Loading...
HomeMy WebLinkAboutBLD2005-01621 Ag Bldg - BLD Permit / Conditions - 4/11/2006 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 111 426 W. Cedar P.O. Box 186 + * Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2005-01621 OWNER: BILL ROSS RECEIVED: 9/15/2005 CONTRACTOR: LICENSE: EXP: ISSUED: 10/10/2005 SITE ADDRESS: 1661 E THOMAS RD GRAPEVIEW EXPIRES: 4/10/2006 PARCEL NUMBER: 221224100040 LEGAL DESCRIPTION: W 330' OF GOVT LOT 2 NLY OF R/W PROJECT DESCRIPTION:, DIRECTIONS TO SITE: agriculture building Hwy 3 to Island View Dr. General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: Type of Constr.: VB Type of Use: SF Insp.Area: No.of Bathrooms: Occ. Group: U Lot Size: Deck: Type of Work: ACC Fire Dist.: No. of Stories: 1 Occ. Load: Building: Valuation: Building Height: 32 Occ. Status: Primary Basement: Barn 6,246 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: W 50.0 Ft. Shoreline: Ft. Water Body: Rear: E 160.0 Ft. Slope: Ft. SEPA?: No Model: Width: Ft. Shoreline Desig.: Not Applicable Side 1: N 161.0 Ft. Year: Serial No.: Side 2: Ft. Comp. Plan Desig.: Rural Plumbing Fixtures FEES Mechanical Fixtures Type Qty. Type ply. 1ipe By Date Amount Receipt Plan Check Fee KKK 9/15/2005 $827.94 S22005 Planning Review Fee KKK 9/15/2005 $155.00 S22005 EH Plan Review ADR 9/23/2005 $35.00 S22005 Building State Fee DLC 10/3/2005 $4.50 S22005 Building Permit Fee DLC 10/3/2005$1,273.75 S22005 Total $2,296.19 BLD2005-01621 Please referto the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD2005-01621 5-01 621 CONDITIONS FOR BLD2005-01621 1) This structure is limited to use as an agriculture building to house farm implements, hay, poultry, livestock or other horticultural products. The structure shall not be used as a place of human haitation or a place of employment where agricultural products are processed, treated or packaged, nor shall it be a place used by the public. Any other use will be in violation of the international codes and Mason County Regulations unless a "Change of Use" permit is applied for, reviewed and approved. 2) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocation. X 3) 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 she jbb de prior to requesting additional inspections. X 4) 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 roads ct with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X l 5) The 240"x 60'0" upper floor, designated as storage space, is designed for 50 pound (live load &dead load)as shown on page 11 of the engineers calculations. Additional loads such as storage of agricutural products may exceed the design load. Contact the engineer of record, Than Sutan, for addtional information. 6) Water quality is ygtto be degraded to the detriment of the aquatic environment as a result of this project. X LLB'/ BLD2005-01621 Please refer to the following pages for conditions of this permit. 2 of 4 7) 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 p o to any further inspections being performed or approvals granted. 8) 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.( ( X 9) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647-0,98 rThe person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X /1E 10) Approver dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. x 11) 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 D9.prtent prior to any further inspections being performed or approvals granted. X 12) 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 eppIied for,.reviewed and approved prior to the change. X � 13) 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 apprgve ents will result in failure of required building inspections. 14) 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 xposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). X BLD2005-01621 Please referto the following pages for conditions of this permit. 3 of 4 15) 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 charged and sheaf collected by the Building Department prior to any further inspections being performed or approvals granted. X Cf� 16) 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 17) All changes to "approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or re la o must be reviewed and approved by Mason County prior to construction. 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 or )n,apces 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 (older have prevenaction from being taken. No more than one extension may be granted. 21) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, c nnectors,and f trig. Install metal connectors approved for contact with the new types of pressure treated material. 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 tructu review and ins ection. /1 OWNER OR AGENT: L DATE: __ BLD2005-01621 Please refer to the following pages for conditions of this permit. 4 of 4 o CONCRETE MECHANICAL MANUFACTURED HOME Footings!Setbacks Date By Ribbons rn Date By Gas Piping Date By Foundation Walls Date By Set-up Date By INSULATION Date By BG I Slab Insulation Floors FINAL INSPECTION Date By Date By Date By FRAMING Walls FIRE DEPARTMENT Date By Date By Date By PLUMBING Attic OTHER Date By Groundwork Date By WALLBOARD NAILING Date By D.W.V Date By '0 Water Line FINa I NSPECTION Date By Data i z-I DV By A-t'Lc- Date By Type of Insp. Pass/Fail Request Date Inspect. Date Done By Comments I- o I L ____ ___ fW0rt Jí 2 aG 66 y I77 \ © _y O _ Sl�~iv fl FL © o L S£E � 4eGf€D y1 to 10 `(116C, L5 5FE A £ ,47f #I r t E� C-114 ivp L _q sse_ `f 111 )016 4/, Z Jo b p it O - pVRDY R E'•A T •'TY. IN0. PRICE AND TERM REVISION Property Location MASON COUNTY WASHINGTON Levi Description _ THE WEST 330' OF THAT PORTION OF LOT 2, SEC 22, TWP 21 N. RGE 2 W.W.M. LYING NORTHERLY OF COUNTY ROAD KNOWN AS ISLAND VIEW RD. EXCEPTING THEREFROM CO. RD. Owner T' '.FFNER HARRY & MARILYN RKNOWN AS THOMAS RD. MAP OF PROPERTY Price 9,950. J"`Y0FEPT CO. Kra' i'o- i P0i,T BLAKEL`( -j 950. DN/273.04 MO./10% INT/15 YR TFPM c' e� MILL �o. Terms _._ uvs rur, r Listed by MARJORIE L. DENNY 3 cc ixsr< 1 From To S 4S o 602-830-4988— MESA, ARIZ. UNTIL END OF MARCH R.WTRITLE — p c Jarrell Cc Call To Show �' �c �Q Q.G fk 5tat e 2754887 F Key on Rackr Lock Box r+� ,r 7 Reason for Selling ALKER r aQ ANDIING. 4> E7 h—�CC 4 . 2� cc ! W � H�-°R' TlN+9 gyp, W P „• i� I V t SAKAi O iF Pierce County Microfiche 3w w .. h - t< i It E � J.. LAND INFORMATION L L Waterfront __ Height Bank MISCELLANEOUS INFORMATION Tidelands Anchorage Light Share __ 9' Acreage + g Easements Cleared HOUSE INFORMATION Encumbrances Age Size Bath Miles to Store Basement Miles to Office Bedrooms School Bus Service Size Sewerage Closets Taxes 211.00 Dining Room Water System Fireplace Personal Property Included Floors Foundation Heating Insulated Kitchen _ Out Buildings Living Room Painting Roof Type Age Miscellaneous Type Const lion Walls Windo Garage $242M574THE STAID VTS AND FIGURES HEREIN, WHILL NOT G�.iFR4Jsrr ,II) ARE BELIEVED ACCURATE! ! ! ( 4 ) ( W2 St E L j . W1N NWSE E2N NW SE - t � � T,.-� "' . 2 ( ray ( 2 ) , S 2 OF NW SE , TA-F s w r�•�s � try 1 i 4 1 WL Ws Ei Ei Es ,J• TR - 2 NX ." Ago � .•.�� - Q�G `'p' � @ i NORR.IS N E. Thomas Rd. t 18918 I � As Built Fence I I 171' ft I I 25' Proposed Barn g 70' 34 I A r 5 j1 i -,= As Built Studio - 36' x 24' I ` � •85' 210' i t I 181' As Built I As Built j t Leach Field 1163' j ---------. Driveway j t As BuiltI Garage I ` I I 24x36' As Built House 64' x40' i I 1 I � I As Built Well House 47' I I j I I As Built ! i Driveway APPROVED MASON COUNTY DCD PLA '1NG SITE PLAN r;c;1UI:?ED To 3L- ON SITE I CHANGES SUB.!E;T ?O A."'P.,,, L i t By � _-- r• � -��-� ! I t i William W. Ross i I 1661 E. Thomas Rd. 360-427-4122 j 0 I I j � S1J� j I i j l i Parcel # ! i 221224100040 I I f j I i Scale : 1 - 100' Lot size: 330' x 1300' ; i i 30' — - ,? Easement 20.5' NORRIS A' I I Centerline of 18918 i V I Thomas Rd. C9.5' I I j I As Built j I Fence 171' 25 —I-- I 26' I Proposed Barn Property I j 80' x 60' Line I ,------ i 608" J 1 ' As Built Studio IT- --- 36' x24' I I ' i I i I I I As Built I Leach Field . As Built ;l i I Garage 24' x3&36' As Builtt Ho House 64' x40' I i 1 I As Built Well House 47' ( 1 10' x10'LJ �' V I � I II I � I k I William W. Ross ! I Judy B. Ross ► �(l -QG r��9 Vl 1661 E. Thomas Rd. 360-427-4122 Parcel # 221224100040 i I 9.5 Acres i I I I i Lot size: 330' x 1300' cl i Scale : 1" = 100' -TO.'BE.KEPT IN THE PARCEL .FI .E S VOL. PG. 9 A SURVEY IN GOVERNMENT LOT 2 SECTION 22 TOWNSHIP 21 NORTH RANGE 2 WEST W.M. 15 15 14 N' s D556'Sr « 26W..6' 2 23 �-C/LCUAIED PDJTON 22 FOI;ND]/!111011.ft T 1/16 CORNEA JJ0.10" rOl YOL'D IS PAGE Y PEII V0.11ME 15 PAGE Y N ES470C/ W OF SUMEYJ OF JURYEY$ 2...4]' 1 1/2'. 1D1 RUE 204 10 CFATER N'1DI R. • L44ED IY CPM,Y•I 3a R/W W n 500 0' 500 1000' SCALE: 1• = 500' I PO/ID J/r NDI NPE ►f WW11E ID PA/E Y MERIDIAN 01 WRYEYS —22 N 89.47'0 W J2IN>5° 2 .# zE•.2.D.' 1?H.3JjEn- ,O9DA 22 23 ASSUMED MERIDIAN FOUND NOUJAN RC04 ACM PER YOAUYE I2 PALE ISO _- - I �' /21' OF 51.11VEYJ S .MIDI coumY ROM @ JXI.74' so]c _ v � DESCRIPTION: F01N0 3/r AON M0E0 _ _= KII NVUME s PACE az 2 THE WEST 330 FEET OF PORTION OF OF MiS GOVERNMENT LOT TWO(2).).SECTOR TWENTY-TWO(22), —__- - TOWNSHIP TWD4TY-ONE(21)NORTH. RANGE TWO (2)WEST,W.Y.•LYING NORTHERLY OF THE _ - - CALCIAATED YC 4000 NORTHERLY RIGM—OF—MAY FOR ISLAND VIEW COUNTY 440.3200 4 PAGE 42 ROAD No. 244401 EXCEPTING THEREFROM RIGNi—OF—WAY ffl or FOR THOMAS COUNTY ROAD No. 29610: EFCEPT�NG THEREFROM 8610 RRxlTS—OF—WAY. ,ojc 3/!RON PIPE PER YOLLYE 4 PAGE 121 of rurs LEGEND PROPERLY LINE FLAGGED & BLAZED 27 20C' 0' 200' 400' SET WOOD STAKE ON PROPERTY LINE SCA_E: 1' = 200 0 CORNERS FOUND AS NOTED • SET #5 REBAR AND NORRIS PLASTIC CAP LS #18918 AUDITOR'S CERTIFICATE SURVEYORS CERTIFICATE B. :FOREST LAND SURVEYS "'°'°"'S°AfJ0M6°tt0 u 'RICHARD B.NORRIS P.L.S. fw 0...E.c.r�tn�._�—.A.r er.�S.I_I9 -.•e1C;86.r, na ms=....cr R•..e•....>w.s b w.vw.wr t•.d 6 1 (meJ 4n-»w NE 1 4. b..k 1{/_.oI 4R1EY3.•t,.9.._QL 42 tN.r.pw•S M w,cnbnwn.1W W4 rgtr.wb M M E.I+r R•�iN M M a * .... f1EiTaL M91Nam..R.R4 SE 1/4 SEC110N PoQIARD B.MORRIS �.lrl.r K..S1E .S9R.t.t; _- ___.__ .}E1 4R J p SOT! — ...... _..._.__._. ..... S/{ xr1E.NR .n_ /J iQ9 Jr.c 522(21 2)1 9 — 91 ,l. �4•ll+�+,a UW 40S.0. ].W. �_�__.__ _.. _�� R.8.N 3' E.D.M T 21 N. R 2 W,W.M. ii A SURVEY V Y IN SEC" TION 22 TOWNSHIP 21 EAST 1/16 CORNER ULAI 330.10' PERCAL VOLI N 89'47'00 W OF SURVI • 298.43' 1 1/2' 1 20.5' TO CENTER c AND 1 D LINE OF COUNTY ROAD 30' R/W O N rn o � � N r7 2 ( N U m Ii a r I N ' N N 2 22 N 89.47'00 W 5288.75' 2612.09' FOUND HOLMAN REBAR & CAP PER VOLUME 12 PAGE 190 30' R/W OF SURVEYS N 0 S ISLAND VIEW COUNTY 8904'04" W ROAD 60' 150.74' FOUND 3/4" IRON PIPES PER VOLUME 4 PAGE 42 OF PLATS N 7UDA '� FOUND 3/4 IF PER VOLUME 4 OF PLATS 200' 0' 200' 400' SCALE: 1' = 200' AUDITOR'S CERTIFICATE SURVEYOR'S CERTIFICATE Filed for record thls..I�rd....,..day 0f4l.'l..6/.. 19. In This map correctly represents a survey made by me or under my diroctlon poge..sZ/ L...at the request of In conformance with the requirements of the Survey Recording Act a: the requestof ..........1 ..�QB ..................................................... RICHARD B. NORRIS 30' ± Easement L — 20.5' _ - NORRIS Centerline of 18918 N 1 Thomas Rd. 9.5 i I As Built I I Fence 171' 25' I 26 _I Proposed Barn Property _ _ _80' x 60' Line 608"— i As Built Studio 36' x24' is I / � � AS Built I I Leach Field As Built ;l Garage 24' x 36' ---- As Built House I 64' x 40' 1 E I t I i I As Built Well House 47' 10' x10' ❑ I I i i I i i l i William W. Ross Judy B. Ross F i 1661 E. Thomas Rd. 360-427-4122 � I i Parcel # } i 221224100040 9.5 Acres I i i I i Lot size: 330' x 1300' t I i Scale : 1" = 100' Building Permit # MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location /66/ 74 S / This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items Listed below must be corrected to gain code compliance S J7 ' T' y L t s- ;?`�` �,�� ....,f;t ;�� ;r L /.mss;rte 2) 1i4-2T Y . l,� C.f • .� You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK '( Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection ❑ OK to ❑ This is not a complete inspection Department Date Inspector 7 /2 moor * No4T M44V THF TmLolm' NORMS j I " 18918 N I E. Thomas Rd. l As Built Fence 171 j I ' I I 25' I I ! I proposed Barn 10' i I A T As Built Studio i -r- 36'x24' l +12 I I ' I , 181' As Built As Built j I Leach Field 1163' Driveway j I As Built I ti Garage I 24x36' As Built House 64'x40' 1 I j j - T1 _1 ! As Built Well House 47' i I 10' x 10' It I DT� f 24' II I ! :. As Built i rkr, t O ED Driveway ! I ti O• r. ,a, t j I 71r.:���: � COUNTY UCH ► L'�'>:Lo�C . I SITE PLAN QU;R1 U TO BE ON SITE I CHANGES SUBJECT 1O A. 'RROVAL I I Cy — rte:, I � j I I I William W. Ross ! l 1661 E. Thomas Rd. j r` 360-427-4122 I I j I ; I I f Parcel # i 221224100040 Lot size: 330' x 1300' Scale : 1 - 100 ! I FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD 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 INFO MATION CONTRACTOR INFORMATION Owner �C4 ',T73 ( /7s , Company Name Mailing Address ,_ GG/ L . 4%t to Mailing Address City_ '/lr.,. State_ Zip Code f≤'.I6, City State Zip Code Phone 4-/77- -/J2-2 Other Ph. ' 37- ; Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic. # DOB Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to ater System ►Name of Water System Well i Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. z 2 L ' , Fire District Legal Description Site Address (Please include street name, street number and city) i_£_ ac a3 Directions to site //-'- / 3 i/'�ti f) '. T 271( ..E s g- !l y Will timber be cut and sold in parcel preparation?Yes Is property within 200' of Saltwater Lake 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 Qher PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building 1A.fv7vrd L Describe Work t' " (1 Lyu,S No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor /Z' 2nd Floor, i 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFOR ATION - Make Model Year Length Width Ser No. of Bedrooms No. of Bathrooms Type of Heat Pt1cse 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 OFA PROGRESS IN TION.INACY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X c Date: Owner/Owner presentati (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED OTES Building Department ________ ________ it) —/71 a,) Ii) u -f / -- CU4 - Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT 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 INFORMATION Owner Company Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address 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. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel preparation?Yes/ No Is property within 200' of Saltwater Lake 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 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 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 OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date. Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department ?3 c Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee 3 - C)CD Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT 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 INFORMATION Owner Company Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address 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. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluff/a 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 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 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 OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building De artment Planning De artment c'31 I Sr Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Plannin Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. V _ -)-) D BUILDING PERMIT APPLICATION C ( .i 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 ), 7s $ Company Name Mailing Address Mailing Address City_7 ,2A1)1 State L'4. Zip Code City State Zip Code Phone 21~ `,02 Z Other Ph. (-/37- 'i 3,a,a Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC I WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic -' Connect to Water System E L) Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. r " ' e: C J Fire District Legal Description Site Address (Please include street name, street number and city) i Ge'/ �+ Directions to site //"- 3 7r-- f> 7�, ,� �., � ' Will timber be cut and sold in parcel preparation?Yes Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffer 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 Describe Work f' '_'1_ ' .Z < No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor_ 2nd 2nd Floor 3rd Floor Basement Deck Covered Deck 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 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 OFA PROGRESS INSPECTION.INACTUl1TY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X ', L Date: /'-/� Owner/ (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department () Planning Department Environmental Health Department Fire Marshal __________ ___________ (4"\ /cçifl ,ç FEES Building Permit Fee l 7 Site Inspection Plan Review Fee Y 7.9 EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee v- Other Wood/Gas/ Pellet Stove Fee State Fee — Violation Fee Pre-Paid at Submittal $a'7 Valuation $ 1 '4 .'?t TOTAL FEES