HomeMy WebLinkAboutBLD2010-01077 Cancelled Replace MFG Home - BLD Permit / Conditions - 12/29/2010 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 t
1rf,, Shelton,WA 98584 r
RESIDENTIAL BUILDING PERMIT
BLD2010-01077
OWNER: JESSLYN SPEER RECEIVED: 11/17/2010
CONTRACTOR: LICENSE: EXP: ISSUED: 12/30/2010
SITE ADDRESS:
102 NE SMITHY FORGE LN BELFAIR EXPIRES: 6/30/2011
PARCEL NUMBER: 223027600050
LEGAL DESCRIPTION: TR 5 OF SURV 2/116
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR, WITH 2-12'X15' GARAGES ON EACH SIDE, REPLACING ST RT 3, R ON BELFAIR TAHUYA RD, L ON BLACKSMITH DR, L ON SMITHY
MFG HOME THAT WAS DESTROYED BY FIRE FORGE LN TO SITE ADDRESS ON THE RIGHT
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: 2 Type of Constr.: VB
Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. GdPrima
Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No. of Stories: 2 Occ. Building:1,080 Garage-Attached 360
Valuation: Building Height: O c. Basement:
Manufactured Home Information Setback Inform doShoreline&Planning Information
Make: Length: Front: E 68.0 t. hor Water Body:
Rear: W 25. t. S SEPA?:
Model: Width: Ft. Shoreline Desig.: Not Applicable
Side 1: 32 t.
Year: Serial No.: ide 2: 19 150. Ft.k1 I Comp. Plan Desig.: Rural
Plumbing Fixtures ech ca Fixtures FEES
Type Qty. Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee GMM 11/17/201 $729.66 S12010000
Hosebibs 2 Ventilation Fan 3 Planning Review Fee GMM 11/17/201 $205,00 S12010000
Kitchen Sink Dryer Vent 1 Fire Warden Review GMM 11/17/201 $73.00 S12010000
Lavatories 2 EH Plan Review KKK 11/17/201 $103.00 S72010000
Water Closets (Toilets) 2 Building State Fee DLC 1 2/2 912 0 1 $4.50 512010000
Water Heaters 1 Building Permit Fee DLC 12/29/201 $1,122.55 S12010000
Bath Tubs 2 Mechanical Permit Fee DLC 12/29/201 $49.20 S12010000
Clothes Washer 1 Mechanical Base Fee DLC 12/29/201 $28.50 S12010000
Plumbing Permit Fee DLC 12/29/201 $93.20 512010000
Plumbing Base Fee DLC 12/29/201 $24.70 S12010000
Total $2,433.31
BLD2010-01077 Please referto the following pages for conditions of this permit. 1 of 5
r
CASE NOTES FOR
BLD2010-01077
CONDITIONS FOR
B LD2010-01077
1) 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.
X
2) All construction and demolition debris must be removed from the site after project completion to aviod hazardous conditions. Proper disposal of
construction debris must on land in such a manner that debris cannot enter or cause water quality degradation of State waters.
X
1
3) 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 PIS " ensure these structures are shown and meet the setback conditions listed.
X
4) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered.
A. Drainfield/Reserve requires a 1 Oft setback from all footing/foundations.
B. Septic tank(s) requires 5ft setback from all footing/foundations.
C. No foundation dra within 30ft, down gradient of drainfield/reserve area.
X
5) Proposed structure(s) must maintain a minimum of a 5'setback from all property lines, easements and 25'from all County and State Road right of ways.
Setbacks are rn sured from the furthest projection of the structure.
X
6) Approved per sions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X I
7) Temporary erosion control measures must be implemented to prevent water quality degradatio of djacent waters or wetlands. Silt fencing may be
installed and maintained until upland vegetation has become established. X
8) 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
1-800-647-098g.jOe person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
BLD2010-01077 Please refer to the following pages for conditions of this permit. 2 of 5
9) 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
Department prior to rt r inspections being performed or approv,91s granted.
X
10) Owner/Agent is res n
sA a to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
11) The plan review check ist 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 do�uRents will result in failure of required building inspections.
X
12) All slabs within the heated space shall be insulated to a mi -10 for at least 24". Monolithic slabs shall be insulated around the perimeter from the
top of the slab to the bottom of the footing X
13) 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 u her inspections being performed or approvals granted.
X
14) Washington State Energy Co e Compliance has been approved using the following:
Heat Type: Electric, 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, Ceiling Insulation R-38, Slab Insulation R-10.
X
15) WIND LOADS - Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85
MPH.
X
16) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's installation instructions.
X
BLD2010-01077 Please refer to the following pages for conditions of this permit. 3 of 5
17) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
r 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. *NOT E if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet 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 wish to consult with the septic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contractor is acknowledging,tat all Ments of the stormwater management system have been installed as
approved on the stormwater site plan.X
18) 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.
X
19) The demolition and disposal of debris must meet the regulations of Mason County and Olympic Region Clean Air Agency(ORCAA).
It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos containing materials have been
identified and removed from the area to be demolished. Work shall not commence on an asbestos project or demolition project unless the owner or
operator has obtained written approval from ORCCA.2490 B Limited Lane NW, Olympia WA 98502, 360.586.1044/800.422.5623 vwvw.orcaa.org
X
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 project.
X
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 bA reviewed and approved by Mason County prior to construction.
X
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
Inspector shall be ma a prior to requesting additional inspections.
X
23) All property lines shall be clearly identified at the time of foundation inspection. X
BLD2010-01077 Please referto the following pages for conditions of this permit. 4 of 5
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
Mason County ordinances a1` [ding regulations.
X
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 fro being taken. No more than one extension may be granted.
X
26) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD WAY.
X
27) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X r 4-W
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 owneror 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 n ructure for review and inspection.
OWNER OR AGENT: DATE: ID
BLD2010-01077 Please referto the following pages for conditions of this permit. 5 of 5
Cn
o CONCRETE MECHANICAL MANUFACTURED HOME
o ___r _______ M
o Footings I Setbacks date By Gas Piping Ribbons M
o Inteno(Date By L interior-Date By Date By
Exterior Date 2--/b-// By L� Exterior-Date B _
set-up rn
INSULATION cf)
Point Load!Isolated Footings Date By Cl)
BG!SLAB INSULATION
Date By Data By FIRE DEPARTMENT Z
Foundation Walls Floors Date By
Date By Data _ By DECKS
FRAMING Walls Date By
Date By Data By PROPANE TANKS
PLUMBING vault Date By
Date By OTHER
Groundwork Attic
Date Z-/O - /� gy Date By Type
Date By
D.W.v DRYWALL Type,
Int.Brace Wail Date By W
Date By Date By FINAL INSPECTION O
w Water Line Fire Seperation IV
40
Date By Date By Dale By
m O
Pass or Request Inspect. c
Type of Insp. Fail Date Date Done By Comments o
w
v
Cn
N
O
8
a
0
0
v
m
0
0
o� to
r � �
i w �
7,3 �
` l�8Af3,d
Ilk
�-- 3
no"-k—
n-rs FIR E
I MARSHAL
F� jotv\15
Name ?_r Parcel# BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
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 2.
'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.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area ` All dimensions in feet
Buildings X 3 = I bsb
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
—Driveways K 15 i'x =
X = Length of drive begins at the right of way
Parking Areas =
X = Any paved, gravel or packed area per definition
above table
X =
Patios[Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
thers U X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all are )
If the Total Impervious Surface AreCovidedaSto
THAN 2000 Square Feet, plea read,acknowledge and sign below.
Based Upon the information you haver water Sit Plan IS required 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-
described property for review and inspection as may be required. n
X Owner/Agent/Contractor(circle one)Date: y
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 1 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:
httpHwww.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 St, Shelton 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
//- L3
ACCESS & GRADE INSPECTION BLD
ADDRESS:
INSPECTOR: f ��
DRIVEWAY ACCESS
( ) need post at access of driveway with reflective address numbers
Length: Width: Surface:
Size of turn-around:
Condition of shoulders:
Vertical clearance:
GRADE OF DRIVEWAY %, OF ROAD %
ROAD ACCESS
Length: Width: Surface:
Condition of Shoulders:
Vertical clearance:
BURN PERMIT REQUIRED FOR LAND CLEARING FIRE.
LOT INSIDE UGA—NO OUTDOOR BURNING PERMITTED.
LOT TOO SMALL FOR: BURN PERMITS 4 X 4 FIRES
2 X 3 FIRES
PASSED ( ) FAILED ( ) ON HOLD ( )
REMARKS:
i
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
APPLICANT INFORMATION CONTRACTOR INFORM AT ON
Owner J-C S U n S -ee� Company Name NA
�A
Mailing Add r ss_10 �� Sn t is �X c En Mailing Address
City ' Stated_Zip Code`�ESQ K- City State Zip Code
Phone Other PhA53.dQ 5 9'-IaL4 Phone Other Ph.
Lien/Title Holder 5t,cS'-' n Se-rye-y— Contractor Reg.# Exp.
E mail address Dw IUD cD FAQ 1 CONA E Mail Address
Drivers Lic. #5ktt_."L3j 5 �T DOB OS-� 30, 19 Lv3 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- 1 Dig Parcel No a 3 O -9 CC)o . -C)7 Fire District
Legal Description_S f- E-t A-'_ h tNA P yk 4-- "A"
Site Address (Please include street name, street number and cit ) S r-tS mck
Directions to site -(X• •L- t k S
S b p SS d23
Wabeg&u,"
and sold in parcel prepa ation? Yes/NoIs 200'of Saltwater Lake River/Creek Pond
W Seasonal Runoff Stream Slopes or Bluffs ] 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye No
TYPE OF JOB - New Add Alt Repair OtherKf 2Ce- PRIMARY RESIDENCE SEASONAL ❑
Use of Building Describe Work
No. of Bedrooms _No. of Bathrooms s2_Square Footage- 1 st Floor nd Floor 3 c a
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached _500 Detached Carport__ 0 Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width Serial No. No. of Bedrooms. No. of Bathrooms
Type of Heat Purchase Price$ Replacement Unit? Yes/No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. /
x Date: 9 07 IO
wne s epresentative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date b Z"1 10
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department Z. _
Planning Department
Environmentat-Health_Department --
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee (�, EH Review Fee
Plumbing & Base Fee q l70 jx0 Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
MASON COUNTY PERMIT 1\10.13rlct26110 - 61677
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
APPLICAW INFORMATI N CONTRACTOR INFORMATION
Owner Company Name
Mai in Addr Mailing Address
City State Zip Cod City State Zip Code
Phone Oth r Ph Phone Other Ph.
Lien/Title Holder Contractor Reg.4 Exp.
E mail address E Mail Address
Drivers Lic.# L 3 cWB 30. LCL& Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septi Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel N . — Q0 Fire District
Legal Description II I',
r
Site Address (Please include treet namestreet number and ity)
Direc ' to site — L L
Is i 0'of Saltwat Lake iver/C eek Pond
Wro d Seasonal Runoff—Stream—Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other QC Use of Building :2 jog
Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNIjS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_ LPCz_ Natural Gas_ Heat Pump_
Toilets �_ Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs rn Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer ( Gas Outlets
Kithen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood I
Hosebibs 2— Dryer Vent 1
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 I N70WORK IS BY MEANS OF A PROGRESS INSPECTIQ[V. 4 . ZV 10
X O ne Date: �'
r wners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND T S POINT
Accepted b lanning Pd Ck# Date 10 2`1 I Bld Pd Receipt No.
DEPARTM NTAL REVIEW APPROVED DENIED NOTES
Building Department
Occ Group—Type Constr.
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