HomeMy WebLinkAboutBLD2008-00185 Final Replace MFG Home with Frame Home - BLD Permit / Conditions - 9/20/2010 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
so Shelton,WA 98584
RESIDENTIAL BUILDING PERMIT BLD2008-00185
OWNER: GERALD DANIELSON RECEIVED: 2/19/2008
CONTRACTOR: LICENSE: EXP: ISSUED: 5/5/2008
SITE ADDRESS: 5523 NE BEAR CREEK DEWATTO RD BELFAIR EXPIRES: 11/5/2008
PARCEL NUMBER: 223011300010 '9if� �Sf
LEGAL DESCRIPTION: N1/2 SW SW NE
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
GGoSG T'�
REPLACE MF HOME WITH FRAME HOME HWY 3 TO BELFAIR, OLD BELFAIR HWY TO BEAR CREEK DEWATTO RD,
GO L TO ADDRESS ON LEFT.
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 2 Type of Constr.: VB
Type of Use: SF Insp. Area: OT No. of Bathrooms: 2 Occ. Group: R-3U Lot Size: Deck: 288
Type of Work: NEW Fire Dist.: 2 No. of Stories: 2 Occ. Load: Building:2,623 Garage-Attached 619
Valuation: Building Height: Occ. Status: Primary Basement:1,811 COVPORCH 220
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: W 137.0 Ft. Shoreline: Ft. Water Body: NONE
Rear: E 280.0 Ft. Slope: Ft. SEPA?: Yes
Shoreline Desi
Model: Width: Ft. Side 1: N 193.0 Ft. g.: Not Applicable
Year: Serial No.: Side 2: S 89.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty.- Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 2 Plan Check Fee KS 2/19/2008 $1,253.82 S12008000
Hosebibs 3 Furnace<100K 1 Planning Review Fee KS 2/19/2008 $190.00 S12008000
Kitchen Sink 4 Ventilation Fan 5 EH Plan Review TW 3/4/2008 $1oo.00 si2bba000
Laundry Tray 1 Woodstove 1 Water Adequacy Plan Review TW 3/4/2008 $40.00 S12008000
Lavatories 4 Heat Pump 1 ADJUST—Plan Check Fee ARC 4/25/2008 $101.92 S12008000
Showers 2 Dryer Vent 1 Building State Fee ARC 4/25/2008 $4.50 S12008000
Water Closets (Toilets) 3 Building Permit Fee ARC 4/25/2008 $2,085.75 S12008000
Water Heaters 2 Mechanical Fee ARC 4/25/2008 $177.20 si2ooa000
Bath Tubs 1 Mechanical Base Fee ARC 4/25/2008 $26.60 S12008000
Clothes Washer 1 Plumbing Fee ARC 4/25/2008 $160.51 S12008000
Plumbing Base Fee ARC 4/25/2008 $23.10 S12008000
Total $4,163.40
BLD2008-00185 Please referto the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2008-00185
CONDITIONS FOR
B LD2008-00185
1) 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
su nect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X
2) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X
3) Wa0& 1-
of to be degraded to the detriment of the aquatic environment as a result of this project.
X
4) Prior to final approval, all upland areas disturbed or tygated by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
5) Ap v e ensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
6) 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 e I �d in 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.
X
7) MFG Home must be removed prior to final occupancy of proposed stick built home. X
8) All other necessary permits from Mason County, Washington State and/or Federal Agencies th �rquired for this proposed development and
construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X
9) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
The�pial risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-8he person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
BLD2008-00185 Please referto the following pages for conditions of this permit. 2 of 5
10) 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 ted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour) will be charged and must be collected by the Building
De en prior to any further inspections being performed or approvals granted.
X
11) Ow er/, e ' esponsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
12) 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
Offi ' I. 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
re o ed documents will result in failure of required building inspections.
X
13) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
14) 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
ap oval 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
Bu 1 D ent prior to any further inspections being performed or approvals granted.
X
15) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors
(Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab
Insulation R-10.
Exc ption: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the
and a roof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation.
X
16) Per 2003 IRC -SECTION 1609 -WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the
mini um wi oads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609
BA ED (3-SECOND GUST) the wind speed for Mason County is 85 MPH.
X
17) Per RC-SECTION R905 - REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in
acc rd nce�i -the applicable provisions of this section and the manufacturer's installation instructions.
X
BLD2008-00185 Please refer to the following pages for conditions of this permit. 3 of 5
18) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. "NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management ApplicationA/Vorksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan"constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system
of this, or any other, parcel. You may also ish to consult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contr dging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
19) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other
ve ical c ncr a rk exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2).
X
20) 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
ther f d u nts are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour) will be
cha n shal collected by the Building Department prior to any further inspections being performed or approvals granted.
X
21) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the
St e o;as
hington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
pe it atio .
X
22) 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 he 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 pr
X OM�E_ -
23) All c ng "appro " building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordi ation, must be reviewed and approved by Mason County,prior to construction.
X
24) 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 t i ern na odes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Insp II be ma prior to requesting additional inspections.
X
BLD2008-00 8 Please referto the following pages for conditions of this permit. 4 of 5
25) All property lines shall be clearly identified at the time of foundation inspection. X )Z2�.
26) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure
to r quest 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
M toC@Llif?�inances and building regulations.
X
27) 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
acti for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit
hol r ve even action from being taken. No more than one extension may be granted.
X
28) Pr sur ated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
c for d flashing. Install metal connectors approved for contact with the new types of pressure treated material.
X
29) Retaining walls needed to support a s r structures, roads, or to support slopes, shall require a separate building permit and approval prior
to construction of the retaining wall. X
t��
30) La dings stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"A d Sit n"to ensure these structures are shown and meet the setback conditions listed.
X
31) By d finition, ropane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
thes str c res eet the setback conditions listed.
X
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progr ss inspection.The own r the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to
the above described prop and structure for r i an i spectio .
OWNER OR AGENT: DATE:
BLD2008-00185 Please referto the following pages for conditions of this permit. 5 of 5
o CONCRETE
E MECHANICAL MANUFACTURED HOME >
C) Unto 8
90 Footings I Setbacks Gas Piping Ribbons M
C) "_' .1-A 1—,7� r_
0 Intenw Date By interior-Date by Dale By C/)
w Exlenof Me BY Extprior, Date-- Setup 0
__
z
Point Load I Isolated Footings INSULATION Dato By
BG)SLAB INSULATION -____—mv;_4 0
DRte By Date By FIRE DEPARTMENT M
foundation Waft Floors Date By
Date Data :7— — r_
8 Y rl-2 By DECKS 0
FRAMING Walls Date By
DWe 1- -,70. Date Z — By PROPANE TANKS
PLIJIVIBING Va* Date 13Y
eats 2- BY OTHER
Groundwork Attic
Date By Date By i Type,
Date By
O.W.V DRYWALL rype
Int.Brace Wall Dale By
Date O:r Date By FINAL INSPECTION 0
CD Water Lin J Fire Seporation
D -2
ate By Dato
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CD 00
6 6
Pass or Request Inspect. (D
0 Type of Insp. Fail Date Date Done By 1 Comments
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NamC_ 1 . Parcel# Qa 3n -• 13- GAL BLD#
Y)'4�_6 Mason County
FEB 1 91008
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet404" MU)NTY
Per Mason County Code, Title 14, Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment', with more than 2,000 square feet of impervious surface?.
'Redevelopment means,on an already developed site, the creation or addition of impervious surfaces, structural development
including construction, installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity, and land disturbing activities associated with structural or impervious redevelopment.
2Common impervious surfaces include,but are not limited to,rooftops, walkways, patios, driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads, packed earthen materials,and oiled, macadam or other surfaces which similarly impede the
natural infiltration of stormwater. Open,uncovered retention%detention facilities shall not be considered as impervious surfaces.
:>:::;
::>:>:::::>:::>::<:::<:>:::::::::::::::::::::::.:................. ....................:..... gnus. .uzfr :.11 ,�... . , ..
:.:::. ........................... ................ ........ .. # :.Thr :: " # ..:::::<.::::::::::::.:::.;:.;:.;:;:.::.;:.;::.;:::::;
......................................................... . :.:.:<. : .:::::::::::::::::::::::
Surface Type Length X Width = Area * All dimensions in feet
Buildings X -
X = Measurements for buildings are taken at the
perimeter of the farthest projections (example:
X = eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parking Areas X
X = �1y� ved, gravel or packed area per definition
C,�S above table
X
Patios/Walks X
X Any paved, gravel or packed area per definition
above table
X =
Others X :
X =
,.;:, trr3r,r� us 4�€ti3e prnposect site >:
ai vela`:``::: i t€is: rat h....z>2i D iy;.::.>:;.;:.>:::
...........
Bt tfriv�atUU: t M..l+'i�n..1�§
.::::.::::::::::::::::::::........mod::::
:.:::::: :::::::::::::::::::::.:::::::::.:.::::.:::::::::::.:::::::::::::::::::.::::::: .............:.:::::::::::::::::::.:::.::::::.::.... ...
ervritus turf c :.;;:.;;:.;::;:.;:.;:<.;::>::>::>::::.»::::;::::::::: ::»::>««:::>::>:;:>::>:>::>
a .Area.sum :::»>::>::::<»:<::»::::::>::::::>:::;:::<::::<:::::<:::::>:;:>::>::>::,:::>:::::<:;<:<:::::>::::>: >::>:XX
:<,:::::>:::»::»::;::<:>
If the Total Impervious Surface rea is LESS THAN 2000 Square Feet,�please a d, acknowledge and sign below.
Based Upon the information you e provided a Stormwater Site Plan IS NOT requ' ed for this development activity.
Owner/Builder/Agent Acknowledges that 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,owner's legal representative,or the contractor. I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
describ ' erty for review and inspection as may be required.
r
X e Owner/Agent/Contractor(circle one)Date: 4-,2-1/ —e)r
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read, acknowledge and sign
the information provided on page 2 of 2.
Page I of 2
Name Parcel# BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14, Chapter 14.48 of the Mason County Code(MCC) regulates compliance requirements for Stormwater
Management in this jurisdiction. A complete copy of the ordinance can be found on the Mason County website:
http//ww-w.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to "Title 14, Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document
entitled "Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan". This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system (see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
'A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
•B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples. (Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT. 450
Mail: P 0 Box 1850, Shelton WA 98584
Physical: 415 N 6th_StsShelton WA 98584
If this development has, or will have, a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or
any other, parcel. You may also wish to consult with the septic design professional involved with the project. Mason
County Division of Environmental Health can be reached at:
Phone: (360)-427-9670 EXT. 352
Mail: P 0 Box 1666, Shelton WA 98584
Physical: 426 W Cedar St, Shelton WA 98584
A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that 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, owner's legal representative, or the contractor. I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
Page 2 of 2
RBCEIV::D
Mason County Planning Intake Checklist FEB 1 g ?JJo,3
Owners ame: Date: c� -ICI-08 MASON COUNTY
Project: Reviewed By: Lt
Proposed uses) of ucture(s) P,
Commercial Development: YES PLANNER: GBM TSW PBC RDH REC S
Site Plan:
Ja' North Arrow ❑ Survey required in All n UGA - ❑ AF# ❑ Monuments
Property Dimensions: _3S(o X
Streets and Driveways Shown. Road name: f-P
,A kOdst tw es.Awn fit backs and use d
�' ell Lo�tii tic Dr in-fi Id hown with setbacks
a str s, onds, shoreline, wetlands, natural or historic drainage, defined
drainage ditches) o `L n
[4 l
,e' To Topography hY (slo es)5=It � G AS+Minimum Structure Saacks (Dire fi ion/Setback): , r
F: �/_11 ) R:aBU / S1: —1 19 n S2:
Utility and Draina a Easements: Yes No (if yes enter condition #5022)
Other Easements PrI V GW Y
Accessory Appurtenances: Propane� Does site plan show landings allex�H=eatpump
O IV
❑ Variance applied for: Yes / i No parking spaces allotted? Yes / No
❑ County Access Permit Needed (add condition #0010)
❑ State Access Permit Needed(add condition #0020) > n
Standard Conditions to be added to all Building permits that plannln reviews: #5019 and #0700
Site Access. Are
there any impediments (dogs/gates) thaiay e riot access to your site?
ra
Is the si a learly marked? How? Address tffs4ad rlU�&WA�
❑ Name
Zoning: ❑ Other:
Corng. Plan: Rural Zoning: UGA Zoning:
Rural ,ERR 2.5 5 10 20 RT/RTC ❑ R-1 ❑ R-5 ❑ HC ❑ BI
❑ RAC ❑ RMF ❑ Unknown ❑ R-1P ❑ R-10 ❑ LTA ❑ VC
❑ Allyn UGA ❑ RC 1 2 3 0 Agricultural ❑ R-1R ❑ PD ❑ FR ❑ T
❑ Belfair UGA ❑ RI ❑ In-holding ❑ R-2 ❑ PF ❑ MU ❑ MHP
❑ Shelton UGA ❑ RNR ❑ LTCFL ❑ R-3 ❑ POS ❑ GC 0 BP
❑ Tribal ❑ GC-CI
Critical Areas: (streams, ponds, shoreline, wetlands, steep slopes)
Shoreline
Desionation: .2 /A ❑ Urban ❑ Rural ❑ Conservancy ❑ Natural ❑ Unkown
Water Body (type of water if unnamed):
SEPA: Yes No Unknov� Flood Plain: Y � Unk n' Map#
Aquifer Recharge: ES/NO nnknown ap#
Tags/Cases:
RLC/SPI Case: 6-Year Dev. Moratorium: Y
Eagle Nest Tag: YE 0 Other ER)
Revised: 02-07-2008 I:\PLANNING\PAC\PLANNING INTAKE
1
MASON COUNTY PERMIT
BUILDING PERMIT APPLICATION - o,ryi_
426 W. Cedar- P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 48 -5269 -K�t -z
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner ? J/S Company Name
Mailing Address �'L�/IG r ►A ZL Mailing Address
City �f- 61�2 State�2rt-Zip Code City State Zip Code
Phonelfo Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
Email address � Coj C E Mail Address
Drivers Lic.#0k0l F&L_CfQ Pit DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic X
Connect to Water System Name of Water System
Well- .—Water System Name of Water System '
PARCEL INFORMATION- 12 Digit Parcel No o / Fire District
Legal Description ° SZ owx/35 U3 3*( G,45 /A -':5'
Site Address(Please include street name, street number and city) j4P v " 1
Directions to site gXW '�'01%0 4'ek QZR9 d 101-j S,
Will timber be cut and sold in parcel preparation? Yes
Is property within 200'of Saltwater Lake 3 G River/Creek ')46 —Pond -7�
Wetland Seasonal Runoffe_26a,__Stream�Slopes or Bluffs > 15% -2fen
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o
TYPE OF JOB - NewjS,Add Alt Repair Other C RIMARY RE ID NC SEA ONAL ❑
Use of Building �- .d /'� Describe Work {-f rYl
No.of Bedrooms�_No. of Bathrooms�Souare Footagfeck.
1st Floor — 2nd Floor —
3rd Floor �---� Basement Deck: _overed ZZ� ther_ Sq. �edlalb___
c
Garaged Attached -�' Detached -�Carport 2�'— Attached — Deta
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width No. of Bedrooms No. of Bathrooms
Type of Heat urchase Pric Replacement Unit? Yes/No
Installer Na 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 Q ON OF WO K IS BY MEANS OF A PROGRESS INSPECTION.
X ,C Date
caner/Owners Representative/Contractor (indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted b
DEPARTMENTAL REVIEW APP 1L D DENIED NOT
Building Department r
Planning DepartmentCOUNTY
Environmental Health Department CJE
Public Works Department
Fire Marshal
FEES
Building Permit Fee ZO • 75— Site Inspection
Plan Review Fee A /d/. Q2 EH Review Fee
Plumbing & Base Fee /$ 3 - 6t. Planning Review Fee
Mechanical & Base fee 203 . ko- Other
Wood/Gas/Pellet Stove Fee State Fee ' so
Violation Fee Jed � • Pre-Paid at Submittal
Valuation$ 2-94 2 1, 3q TOTAL FEES
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MASON COUNTY PERMIT NO.*Ia[i)�3-00(b5
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
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner !.5 0 C Company Name S
Mailin�,A,ddres /J =A C O Mailing Address
City,�r4CAl2 State W�_Zip Code °� City State Zip Code
Phone 160-31A'.21411 Other Ph. Phone Other Ph.
Lien/Title Holder "K o 14 E Contractor Reg.4 Exp.
Email address Q�--o0,1v10"PtJ @1407IN-414,cOOK E Mail Address
Drivers Lic.# OANI ELL L 91zruH DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic As Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. 12301 13 430010 Fire District A7;2
Legal Description 50"/}- 01-S,18-OT 4 N,El4T SEC l IPAL-2U wf w w.
Site Address (Please include street name, street number and city).J"S73 Ntr Are 4eGRE£!c Po`wArre
Directions to site Sire &A P A17ifeAE0 To 64140jt'? Ldevc-5
Is property within 200'of Saltwater -240 Lake :120 River/Creek ' d Pond
Wetland Seasonal Runoff 'X- Stream- Slopes or Bluffs > 15% -ne
TYPE OF JOB - New K Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1 st Floors 2nd Floor Basement 1 — Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNI
Type of Fixture No. of Fixtures Fees Fuel Type:Electric-v—O' LPCL_ Natural Gas_ Heat Pump_
Toilets Type of Unit No.
Fees
Bathroom Sink 4' Furnace
Bath Tubs Heatpumps
Showers 10' Spot Vent Fan
Water Heater #3- Propane Tank 44,
Clothes Washer I SePnIERhaust
Outs 0
Kithen Sinks /Pellet Stove /
Dishwasher Hood 2.1
Hosebibs �"5 Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other parry 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,/C�A[CINUATION OF ORK IS BY MEANS OF A PROGRESS INSPECTION. RECEIVED
„�- Date:
Owner/Owners Representative/Contractor (indicate which one) FEB 19 2008
FOR OFFICIAL USE BEYOND THIS POINT Q
Accepted by: Planning Pd Ck# Date•�f.GI✓� Bld Pd M%rcei I�OUNTY
DEPARTMENTAL REVIEW APPR9KED DENIED NOTES
Building Department
Occ Group-Type Cons r.—
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Ins ection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES