HomeMy WebLinkAboutBLD2008-00352 Final SFR - BLD Permit / Conditions - 11/25/2009 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 BLD2008-00352
OWNER: RICHARD NEWTON RECEIVED: 3/28/2008
CONTRACTOR: LICENSE: EXP: ISSUED: 5/8/2008
SITE ADDRESS: 6960 NE ELFENDAHL PASS RD BELFAIR EXPIRES: 11/8/2008
PARCEL NUMBER: 223117600180
LEGAL DESCRIPTION: TR 18 OF SURVEY VOL 4/19-22
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
Replace M.H. with SFR. FROM BELFAIR TAKE BEAR CREEK-DEWATTO RD TO RIGHT ON NE
ELFENDAHL PASS RD. SITE ON LEFT W/ BJ'S SIGN POSTED.
General Information Construction &Occupancy Information Square Footage Information
No. of Bedrooms: 4 Type of Constr.: V-B
Type of Use: SF Insp.Area: No. of Bathrooms: 4 Occ. Group: R-3, U-1 Lot Size: Deck: 368
Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:3,034 Garage-Attached 896
Valuation: Building Height: Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: E 319.0 Ft. Shoreline: Ft. Water Body: None
Rear: W 500.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: S 63.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: N 63.0 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 KKK 3/28/2008 $1,246.54 S22008000
Hosebibs 3 Furnace<100K 1 Planning Review Fee KKK 3/28/2008 $190.0o S22008000
Kitchen Sink 1 Gas Outlets 2 EH Plan Review TW 4/3/2008 $100.0o S12008000
Lavatories 6 Propane Tank 1 Building State Fee RTB 4/11/2008 $4.50 51200i3000
Showers 2 Ventilation Fan 6 Building Permit Fee RTB 4/11/2008 $1,917.75 51200i3000
Water Closets (Toilets) 4 Heat Pump 1 Mechanical Fee RTB 4/11/2008 $247.00 51200i bbb
Water Heaters 2 Propane Stove 1 Mechanical Base Fee RTB 4/11/2008 $26.60 51200i300i)
Bath Tubs 2 Dryer Vent 1 Plumbing Fee RTB 4/11/2008 $160.51 S12008000
Clothes Washer 1 Plumbing Base Fee RTB 4/11/2008 $23.10 S12008000
Total $3,916.00
BLD2008-00352 Please refer to the following pages for conditions of this permit. 1 of 5
CASE NOTES FOR
BLD2008-00352
CONDITIONS FOR
BLD2008-00352
1) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X l �
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
1-8000-6 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) 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
such roads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X
4) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. X
NEW SEPTIC MUST BE INSTALLED PRIOR TO OCCUPANCY.
X.
5) 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
6) 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 any further inspections being performed or approvals granted.
7) Owner/Agent 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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8) 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
X removal of�ed documents will result in failure of required building inspections.
BLD2008-00352 Please referto the following pages for conditions of this permit. 2 of 5
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 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.
X
11) 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
underside of the roof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation.
X
12) 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/contractor is acknowledging that all components of the stormwater management system have been installed as
approved on the stormwater site plan. X
13) 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
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
permit revocation.
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 project.
X
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BLD2008-00352 Please referto the following pages for conditions of this permit. 3 of 5
16) 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.
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
Inspector shall 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 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 and building regulations.
X
20) 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
pr nted action from being taken. No more than one extension may be granted.
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21) 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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22) 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
23) 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.
X
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24) Water quality is not to be degraded to the detriment of the aquatic environment as a result of this project.
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25) 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�r�/'i��f
26) All construction and demolition debris must be removed from the beach after project completion. Proper 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
BLD2008-00352 Please refer to the following pages for conditions of this permit. 4 of 5
27) Temporary erosion control measures must be implemented to prevent water quality degradation of adjacent waters or wetlands. Silt fencing must be
installed and maintained until upland vegetation has become established. X
This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is
commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of
work is by means of a 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.
OWNER ORAGENT�/.p DATE:�GL 2 (2
BLD2008-00352 Please referto the following pages for conditions of this permit. 5 of 5
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CONCRETE MECHANICAL MANUFACTURED HOME m
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CD Footings/Setbacks Date /� BY Footings90 Gas Piping O
o Interior Date By Interior-Dote f -/ -p BY Date E3y Z
� Exterior Dab y Exterior-Date B By _ _ _.._.__ _
N � �� ��� Set �
Point toad 1 Isolated Footings INSULATION Date By 0
BG!SLAB INSULATION ---_•--- -
Date BY Dace By FIRE DEPARTMENT _
Foundation Walls Floors Date By X
Date By Data —2— ap 2 BY I DECKS
FRAMING COS Walls Date BY
Date ey Date �� � By PROPANE TANKS
PLUMBING Vauk Date By
Date By OTHER
Groundwork Attic
Date '7 Z_ —� By LC�O Type.
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Date s- By int.Brace Wall Date By W
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ALL SETBACKS ARE MEASURED
22311-76-00180 FROM THE FURTHEST
PROJECTION OF THE BUILDING
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APPROVE J
MASON COUNTY DCU iPLANNING
SITE PLAN REQUIRED TO B- riN
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NAME n JOBNAME
ADDRESS DELIVERY ADDRESS
PHONE - i v PHONE
BATE TRUSSES NEEDED LOCATION (LEGAL DESCRIPTION)
-AR CUSTOMER As of lhis dare the talowlnq order cf trusses and components hes been entered
Shawn below.UrJ"s wo are notified of arty dfacrepancias within 48 houm,we wilt pmcaed wIM
oduct1w.Am trusses are unique for oech altuallon,returu or cance3atlon Layond that tkne is not
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SPECIAL INSTRUCTIONS
RATS 1.loth,ttEY 10th, OAC. F,O,B.PLATE LINE OR SI1 E PER CONTRACT,P ROVIDING BUILDING 15 ACCESSIBLE. DRIVERS SOLE JUDGE OF ACCESSIBILITY.1.5%per month charged on deliquont accounts,
ARRIIIG,BACK CHARGES WILL NOT BE ACCfSrTEO RFGARE)LESS OF FAULT,WITHOUT PRIDR NOTIFICATION BY CUSTOMER WITHIN 48 HOURS ANO INVESTIGATED BY M—n]nsufa Truss_NC EXCEPTION$.
AYiMENT A U ANGEMENr'TS SIGNATURE
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18' 40' 20'-
I Roof Plane Sheathing Area =523 s
iv Gable Sheathing Area 5 .ft
q=332 sq.tl
T Total Sheathing Area=5566 sq.ft
Fascia Material=362 linear ft r.•AF C
VaNey Flashing Material=58 linear I
Ridge Cap Material=101 linear ft C
Hip Ridge Material=176 linear R
Total Material Cost: S 0.03
750 Total Labor Cost: $ 0.00
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PAGE NO:
1 OF 1
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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 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.
. ;::.. .. ......
"a Cnulat�/rirnr�c�rs. rr#acs � tgompiret�;Yt>r "abf�
..
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
Parking Areas A if I�
_ Any paved, gravel or packed area per definition
above table
Patios/V1/alks
X = Any paved, gravel or packed area per definition
above table
X =
Others X = .
_ if#f18 fidtBI rr :_>:: 3r 0 is a �? stir€t> i `" ddl>. <
X lm. :,:1> :.:
..... i i3fi 1s' ter than n 2t1QQ ua'e fi r l E#
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Tirtai.lrn' rcrit tl ' iitf t lktea st m cxf 11 MV6
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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 I of 2
Name 74C'N Parcel# 1 Z 3/ 1 7�s d 0/b'6 BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14, Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction. A complete copy of the ordinance can be found on the Mason County website:
http//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
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 985.84
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 pebeerty for eview and inspection as may be required.
0�
X Owner/Agent/Contractor(circle one)Date: .3•- 2&-
Page 2 of 2
MASON COUNTY PERMIT NO. »o
BUILDING PERMIT APPLICATION os
426 W. Cedar• P.O. Box 186, Shelton, WA 98584
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Company Name
Mailing Address F ,u o sL x Mailing Address
City - State L-10- Zip Code 9 51 S City State Zip Code
Phone Other Ph. -1 S-S2 t S Phone Other Ph.
Lien/Title Holder 6"I f mid t,.n / ..K Contractor Reg. # Exp.
Email address S1je-tew& 66�0 0,5, ve f E Mail Address
Drivers Lic. # DOB Drivers Lic. # DOB
SEPTIC / WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. 400& J fio Fire District
Legal Description ft, 10 Or SU lot 4/0- 7 Z
Site Address (Please include street name, street number and city) 9GU NE ,4 A.SS
Directions to site
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater P 0 Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs >/o
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 r;,On-a escribe Work ^ �� ``Ir` -5-' e & i-
No. of Bedrooms '"t No. of Bathrooms Square Footage- 1 st Floor 3U 3 N' 2nd Floor
3rd Floor Basement -40' Deck_ Covered Deck 3Se—Other Sq. ft.
Garage Attached 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 informaticn provided is accurate and grants employees of Mason County access to the above
described property and structure for rbview 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
MEANSOFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X Date 3-
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW A PROVED DENIED NOTES
Building Department
c
Planning Department
Environmental Health Department J `f.
Fire Marshal
FEES
Building Permit Fee 117 Site Inspection
Plan Review Fee 11,6, EH Review Fee
Plumbinq & Base Fee Planning Review Fee
Mechanica & B ee v Other
Wood / as Pel et tove Fee . Ott State Fee
Violatio ee 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 INFORMATION CONTRACTOR INFORMATION
Owner ,R c 44 irf tJP9-✓'tu1J ALCompany Name
Mailing Address !n% MI5 F/.l"N, a-A A 55 k_ Mailing Address
City State w ex Zip Code 9 5SZ $ City State — Zip Code
Phone 366 /a—z 6'6 Other Ph. .360- Z b.S 5226_ Phone Other Ph.
Lien/Title Holder r "'I I w I 1 11,0 X Contractor Reg. # Exp.
E mail address 10et'te,J Op we < • N 0 t E Mail Address
Drivers Lic.# 1�► r'-'l>P u/3a' �'J DOB "-j 1 --&G 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 V 9 Fire District
Legal Description T#< 1 $ e -6 u r✓c Y V oi. '4 1 9 1 L
Site Address (Please include street name, street number and city) Zi c)F.0 AJ,6 0,t e-x1d.4f l r, rJ
Directions to site
Is property within 200'of Saltwater Lake N G River/Creek AO a Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric— LPCI-)—( Natural Gas_ Heat Pump_
Toilets I I _ �_ Type of Unit No. of Units Fees
Bathroom Sink / „H 5 GQ Furnace
Bath Tubs �_ / Heatpumps
Showers Spot Vent Fan
Water Heater _ Propane Tank 1.
Clothes Washer Gas Outlets .2.
Kithen Sinks —_ F. lU Wood/Gas/PelletStoveT—
Dishwasher 1 C3. 10 Kitchen Exhaust Hood
Hosebibs 7 Dryer Vent t
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other parry in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X �'. ! ��r ; _mil Date: 3 2 6 -- o �
Owner/Owners Representative/Contractor (indicate which one)
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 Constr.-
Planning Department
Environmental Health Departmient
FEES
Plumbing & Base Fee Site Inspection
Mechanical & Base fee UFC Plan Review Fee
Wood/Gas/ Pellet Stove Fee Other
` Violation Fee TOTAL FEES