HomeMy WebLinkAboutBLD2005-01725 Final Garage - BLD Permit / Conditions - 3/30/2006 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
IrP4 Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2005-01725
OWNER: STEPHEN WEBER RECEIVED: 9/29/2005
CONTRACTOR: BUTCH'S BULLDOZING (360)275-5541 LICENSE: BUTCHB1994QE EXP: 11/5/2005 ISSUED: 11/4/2005
SITE ADDRESS: 180 NE MAHOGANY CT BELFAIR EXPIRES: 5/4/2006
PARCEL NUMBER: 223097700250
LEGAL DESCRIPTION: TR 25 OF SURV 13/234
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
CONSTRUCT 480 S.F. GARAGE ATTACHED TO MANUFACTURED BEAR CREEK DEWATTO TO BLACKSMITH TAHUYA TO LEFT A"Y"
HOME. MONSON TRACTS TO 180 MAHOGANY CT.
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr.: VB
Type of Use: MH Insp.Area: No.of Bathrooms: Occ. Group: U Lot Size: Deck:
Type of Work: ACC Fire Dist.: 2 No.of Stories: 1 Occ. Load: Building: Garage-Attached 480
Valuation: Building Height: 13 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
:
y
Make: Length: Ft. Front: E 450.0 Ft. Shoreline: Ft, Water Body:
No
Model: Width: Ft. Rear: W Ft. Slope: Ft.
Side 1: S 37.0 Ft. Shoreline Desig.: Not Applicable
Year: Sedal No.: I I Side 2: N Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures FEES
Mechanical Fixtures
Type Qty. Type a By Date Amount Receipt
Plan Check Fee CMH 9/29/2005 $136.01 B12005
Building State Fee ARC 10/21/200 $4.50 S12005
Building Permit Fee ARC 10/21/200 $209.25 S12005
EH Plan Review GMM 11/4/2005 $35.00 S12005
Total $384.76
BLD2005-01725 Please referto the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLU2005-01725
CONDITIONS FOR
BLD2005-01725
1) Water qualit e'degraded to the detriment of the aquatic environment as a result of this project.
X
2) Prior to final approval, all upland areas disturbed or newly .re ted by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X ��
3) Approve p�rd* ions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
4) 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�� ////-6,�7�Q�he person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
5) 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
Xepartmgn ri t any further inspections being performed or approvals granted.
6) 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 jurisdi:;��7
ternational codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting
inspections.
X
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 ap cuments will result in failure of required building inspections.
X �,�'
BLD2005-01725 Please referto the following pages for conditions of this permit. 2 of 4
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 shall �pie or, reviewed and approved prior to the change.
X QQ
9) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
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 grante . In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Building De e p ' r to any further inspections being performed or approvals granted.
X
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).
X
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
internation d a Mason County Regulations unless a"Change of Use" permit is applied for, reviewed and approved.
X
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 reM
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 bi��7
'of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affect your proje
X
15) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance Arr#gulatio , must be reviewed and approved by Mason County prior to construction.
X
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
Inspector shay;b d prior to requesting additional inspections.
X
BLD2005-01725 Please referto the following pages for conditions of this permit. 3 of 4
17) Ap property lines,shall be clearly identified at the time of foundation inspection,. X uJ �
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
X Mason�C t rd' a es and building regulations.
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 hav p v nt action from being taken. No more than one extension may be granted.
X ,�
20) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connectoyaa nd fl ing. Install metal connectors approved for contact with the new types of pressure treated material.
X S
21) Over framed roof system that is attached to a manufactured home must be approved by Washington State Labor and Industries for connection/bearing
onto man ature h e.
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 property and 5ructurreee for review and insp do
OWN ER OR AGENT: DATE:_ZZ xg to S
BLD2005-01725 Please refer to the following pages for conditions of this permit. 4 of 4
co
o CONCRETE MECHANICAL. MANUFACTURED HOME
Footings 1 Setbacks Date By Ribbons
�y� 1 Gas Piping
Date B [}ate By
o-. y 7,1
Cnn FoundationWalls Date By Set-up
Date By INSULATION Date By
BG I slab Insulation Floors FINAL I NSPECTION
Date By pate By Date By
FRAMING walls FIRE DEPARTMENT
Date By Date By Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLBOARD MAILING
DON Date Y31a. sy W K.
Date By
CD
Water Line FINAL INSPECTION
Date By pale 3 31) X sy L,0-- Date By
o Type of Insp. Pass/Fail Request Date Inspect. Date Done By Comments
CD
0)
a� W
y m
v00
j M
8 F l S /06 c
0
U-)AccB�rd A., "
°3/cs`� a31 (zl�
-l!<Xt ll D3 20 D� ZZ c LS QEv 09/7 N _
CD z
vw( P��S 3 Ito 3
0
h
I
i �Y
Stp 13 2005 10:53RH HP LRSERJET 2330
p.3
z23e q -77_Do
Par.ta L
I
c�
Q 0 0
m Q
LLI p 00 rP
U I u _
0 eu
a 1-7
:::r_ OU
�+ - --
O oLIJ
_
V r �' D
v�
r
O �, t4L0 m c DO
C m 2
GNNv. � - looms
C+� O 3 act,q3 ,
Mar 24 :2006 10: 45AM Hutch 's Bulldozing Inc. 360-275-7479 p. l
Butch's Bulldozing Inc. Phone 360-275-5541
P.O. Box 733 Fax 360-275-7479
Belfair, Wa. 98528 p a
TO: �4 f�oh
,4 - I�
PAGES TO FOLLOW /
COMMENT
E) 6(l�Aza
Mar 24 ,2006 10 : 45AM Butch 's Bulldozing Inc. 360-275-7479 p . 2
MAR-23-2.006 THU 11 ! 19 AM Liberty Homes Inc—Sales FAX N0, 503 643 7369
Mar 23 06 02112p EncineerinC Department 5745333SPS p.2
LIBERTY HOMES, INC.
)=Petf corporate ofl tioc
March 23, 2008
To Whom It May Concern:
When a 20' wide starage Is added to a Liberty home, the dormer must be vented
not only for the domler but also to provide s vented area into the main roof
section betow the dormer.
The sae of the area to be vend is 132.5 aq, ft. (venblatim 1/W). A minimum
of two (2) 12' x 12" openings are needed in the lower 50% of the main roof
(through the decking)In the dormer area,
Sinceraty,
1. F.,R OMES. INC.
Lee t_ehmart,
F_riginewin DirFi trx
tlnl hircahower Drive NOrh 0 P.O.U4x 35 9 U9a1ic4 IN 4652?-W33 • (574)333-043, . F'&x(574)537-043A
Mar 24 ,2006 10: 45AM Butch 's Bulldozing Inc. 360-275-7479 p. 3
2UUb/NAX101HK1 09:011 AM L & I — BREM PAX Ho, 3604154047 P. 002
Pagc l.of2
POST ON JORSITE PRIOR TO BEGINNING OF WORK
FAS ALTERATION PERMIT 4FP1170216
CONTRAC70RNAAtE LICENSE NUN9ER IN3I0NIA:172196
BUTCH'S BULLDOZING INC BUTCHB19940E INSTALLATION DESCRIPTION:
MH Structural
PURCHASER'$MArLINOADDRESS
PO BOX 733 SERVICES TO INSPECT:
BELFAIR WA 98528 DESCRIPTION QUANTITY
TELEPHONE NUMBER FAX NUMBER
(m)276-6641 ()_ AMOUNT
IN5IGNIA-INSIGNIA FEE-
PREMiSES OWNER'S NAME LTERATION F $10 8Q
Weber, Stephen STRUCTURAL-CHANGES T
OME WHEN ADDITIONS
ADDRESS OF INSPECTION EAR L __ 74 80
180 NE Mahogany Ct Ihspection fee; S84.90
Belfair
This permit expires In one(1)year from date of last activity.
Applied: III W2006 Expiration; V19/2007
MECHANICAL
Data Approved By Date Approved By
PLUMBING
Type Type
ELECTRICAL STRUCTURAL
Type Type
OTHER OTHER
Type Type
Inspection Date Ares, Building or'Equipment Inspected Action Taken Inspector
As ���,.� APP•t:?u��
SDL�s
Property Owner: This Is your permanent record of inspection
! http://sesd.apps-inside.Ini.wa.gov/paimperniitl tFASPenTdt.a x?A IDs101
� � i'p 1/19/2006
Mar 24 , 2006 10: 45AM Butch 's Bulldozing Inc. 360-275-7479 p. 4
Page l of 2
' POST ON JOBSITE PRIOR TO BEGINNING OF WORK
r
x �
a FAS ALTERATION PERMIT #FP1170216
CONTRACTOR NAME LICENSE NUMBER INSIGNIA:172196
BUTCH'S BULLDOZING INC BUTCHB19940E INSTALLATION DESCRIPTION:
MH Structural
PURCHASER'S MAILING ADDRESS - - --
PO BOX 733 SERVICES TO INSPECT:
BELFAIR WA 98528 DESCRIPTION QUANTITY
TELEPHONE NUMBER FAX NUMBER AMOUNT
(360)275-5541 ( ) -
INSIGNlA- INSIGNIA FEE -
FREMISES OWNER'S NAME [ALTERATION f i j 10.80
Weber, Stephen STRUCTURAL - CHANGES TO 1
HOME WHEN ADDITIONS !
ADDRESS OF INSPECTION BEAR L F7 74.39
180 NE Mahogany Ct ESIGN PLAN - STRUCTURALI
Belelfair �_ILT -ONE YEAR DESIGN. 84.90
Inspection fee: $169.80
This permit expires in one(1)year from date of last activity.
Applied: 1/19/2006 Expiration: 1/20/2007
Date Approved By Date Approved By
MECHANICAL PLUMBING
Type —- - - — Type
ELECTRICAL. STRUCTURAL
Type Type ---
OTHER OTHER
Type Type
:nspection Date Area,Building or Equipment Inspected Action Taken Inspector
V r/2 L)(-I-(j --r-;u stee-C,/7 b, �
Propes-tty w er: ts Is your permanent$TAVEdOFf-A WITpN
DEPT. OF LAWR& ffiou ' ms
CONSTRUCTION C`QMPLIA-NCE SECTION
�s ? gel TsstAlEs FACTORY BUILT MONO STRUCTURES
r►ON
C AI�CIAL
°�pq��� y PLANS ACCEPTED to �A G Doc
m ktt ZOOS SUBJECT TO HELD NSM"ON OVERSIGHT
OR VIOLATM OF RCW IS NOT INCLUDED
T , aC7E
- s u�a.1E t ��----- _____
ATE: 3 ~l 3 -2®o t
http://scsd.apps-inside.lni.wa.gov/pairspermit/rptFASPermit.aspx?AppID=106 1/20/2006
Mar 24 ,2006 10: 45AM Butch 's Bulldozing Inc. 360-275-7479 P. 5
•
Page I of.2
1 1 I 1-• ST
E PRIOR TO BEGINNING OF WORK
INSY lA NUM![M: ALTERAMON PERMrr NUYSER: MORYWYR APP►ED FOR:
lul' 172196 _
1-7
S ALTERATION PERMIT#FP1170216
INSIGNIAA72196
P.A pF`APPI . INSTALLATION DESCRIPTION:
MH Structural
PURCHASER'S MAILING ADDRESS _.__ ..- ___--_-._._-._.._._
PO BOX 733 SERVICES TO INSPECT:
BELFAIR WA 98528 DESCRIPTION QUANTITY
TELEPHONE NUMBER FAX NUMBER
(360) 275-5541 AMOUNT
INSIGNIA - INSIGNIA FEE-
PREMISES OWNER'S NAME I-7EATION i 1 p_gp I
Weber, Stephen STRUCTURAL-CHANGES TO
HOME WHEN ADDITIONS
ADDRESS OF INSPECTION BEAR L I �-' 74.30 f
'ISO NE Mahogany Ct _... - - -- --- ----- _
Belfair
Inspection fee: $84.90
This permit expires in one(1)year from date of fast activity.
Applied: 1/19/2006 Expiration: 1/1 912 0 0 7
MECHANICAL
Date Approved By Date Approved By
PLUMBING
Type Type
ELECTRICAL STRUCTURAL
Type Type
OTHER OTHER
Type Type
Inspection Date Area, Building or Equipment Inspected Action Taken Inspector
Property Owner: This is your permanent record of Inspection
�TE�F ]AN1 NDUDS
DEPrT RIE8
A5 P TV w �CTION 1
MAK l S Zaos MAR o 7 2906
eu9jS T T Q FACTORY Ab6tiVIBLED
STRUCTURES
http:/iscsd.a s-inside.Ini.wa. ovJ airs emiit! tFA i —
PP g p p rp SPerrn t.aspx.AppII3-101 I119,2006
i
Mar 24 , 2006 10: 45AM Butch 's Bulldozing Inc. 360-275-7479 P. 6
c z Box
�� �S S D � J L, Bremer+a O,WA 4L•312
P:360-792-2421
MAR 0 F:360-792-2949
ENGINEERING �AC7 20�6 ha rry.willioms@marchriss.com
,,I1� OkiY ''ijSEMEXED
NC. STRUCTURES
To: Terry Kleier STATE OF WASM(PJ;MN
Department of Labor and Industries
p DEFT. 0:='1_!��30R & INDUSTRIES
P.O. Box 44430
Olympia,WA 98504-4430 CONSTR1JC ?- 1 COMPUA-NCE SECTION
FACTORY EU:LT HOMES COMMERCIAL STRUCTURES
PLANS ACCEPTED Na 96 Md o 6 D CC] &I�
Re: Butch Warren
Butch's Bulldozing SUBJECT TO FlELO INSPECtiDN OVERSIGHT 3
Model/Design#FP 1170216 OR VIOLATOR Of RCiW IS NOT INCLUDED
Plan Review ID#MH0600021
Dear Terry,
I have been asked to assist Mr. Warren in answering your comment regarding the
dormer addition for the above mentioned project. As we discussed on the phone,this
letter only addresses the adequacy of the manufactured home roof to take the added load
of a dormer as installed by Butch's Bulldozing. After obtaining technical information
from Liberty Homes (home manufacturer)and construction sketches of the dormer
provided by Mr. Warren, it is my determination that the manufactured home roof is not
adequate. The loading condition created by the way the dormer was installed indicated
that the roof would be overloaded. I used the engineering data as shown on drawing
C2070R06 (attached) to arrive at this conclusion. Therefore, I have attached a retrofit
sketch (Engineer's Sketch "A' and "B")that shows a reinforcing method so that the roof
could safely support the dormer. If you have any questions or need clarification please
call me anytime.
f STATE OF ASHtNGTON
Harry Williams P.E. SQ. �'Jii.i 9 OE P�O NB4P ANyyD�t 1GT�oNKg
C'. �f+
MAR 13 2006
STATE OF WASHINGTON
DEPT.OF LABOR AND INDUSTRIES 59
FAS PLAN REVgW SECTION �' 'QF 4
A P P R
V E D SUBJECT,TOODE�,s G'lSTF V
r t-, w 1'1 l tT1 �l�r PT�I,
MAK 1 3 2006
EXPIRES OW13/
SUBJECT T CODE
AND FIELD INSPECTION
RESIDENTIAL COMMERCIAL- INDUSTREAI
I
Mar 24 2006 10: 47RM Hutch 's Bulldozing Inc. 360-275-7479 p. 7
� r •
orCPU
- � vm - .
F --
X ------------
t J ( 6
I �
La
ll -•..�..,}M .Mj %'.,.ice— .,�;, � —Il
STATE tES
OF yy�hllNdTfl 8 i]
FT.OF l.I�
DE NBDH ANfl fNat S _• •,'
IA
APP
TT
Mar 24. 2006 10: 49AM Hutch 's Bulldozing Injjc. 360-275-7479 p. 8
I
r\
I �
N
y�•''f 9�*Z glad N�1aN
S�a�ilrrVA phL
3G L
-a
c.,
v
x
C
N VIA
SN
.--
s sk lv
DEFT QE B�OgW�8N4yptNOTiO F068�
NOIl AV
ol NIHOYM 4L Its' cj
I —nrSUSaT SUH go
Mar 24. 2006 10: 51AM Butch 's Bulldozing Inc. 360-275-7479 p. 9
�XIST►r�G� �xl�J�..��1
Tr
4 3
i � bx3b�
I _
yu t���c� 5l-l)pj a')
3 ewe llal 3 Co r I
• 1
z,
16° GIYL9Gb p. ----
DEEP t OF Lh aRR AN DD 111
-- —
FA8 P APVA Y ICy1l �.
_ MAN 3 2006
all F
��
Mar 24. 2006 10: 51AM Butch 's Bulldozing Inc. 360-275-7479 p. 1O
TfE
FI Rol.PRe DFr,3 j . 3/
o _,,
� Corr., SCAB
oa Gk��� RSR
':IbAM R �7LoOUR-
S Y b'�
�cP a
Sao
OEPT,d T�qB 'n A�NeD�INdU T ES
FAS A1PI CTp.
i
MAK 1 2006
SUBJECT TO�OD
AND FIELD INS C
c
WSJ --- _
ry L
Mar 24 2006 10: 52AN Butch 's Bulldozing Inc. 360-275-7479 p . 11
1 ry'nS
I v"IL"1 VAt16`
Eli
14-
e.
't
i ''vQJ
AV^1�7.'•,•.:2..r.1 6aa .i:N F'..1• '':+i'` .,ry''• �,
;
•''r,'r A.DS
' �:'�j r� ..' .'z' •gig = .
CAB PI.AF L
t3�i;• �r�;..�: x c.
tom! ;fir
APB �—^—
3
- dl
N
N
O
O
O
% •L �t,,,. K^++�wnr.w.w..o�o.a�+�rsc,,,.�ae.,.o..,,.
m
Ct
r� a
N>74
,
- ----+,w----w: --- v -.-.:+s•�'.
�tu_.�'c.
C.. \ -�'H''a1ia�' :w...o,ar. •�+w+�.. .riiwlC`r-?..+f.+l »,�� O
� �•-�� 3pL�� .- ! � - _ v**�rwr a.,...r-•..i- -3If•�J
F41!1 av
c� a amzy� I r
m rn -4cFf*( I ------ .... 7
zoo
1.4
" :. cn
to 4 J
M
r
N
f
3 I
N
N
O
O
O
r
o
rA
03
m � �
yfim ___-__- - ti. _ - --- ---
t H
N 4:*DT --- --—-- C1
n C3 mtAZ2
z;p
m
----
E-LEVAEON CD
I
r
w
Mar 24 2006 10: 55AN Butch 's Bulldozing Inc. 360-275-7479 p. 14
-j-O •. }f�V,--�;�: c', .:- %'. ';ram;'.
WIFIr
N A;
ri1R15TIrJ�1 � ,R:..
_ .j.�,jtt.y;;4F!�a,_.t;`fi_.'.T'( .t. .t_d.�{Y t r�a sr—a � I�t��±� '•� .`'.
• 5
'`
se."•
MW
SEE
—96
ion
SEE A66ED,0ETr�,IL::SHEET
.,..tom
jen-
r _
STATE OF WASHINGTON
DEPT. OF LABOR AND INDUSTRIES
FAS PLAN REV W SECTION
APPR
OVED
MAt� 1 9 2006
sueACT TO CODE
ANC FIELD INSPECTION
I
3
7
N
,41
N
O
O
O
r
O
Ul
i 3
�`a�a`.F.4�F1f4 'M,1�6KWn
/.�•
- sty �hl�R�lil.MnY'�+W"MnKYak "
LA
' Tiab Co M� m
7777
77.
N
o� b m SRIiA G --- , ---- I o
mm vZ o'n I
m � ,
offiO
n o om�
m 0
EI
60
Qm Z Q,; � y k ❑
z z rnQUM
R!A ON
1 t INS �-_._.____ . �•---_..,;� l ro
cn I
CD
.a
1
r
U1
7-7
MASON COUNTY PERMIT No. D":?wei
BUILDING PERMIT APPLICATION 09-5,MW
426 W. Cedar • PO. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 1-7 A
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner. 4 Company Name r� �ic�t�l�C��✓K�t
Mailing Address Mailing Address I" a ol!
City ,:(�" Ld State Zip Code City State�— Zip Code
Phone .9Z R70ther Ph. Phone ' Other Ph.
Lien/Title Holder Contractor Reg. Exp.
E mail address E Mail Address
Drivers Lic.# ✓ 4 DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Water System Name of Water System 4
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description L ^ r.�. ."r "i. 3 bfi&
Site Address (Please include street name, street number and city) G rf... e- .
Direc cons to site
I PLC
Will t ber be cut and sol in parcel preparation?Yes o'
Is property within 200'of Saltwater Lake C River/Creek k/o Pond f�
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - Newer Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building n Describe Work
No.of Bedrooms No. of Bathrooms Square Footage - 1st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make l(�5..0"'i714 Model 4AIAl Year
Length Width ., Serial No. �k �d� No. of Bedrooms No. of Bathrooms e
Type of Heat ' � Purchase rce $ �� 4 D c� Replacement Unit? Yes!No
Installer Name "�� r' Certification No. if ?��
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,repr Al rmation
provided is accurate and grants employees of Mason County access to the above described property and structure for review % 1).
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X .alJ.�- _--"/,' >/�`" _' Date: SEP 2 g ?005
Owner/Owners Representative/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date F/CE
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department ; ,
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
BuildingPermit Fee -O Q/, Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee PlanningReview Fee
Mechanical & Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Al LNF Pre-Paid at Submittal
Valuation $ • eo TOTAL FEES