145 m
LUMBER BRACING
TOP CHORD 2 X 4 HF Not TOP CHORD Shute d or 2-4-2 cc purllns.
BOT CHORO 2 X 4 HF Not-Except BOT CHORD Rigid calling directly applied or 10-0-0_oc brarAv.
10-12 2 X 4 HF 1850E 1.5E WEBS 1 Row at micipt 5-12,7-12
VYEBS 2 X 4 HF Sbtd/Std
REACTIONS (16/etre) 2-1844/0 5-8,10s1678/Machankail
MIDI Hors 2 60(LC 5)
FORCES (lb)-Maximum Ccmp sskwv {axlnwm Tenon
TOP CHORD 1-2-(153,2-3-358®l0,3-4=3212AX 44-3124/0,5-6--225210,6-7=226=.7-8-3122/0,8-9---320W,9-10=353w
BOT CHORD .2-13-013f95,12-13-Q2818,11-12-2815,10-11=WS179
WEBS 3.13>`417Fv7,S13"Ol553,512�831/10,8-12=0f1239,7-12�-8.10/17,7-11'•0/550,9-11a408/68
NOTES
1)Unbalanced roof INe loads have been considered for this design.
2)Wind:ASCE 7-98;85mph;hb25 t;TCDL'6.0paf;BCDL-6.0pat,Category II;Exp B;enclosed;MWFRS(low-rise)infector zone;canillaver
b8 and right exposed;end vertical Wand right exposed; Lumber DOL-J=pule grip DOL-1.35 P late metal OOLe12&
3)This truss has bean designed for a 10.0 par bottom chard rare load nonconcunent with any o8her We bads.
4)Refer to girder(a)for fuss to truss oonnerliona. .
LOAD CASE(S)Standard
VL S.r cs
h� O�
3
� 1
S O
S�aNAL��'
EXPIRES4 08-01-08
October 18,2007
Q WANGWO•VWIfbdeWan perentreera andaaJD a01]ra Derr�saDmQ�Daarsa ltlJ�l"1<7�aR le'F94?3 S6fQRi lTea:.
Dwlprt veld far uw anhy wah PM*k eartrtecfm Litt dwfgn b based only opal aoronwen N,a.rn.and b foranlrtArAduri bukar3 cerrponent. us
Applica -P ofdwQt Porarrneers and prQWInoorparo8an d 0ormanenl b lwpartmbOy of bWdkv degtr-rwn taw dayrtec lf* show„
b nor gferd waporl of ktdlAd web rrattbM'- t4oraY tg to Ywrre mrbmly dasq conettrdbn b 1he fe+Palabety d tM eY1r
ettecfor.Addrlbnd 0etrronwft txadhg ofry1he�r7m�erall shuchas Ts the re porrsbiftyRo�ff*m Lh Ikk g dwkxw.F< general gvido—rsyordkv -
}oWlcWbn-quo0ymthd.elaeage,dbiwry.ahrRlut SBS OIXrwfifo Madbon.WI Si719.M Crera.OSL»see efsn addtnO ComPaewd 1;Orweack Len.tale 10e
sawty 1NOrmdoe erOilaC11 Rom SNas -
Chw Mr 95510
0
0
Symbols --
Numbering System ® General Safety Notes
ED ED `! PLATE LOCATION AND ORIENTATION
B 1314 Center plate on joint unless x,y Failure to Follow Could Cause Property
a offsets-are Indicated. 6-4-8 dimensions shown In tt-In-sixteenths Damage or Personal Injury
N Dimensions are in ft-in-sixteenths. (Drawings not to seafe)
Apply
y plates
llly sees to both
tee sides of truss
l h. . Additional stability bracing for truss system,e.g.
dlogonal orX-bradng,k always required• See BCSiI,
2. Truss bracing musi by designed by an engineer.For
I 2 3 wide tens spacing,Individual lateral braces themselves
OEy may require blaring,a ollemativa T.L or f3mksalor
to cia TOP CHORDS c24 bracng should be corssidered.
C3 4 3. Never exceed the
WEBS design loading shown and never
Np. �, stack materials on Inadequaiety braced trusses.
Cs] p� Q u � ,�s�� � a 4. Provide copies of this truss design to Ihabs>Ildfng
CV B For 4 x 2 orienfatlon,locate ] J, Oz designer,erection supervisor,property owner and
o plafe5:0-'A!'from outside rL O apoihe'Interestedparties.
r r- edge of truss. O a
O 5. Cut members to bear tightly agairul each other.
BOTTOM CHORDS ~ 6. Place pintas on each face or truss at each
�.� This symbol indicates the joint and embed rvGv.Knots and wane at Joint
.� required direction of slats to 8 7 6 5 aIons ore regulated by ANSUTPI 1.
connector pfates. 7. Design astumes busses Wg be suftabfy protected rrom
the environment In accord with ANSI/iPl 1,
'Plate location details available In Mrr* 20/20.
E011ware of upon request. 8. Unless otherwise noted,moisture content or lumber
JOINTS ARE GENERALLY NUMBERED/LETTERED CLOCKWISE shall not exceed IM of time of fabrication.
AROUND THE TRUSS STARTING AT THE JOINT FARTHEST TO expressly
N PLATE SIZE THE LEFT. 9. us
e w m fire retardant,preservative treated,treate,o greeoible nor
lumber.
r The first dimension is the plate CHORDS AND WEBS ARE IDEN 11FIED BY END JOINT Ip,Camber is a non huctural consideration and h the
to 4 x 4 width measured perpendicular NUMBERS/LETTERS
m P P responslblity of truss fabricator.General practice Is to
ti !o slots.Second dimension is camber for dead bad deflection.
the length parallel to slots. I I.Plate type,size,orientation and location dimensions
CM PRODUCT CODE APPROVALS Indfca ed are rr**mm plating requirements,
LATERAL BRACING LOCATION 12,Lumber used shd be of the species and she.and
IOC-ES Reports:' �, P
In of respects,equal to at better than that
Indicated by symbol shown and/or ESR-1311,FSR-1352,ER-5243,9604B, specified.
by text in the bracing section of the 95-43,76-31,9667A 13.Top chords must be sheathed or palms provided at
output. Use T,I or Eliminator bracing NER-487,NER-561 spodri nclicated on design.
If Indicated. 95110,8432,96 67,ER 3907,9432A 14.Bottom chords require lateral bracing at to fir.spacing,
BEARING or less.If no telling Is Installed,unless otherwise noted.
15.Connections nor shown ore she responsibility of others.
Indicates location where bearings
(supports).occur, icons varybut 16.Do approval cut
0n an afterginear.member or piafe without prior
m 2006 M(fek®Ap Rights Reserved PPr
cc
reaction section indicates joint 17,Instas and load vertically,
number where bearings occur, �� Ityunless Indicated otherwise,
18.Use of green or treated lumber may pose unacceptable
W envronmenlat,health or performance risks.Consult Wth
Industry Standards: project engineer before use.
I L� ANSI/TPIi: National Design Specification for Metal 19'.Review alporflom of iNt design(front,back,words
Plate Connected Wood Truss Construction. iTe k� and picivres)before,use.Reviewing pictures alone
WM
DS5-89: Design Standard for Bracing. Is notsufAdent.
BCSI1: Building Component Safety Information, 20.Design assumes manufacture In accordance with
L j Guide to Good Practice for Handing, PQWKR Tra PERFORM." ANSI/TPI 1 Quality CrEOrlo.
I„ Installing&Bracing of Metal Plate
Connected Wood Trusses, Miiek Engineering Reference Sheet MII.7473
MASON COUNTY PERMIT NO. f2_
BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Bo //--����
x 186, Shelton, WA 98584 V1
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 BEM t f M—i r / (3EN1 A MC. ,Do BALD Company Name f f l t-I►J E H01AES
Mailing Address 340 5e- ALPINC AJC Mailing AddressVo 130x
City 'Sl C`_1VN State A Zip Code `N�j -7 7zZ City AE,FR ifL State V4 Zip Code a
Phone 2- p her Ph. W-7 Phone 3�6 -2`75--i1,q i Other Ph.
Lien/Title Holder )&DA SAP ' ' k-T.1 Contractor Reg. # f-Hlt-ftJ 04'g9I3i Exp. 241010d
E mail address E Mail Address
Drivers Lic.# MCyON 1_304 K� DOB 0 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 a Fire District
Legal Description Imcr r 5!{G2T P i` 4t 924f
Site Address(Please include street name, street numhPr and city) J 6r 0 E �f� (_N S nEt-I rJ
Directions to site 7 A LDG�� , LT`NClf(Ct,l( (3T Oi RRG KD'4 i� 2 i 0�� ,J tsNSe LT c u
_j 1 t t Lg i-.AfJ 9 , r Piz-lV ei j t Ri:,v"z AT r.1 ROAD D i2 )SS' A N I M t f►c 3 C V
Will timber be cut and sold in parcel preparation? Yes/
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? o
TYPE OF JOB- New V Add Alt__Repair Other PRIMARY RESIDENCE ® SEAS AL ❑
Use of Building 'P-EStDM- 774t-. Describe Work D( tJ WCCC) Ft2- j- 0 \k
No. of Bedrooms No. of Bathrooms 7- Square Footage- 1 st Floor -K 2nd Floor 0
3rd Floor_Basement O Deck r) Covered Deck--Other O Sq. ft.
Garage__5!LC1_ 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 - C,ertification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in�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.
PRO F OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
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Date:
Ow /Owne s Representative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department L�
Planning Department 1 6 Db -1G
Environmental Health Department
Public Works Department
Fire Marshal `
FEES
Building Permit Fee O Site Inspection
Plan Review Fee EH Review Fee
Plumbing& Base Fee I I •'� Planninq Review Fee
Mechanical & Base fee 85• Other
Wood/Gas/Pellet Stove Fee I I State Fee ' 5
Violation Fee //D E40-:7 Pre-Paid at Submittal
Valuation $ 7 2 2-73 • TOTAL FEES
MASON COUNTY PERMIT NO.
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar•P.O. Box 186, Shelton,WA 98584
Shelton (360)427-9670•Belb (360)275-4467•Elma(360)482-5269
On the we www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner 8 . ti YALF 1 a>�UW PAC WNAyLD Company Name tt I l-itJ L
Mailing Addres ACE Mailing Address Fe &Ax
City T N State WA Zip Code q$ City *eo UiZ —State VIA —Zip Code 5�Z-T
Phon 424, ` 3-`Iz3 Other Ph. 14T5--. jZ Phone SLO - Z7S-11?T,i Other Ph.
Lien/Title Holder 2 f% Md�'TC. 4 E_ Contractor Reg. # H I to^t+I I Exp. 08
E mail address E Mail Address
Drivers Lic.# i'' "'L IF
DOB 0 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 2 2 2-Cl 0 0 Fire District
Legal Description L
Site Address(Please include street name, street number and ci 0 E aLGIZ- L-iV ' NHCVVN
Directions to site L' Nc R .N ; G" 4D P--)Q"e L-'
rJ N D rQ S rEIZ.QA J
Is property within 20 'of Saltwater Lake River/Creek Vf Pond
Wetland Seasonal Runoff Stream—Slopes or Bluffs > 15%
TYPE OF JOB -New Add Alt Repair Other Use of Building R-n I DEW IA 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 V LPG_Natural Gas_Heat Pump_
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace
Bath Tubs I Heatpumps
Showers Z- Spot Vent Fan 1
Water Heater I Propane Tank
Clothes Washer I Gas Outlets 0
Kithen Sinks I Wood/Gas/Pellet Stove-7_
Dishwasher i Kitchen Exhaust Hood I
Hosebibs I Dryer Vent I
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 1 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.
PRO O ONTIN ON OF ORK IS BY MEANS OF A PROGRESS INSPECTION.
X / b.
Date: � �
Own Ow rs Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ GroupTConstr.
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