HomeMy WebLinkAboutBLD2004-01845 Final SFR - BLD Permit / Conditions - 2/21/2006 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
Mason County Bldg. 3 426 W. Cedar P.O. Box 186
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2004-01845
OWNER: MARY ANN SPIRES RECEIVED: 12/1/2004
CONTRACTOR: HI LINE HOMES 253-840-1722 253-840-1849 LICENSE: HILINH"981BT EXP: 11/7/2005 05
SITE ADDRESS: 51 NE STEELHEAD DR NORTH BELFAIR EXPIRES:ISSUED: 5/16/20/16/200
PARCEL NUMBER: 223255006010
LEGAL DESCRIPTION: MISSION CREEK BLK: 6 LOT: 10 51 NE STEELHEAD DR NORTH
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
SFR STOCK PLAN 2003-0003 NORTH SHORE RD BELFAIR TO MISSION DCR TO STEELHEAD DR NE
General Information Construction &Occupancy Information Square Footage Information
No.of Bedrooms: 3 Type of Constr.: VB
Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck:
Type of Work: NEW Fire Dist.: 2 No.of Stories: 1 Occ. Load: Building:1,716 Garage-Attached 484
Valuation: Building Height: Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: E 37.0 Ft. Shoreline: Ft. Water Body:
Rear: W 130.0 Ft. Slope: 25.0 Ft.
SEPA?: No
Model: Width: Ft. Side 1: N 32.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: S 20.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Dishwasher 1 Exhaust Hood 1 Plan Check Fee KS 12/1/2004 $227.87 S12004
Hosebibs 2 Unit Heater 1 Planning Review Fee KS 12/1/2004 $155.00 S12004
Kitchen Sink 1 Ventilation Fan 3 Building State Fee ARC 12/2/2004 $4.50 S12005
Lavatories 2 Dryer Vent 1 Building Permit Fee ARC 12/2/2004$1,139.35 S12005
Water Closets (Toilets) 2 Mechanical Fee ARC 12/2/2004 $54.45 S12005
Water Heaters 1 Mechanical Base Fee ARC 12/2/2004 $23.50 S12005
Bath Tubs 2 Plumbing Fee ARC 12/2/2004 $75.00 S12005
Clothes Washer 1 Plumbing Base Fee ARC 12/2/2004 $20.00 S12005
EH Plan Review CEW 12/6/2004 $75.00 S12005
Public Works Review AT 3/23/2005 $39.22 S12005
Public Works Review AT 5/10/2005 $39.22 S12005
Total $1,853.11
BLD2004-01845 Please refer to the following pages for conditions of this permit. 1 of 4
CASE NOTES FOR
BLD2004-01845
CONDITIONS FOR
BLD2004-01845
1) The internationnl 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 road connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
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2) 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.
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3) In accordance with international codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus Access Roads," all new structures that
require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from the
access road. The numbers shall also be plainly visible and legible from the street or road fronting the property and shall contrast with their background.
Mason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted
by the jurisdiction and the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting
inspections.
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4) 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
rerQoval of approved documents will result in failure of required building inspections.
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5) 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
Bing De,partment prior to any further inspections being performed or approvals granted.
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6) Washington State Energy Code Compliance has been approved using the following:
Heat Type: Ely tric or other fuels, Compliance Method: IV, Window (Max U-Factor):0.40, Skylight (Max U-Factor):0.58,
D,_oors (Type/Yax U-Factor):0.40 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-30, Slab Insulation R-10.
BLD2 104-01845 Please refer to the following pages for conditions of this permit. 2 of 4
7) Stock Plan Identification number:
This project is approved subject to the provisions identified the Mason County Stock Plan Policy. The site plan approved by the Planning Department,
original building plans, and all attachments approved by the Mason County Building Department shall be available for the Mason County Building
Inspectoch required inspection.
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8) 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
ck aargeg a dt shall be collected by the Building Department prior to any further inspections being performed or approvals granted.
9) 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 revocf tion.
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10) 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.
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11) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulation, must be reviewed and approved by Mason County prior to construction.
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12) 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
Xspector shAe made prior to requesting additional inspections.
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13) All property lines shall be clearly identified at the time of foundation inspection. X / i'
14) 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 fdinances and building regulations.
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BLD2004-01845 Please referto the following pages for conditions of this permit. 3 of 4
15) , 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
h Ider have ptevented action from being taken. No more than one extension may be granted.
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16) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
cgnnector�/,Iand flashing. Install metal connectors approved for contact with the new types of pressure treated material.
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17) 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-$00-647-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
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18) later quality is not to be degraded to the detriment of the aquatic environment as a result of this project.
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19) Prior to final approval, all upland areas disturbed of newly created by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X � z
20) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
21) The approval of this project is subject to the recommendations and specifications outlinpd in the attached geotechnical report or assessment. Structures
and /or land modifications (grading, cuts, fills, etc.) required in the geotechni_cal_report'/assessment, may require a seperate permit. The geotechincal
report/assessment shall remain attached to the approved building plans. 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 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 structuref review a inspection.
OWNER OR AGENT: DATE: V
BLD2004-01845 Please referto the following pages for conditions of this permit. 4 of 4
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o CONCRETE MECHANICAL MANUFACTURED HOME
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Footings / Setbacks Date Ribbons
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C- Date 7 �� By La}t- Gas Piping Date By
Foundatiqn Walls Date B y Set-up
Date L' 03 T By INSULATION Date By
B G / Slab Insulation Floors Final
Date By Date Z 2�ll� Date By
FRAMING Walls �d FIRE DEPT
Date l , /09 ,P%S - By Date 11 C>r - Byjj Date By
PLUMBING Attic OTHER
Groundwork Date `1/Z11/010 B�__
Date By WALL O RD NAILING
D.W.V. Date ( �( 0 �- By
Date &1> Byj S FINAL INSPECT
Water Line // Date 2 '2-1 10b y
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MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING WSEC/VIAQ Compliance Application
d
Owner: ts I
Telephone: xs-oLi4 Parcel#: 435=
ype of project o� New Residence ( ) Addition ( ) Remodel
Total Sq. Ft. 15 Floor : 2 nd floor: Heated asement:
of heated area:: J7 i Le NO
Heating System: RECEIVED
Glazing� Prescriptive Option see �s&e *cfe one: I II fll' Percentage: Compliance
Method O Component Performanc a AR-Slalculation worksheets required
Check one::
% O Systems analysis, Chapter 4
Whole House Ventilation system O Whole House Ventilation using a Heat
Ventilation using exhaust fans&window or wall fresh air
Recovery Ventilation System (VIAQ 303.a.a)
System vents (VIAQ 303.4./)
Check one
O Whole House Ventilation Integrated O Whole House Ventilation using an inline
with a Forced Air System (VIAQ 303.4.2) supply fan. VIAQ 303.4.3J
Window & Door Schedule (If needed, attach an additional sheet)
Total
Manufacturer Room/location U-Factor Size Quantity Square Feet
Windows: c10 X-.510 1 la2c)
ol Webm 113 46 s-/& Oq 9
i 994 &'D 'D lay
ft b,r or, '0 X Vo
L'v1 q0 )C � 0
'0 st l Vo
Windows: Total Sq. ft.
Doors:
1 l.ITA `► Ll TI
Doors: Total Sq. Ft
Total window and door area
Total window & door area �8$ /(divided by) total sq. ft of heated area = i�%of glazing
MASON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
Permit Assistance Center
SHELTON (360) 427-9670 BELFAIR (360)275-4467 SEATTLE (206)464-6968
ELMA (360)482-5269 FAX: (360) 427-7798 WEB SITE: www.co.mason.wa.us
P.O. Box 186, SHELTON 98584
2001 Washington State Energy Code (WSEC)
effective July 1, 2002
2000 Ventilation and Indoor Air Quality Code (VIAQ)
Code Compliance Application Form
The following information will be required for the WSEC and VIAQ plan review:
1. Complete the Washington State Energy Code/ Ventilation and Indoor Air Quality Code
(WSEC/VIAQ)application located on the reverse side.
2. Complete the window and door schedule on the reverse side. Include all windows, skylights,
sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening
dimensions of the windows and doors. Information about the U-factor of the window will also help
to expedite the energy code review. If you are complying with the WSEC by prescriptive path and
are using the area weighted average method you must include your calculations.
3. On your building plans note the location and fuel type of water heater, location of exhaust fans
(bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and
slabs,
4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 284. Additional
WSEC and VIAQ compliance information is available on the internet at:
www.energy.wsu.edu/buildings/
Prescriptive Requirements 0,1for Group R Occupancy
Climate Zone 1, Table 6-1
Glazing Glazing U-factor Wall Wall Wall
Area %of Door Ceiling Vaulted Above interior° exterior Slab
°
Option Floor U s 2 Ceiling3 Grade below 4 Below Floors on
10 Vertical Overhead Factor 12 grade Grade Grade
t 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10
It* 15%" .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
III Unlimited
Single Family Res .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10
(R-3)Only
'Reference Case/Call (360)427-9670 ext. 284 for footnote information. Log& solid timber wall with a min. avg.thickness of 3.5"are
exempt from the above grade wall insulation requirements.
ON.STA MASON COUNTY
�P5 M c DEPARTMENT OF COMMUNITY DEVELOPMENT
o s"° Planning Division
~ NOT �? P 0 Box 279, Shelton,WA 98584
J Y �,o~ (360)427-9670
1864
NOTIFICATION OF INCOMPLETE APPLICATION
March 29, 2005
MARY ANN SPIRES
111 PEDERSON DR
BELFAIR WA 98528
Parcel No.: 223255006010
Project Description: SFR STOCK PLAN 2003-0003
Dear Applicant:
You have submitted a permit application (case no. BLD2004-01845) for proposed
construction or development in the county. Upon review of your application, I have
determined that the contents of the application are incomplete or do not provide
enough detail for review.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360) 427-9670, ext. 294 if you have questions.
Sincerely,
Charles Mead McCoy III
Land Use Planner
Mason County Planning Department
Comments: Please find enclosed your Geotechnical Report. It is being returned to
you for modifications. Please have your engineer review the enclosed
letter from Alan Tahja to assist in making revisions.
Please send the revised Geotech Report to my attention.
3/29/2005 1 of 1 BLD2004-01845
ON.STgTF MASON COUNTY
o P� A o N DEPARTMENT OF COMMUNITY DEVELOPMENT
o N E Planning Division
7 N y y P O Box 279, Shelton, WA 98584
rasa (360)427-9670
NOTIFICATION OF INCOMPLETE APPLICATION
December 08, 2004
MARY ANN SPIRES
111 PEDERSON DR
BELFAIR WA 98528
Parcel No.: 223255006010
Project Description: SFR STOCK PLAN 2003-0003
Dear Applicant:
You have submitted a permit application (case no. BLD2004-01845) for proposed
construction or development in the county. Upon review of your application, I have
determined that the contents of the application are incomplete or do not provide
enough detail for review.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360) 427-9670, ext. 577 if you have questions.
PUse
Land PI er
Mason County Pla gg._L2e�a ent
12/8/2004 Page 1 of 2 BLD2004-01845
i
NOTIFICATION OF INCOMPLETE APPLICATION
12/8/2004 Case No.: BLD2004-01845
Comments: A field inspection of the subject property was conducted on 12/7/04 to
assess critical areas issues and setbacks relevant to the construction
of a single-family residence.
The parcel is adjacent to or contains a steep slope. A steep slope
trends downward toward the building site at an angle in excess of 21.8
degrees. This area meets the criteria for a Landslide Hazard Area per
the provisions of the Mason County Resource Ordinance No. 77-93.
Any site work or application for development within 300 feet of a
Landslide Hazard Area requires a Mason Environmental Permit and
geotechnical report to assess slope stability and address specific
efforts to remediate the hazard. Enclosed is a copy of the Landslide
Hazard Areas chapter of the Resource Ordinance. Please note the
distinction between a geologic assessment and a geotechnical report.
This project will require a geotechnical report. Actual slope setbacks
will be established by the contents of the geotechnical report. The
report must state that the hazards of the landslide area can be
overcome in such a manner as to prevent harm to property and public
health and safety, and must also assure the project will cause no
significant environmental impact. If you have questions or require
clarification of this issue, please contact me.
12/8/2004 Page 2 of 2 BLD2004-01845
6+; ( D0
_ FORM MUST BE COMPLETED IN INK PERMIT NO: BLD
PLEASE PRESS HARD MASON COUNTY
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 3601427 9670 Belfair 360 275.4467 Elma 360 482-5269 Seattle 206 464-6968
APPLIC T INF�ORMATION CONTRACTOR INF RMATION
`
Owner_J 1_ Contractor Name
Mallmr Add,eSs Mailil Address
City �r State Zip Cede city Y State Zip Code
Phone( a -O ther Ph. — Ph. Other Ph.(__}
Lien/Title Holder r Contractor g. #
Address Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Co n ct to Sewer
System__Name of Sewer System Well Wate System�Name of
Water System
, 51
-
PARCEL INFORMAI'I N-12 digit Tax Pa cel No. ).5 ��' - f G Fire District
Legal Description �a �r — - �o
Site Address(Please includ street nam , stLrett number and city) —
Dir ctio to site
Will timber be. cut and sold in parcel preparation? (Yes/No)
Is your properly within 200' f the folio win Body et Wat r (Name) Saltwater
Lake_ b? _River/Creek Pond Runoff"" Stream Slopes or
Bluffs
PERMANENT RESIDENCE SEASONAL RESIDENCE❑
TYPE OF JOB NI Add Alt Repair Other Use of Building
Describe Work
No. of Bedro%p;_. _No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor
31d Floor 4 Lott Basement 43` Deck_�Other 77
Garage 7��—Attached Detached sq. ft.
At Carport Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length Wi t No. of Bedrooms No. of Bathrooms
Type of Purchase Price $ Replacement Unit ?(Yes/No)
Insta .6,Name Certification No.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a
Contractor Re tration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements w ich this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
cortrormanc t er ith. N hanges shall be made without first obtaining shall be don in conformance thereW h. No changes shall be made without
approval. first obtaini approval.
X— Cate—� X ClCz ��-! ` E
Date
41 FOR OFFICIAL USE BEYOND THIS POINT
Accelaed by Date Submittal Amount Due Receipt No.__
DEPARTMENTAL REVIEW 'APPROVED DENIED CONDITION CODES
Building Department v U BL)
Occ Group Type Constr. '__ .
Planning Department
l i i
Environmental Health Department --�
a 6C, , T
Public Works Department
Fire Marshal i
r
I I '
Valuation $ 12 $—„
FEES
Building Permit Fee I Site Inspection
Plan Review Fee EH Review Fee
I
Plumbing& Base Fee 9 S O Planning Review Fee
I
Mechanical& Base Fee 1 - . 9 S Cther �
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee /A 0 EW Pre Paid at Submittal t )
TOTAL FEES
Jo
FORM MUST BE COMPLETED IN INK PERMIT NO.:
PLEASE PRESS HARD MASON COUNTY
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 Seattle(2061464-6968
APPLIC T INFOR V11
ION CONTRACTOR INFO, �}M TION
Owner r Contractor Name /�` L%
MailiriA Address MaiAio—;70ther
d City State] Zip Code sot City tate Zip Code
Phone('3(bn -O Other Ph ( loo ) Ph. Ph.(_)
Lien/Title Holder t,rtzj Contractor Re . #
Address 77 Expiration_
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
ewer System
PARCEL INFORMATIO 12 di it Tax Parce) o. / / Fire istrict
-
Legal Description 8` I G
Site Address (Pleas incilwde street name,street number and city)
Directions to site Op Q a1 e
Is your property within 200'of the folloving: Body of Water (Name) A/0 Saltwater
Lake River/Creek l� Pond f Wetland / Seasonal Runoff „�/ Stream
Slopes or Bluffs_
TYPE OF JOB New Add Alt Repair Other Use of Building
Location of Fixtures/ nits 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric
Type of Fixture No. f Fi ur s Fees LPG Natural Gas Heatpump
Toilets Type of Unit No. of Units Fees
Bathroom Sink Furnace
Bath Tubs �_ Heatpumps
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Out
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs �_ Dryer Vent
Other Oo Other a AA<
Base Fee z-0. 00
Z
TOTAL PLUMBING
9� Base Fee_ TOTAL MECHANICAL ,1j
A FLOOR PLAN AND Pi AN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
FNOTICE: IS PERMIT BECOMES NULL ID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
ION WORK IS SUSPENDED L• ;ANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
ONTINUATION OF WORK IS L �4-ANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
rovided is accurate and granl.employees of Mason County access to the above described property and structures for review and
this project. Acknowledgmf,.i of such is by signature below:
IDAVIT-I certify that I am exempt lro;i:ne requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and ar- ire of the ordinance contractor in the State of Washington and that I am aware of the ordinance
[approval.
quirements for hich this per it is issued am all work will be done in requirements regulating the work for which this permit is issued and all work
nformance t ew No n es shall be r without first obtaining shall be done in conformance there ith. No changes shall be made without
first obtainih' approval.
L Date
R OFFICIAL USE BEYOND THIS POINT
Accepted by _ )ate Submittal Amount Due Receipt No.
DEPARTMENTAL REVIEW kPPROVED DENIED CONDITION CODES
Budding Department
Occ Group iyPe Constr.
Pianning Department --- — — — ------..---- —�
Other --
Other
\` \\\ ,`
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES