Loading...
HomeMy WebLinkAboutBLD2008-01472 Final SFR - BLD Permit / Conditions - 6/19/2009 0 C) O N N < n ° D v CD a -i T -• v = N m0 O (CD O (DCD w o c� Z m w = � R. o QN m D v m cn cn c m m D cn v cn '� S. m .�. o' (D ,. cn r X cn IN N CD �. CD c c 7C ,��, 7 0 0 C) n � N in a c'o CD 2 � mmmZ a z (n @ r r- p cc c c mT g z =! ;uZ o ID 0 c z a co O 0mccn0m � CD o S � -�„ w. z Z) cn ,m po N -n y p m N 7 p ^> 0NV C) 0 oD rn � ; � D � c z 0 T T 7 0 m O w N m r Z D �_ ^ w � ' w � " O 0 m co ♦' N 4 -co n (o � co0 w � m � Z rn m X N v < m cncn w OX o o 0m � m '� , � a X0 S. zo O (D = v o CD m CD a o -. Z ca :3 --% S a l r a .. ° cnZm < CD o 0 0 1 cri D m 0 co N ° w m 3 O -o -n3. oo � o m C -n o ° o n O O O O r N N W 3 (n m co 0 ic -n -n -n -nCD n Q0 _ (n z X C 0 co .X► Cf00 O `G 0) C D) H w a) 0000a "t s -< ;o C/) p C CD Cn N 7 w r 'n O �, D r C D) c y O O M 0 v v m m y, a -o . 3 m -1 z m Q wW0 o0 � m 0 c m � � m O a) m 0 m � � vvwcD _nvD m v T � rwfn 2 cD co m a m 2 w z v 33 a a (D m _v n m O m m v r r > > (a U2) w > :3 � ( m CD (p f0 N T 0. N �f y m - -nID ID W m m ID m m o co m � CD m n co W zo O a cn O S CD V N 2 O v �' m@ rn m m rn Duo v o OD CD D-ncn `� m -� -i N (T C\ U1 U1 Z\ Ut N N N , N N c •. •• 7 iv0000oo semen c O_ O 3 'O T O O o 0 0 o O N N N N N N C coD O O O O O O C) O O O C) 0O O D N 3 G _ O U) O � pO O mm o ° D � � w m r O 0 0 o W 0 A U U WO Q a)W O O 0ti M C < O m O O O o 0 N p o mm m 00000C) 00000w " � CD 3 IQ CD ° � IQ (A.cn' n W,cn cn a in Ni N'N J CD Q7 Ul N'N'N'N'N'N'N'N'N'N'N'N'N N y O o'o'00000000000' ' ' ' ' ' ' ' ,� N N I o o'o'o'o'o'o'o'o'o'o'o'o'o to N D co'co'�'c0'm'm'c0'Oo'00'oo'w'00'0D m 00 W N co\ c\O N O X v 'O'o'O'o'O'O'0'O'O'o'O�o'o N N ,_„ 0:0:0:0'0:0'0'0'0'0'0:0'0 O i o'o'o'o'o o'o ono 0 0 0 o A o 0 o V I{ OO Ul CD OOD N NN ii W p ' N � O CD , CD X D v O v Kv o 5• D X c m �--I X � cn _ —{ p� t3 N - CD = a) M• * <n � x O << m 0) ( CD Ma) < N 0 � � �_ a 0 -0 w � 'mmv mm � � ' v' cm = D � n� � v qcn 0co0) (DCDCD � Wo O CD x CD CAI rc (nmm-0 ,< �. 0 0 c mO � 3 n Q 1 p CD N O C) a ° j CD p M 0 v n a n � � Cr (D y O 7 p � n �, m — (n (D (D N v 0 o ° m v cfl m 5' � m� cmi (� � � oCD � cn ohm mN � gym - (Q sli CD CD 0 � 3 s � o � � v < v m o ca o c3D y 3 m 0 m _ o� �• CD c ai m 3 .�. (D n v = O (D n Z ti v a CD fl' �• 0 m tea) 3 � °_-o o 5 3 _ o- � � m m N ? y O CCD (o O O m (cn M j "� •< (mn m (D ° (cn N O Q 7 (D C = 0 S 7 (n 0 > Ul CT In (n (� CD � N :3 < C Oo aQ � 3 (o CD CD y5• 03 � a' (nn) (n 3 CD m�° � y =3npmoo a c0 a Q -, N y' ° (D c N ° N C .. CD 3 N (D n c c cn v � o 3 m ° � N mom l< CA ;r CD :3ma ., CD m o � o. z o ( ° m 5 ^� LA. � cD 0a) r (n c < c yam (nCD Imo Wn CD v m = y�. ='c.� (D (Q �. o =3 p CD o m a m 5 Z 6 m N �dm ::r(a � pvQ 5m 0 -o(a cCD 0xv0 � � � z 0 0 � rn � ° � cry 0v o � � Q� o v o � o0 00 o Q � r- o 3 m Q < 7 � m �'. v m 5 m bZ bm y -� N o 3 N 3 3 v, 3 wo C p m to (p N cn o � O (8' m � v (D m m � Cl) ° nCo 0 ° m m - � - 'n Cll N �' (D CD Q O m G 3 v! Cb Q (n N N 0 -"a " Q � p�j �'O � �' NY �' Q(O � � O (D (7 a a in m m � � -0 � (n (n < (o O m m (o m 57 (n O uNi N m m (a U 6 N c cn to tan ° N N �m < r„ c �• �,o (Q � 3 cnm o 0) n cn 5 X �o mo0 • a = - o � o v -• CD 0� m ooa °'v < 3 moo ( Q oo � o c Cl) CD _ 0 m o CD CD -i m M' c m m p (D � �• Q 5' N � rt N CD (On N O ,�_„ D Q(p' (o (nm9 < 30m53 � m N � QAQ 3 :3 �. v CD -o3 m v m Qo a c .< Q CCDD 0. v -0 n v .�-. CB, 0 Q 0 = N a� Q N ,c O - m O Q Cy CD 0 � � � N Cl) 03 � cn � 3 < o o Wv my oc m CD CD 3 Q Q r. r. � m 00 �. 6 : m ° =r 3 m ° v m m ;i (n a ° m (p < 3N �' � 3 (-n °' uD O mc_ a) 0 < ai � 0 o QCD vca ° X o � rn ° o m N � ^`� cn W -O CD (n � m O n `< CD : Q- y v m � _. v �, m m � � -� m CD :3 0m m o O P. O O N j "p N 3 v � 3 -uT 6 m 3 (D cn m , (D < vcn — _ - v (nZ) va (D (n m c = : p� CC ° � Q m (n (n Q-0 -0_ 0 n 3 (n m n p� N Cl) N �• m N n n (D 7 '0 CD 7 : (j 0 p to (n a) � m Q ^� Q .+ (n (fin C m m :3 (D p. N. O CD (D - (Q 3 w i 1 (D 00 O N ' O O I 00 Xo n D XCD Oo = XOo D Xo D X1 � o o X0 ro XD3 � X �°� � ao a o 0 m m cv � � o o � 3 o v o (n � Qv m N m7m < a) 0 � (D -0 CD Cn--0 0C: o oOa) in OL Coco 5' < M 7 O 3 O 7 p " -a O w 0 � 7 a) n o (O a) 0 a) N' O -{ 7 (D a) < m v (D O c n W ;(CD � y (D 3 3 (D y, << ' a - n. m O -am °' ° ' m ° vami - � � ° o' v � m � n � m CD m oCD Q ° 7 m m OD cc 7 y n � ° � O Q < a. , O " 0 n O. Q y N � O 7 7 —� O O (A (n m 'o CD mm ° a) v a, 0 3 =r � (D mz mCL CD CDm Qr' O QUO x � � 7 0 m (' : CD CD a) Dy -I 0 a O :D p n n X m n O y' �, p' CD 3 CD Q - OO W y Z � 7 m 7 C -0 a) y a) o ' cn (D CD �. m a) � c 7 n O 7 U) M. (n M .-. Q �. 7 Q 01 (D y -O 7 � 0) 's y c N 7 O' O 7 C 77 n rn O ((D 7 Q (D m N a) (n (a "a (D m O a) O ca CD N y 7 n _. (D a n l< (o p m O m O Q O .� 7 C a - O Z a) 3 OD(D (n 7 O: - o o C Q m mom = : OCD m � m CDC (D (o v m — v < � � aQ T. O, -' CD 0 (D o v v �� " X c o m c 5' Z o 0 -� o -. 7 - ° o (°•gy m' c m m (7n - - (( o m a O N O- 0 cn M Apr 5' � m m y y — 0 3 y 7 � 7 ' a) n C O Z m 0 y O O - C a) 7 .••. CD - 7 (D m a) -. 7 -w (� '0 7 m � Q' a) m m a) � � O (� a) " O O m p n� C CD y' (QD ;(D S (n m n =. y N 0 3 0 (D j y I 'O �. (n cn O 0 n y 0 a (n � ccn m 0 -� 7 O (D m a) F. 7' m :O 0 � m a) y' n . O -sCD (D C - -. (p O moo -, n m 3 O0 O 0 � N � � =r � y 7 O m � � �' 0 y o � � � ;pr Q (p O a j 3 (RD 3D v 0 Cl o p �-a m m CD 7 0 y a CD Q -, 0 3 O N w m ° O c � O a) �_ a, CD 7 -« O a) O Q - < 01 �,0 `< = =r 7 Q (D (D < O n �-p o CD (D �•'O o Q m CD (CD (DD O p 7 ° O to 3 m (pn 7 v CD � m O a p y o 3 3 7 (D p '"` p 7 N 7 Q ° O .X+ m (D � 0 .Z7 N < n N y O -� N Z 7 <n p n y co m ::3 �. N O 7 a) (D �, 3. "O c (� O. Si,- n O (D d y m p � Q < y to Q a) `2- � n 7 N Q Cl) n c " W 0 (D y X_ y y a) (O C 7 .-: = 7 O '` ' 7 Q C U 3 vim, m m (D 0Q v m -' �� � � 3 m a - N y 3 o - = 3 y � 0 (o � -' O N � y 3 5. O< (D 7 v om o a � c Qom'DCD 0 X c CD c y v' waN N CD y �' 0 CD D ma 7 (n � m c 7 ° (m D 0 w o � � ? CD 0 cc (cDa� ov cn vp ::r y 0 = � O mco CA cn 0 — 3 7 7 7' n y o m c� v O o n m Q 7 o m < r: o o �'a CDo y 0 CD Qm m 7 0 � 3 N. T a�• N m ��. CL p 0 N b (D N cnCD n �. (CD m •O n %D O (D n 7 "O y 7 Q 3 -0 m ? 7 O __ -, (4 O O a) 0 y N m 7 0) j C a) A a) y Q(O " m Q 7 CD co m _ � 3 � mm' ° -a m � � � o c �' � ay 7v 0 Q O m (a y a) n' fD c a) m 0' (p v Q 7 's =r 7�" 7 Q O S ° � vm mp Q m Q a) c O " y O n Qm (n •< - - m �. m O y m - w m 3 � m � y - � W � m O 7 7 a) c O 7 O O � N ((DD p �• m Q Q 3 (C � ° , N 0 CD 0 -0 n -v n Q o �. a' c < N' c• n 3 (p CD o m v o< = = N a' y a) v cn p- < Q '' (D �co n _ .< .. p c (Q .. o � w I< o c ° m n ,� O m 6 n a) 7 n 7 � a 7 0. v, O 3` -� C o (D O n N (D =3r: :3 O. - m 0 0 0 7 �' y y m Q m C O N n Q O cr o m = Q y 3 (CD (D N --°O (D m m p - p v 7 0l< 0 = 0 Q� m cr.. O n 3 m - (n cr 0 m n N 0 CD ° N O a) v -n =r 7 W 0 ct 7 3 0 0 � 7 N Dm "d Q C � 0 O O O O 3 m (n (n a a) _0 (D X Q 7 CTIa) ? a) W 7 v A "d O. Ill C) CD m Q (D N QO (� m m O T � m am O � W — �' N y 01 N O � � (D 3 c (O < (O �< m 3 m Q m y 7 j O (D (O W N N N N p O (D OD 0 Ul N O O t 00 o m -0 XO Xc cnD Xo D XC ? � ? X � 3 WCC� = XK6D a) 0 � Q- -0 0 0 v q � v , � � v � m O N CD 3 0 ° O J 'n. -, 3 3mo � � cQ (D m o rZ m 0 -0C: � 30 � 0 CD cn 3 a v m -� O m Q o a' CD o' -0 D < C � � � • cn Zw C ny a v' O N O N n O umi Q m N cD c G C z c c0 act] N �. 0 o m so o Qc0) a � _ (� 0 p �c Xa o o o o oa o � w a) O a- . � 00 � ov3 CDCr w Nc 3 o co 3 = 3o m o o mz O m n� Qm a, CD 3 �' N in cn ai O -0 N "` Z 0 y o o Co N a O O m to 0 O �7 -0 � N N m m � v 03 o v o m O 0 0 m o � O m e m = CO) 0 m a " (n Q Q v n cn m Q 3 N' �O' � 0 ' m n> oc a=' o�' m cm o 0 CD o3 < �0 Xv cn m ?0- 3 = Q - Oa O m a o < 0 f onX m a' 0 nai cy 33 -00 -00 cn 0)CD cn com fDo �PD � m � W D CL � � momQ -- c r O -+ m y -- — Q w m m — � m Qom• rn r : D) ° v v 3 v 3a m � CDy ac30 fan T W � 3 � N CL a- : N 3v- — m ca - — -a -CO v, v m� 0- - — - v - m mac) --• _ v, 0o m -a m a� ,Ya• � 3 cQ cn' r co s — m Q .. — 3 cn o y .•.. m ni m �• � m — v Qm p � � � � cn 3 m a- o m cn a c°' o am to M. ( Qa c 0 v o 3 n� � m � 3 m Q - om n O � m�Q m n O -m m � COcnD aa nspa XO 0 -o 0 X m O On a� ` 0v a cq ca om o OO mZ 3KWC nc � ( a O v m CD Nmm Q m tl< cn K0 v a a m Z Q N a — - " < m9m o Om3cn3 < 0 O N o- 3ZC ci c p CD 3v Q K0 = (A = D 0 -4 . O a O -a m 00 �. 0 0 CD rn cn C 3 -a -- 3 0 m 3 m O Cr (D 3 v 7 c co O a' m cD O .c r x 3 `� c 3m n -- 3 � � �' a `� `n CO OO � � N N � co p n c (D �, Q Q cD `G cD C m (D 3 3 CCD N 3" m 3 c O- O —� Q `� — iU (0 Q 3cn. ai Q ,� � -' � o DK m Z m a _ 3 0 � m m m 3 -a m 3 3 w 3 cn p D m Fp D = qs 0 N �• 3 m " `� O _I (o � 0 O n -'. 3 N 0 O �• m 3 (� (� 3 m p) m n m m 3 0 Q 0 - 0 (n cn � � o � m a � � y � a � � v , CD o 8 O v m n o m j' w 0 CD a 0 y y 0cnQP o �` 0- -0" 0 O (� O- 0 m O 5'z 0 0 �D "a 'U d m 3 O y CD M. y =N N cn W z X `G 0 N m -� O cn 2 CDa. 0 0 O 0 3 co A cnCD m ^•►. {v m 3 O � Q 0 0 3 j m a O O m . N m � v ED C QW v�_ N v 0 CD a. d 3 -3•.• 3 -D .-. m 3 m p Z 0 O .-. m m m N cn CD m (D N O 0 (p -I O 3 Q 0. (n 3 �. In 'a 3 d -•. m m (0D j O N C O0 CD -0 Q O N W -_�. 3 M O 3• .3-. 0 < cn m m y o m Q 3 0 3 c !D 0 0 C' Qm Q N Q'aCD CD 0 a O O Q m p� 7 p_ --a 0 �_ n N c0i � Q N v cp CD = O CL Z m 0 O v Q j Q 3 D O -. 3 m Q to n > > o c ' o � � — p � m rno0fl - 0 v Q o � j: < O3m m 0CD-0 m m a) � �0 � � �CA (D cn D CD 3 = c a a O . U' cD � cp , m a v � ma3 .. n -a- 3 � � o w 3 a m 3 v ? a - `G0 � cn CD Q - (D N m `) 3 Z N � m po m m 3 v 0 a- o m : � m v, � v --% - v, 0 � � N v K3 -� a Tm F)' m (n 3 0 0 m 3 — cn v cn D m 3 O Qa -0 -1 3 c �• 0 U) Z 3 3 CL 0 C o a- p cn CL c c 0 o cn 330 3 m � 3 � * `<0 3 0 0 0 3 cn N O 0 O 0 0 � 3 0 33' c o =. = 3v 000�imm � � v C O 3 m 3 a (� m n Q x- 3 � - Q O = O c 0 � �`� 3+ 3 D O = � � O O N a oc c 0Iz CD WE p 3 3 c n� O v, m CD cn � Q3' Q3 �. 33cn � O fv c - cQ 7 0 m w m cnN 3 OD _- � Cr cn m p �. c `� = v 3' m m Fr cD c) 0 0 / Err :E0 , \ q < \ . CD ? 3rr � / L cq _ m 4 Q ° M8 R m ` 5 a 5 ® z 90a CD 3 < e m a -02R � ED $ � 72E @C ' m = — � Jab & ® q » ■ & < k E � @ CL=3 -,a, & ] E § \ S% K \ \ n . Eo » G ] / � « ° cCD 4 / f § as D < * 0 / / \ m k \R .0 / 2 Z) Z ■ @ ( c k2J ¢ � % / ƒ \7m E � » ƒ ' go » m � m ) CD cr Ck / cnk _ CL \ / � 3 :3 E § / 2 � G k C o =r0 J k ƒ i / § . \ < ƒ/ k . dk # D ® § k » C ] \ — $ � � O % k M $ k �� 0 & k S /- \ n ( C E Kr�, CD q £ 2 0 ® 0 k/ 0 ( j \ / q / ƒ k = cna- CL ƒ 0 &/ CD c 2 < % \ f E] f m / 7 0 § \ a k \ o m � { a & o § � F CD i / --h & ter o a - to (D / F CD 0 0 ® ƒ R / � k � � CD & 0- cn 70 a S0 7 o 0o3 ® } 22 k 0 . . Eft so7 ESE � . . . r � t �00 o CONCRETE MECHANICAL MANUFACTURED HOME A Date o Footings rSetbacks •©� Bt N Ribbons 3 o Gas Piping InteriorDate-7 Zm/off iy�.��.- Interior-Date By Data By m NExterior Date ! $x Exterior-Date B Point Load i Isolated Footings INSULATION Date By CA BG f SLAB INSULATION _ Date By Data By FIRE DEPARTMENT Z Foundation Walls Flogs Date By m Date By Data By DECKS FRAMING waft Date By Date - B Data /.� sy / PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Date By Gale By Type:II Darn By D.WaV DRYWALL Type. '/ Int Br cs Wall Oat- By W Date 7` Pj a Date v4 0 C. By FINAL INSPECTION v m Water Lids Fin Separation C Date By tiiPData By Date oPass or Request Inspect. Type of Insp. Fail Date Date Done By Comments Oh Al.-Z. -3,d 47 a 1 8 a CA f-v 9 S-e I i i 0 h HOQ-4-k " _ MASON COUNTY PERMIT NO. awl{ Pob BUILDING PERMIT APPLICATION 7426 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 APPLICA T INFORMATION CONTRACTOR INFORMATION Owner ♦e_4 E,N4 q,4,,, �Q Company Name 4 %4•A e— NO Mailing Address 11 /ea3 Maili Address G Cityl State Zip Code City State a Zip Code Phone' 6� 00 O her Ph.�2fi y�j� �3 7 Phone J Other Ph. ='UJi4 Lien/Title Holder �- _A K Contractor Reg. #H Exp. v E mail address IzElb36-D Drivers Lic.# DOB '' Drivers Lic. # DOB ^J7l SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic AJA- Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No Fire District MAI- Legal Description Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel aration? Yes/ Is property within 200' of Saltwater /V U Lake A_�'0 River/Creek Pond A-' U Wetland _�(ZSeasonal Runoff ALO Stream /J 0 Slopes or Bluffs ] 15% n? 0 Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye TYPE OF JOB - New ><`�IVN dd Alt Repair Other PRIMARY RESIDENCE M'SEASONAL ❑ Use of Building 4: , • Describe Work No. of Bedrooms --No. of Bathrooms a Square Footage 1 std loor 2nd Floor 3rd Floor—Basements Deck '�k Other Sq. ft. ­261 4"'e4 Garage Attached —Detached Carport `' Attach d v'-74 MANUFACTURED HOMj= INFOR ATI - Make A)A Model A.;-,A Year•1- � � Length Width Seri No. `� r-T l No. of Bedrooms a.a3_ No. of Bathrooms Type of Heat r se ric $ A�- Replacement Unit? Installer Name ?A 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. PROOF F CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. v2- ✓ N'nvz— Date /,? C_15_wnep Owners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROyqD DENIED NOTES Building Department t Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee tS EH Review Fee Plumbing & Base Fee z3`° Planninq Review Fee Mechanical & Base fee 1;P'11 'a — Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal All Valuation $ 9 3S� 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 APPLICA T INFORMATION r CONTRACTOR INFORMATION I Owner Iklmlvll Company Name Marlin Addres Mailing Address City State WA Zip Code s S� City State Zip Code � Phoneg,66 -M-6-210 v Other Ph.6?53 `Yids }3 E/ Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address 4 _ ��� E Mail Address Drivers Lip.# DOB S'i 4 Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic ?C, Existing Septic ' Connect to Sewer System 1� '4 Name of Sewer System,4) /9' PARCEL INFORMATION- 12 Digit Parcel No Fire District /J— Legal Description 4I Site Address(Please include street name,street number and city) i r.12I.Q_ ag Directions to site Is property within 200'of Saltwater A C Lake W-u River/Creek Pond Wetland j jt% Seasonal Runoff -j 0 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 LPG_Natural Gas_Heat Pump_ 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 Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other. Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other 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 F CONTINUAT:M,410 WORK IS BY MEANS OF A PROGRESS INSPECTION. X • Date: �o2 ./L7"-D2®d8 w r/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing& Base Fee Site Inspection Mechanical& Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES N 1 I r' APPROVED \ SON COUNTY DCD PLANNING SITE PLIN REQUIRED TO BE ON SITE � 4. \ B / AN ES SUBJECT TO APPROVAL Date - �q 3 a -N 1 NG o 1�0�, Al X ,�bIla y r O r Y!