HomeMy WebLinkAboutBLD2007-02031 Final Covered Deck - BLD Permit / Conditions - 6/24/2008 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Inspection Line(360�27-7262
Phone: (360)427-9670,ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2007-02031
OWNER: PAUL VANDEHEY
CONTRACTOR: LICENSE: EXP: RECEIVED: 12/11/2007
SITE ADDRESS: 567 E MIKKELSEN RD SHELTON ISSUED: 12/21/2007
PARCEL NUMBER: 321341390060 EXPIRES: 6/21/2008
LEGAL DESCRIPTION: TR 6 OF SW NE S 8/32 LOT: 1 SP#783
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
COVERED DECK HWY 3 TO MASON LAKE RD APPROX 1 MILE TO MIKKELSEN GO APPROX
1/2 MILE ON L
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.: V-B
Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: U-1 Lot Size: Deck:
Type of Work: ACC Fire Dist.: 5 No. of Stories: Occ. Load: Building:
Valuation: Building Height: Occ. Status: Basement: cov. deck 240
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: W 165.0 Ft. Shoreline: Ft. Water Body:
Rear: E 97.0 Ft. Slope: Ft. SEPA?:
Model: Width: Ft. Side 1: S 110.0 Ft. Shoreline Desi g..
Year: Serial No.: Side 2: N 113.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures . Mechanical Fixtures FEES
Type Qty. Type Qty.- Type By Date Amount Receipt
Plan Check Fee KS 12/11/200 $72.31 S12007000
Planning Review Fee KS 12/11/200 $170.00 S12007000
EH Plan Review ADR 12/18/200 $35.00 522007000
Building State Fee RTB 12/20/200 $4.50 S22007000
Building Permit Fee RTB 12/20/200 $111.25 S22007000
Total $393.06
BLD2007-02031 Please referto the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLD2007-02031
CONDITIONS FOR
BLD2007-02031
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. .E 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) Owner/Agent is r onsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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3) The international 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
X such roads co w\ t ith a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
4) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are req&-ed-#qr this proposed development and
construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X 1('
5) All approved plans are Eequired 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 pj further inspections being performed or approvals granted.
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6) Owner/ t is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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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
removal of a d documents will result in failure of required building inspections.
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8) This structure is approved as un-heated space. If at any time this building is to be used for anything other than what it is approved for, a change of use
permit shallb applied for, reviewed and approved prior to the change.
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9) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X J(
BLD2007-02031 Please referto the following pages for conditions of this permit. 2 of 4
10) 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 Departme �rior to any further inspections being performed or approvals granted.
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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 concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
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12) This structure is limited to U-occupancy use only(private garages, carports, sheds, and agricultural buildings.) Any other use will be in violation of the
international cod d Mason County Regulations unless a"Change of Use" permit is applied for, reviewed and approved.
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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 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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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 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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15) 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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16) 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
In J be 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
BLD2007-02031 Please referto the following pages for conditions of this permit. 3 of 4
18) 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 Count inances 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 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 ham prevented action from being taken. No more than one extension may be granted.
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20) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
X connectors� -dashing. Install metal connectors approved for contact with the new types of pressure treated material.
21) 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 SitePllan"to ensure these structures are shown and meet the setback conditions listed.
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 prope cture for r iew and inspection.
OWNER OR AGENT: C �JL � �!11 DATE:
BLD2007-02031 Please referto the following pages for conditions of this permit. 4 of 4
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MECHANICAL o CONCRETE MANUFACTURED HOME
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Date By Data By. FIRE DEPARTMENT c
Foundation Walls Floors Date By r
Date By Data By DECKS _
FRAMING Walls Date By
Date By Data Lay PROPANE TANKS
PLUMBING faun Date 13y
Date By OTHER
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Date By Date By.
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Roof Rafter[2003 International Residential Code(01 NDS)1 Ver:7.01.10
By: rich balderston , mason county dcd on: 12-19-2007 :4:07:10 PM
IN OtMOMOW"fter
Summary:
'4N^A.13.{F-T.41 1 44 VUctural.j it-Dry Use
**q6_ew.4nodeaw0bafSJA.4% Controlling Factor: Moment of Inertia/Depth Required 5.53 In
Interior Span Deflections:
Dead Load: DLD-Interior= 0.11 IN
Live Load: FAILED LLD-Interior- 0.34 IN= U355
Total Load: TLD-Interior= 0.44 IN = U270
Eave Deflections(Positive Deflections used for design):
Dead Load: DLD-Eave= 0.00 IN
Live Load: LLD-Eave= 0.14 IN =2U503
Total Load: TLD-Eave= 0.07 IN =2U1020
Rafter End Loads and Reactions: LOADS: RXNS:
Upper Live Load: 125 PLF 250 LB
Upper Dead Load: 46 PLF 91 LB
Upper Total Load: 171 PLF 341 LB
Lower Live Load: 211 PLF 423 LB
Lower Dead Load: 85 PLF 169 LB
Lower Total Load: 296 PLF 592 LB
Upper Equiv.Tributary Width: UTWeq= 4.55 FT
Lower Equiv.Tributary Width: LTWeq= 8.45 FT
Rafter Data:
Interior Span: L= 10.0 FT
Eave Span: L-Eave= 3.0 FT
Rafter Spacing: Spacinq= 24.0 IN O.C.
Rafter Pitch: RP= 0.0 : 12
Roof sheathing applied to top of joists-Top of rafters fully braced.
Live Load Deflect. Criteria: U 360
Total Load Deflect.Criteria: U 240
Rafter Loads:
Roof Live Load: LL= 25.0 PSF
Roof Dead Load: DL= 10.0 PSF
Roof Duration Factor: Cd= 1.15
Slope Adjusted Spans And Loads: THESE PLANS MUST BE
Interior Span: ON THE ��g SITE: L-adi= 10.0 FT
Eave Span: L-Eave-adi= 3.0 FT
Rafter Live Load: FOP, INSPECTION- wL-adi= 50 PLF
Rafter Dead Load: wD-adi= 20 PLF
Rafter Total Load: wT-adj= 70 PLF
Properties For: Select Structural-Hem-Fir
Bendinq Stress: Fb= 1400 PSI
Shear Stress: Fv= 150 PSI
Modulus of Elasticitv: E= 1600000 PSI
Stress Perpendicular to Grain: Fc-perp= 405 PSI
Adjusted Properties
Fb' (Tension): Fb'= 2407 PSI
Adjustment Factors: Cd=1.15 CF=1.30 Cr=1.15
Fv': Fv'= 173 PSI
Adjustment Factors: Cd=1.15
Design Requirements:
Controllinq Moment: M= 831 FT-LB
4.9 Ft from left support of span 2(Center Span)
Critical moment created by combining all dead loads and live loads on span(s)2
Controllinq Shear: V= 354 LB
At a distance d from riqht support of span 2(Center Span)
Critical shear created by combining all dead loads and live loads on span(s)2, 3
Comparisons With Required Sections:
Section Modulus (Moment): Sreq= 4.14 IN3
S= 7.56 IN3
Area(Shear): Areq= 3.07 IN2
A= 8.25 IN2
Moment of Inertia(Deflection): Irea= 21.10 IN4
FAILED 1= 20.80 IN4
Roof Rafterf 2003 International Residential Code(01 NDS)1 Ver: 7.01.10
By: rich balderston , mason county dcd on: 12-19-2007:4:10:17 PM
Project:vandehey covered deck-Location: roof rafter
Summary:
1.5 IN x 5.5 IN x 13.0 FT(10+3)Ob 19.2 O.C./#2- Hem-Fir-Dry Use
Section Adequate By:0.1% Controlling Factor: Moment of Inertia/Depth Required 5.5 In
Interior Span Deflections:
Dead Load: DLD-Interior= 0.10 IN
Live Load: LLD-Interior= 0.33 IN= L/361
Total Load: TLD-Interior- 0.44 IN= U274
Eave Deflections(Positive Deflections used for design):
Dead Load: DLD-Eave= 0.00 IN
Live Load: LLD-Eave= 0.14 IN=2U511
Total Load: TLD-Eave= 0.07 IN=2L/1036
Rafter End Loads and Reactions: LOADS: RXNS:
Upper Live Load: 125 PLF 200 LB
Upper Dead Load: 46 PLF 73 LB
Upper Total Load: 171 PLF 273 LB
Lower Live Load: 211 PLF 338 LB
Lower Dead Load: 85 PLF 135 LB
Lower Total Load: 296 PLF 473 LB
Upper Equiv.Tributary Width: UTWeq= 4.55 FT
Lower Equiv.Tributary Width: LTWeq= 8.45 FT
Rafter Data:
Interior Span: L= 10.0 FT
Eave Span: L-Eave= 3.0 FT
Rafter Spacing: Spacinq= 19.2 IN O.C.
Rafter Pitch: RP= 0.0 : 12
Roof sheathinq applied to top of joists-Top of rafters fully braced.
Live Load Deflect. Criteria: U 360
Total Load Deflect. Criteria: U 240
Rafter Loads:
Roof Live Load: LL= 25.0 PSF
Roof Dead Load: DL= 10.0 PSF
Roof Duration Factor: Cd= 1.15
Slope Adjusted Spans And Loads: THESE PLANS MUST BE
Interior Span: ON THE JOB SITE L-adj= 10.0 FT
Eave Span: L-Eave-adi= 3.0 FT
Rafter Live Load: FOR INSPECTION. wL-adj= 40 PLF
Rafter Dead Load: wD-adi= 16 PLF
Rafter Total Load: wT-adj= 56 PLF
Properties For:#2-Hem-Fir
Bendinq Stress: Fb= 850 PSI
Shear Stress: Fv= 150 PSI
Modulus of Elasticity: E= 1300000 PSI
Stress Perpendicular to Grain: Fc-perp= 405 PSI
Adjusted Properties
Fb' (Tension): Fb'= 1461 PSI
Adjustment Factors:Cd=1.15 CF=1.30 Cr=1.15
Fv': Fv'= 173 PSI
Adjustment Factors: Cd=1.15
Design Requirements:
Controllinq Moment: M= 664 FT-LB
4.9 Ft from left support of span 2 (Center Span)
Critical moment created by combining all dead loads and live loads on span(s)2
Controllinq Shear: V= 283 LB
At a distance d from riqht support of span 2(Center Span)
Critical shear created by combining all dead loads and live loads on span(s)2, 3
Comparisons With Required Sections:
Section Modulus(Moment): Sreq= 5.46 IN3
S= 7.56 IN3
Area (Shear): Areq= 2.46 IN2
A= 8.25 IN2
Moment of Inertia (Deflection): Ireq= 20.77 IN4
1= 20.80 IN4
Floor Joist[2003 International Residential Code(01 NDS)I Ver: 7.01.10
Bv: rich balderston , mason county dcd on: 12-20-2007:08:36:51 AM
Project:vandehey deck-Location:floor joist
Summary:
1.5 IN x 5.5 IN x 4.0 FT C2 12 O.C./#2-Hem-Fir-Dry Use
Section Adequate By: 700.8% Controlling Factor: Section Modulus/Depth Required 2.42 In
Center Span Deflections:
Dead Load: DLD-Center= 0.00 IN
Live Load: LLD-Center= 0.01 IN= U5633
Total Load: TLD-Center= 0.01 IN= U4507
Center Span Left End Reactions(Support A):
Live Load: LL-Rxn-A= 80 LB
Dead Load: DL-Rxn-A= 20 LB
Total Load: TL-Rxn-A= 100 LB
Bearinq Lenqth Required (Beam only, support capacity not checked): BL-A= 0.16 IN
Center Span Riqht End Reactions(Support B):
Live Load: LL-Rxn-B= 80 LB
Dead Load: DL-Rxn-B= 20 LB
Total Load: TL-Rxn-B= 100 LB
Bearing Length Required(Beam only, support capacity not checked): BL-B= 0.16 IN
Joist Data:
Center Span Lenqth: L2= 4.0 FT
Floor sheathinq applied to top of joists-top of joists fully braced.
Live Load Duration Factor: Cd= 1.00
Live Load Deflect. Criteria: U 480
Total Load Deflect. Criteria: U 360
Center Span Loadinq:
Uniform Floor Loading:
Live Load: LL-2= 40.0 PSF
Dead Load: DL-2= 10.0 PSF
Total Load: TL-2= 50.0 PSF
Total Load Adjusted for Joist Space ES E PLAN 5 MUST B E wT-2= 50 PLF
Properties For#2-Hem-Fir ON THE JOB SITE
Bendinq Stress: Fb= 850 PSI
Shear Stress: FOR INSPECTION. Fv= 150 PSI
Modulus of Elasticity: E= 1300000 PSI
Stress Perpendicular to Grain: Fc-perp= 405 PSI
Adjusted Properties
Fb' (Tension): Fb'= 1271 PSI
Adjustment Factors: Cd=1.00 CF=1.30 Cr=1.15
Fv': Fv'= 150 PSI
Adjustment Factors: Cd=1.00
Design Requirements:
Controllinq Moment: M= 100 FT-LB
2.0 Ft from left support of span 2(Center Span)
Critical moment created by combining all dead loads and live loads on span(s)2
Controllinq Shear: V= 78 LB
At a distance d from riqht support of span 2 (Center Span)
Critical shear created by combining all dead loads and live loads on span(s)2
Comparisons With Required Sections:
Section Modulus(Moment): Sreq= 0.94 IN3
S= 7.56 IN3
Area(Shear): Areq= 0.78 IN2
A= 8.25 IN2
Moment of Inertia(Deflection): Ireq= 1.77 IN4
1= 20.80 IN4
Uniformly Loaded Floor Beam[2003 International Residential Code(01 NDS)1 Ver: 7.01.10
Bv: rich balderston , mason county dcd on: 12-20-2007:08:34:10 AM
Project:vandehey deck-Location:floor beam
Summary:
3.5 IN x 5.5 IN x 6.0 FT /#2- Hem-Fir-Dry Use
Section Adequate By: 77.2% Controlling Factor: Section Modulus/Depth Required 4.13 In
Deflections:
Dead Load: DLD= 0.02 IN
Live Load: LLD= 0.07 IN= U974
Total Load: TLD= 0.09 IN = U765
Reactions (Each End):
Live Load: LL-Rxn= 480 LB
Dead Load: DL-Rxn= 131 LB
Total Load: TL-Rxn= 611 LB
Bearing Length Required (Beam only, support capacity not checked): BL= 0.43 IN
Beam Data:
Span: L= 6.0 FT
Unbraced Lenqth-Top of Beam: Lu= 1.0 FT
Live Load Deflect. Criteria: U 360
Total Load Deflect. Criteria: U 240
Floor Loadinq:
Floor Live Load-Side One: LL1= 40.0 PSF
Floor Dead Load-Side One: DL1= 10.0 PSF
Tributary Width-Side One: TW1= 2.0 FT
Floor Live Load-Side Two: LL2= 40.0 PSF
Floor Dead Load-Side Two: DL2= 10.0 PSF
Tributary Width-Side Two: TW2= 2.0 FT
Live Load Duration Factor: Cd= 1.00
Wall Load: WALL= 0 PLF
Beam Loadinq:
Beam Total Live Load: THESE PLANS MUST BE wL= 160 PLF
Beam Self Weiqht: BSW= 4 PLF
Beam Total Dead Load: ON THE .JOB SITE wD= 44 PLF
Total Maximum Load: FOR INSPECTION wT= 204 PLF
Properties For:#2-Hem-Fir
Bendinq Stress: Fb= 850 PSI
Shear Stress: Fv= 150 PSI
Modulus of Elasticitv: E= 1300000 PSI
Stress Perpendicular to Grain: Fc_perp= 405 PSI
Adjusted Properties
Fb'(Tension): Fb'= 1104 PSI
Adjustment Factors:Cd=1.00 CI=1.00 CF=1.30
Fv': Fv'= 150 PSI
Adiustment Factors:Cd=1.00
Design Requirements:
Controllinq Moment: M= 916 FT-LB
3.0 ft from left support
Critical moment created by combining all dead and live loads.
Controllinq Shear: V= 525 LB
At a distance d from support.
Critical shear created by combining all dead and live loads.
Comparisons With Required Sections:
Section Modulus(Moment): Sreq= 9.96 IN3
S= 17.65 IN3
Area (Shear): Areq= 5.25 IN2
A= 19.25 IN2
Moment of Inertia (Deflection): Ireq= 17.94 IN4
1= 48.53 IN4
Roof Beam[2003 International Residential Code(01 NDS)1 Ver: 7.01.10
Bv: rich balderston , mason county dcd on: 12-20-2007:08:45:00 AM
Project:vandehey deck-Location: roof beam
Summary:
3.5 IN x 5.5 IN x 6.0 FT /#2-Hem-Fir-Dry Use
Section Adequate By:46.0% Controlling Factor: Section Modulus/Depth Required 4.55 In
Deflections:
Dead Load: DLD= 0.04 IN
Live Load: LLD= 0.09 IN= U779
Total Load: TLD= 0.13 IN=U549
Reactions(Each End):
Live Load: LL-Rxn= 600 LB
Dead Load: DL-Rxn= 251 LB
Total Load: TL-Rxn= 851 LB
Bearing Length Required (Beam only, support capacity not checked): BL= 0.60 IN
Beam Data:
Span: L= 6.0 FT
Maximum Unbraced Span: Lu= 2.0 FT
Pitch Of Roof: RP= 0. : 12
Live Load Deflect. Criteria: U 360
Total Load Deflect. Criteria: U 240
Roof Loadinq:
Roof Live Load-Side One: LL1= 25.0 PSF
Roof Dead Load-Side One: DL1= 10.0 PSF
Tributary Width-Side One: TW1= 3.0 FT
Roof Live Load-Side Two: LL2= 25.0 PSF
Roof Dead Load-Side Two: DL2= 10.0 PSF
Tributary Width-Side Two: TW2= 5.0 FT
Roof Duration Factor: Cd= 1.15
Beam Self Weiqht: BSW= 4 PLF
Slope/Pitch Adjusted Lenqths and Loads:
Beam uniform Live Load: THESE PLANS MUST BE Law i= 200 FT
PLF
Beam Uniform Dead Load: ON THE JOB SITE wD_adj= 84 PLF
Total Uniform Load: FOR INSPECTION, wT= 284 PLF
Properties For:#2-Hem-Fir
Bendinq Stress: Fb= 850 PSI
Shear Stress: Fv= 150 PSI
Modulus of Elasticitv: E= 1300000 PSI
Stress Perpendicular to Grain: Fc_perp= 405 PSI
Adjusted Properties
Fb'(Tension): Fb'= 1267 PSI
Adjustment Factors: Cd=1.15 CI=1.00 CF=1.30
Fv': Fv'= 173 PSI
Adjustment Factors: Cd=1.15
Design Requirements:
Controllinq Moment: M= 1276 FT-LB
3.0 ft from left support
Critical moment created by combining all dead and live loads.
Controllinq Shear: V= 732 LB
At a distance d from support.
Critical shear created by combining all dead and live loads.
Comparisons With Required Sections:
Section Modulus(Moment): Sreq= 12.08 IN3
S= 17.65 IN3
Area (Shear): Areq= 6.36 IN2
A= 19.25 IN2
Moment of Inertia (Deflection): Ireq= 22.43 IN4
1= 48.53 IN4
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MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION
426 W. Cedar- P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANTTQNFORMATION CONTRACTOR INFORMATION
Owner A a` VaA de lke�j Company Name
Mailing Address W��tAgn Mailing Address
City 5hQ11-4 OL State %.,.A Zip Code 9-8��� City State Zip Code
Phone .3& M-V Vr P Other Ph. Phone Other Ph.
,
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic.# Y a. DOB ✓ — Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms No. of Bathrooms Square Footage- 1st Floo 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 informaticn 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
M rpa.RO RES IN PECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
x Date: f a J f D 7
Owner/Owners Represer}ative/Contractor (indicate which one) Ir or
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DE IED NOTES
Building Department b'
Planning Department `
Environmental Health Department d
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee 7 Z '3 EH Review Fee
Plumbing & Base Fee Planninq Review Fee
Mechanical & Base fee Other
Wood /Gas/ Pellet Stove Fee State Fee `l S-
Violation Fee �,Z � A-4 Pre-Paid at Submittal
Valuation $ TOTAL FEES