HomeMy WebLinkAboutBLD2008-00320 Final SFR - BLD Permit / Conditions - 6/10/2009 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
P14
RESIDENTIAL BUILDING PERMIT BLD2008-00320
OWNER: ROBERT ENGLISH RECEIVED: 3/21/2008
CONTRACTOR: ORSER CUSTOM HOMES 360-509-8403 LICENSE: ORSERCH963NL EXP: 8/13/2008 ISSUED: 5/13/2008
SITE ADDRESS: 51 NE LAKEWAY DR NORTH BELFAIR EXPIRES: 11/13/2008
PARCEL NUMBER: 223107990721
LEGAL DESCRIPTION: TR 72A OF SURVEY 11/17 LOT: A OF SP#1495
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW SFR WEST ON BEAR CREEK/DAWATTO RD, L ON BLACKSMITH LAKE RD, R
ON LAKEWAY DR, R AT"T", 4TH PROPERTY ON LEFT
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: 3 Occ. Group: R-3, U-1 Lot Size: Deck: 280
Type of Work: NEW Fire Dist.: 2 No. of Stories: 3 Occ. Load: Building:1,615 Garage-Attached 465
Valuation: Building Height: Occ. Status: Primary Basement:530 carport at 252
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: E 25.0 Ft. Shoreline: Ft. Water Body: BLACKSIMTH LAKE
Model: Width: Ft. Rear: W 160.0 Ft. Slope: Ft.
SEPA?: No
Side 1: N 43.0 Ft. Shoreline Desig.: Unknown
Year: Serial No.: Side 2: S 19.0 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 3/21/2008 $860.70 S12008000
Hoseblbs 2 Furnace<100K 1 Planning Review Fee KS 3/21/2008 $190.00 S12bb8bbb
Kitchen Sink 2 Gas Outlets 3 Address Fee KS 3/21/2008 $162.00 S12008000
Laundry Tray 1 Propane Tank 1 Fire Warden Review KS 3/21/2008 $68.00 S12bb8bbb
Lavatories 4 Ventilation Fan 4 Building State Fee RTB 4/2/2008 $4.50 S22bb8bbb
Showers 1 Heat Pump 1 Building Permit Fee RTB 4/2/2008 $1,363.35 S22008000
Water Closets (Toilets) 3 Propane Stove 2 Mechanical Fee RTB 4/2/2008 $310.55 S22008000
Water Heaters 2 Dryer Vent 1 Mechanical Base Fee RTB 4/2/2008 $26.60 3 bb8bbb
Bath Tubs 2 Plumbing Fee RTB 4/2/2008 $144.31 S22008000
Clothes Washer 1 Plumbing Base Fee RTB 4/2/2008 $23.10 S22008000
ADJUST--Plan Check Fee RTB 4/2/2008 $25.48 S bb0 000
EH Plan Review TW 4/15/2008 $100.00 S22008000
Water Adequacy Plan Review TW 4/15/2008 $40.00 S22008000
Total $3,318.59
BLD2008-00320 Please referto the following pages for conditions of this permit. 1 of 6
CASE NOTES FOR
BLD2008-00320
CONDITIONS FOR
BLD2008-00320
1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division.
There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at
1-80�4 P82. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X (_((��
2) 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
suc roa onnect 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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3) All other necessary permits from Mason County, Washington State and/or Federal Agencies that re reAjired for this proposed development and
construction must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X
4) All approved plans are required to be on-site for inspection purposes. If an inspection is called for nit 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
Departmopt prior to any further inspections being performed or approvals granted.
X
5) Own r/Aflent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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6) 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
rem a approved documents will result in failure of required building inspections.
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7) 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
per t s II be applied for, reviewed and approved prior to the change. Basement only.
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8) THE _V A
OUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X
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9) 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
Buil ing partment prior to any further inspections being performed or approvals granted.
X
10) 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.
Exception: 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 ide ZI the roof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation.
X
11) 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 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/contra for i cknowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
12) 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 (I RC Table R402.2).
X
13) 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 ged d shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
X
14) 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
per it r cation.
X
BLD2008-00320 Please referto the following pages for conditions of this permit. 3 of 6
15) 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 pito '
* t.
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16) All changes pproved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ord' nrobr regulation, must be reviewed and approved by Mason County prior to construction.
X
17) 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 all be made prior to requesting additional inspections.
X
18) All property lines shall be clearly identified at the time of foundation inspection. X
19) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks filled
on site must be located a minimum of 10' from any possible source of ignition (electrical outlets, electrical fixtures, compressors, etc), mechanical system
air intake (direct vent appliance, ventilation air intake, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. Propane
tanks less than 125 gallons must also be located a minimum of 5' from any building opening (foundation vents, windows, doors etc). Setback to the public
way, or access easements shall be the greater of 25-ft or as specified in the Mason County Development Regulations. Setback to property lines shall be
the greater of 5-ft or as specified in the Mason County Development Regulations. If a propane tank is exposed to probable vehicular damage, protective
bollar s t be installed.
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20) All pro ane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All Propane tanks
between 125 and 500 gallons must be located a minimum of 10' from any building, possible source of ignition (electrical outlets, electrical fixtures,
compressors, etc), and/or any weeds, grass, brush, trash or any other similar combustible materials. Setback to the public way, or access easements
shall be the greater of 25-ft or as specified in the Mason County Development Regulations. Setback to property lines shall be the greater of 10-ft or as
specified in the Mason County Development Regulations. If a propane tank is exposed to probable vehicular damage, protective bollards must be
insta ed.
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21) All propane tanks must be installed in accordance with the International Fire Code and all applicable Mason County ordinances. All propane tanks must
me th P stallation requirements and minimum setbacks as listed in the Mason County Fire Marshal's Standards for the Installation of Propane Tanks.
X
BLD2008-00320 Please referto the following pages for conditions of this permit. 4 of 6
22) Fuel piping shall be inspected after the installation of fuel piping is complete, and before the attachment of fixtures, appliances, or shut-off valves. At the
time of inspection the test pressure shall be no less than 10 psi held for no less than 15 minutes. Appliances to be attached to the fuel piping system shall
not a used until the final inspection has been performed and approved by a Mason County building inspector.
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23) The placement of small propane tanks are not normally subject to a permit review by the Planning Department; however, propane tanks are subject to
Planning Department regulations. Such regulations primarily consist of setbacks from shorelines and features considered to be critical areas (streams,
wetlands, slopes, etc.) If you think suc feahires exist on or nearby your property, please contact the Planning Department so that exact setback
requirements can be determined. X
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 n C ty 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
hol er h l prevented action from being taken. No more than one extension may be granted.
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26) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
conct 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 nd stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Ap N- 2
ovSite 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
30) Wat r q ity is not to be degraded to the detriment of the aquatic environment as a result of this project.
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31) Prior o final approval, all upland areas disturbed or ewl reated by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
32) All construction and demolition debris must be removed from the beach after project completion. ro disposal of construction debris must be on land
in such a manner that debris cannot enter or cause water quality degredation of State waters. X
BLD2008-00320 Please referto the following pages for conditions of this permit. 5 of 6
33) Temporary erosion control measures must be implemented to prevent water . lityMegradation of adjacent waters or wetlands. Silt fencing must be
installed and maintained until upland vegetation has become established. X
34) App ove r dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
10
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a progress inspection.The owner or the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to
the above described property and strut re for review and inspection.
OWN ER OR AGENT: DATE: .
Z-43 ILE
BLD2008-00320 Please referto the following pages for conditions of this permit. 6 of 6
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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:
bgp//www.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)V 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 acknowled a that the information provided is accurate and employees of Mason County are granted access to the above-
d cribed prope for review and inspection as may be required.
X Owner/Agent/ ontractor circle one)Date:
Page 2 of 2
Name 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'.
'Redevelopment means,on an already developed site, the creation or addition of impervious surfaces, structural development
including constriction,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.
'Common 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.
iy lG[fJ$tHJ lrri rVi6"Sur#$c,�s ���Se;C��pinte Tuts �"�bi0
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Surface Type Length X Width = Area " All dimensions in feet
Buildings X =
X = Measurements for buildings,are taken at the
X _ perimeter of the farthest projections (example:
eaves/gutters)
X =
Driveways X
X = Length of drive begins at the right of way
X =
Parking Areas X
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 =
Others X =
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If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read, acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT 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.
X Owner/Agent/Contractor(circle one)Date:
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
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 I FORMATION
Owner Robert �yto►1� 4 BrfeA a Plot. Company Name arfir
MailingAddress 4S 3 O a R& N�- Mailing A dress P4 1
City r1 . r' State WA Zip Code�9�(0 City�ou wort State Zip Code 910
Phonp 1-041- '-'POW Other Ph. P t� �007 03 Other Ph.
Lien/Title Holder . w- 03 Exp..
Email address C2KI E Mail Address -TI-LIRSER Q W4veub/e . COin
Drivers Lic. # 61146 DOB -8•.T Drivers Lic. # 0RSA?J'W35/ D DOB a U 177
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic X
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Di it Parcel No. ' `� , � � Fire District
Legal Description (� °`f� /
Site Address (Please include street name, street number and city)
Directi s to site d
Will timber be cut and sold in parcel reparation?Ye o
Is property within 200'of Saltwater Lake IS River/Creek Pond
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 - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building a !1- C; (Scribe ork-2&w C nn ru��l,we
No. of Bedrooms —No. of Bathroom uare Footage- 1st Floor 2nd Floor
3rd Floor Basement 530 Deck Covered Deck Other 110 Sq. ft.
Garage Attached Detached Carport -? "t Attached X 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. This permit/application becomes null & void if work or authorized construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
MEANS FAP SS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X FIGRE
r _r �'�� �Yi')Q Date It
Owner/Owners Representativ2/Contractor' (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DE r4lED NOTES
Building Department kfto;7P
Planning Department
Environmental Health Department
Fire Marshal
FEES
Building Permit Fee 6.3. 3j— Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee M141. )/ -tt/b PlanningReview Fee
Mechanic I & B e fee .cp. 0 Other
Wood /Ga / el et Stove Fee 04 State Fee 41 S\O
Violation Fee r 5 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
On the web www.co.mason.wa.us
APPLICANT INFOR ATION CONTRACTOR INFORM ION
Owner �" Company Name
UrJcr 4' o
Mailing Address f{'�° Mailing Address
City g. Zs• state WA Zip Code_U/ld City-'oUState VJA Zip Code gn
Phone Other Ph. Phone _5W 5_0q 1990 Other Ph.
Lien/Title Holder Contractor Reg. /O8Q6Exp.
E mail address f"P�II �Id w1a� - ► E Mail Address ZZLO/QDS", 11Jalid,"biff, O1h
Drivers Lic.# "k 4f DOB II- Drivers Lic.# RS)ff ,'yyno n DOB /L!�`�'"►
SEPTIC INFORMATION - Connect to New Septic Existing Septi Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. i, D Fire District
Legal Description o (
Site Address (Please include street name, street number and city)
Directions to site C G o
- - (0-- , , j
Is property within 200'of Saltwater. Lake River/Creek Pond
n ff m Slo es or Bluffs 15/o
Wetland Seasonal Ru trea o S
P
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 UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPCA Natural Gas_ Heat Pump_
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace / L:a
Bath Tubs Heatpumps 5
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets 3
Kithen Sinks Wood/Gas/Pellet Stove
��—
Dishwasher Kitchen Exhaust Hood /' d-
S
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.
PROOF7 CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION
X _ Dater
Owner/Owners Representati ontract (indicate which one)
i
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bid 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 UFC Plan Review Fee
Wood /Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES