HomeMy WebLinkAboutBLD2007-00878 Final SFR - BLD Permit / Conditions - 2/12/2008 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 BLD2007-00878
OWNER: PATRICK SULLIVAN RECEIVED: 5/22/2007
CONTRACTOR: HILINE HOMES LICENSE: HILINH*981 BT EXP: 2/10/2008 ISSUED: 6/21/2007
SITE ADDRESS: 600 NE TOONERVILLE DR BELFAIR EXPIRES: 12/21/2007
PARCEL NUMBER: 223024200130
LEGAL DESCRIPTION: TR 13 OF SE
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR North side of Toonerville Dr. approx. .6 miles SE of Toonerville Dr. and Bear
Creek Dewatto Rd.
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-1 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No.of Stories: 1 Occ. Load: Building:2,152 Garage-Attached 576
Valuation: Building Height: 20 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: S 290.0 Ft. Shoreline: Ft. Water Body:
Rear: N 520.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: E 60.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: W 75.0 Ft. 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 KS 5/22/2007 $280.51 S12007000
Hosebibs 3 Furnace<100K 1 Planning Review Fee KS 5/22/2007 $170.00 S12007000
Kitchen Sink 1 Ventilation Fan 3 Building State Fee RTB 6/12/2007 $4.50 S12007000
Lavatories 3 Heat Pump 1 Building Permit Fee RTB 6/12/2007 $1,402.55 S12007000
Showers 2 Dryer Vent 1 Mechanical Fee RTB 6/12/2007 $76.20 512007000
Water Closets (Toilets) 2 Mechanical Base Fee RTB 6/12/2007 $25.30 S12007000
Water Heaters 1 Plumbing Fee RTB 6/12/2007 $97.90 512007000
Bath Tubs 1 Plumbing Base Fee RTB 6/12/2007 $22.00 S12007000
Clothes Washer 1 EH Plan Review TW 6/18/2007 $75.00 S12007000
Total $2,153.96
BLD2007-00878 Please referto the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2007-00878
CONDITIONS FOR
BLD2007-00878
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
x f su 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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2) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-8Q0-647-0982. 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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3) Wa er quality is not to be degraded to the detriment of the aquatic environment as a result of this project.
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4) 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 K
5) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
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6) 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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7) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
A proved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
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8) All other necessary permits from Mason County, Washington State and/or Federal Agencies that are required for this proposed development and
construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X
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9) 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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BLD2007-00878 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 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
De artment prior to any further inspections being performed or approvals granted.
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11) 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
inspections.
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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
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 approved documents will result in failure of required building inspections.
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13) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X y�
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
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) 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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16) 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
Inspector at each required inspection.
17) 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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BLD2007-00878 Please referto the following pages for conditions of this permit. 3 of 5
18) 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
ch rged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
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19) 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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20) 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 V
ct.
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21) 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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22) 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
Ins ector shall be made prior to requesting additional inspections.
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23) All property lines shall be clearly identified at the time of foundation inspection. X��S
24) 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
Ma on County ordinances and building regulations.
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25) 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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BLD2007-00878 Please refer to the following pages for conditions of this permit. 4 of 5
26) 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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27) 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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28) 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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29) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. 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 fora period of 180 days at anytime 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 and structure for review and inspection. /
OWN ER OR AGENT: DATE:
BLD2007-00878 Please refer to the following pages for conditions of this permit. 5 of 5
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a CONCRETE MECHANICAL MANUFACTURED HOME
N
o Foutinas L Setbacks Gate r =Li�7 By �'�` Ribbons� Gas Piping
o Interior Date By
Interior-Date By Date By
� Exterior Date Bco y Exterior-Date B _... .,____.
_ _..a Set-up
Point Load t Isolated Footings INSULATION Date By D
BG f SLAB INSULATION W - >
Date By Data By FIRE DEPARTMENT M
Foundation Is Floors Date By 0
Date (r 07 ByTA Data G_� BY DECKS T`
FRAMING walls Date By
Date r^ CC2 g Data (I-,' —C77 BY C PROPANE TANKS
PLUMBING Vault Date By
Data By OTHER
Groundwork Attic
Date By Date By Type:
Date By
D.W.V DRYWALL Type:
Int.Brac Wall Date By W
Dare - - 8 vl Date By FINAL INSPECTION
Water Line1 Fire Sep*ration IV
Date W J key � Date By Date <— 'f Z �v� By �� o
m ,
Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments .00
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365 f I ' So
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PLANNING.
95 f 6=2
ALL SETBACKS ARE MEASURED + 2
22`
FROM THE FURTHEST 'C __
1000'f— � ` �—PROJECTION OF THE BUILDING �. s-2
0-2"
9 -
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BUILDING
PLANNING
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1 PRIMARY 10OX RESERVE c
PROPOr EO I DRA/NF/ELD GRAINFIELD S-4
AREA i
\ WELL
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aa° A
SITE PLAN
SCALE. 1"=100'
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GtiA'Qa GENERAL NO TES �
1. DRAINnELD PROTEC77ON 5. MISCELLANEOUS
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A w, THE OMER IS
4 r0 ,e�qq�,���'Y/ AREA(). ALL ORAIINFOELO AND PR07EC77ON OF THE
MUST BE PR07ECTEDDFROM IS RESPONSIBLE FOR ENSURING T HAT THE TOTAL DAIL FLOWS DO NOT DER `
CONSTRUC7701v DEBRIS, VEHICULAR TRAFFIC, BURNING AND ANY OTHER EXCEED THIS DESIGN VALUE.
q� AC77WTY THE COULD ADVERSELY AFFECT THE ABILITY OF THE SOIL TO
RECEIVE AND TREAT EFFLUENT. NO GARBAGE DISPOSAL SHALL BE USED WIN THIS SYSTEM.
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0 2. SURVEY INFORMATION 774E OWNER IS RESPONSIBLE FOR THE PROPER OPERA7701V AND Q•
MAINTENANCE OF THIS SYSTEM. ANY ALTERNA77VE" SYSTEM WILL REOUIRE
7HIS 1S NOT A SURVEY THE BOUNDARIES SHOWN ON THESE PLANS ARE AN ANNUAL OPERA17ONS AND MAINTENANCE REPORT TO BE FILED WITH THE
BASED ON INFORMATION FROM THE OWNER AND/OR PUBLIC RECORDS COUNTY HEALTH DEPARTMENT.
BOUDARIES SHOWN ARE FOR REFERENCE ONLY. ELEVA77ONS AND OTHER
TOPOGRAPHIC FEATURES SHOWN ARE BASED ON AN ASSUMED DATUM AND DIRECT SURFACE WA7ER AWAY FROM DRAINFIELD AREAS TO THE GREATEST
I ARE IN7FNDED FAR LOCAL REFERENCE ONLY. EXTENT POSSIBLE.
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3. WORKMANSHIP AND MA7ERIALS of WASNrNc !_
ALL WORKMANSHIP AND MATERIALS SHALL BE IN ACCORDANCE WITH yT
CURRENT COUNTY HEAL7N DISTRICT AND WASHINCTON STA7E DEPARTMENT
OF HEALTH REGULA 77ONS AND GUIDELINES REGARDING ON-SITE SEWAGE
DISPOSAL SYSIEMS.
4. INSPECTIONS AND PERMITS 'O
.p 33770 v �4
THE OWNER AND/OR CONTRACTOR ARE RESPONSIBLE FOR OBTAINING ANY o��ssl0 sT>v B�G,��
REOUIR£D PERMITS AND INSPECTIONS. WARNING. If installation of on-site sewage system does not follow project plan or it NAL
dwelling unit/structure encroach in droinfleld area, the Onsite Sewage Permit may be
rescinded and/or occupancy be withheld (EXPIRES 12 27
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MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
WSEC/VIAQ Compliance Application
Owner: rr J`U I V Telephone:931.8`-)D8 I Parcel#: Da-cra t�0130
Type of project ew Residence ( )Addition ( ) Remodel
Total Sq. Ft. 1S Floor: 2" floor: Heated Basement:
of heated area:: 1 C--2 Jrj
Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace
*Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type:
O Other: Specify
Glazing Prescriptive Option see reverse side circle one: 1 II IV
Percentage: Compliance
Method O Component Performance , Chapter 5— Calculation worksheets required
o/ Check one::
o O Systems analysis, Chapter 4
Vtfa
s Ven ion tem O Whole House Ventilation using a Heat
Ventilation u i e & 'ndo or II a aiS stem nt II) Recovery Ventilation System (VIAQ303.4.4)
Y
Check one
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 Room/location U-Factor Size Quantity Square Feet
Windows:
t
Windows: Total Sq. ft.
Doors:
Doors: Total Sq. Ft
Total window and door area
Total window&door area /(divided by)total sq. ft of heated area = %of glazing
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELTON (360) 427-9670 BELFAIR(360)275-4467 Elma (360)482-5269
FAx: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 186, SHELTON 98584
2004 Washington State Energy Code (WSEC)
2003 Ventilation and Indoor Air Quality Code (VIAQ)
effective July 1, 2004
Code Compliance Application Form
The following information will be required for the WSEC and VIAQ plan review:
1. Complete the Washington State Energy Code/Ventilation and Indoor Air Quality Code
(WSEC/VIAQ)application located on the reverse side.
2. Complete the window and door schedule on the reverse side. Include all windows, skylights,
sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening
dimensions of the windows and doors. Information about the U-factor of the window will also help
to expedite the energy code review. If you are complying with the WSEC by prescriptive path and
are using the area weighted average method you must include your calculations.
3. On your building plans note the location and fuel type of water heater, location of exhaust fans
(bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and
slabs,
4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 352. Additional
WSEC and VIAQ compliance information is available on the internet at:
http://Www.energy.wsu.edu/code/
Prescriptive Requirements °,'for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing Ll-factor Door Wall Wall Wall
Area%of Vaulted Above interior° exterior Slab°
Option Floor „ s Ceiling Ceiling3 Grade below °Below Floors on
,o Vertical Overhead Factor 2 12 grade Grade Grade
I 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10
II * 15%* .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
IV Unlimited
Single
9 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.352 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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MASON COUNTY PERMIT NO,j`-•'j( � I O Pr y
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
4PPLICA T INFORMATION CONTRACTOR INFORMATION
Dwner g f Lt s ��� Company Name
\Aailin q Address S= �� Mailing Address A 0, 6OX
,iry State Zip Code Ciry 42&-C 7LA-/4. State Gi,14- Zip Code
Phone :L0 LI Other Ph. Phone D S Other Ph.
Lien/Title Holder l J8-Sr C 0A5T 0 Contractor Reg. # Exp.
E mail address OA-7-!xyL- KOTM,11L ' Con E Mail Address
Drivers Lic.# -Sul-4-11 PS Z0O 'v1� DOB j—Z- -A!f O Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
;;onnect to Water System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No. -Z--2- 2-oOl 3o Fire District
Legal Description
Site Address (Please include street name,street number and city) 00 N A- 12- ./0,2
Directions to site d B� �fki� 1i`t✓ CV2-fly L >--ic,7- otj Gfir- CAA r�✓r� /Z ���`tl�S
/11jLE7 SIV
Will timber be cut and sold in parcel preparation? Yes 6o AlC)
Is property within 200' of Saltwater AlO_Lake River/Creek �D Pond
Wetland A kQ Seasonal Runoff ^-- Stream Aln Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes o
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE SEASONAL ❑
Use of Building 4M "t / Describe Work
No. of Bedrooms 7 No. of Bathrooms Square Footage- 1st Floor Z /SZ 2nd Floor
3rd Floor _ Basement Deck Covered Deck Other Sq. ft.
Garage •77410 — Attached X�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 O CONTINUA ON OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
Xl `� Dater "O
Owner/Owners Representative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: aeA L>✓ Date 3�
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department . E 1 O
Planning Department
Environmental Health Department _oo Oyn-1-on vQ
Public Works Department
Fire Marshal Z-
FEES
Buildinq Permit Fee D S Site Inspection
Plan Review Feel-SAIC EH Review Fee
Plumbing & Base Fee 77-9- 9 Q Planning Review Fee
Mechanical & Base fee lb Other MASON
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee O Pre-Paid at Submittal
Valuation $ TOTAL FEES
MASON COUNTY PERMIT NO.
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton,WA 98584 —
Shelton (360) 427-9670• Belfair (360) 275-4467• Elma (360) 482-5269 �� 1 �!a
On the web www.co.mason.wa.us 1
APPLICANT INFORMATION CONTRACTOR INFgRMATION
Owner y I✓ Company Name /�
Mailing Address " S' �'V' Mailing Address rO XX � ;�i
City tate Wt` Zip Code id""')"-I City -ram , ' L State �" Zip Code
Phone—, S_4� Other Ph I _ 40`f Phone 17' Ot er Ph.
Lien/Title Holder " .ST rr_ _ Contractor Reg. 4 `' Exp.
E mail address t Xc/( /41 jm E Mail Address
Drivers Lic.# i PS 7 DOB _Z — " 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. d " V t- Fire District
Legal Description
Site Address (Please include street name, street nu(nb r and )I- V1'
Directions to site
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other. Use of Building
Location of Fixtures/Units - 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNNgS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPC____ Natural Gas Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink A Furnace
Bath Tubs Heatpumps
Showers �— Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher I Kitchen Exhaust Hood
Hosebibs _ 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 party in interest regarding this application or the work proposed in the application, I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X Date: G G U
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date 01 Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group—Type Constr.
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical & Base fee F UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES