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Mh Permit Packet

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Mason County Building Department
MANUFACTURE HOME SUBMITTAL CHECKLIST
APPLICATION REQUIREMENTS
NOTE: Applying for a Building Permit may require additional approvals prior to applying for a
Building Permit. Such permits are: Accessory Dwelling Unit approval, Flood Hazard Permit
(requirement when located in Special Flood Hazard Area), well report and septic design
approval.
❒ Building Permit Application. Fill out the application as completely as possible. Please
use only blue or black ink. You can find your tax parcel number on the Mason County
Assessor’s office to locate this information. If the parcel does not have an address, it will
be assigned an address when the application is processed. Signature by owner or
authorized agent is required on the application.
❒ Manufactured Home Plan Review Submittal Specifications
You will need to have verified the unit is designed and rated for the snow load at
address to be placed. A snow load map is available at:
https://www.co.mason.wa.us/forms/Community_Dev/snow_load_map.pdf
❒ Provide a Tie-Down and Foundation Plan and include footing/pier size.
• New units. The manufacturers pier plan and layout, to be supplied by the
manufacturer.
• Relocated units to be set up to the ANSI or HUD standards. Must provide a pier plan
and reference documents for setup. Copy of tables and specifications from
standards.
❒ Provide Model Specific Floor Plan- showing use of each room.
❒ Site Plan. Your site plan must be no larger that 11”x 17” plain white paper. It must be
drawn to scale, include all structures, setbacks to all property lines, driveway, septic
system, well, stormwater (drainage) components and plan.
❒ Stormwater Worksheet. All stormwater controls and details to be included on the site
plan or a separate Stormwater Plan.
❒ Water Adequacy compliance- Water adequacy application and all fees and documents
must be submitted.
❒ Septic System Approval- Septic design must be approved prior to application submittal.
❒ Submittal Fee’s
❒ Access Permit-Required for new or modified access off a County or State maintained
road. You can reach Mason County Public Works at (360)427-9670 ext. 450 or
Washington State Department of Transportation (360)357-2736.
Please contact permits@co.mason.wa.us or call 360.427.9670 ext.352 for assistance.
MASON COUNTY COMMUNITY SERVICES
PERMIT ASSISTANCE CENTER:
BUILDING
PLANNING
PUBLIC HEALTH
FIRE MARSHAL
615 W. Alder Street, Shelton, WA 98584
Phone Shelton: (360)427-9670 ext. 352 • Fax: (360)427-7798 Phone
Belfair: (360)275-4467 • Phone Elma: (360)482-5269
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION:
NAME:_______________________________________
MAILING ADDRESS:___________________________
CITY:_______________ STATE:______ ZIP:________
PHONE #1:____________________________________
PHONE #2:____________________________________
EMAIL:_______________________________________
PARCEL INFORMATION:
PARCEL NUMBER (12 Digit Number) _______________________________________ ZONING____________________
LEGAL DESCRIPTION (Abbreviated) _______________________________________ FIRE DISTRICT_______________
SITE ADDRESS_____________________________________________________CITY___________________________
DIRECTIONS TO SITE ADDRESS ____________________________________________________________________________
__________________________________________________________________________________________________________
IS THE PROJECT WITHIN 300 FT OF SLOPE(S) GREATER THAN 14%: YES⎕ NO ⎕ SNOW LOAD:_______psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER ⎕ LAKE ⎕ RIVER/CREEK ⎕ POND ⎕ WETLAND ⎕ SEASONAL RUNOFF ⎕ STREAM ⎕
TYPE OF WORK: NEW ⎕ ADDITION ⎕ ALTERATION ⎕ REPAIR ⎕ OTHER ⎕_______________________
USE OF STRUCTURE (Residence, Garage, Commercial Bldg, Etc.)__________________________________________________________
IS USE: PRIMARY ⎕ SEASONAL ⎕ NUMBER OF BEDROOMS_________ NUMBER OF BATHROOMS_______
HEATED STRUCTURE? YES (Whole Bldg) ⎕ YES (Part[s] of Bldg) ⎕ NO ⎕
DESCRIBE WORK__________________________________________________________________________________________
SQUARE FOOTAGE: (proposed)
1ST FLOOR________ sq. ft. 2ND FLOOR________ sq. ft. 3RD FLOOR________ sq. ft. BASEMENT________ sq. ft.
DECK________ sq. ft. COVERED DECK________ sq. ft. STORAGE__________ sq. ft. OTHER________ sq. ft.
GARAGE________ sq. ft. Attached ⎕ Detached ⎕ CARPORT__________ sq. ft. Attached ⎕ Detached ⎕
OWNER 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 and I further declare that I am entitled to receive this permit and to do the work as proposed. I have
obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The owner or legal
representative, represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s) 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
X_____________________________________________ _________________________________
Signature of OWNER (Must be signed by the OWNER) Date
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE___________________________ MODEL_______________________ YEAR______________ LENGTH_____________
WIDTH___________ BEDROOMS____________ BATHS______________ SERIAL NUMBER________________________
CONTRACTOR INFORMATION:
NAME:_________________________________________
MAILING ADDRESS:_____________________________
CITY:_______________ STATE:______ ZIP:_________
PHONE:________________ CELL: _________________
EMAIL :________________________________________
L&I REG #______________________ EXP. ___/___/___
DEPARTMENTAL REVIEW
APPROVED
D
DENIED
DATE
TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Permit No:___________________
PUBLIC HEALTH
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC ⎕ SEWER ⎕ / NEW ⎕ EXISTING ⎕
PLUMBING IN STRUCTURE? YES ⎕ NO ⎕ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ⎕ NO⎕ EXISTING SQ. FT. _________________
EXISTING BEDROOMS __________ PROPOSED BEDROOMS __________ TOTAL BEDROOMS __________
PRIMARY CONTACT: OWNER ⎕ CONTRACTOR ⎕ OTHER ⎕
NAME ______________________________________________________________________ EMAIL ________________________________________________________
MAILING ADDRESS _______________________________________________________ CITY ______________________ STATE __________ ZIP____________
PHONE ______________________________________________ CELL _______________________________________________________
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SITE PLAN CHECKLIST
A COMPLETE, ACCURATE AND DETAILED SITE PLAN IS IMPORTANT TO AVOID
DELAYS IN THE REVIEW AND APPROVAL OF YOUR PROJECT. USE THE
CHECKLIST BELOW AS A TOOL TO HELP YOU COMPLETE THE SITE PLAN.
Scale: A scale of 1”=20’, is typical but other scales such as
1”=10’ or 1”-40’ are also acceptable. Do not exceed 1”=60
North arrow
Property line location and dimensions.
Label abutting streets
Shoreline/Surface water: Indicate creeks, streams, lakes,
ponds, wetlands and other bodies of water within 300 ft of
the proposed project
Wetlands and Seasonal Drainage: Show setback distances
from wetlands or seasonal drainage.
Easements: Indicate location and size of road, utility, and
private easements.
Show All Existing Development: Identify existing and
proposed structures. Include porches, decks, roof
overhangs, cantilevers, and structures that will be
demolished.
Proposed Building Footprint: Use scale to show distances to
property lines, existing structures, septic tank and drainfield.
Stake or flag footprint of proposed structure.
Sewage Disposal System: Identify septic tank location and
drainfield.
Existing/proposed Buffers: Include open space, fences,
sidewalks and parking areas.
Retaining walls: Proposed and existing.
Slopes/Site contours (Topography): Identify any slopes
greater than 15%, fills or cuts greater than 4ft. that are
located within 300 ft of the proposed project. Use Contour
lines or arrows to show the direction of the slope
Wells: Show existing/ proposed.
Waterfront projects: Show all structures on adjacent
property.
Driveway/ Site Access
Stormwater Run-off Path: Identify stormwater path and
direction of flow.
Mason County
Community Services-Building Division
MANUFACTURED HOME PLAN REVIEW SPECIFICATIONS
UNIT INFORMATION: Snow Load________________
Make___________________ Model ___________________ Year___________________
Square feet______________ Width ___________________ Length_________________
Single/ Double/ Triple-Wide (indicate) NEW or Replacement (indicate)
All footings must be min. 12” below grade within 24” of the skirting when perimeter blocking is
required.
When manufacture specification is not available use ANSI A225.1 or HUD 24 CFR 3285. Must provide
pier plan with reference sections.
SET UP SPECIFICATIONS:
❒ Manufacturer’s Pier Plan
❒ ANSI A225.1/HUD24 CFR part 3285
FOUNDATION:
Check the type of foundation and attach detail plans from manufacturer’s or the ANSI
A225.1/ HUD24 CFR part 3285
❒ Pads
❒ Continuous concrete footing (runners)
❒ Slab
ANCHORING:
❒ Ground
❒ Magnum
❒ Concrete-2500 PSI
❒ J-bolt
❒ Expansion bolt
For new units, this information can be obtained from the home retailer or contractor. Previously
owned units, which manufacture’s instruction are not available must utilize the ANSI A 225.1/ HUD24
CFR part 3285 code for installation. Washington State law requires that a certified installer install
manufactured homes.
The undersigned I hereby acknowledge he/she does understand that the Mason County submittal and
review processes will be based on the information provided herein and will be verified at time of
inspection.
X_________________________ Applicant/ Dealer/ Installer (indicate)
Date_______________
Allowable Pressure (Pound Per Square Foot) No Allowances made for overburden pressure, embedment
depth, water table height, or settlement problems
Soil bearing is assumed at 1500 psi
If set-up is using a greater soil bearing capacity a soil
report from a design professional is required
Fill (compact or uncompacted)
Compaction Report required through Special analysis
Peat or organic clays
Compaction Report required through Special analysis
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EXAMPLE PIER PLAN
Name_______________________ Parcel # ____________________________ BLD#___________________________
Page 1 of 2
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 redevelopment¹, with more than 2,000 square feet of impervious surface².
¹Redevelopment 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.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area * All dimensions in feet
Buildings
X=
X=
X=
X=
Measurements for buildings are taken at the
perimeter of the farthest projections (example:
eaves/gutters)
Driveways
X=
X=
X=
Length of drive begins at the right of way
Parking Areas
X=
X=
X=
Any paved, gravel or packed area per definition
above table
Patios/Walks
X=
X=
X=
Any paved, gravel or packed area per definition
above table
Others
X=
X
=
X
=
Total Impervious Surface Area (sum of all areas)
If the total impervious area of the proposed site
development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
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.
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Name_______________________ Parcel # ____________________________ BLD#___________________________
Page 2 of 2
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
A) _____ 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 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:_______________________
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Rev. 12/27/18
Address Request Form/Application
Name: _________________________________________________________ Phone:_______________________________
Mailing Address: _____________________________________________________________________________________
City: ________________________________ State: ______ Zip: ___________ Prefer: Mail or e-Mail notification [Circle One]
E-Mail Address: ______________________________________________________________________________________
Parcel Number: ______________________________________________________________
(12-digit number)
SITE MAP: PLEASE PROVIDE DRIVING DIRECTIONS TO THE PROPERTY (and most importantly a sketch). SHOW WHICH SIDE OF THE
ROADWAY YOU WILL BE BUILDING ON IF THE ROAD INTERSECTS YOUR LAND. LIST ANY ADJACENT ADDRESSES YOU ARE AWARE OF AND
NOTATE WHERE YOUR DRIVEWAY IS/WILL BE LOCATED ON THE PARCEL AND NEIGHBORING DRIVEWAYS.
Application fee: $185 due at time of submittal
Make checks payable to: Mason County Treasurer
Mail application to:
Mason County Permit Center
Attn: Addressing Division
615 W. Alder St
Shelton, WA 98584
Addressing questions? Call (360) 427-9670 ext. 365
The Mason County Addressing Ordinance
requires you to post your new address
within 30 days of assignment.
It must be placed at your driveway entrance
clearly visible from the road in reflective
contrasting material.
Address must also be posted to any structure
within 30 days of its erection in a contrasting color,
visible from the roadway or driveway.
*******************************************THIS SECTION IS FOR OFFICIAL USE ONLY************************************************
YOUR NEW ADDRESS IS:
RECEIVED LOGGED IN TIDEMARK FIRE DISTRICT __________
BILLED___________ PAID______________ RECEIPT # ____________________________
415 N 6
th
Street, Bldg 8, Shelton WA 98584,
Shelton: (360) 427-9670 ext 400 Belfair: (360) 275-4467 ext 400 Elma: (360) 482-5269 ext 400
FAX (360) 427-7787
This form may be scanned and available for public view at www.co.mason.wa.us.
J:\EH Forms\ Drinking Water Revised 1/25/2018
WAT ______-_________
Application for Determination of Water Adequacy
Instructions
1. Complete Part 1. No determination can be made until Part 1 is fully completed.
2. Complete only the portion of Part 2 applying to the type of water connection utilized.
3. Submit completed application, with any required attachments for review.
4. An approved building site plan must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant:
Date:
Mailing Address:
Phone:
Parcel Number:
Type of Water System
Public/Community Water System (2 or more
connections)
Individual water source (one connection),
Well
Spring/surface water
Other (explain)_______________
If you have more than one residence connected
to this well, check the Public/Community Water
System box.
Reason for Application
Building permit
Division of land:
# of Parcels? _______ SPL_______________
Boundary line adjustment
Other (explain)________________
Replacement or Remodel (please indicate name
of water system below if applicable – no
signature required)
Part 2: Water Connection Information
Complete the section appropriate for the type of water connection being evaluated:
Public Water System
Name of Water System: _______________________________________________
Water Facility Inventory (WFI) Number: ___________________
(write “none” for two-party)
I am the manager of this water system. The water system has been approved for services.
There are presently connection(s) in use. This will be the connection.
I am the manager of this system. This connection will be to upgrade or change the use of an existing
connection on this system (i.e.: recreational to full time). Please indicate on the following line the nature
of this change: _________________________________________
This water system is able and willing to provide water to this (these) connection(s) without exceeding
the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager _______________________________ Date __________________
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Page 2 of 2
Water well report (attached to application). Depth _______________ft.
Well capacity Test (attached to application) ________________gpm ______________gpd.
The well driller often performs well capacity tests at the time the well is constructed. Results from
these tests are noted on the water well report. Results from these tests will be accepted. If the water
well report cannot be located by the applicant or if the water well report does not have a capacity test,
a well capacity test, which provides stabilization of draw-down and recovery data, must be performed
by a licensed contractor.
Satisfactory bacteriological test (attach to application).
Development within which WRIA http://gis.co.mason.wa.us/planning 14___ 15___ 16___ 22___
Water use or limitation recorded……………………........... N/A_____ Yes_____
Well Drilled ……………………………………………………… Date _______________
Individual Water Well
Water Resource Inventory Area (WRIA)
Individual Spring/Surface Water
Part 3: Mason County Community Services Evaluation (staff use only)
WDOE permit (attach to application)
Method of disinfection _________________________________________________________
___________________________________________________________________________
I have reason to believe that this water source can provide at least 800 gallons per day; and/or
provides water at a rate of 2 gallons per minute b
ased on the following observations.
_______________________________________
____________________________________
_______________________________________
____________________________________
Author of Statement ______________________
_______________ Date _______________
Relationship to Applicant ___________________
_______________
Satisfactory Determination:
This determination does not address adequacy of the distribution system, guarantee an adequate supply of
water indefinitely in the future, or guarantee compliance with all applicable WDOE water resource regulations.
Recommended approval indicates requirements of Sanitary Code, Title 6, Chapter 6.68.040-Determination of
Adequacy for Building Permits are satisfied. Additional Growth Management requirements may apply. Chapter
36.70A RCW.
Unsatisfactory Determination:
Applicant’s water supply does not appear adequate to
meet the needs of its intended use for the following
reason(s). __________________________________________________________________
____________________________________________________________________
Reviewer’s Signatures:
Environ. Health: _____________________________________ Date __________________
CSD Director: ________________________________ Date___________________
BEDROOM BATH
DINING
LIVING ROOM
BEDROOM BATH
MASTER
BEDROOM
SAMPLE FLOOR PLAN
UTILITY ROOM
KITCHEN
D
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Mh Permit Packet

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Completed 18 April 2022

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