HomeMy WebLinkAboutBLD2019-01196 Final Pole Bldg - BLD Permit / Conditions - 12/31/2020 Mason County
Mason County - Division of Community Development
� 615 W. Alder St. Bldg.8
Shelton, WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
B DD2019-01196 GARAGE/ STORAGE
PROJECT DESCRIPTION: NEW DETACHED POLE BLDG ISSUED: 01/13/2020
SITE ADDRESS: 401 NE TOONERVILLE DR BELFAIR
EXPIRES: 07/11/2020
PARCEL: 223024100040
APPLICANT: CATHERINE A MAY OWNER: CATHERINE A MAY
1717 SW COZY LN 1717 SW COZY LN
PORT ORCHARD,WA98367 PORT ORCHARD,WA98367
1.360.710.8978
VALUATIONS: FEES: Paid Due
U VB Utility, miscellaneous 1080.00 $52,164.00 State Fee-Residential $6.50 $0.00
Planning Review Fee $240.00 $0.00
Plan Check Fee $470.29 $0.00
Building Permit Fee $723.52 $0.00
Technology Surcharge $23.88 $0.00
Total: $52,164.00 Totals : $1,464.19 $0.00
REQUIRED INSPECTIONS
Setback Inspection Framing Inspection
Footing Inspection BLD-Final Inspection
CONDITIONS
* Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance
with Mason County Title 14.28 and 14.17.
* 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 1-800-647-0982.The person signing this condition is either
the homeowner, agent for the owner or a registered contractor according to WA state law.
* 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.
Printed by:Genie Mcfarland on:01/13/2020 10:54 AM
Page 1 of 4
Mason County
Mason County - Division of Community Development
j' 615 W. Alder St. Bldg.8
Shelton,WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
GARAGE/ STORAGE BLD2019-01196
" By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your
"Approved Site Plan"to ensure these structures meet the setback conditions listed.
* All surface water and potential runoff must be controlled on site and shall not adversely affect any adjacent properties nor
increase the velocity flow entering or abutting to any state or county culverting/ditching system or road way.
* Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly
corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of
pressure treated material.
* The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more
than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards
for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to
another fire apparatus access road which connects to a county maintained public road.
* All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building
Official may grant a one time extention of 180 days, upon the receipt of a written extension request prior to permit expiration.
Letter must indicating that circumstances beyond the control of the permit holder preventing action from being taken. No
more than one extension may be granted.
* 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.
* When parcel development requires direct access to state road(s), a Road Access Permit or Approval must be granted and
approved by the Washington State Department of Transportation. For more information contact Washington State
Department of Transportation, at(206)357-2620, ext. 630.
* Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the
structure.
* CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING
DEPARTMENT AND THE ADOPTED BUILDING CODE.
The construction of the permitted project is subject to inspections by the Mason County Building Department. All
construction must be in conformance with the international codes as amended and adopted by Mason County. Any
corrections, changes or alterations required by a Mason County Building Inspector shall be made prior to requesting
additional inspections.
* The plan review check list and corrections are part of the approved plans and must remain attached. It is the responsibility
of the applicant, owner or contractor to make the required 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 approved documents will result in failure of required building inspections.
* WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind
speed for Mason County is 85 MPH.
* The foundation/footing must be placed on undisturbed, firm-native soil.
* All property lines shall be clearly identified at the time of foundation inspection.
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Mason County
Mason County - Division of Community Development
/ 615 W.Alder St. Bldg.8
Shelton,WA 98584
~-- 360-427-9670 ext 352
www.co.mason.wa.us
GARAGE/ STORAGE BLD2019-01196
* The stamped 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, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule,
minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being
performed or approvals granted.
* REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable
provisions of the current code and the manufacturer's installation instructions.
A drip edge shall be provided at eaves and gables of shingle roofs.
* All RED stamped 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.
* All construction must meet or exceed all local and state ordinances in addition to 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.
* A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit
application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the
responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that
Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement
of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled"Managing Storm Drainage on Small Lots,The Small Parcel
Stormwater Site Plan"constitutes an approved plan based on the criteria listed on the application/worksheet. If the
development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other,
parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final
inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater
management system have been installed as approved on the stormwater site plan.
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.
* When parcel development requires direct access to county road(s), a Road Access Permit or Approval must be granted by
the Mason County Department of Public Works. For more information contact Public Works, at(360)427-9670, ext. 450 or
100 W Public Works Dr. Shelton.The building permit will not be finaled until the permit holder can show proof that the
access permit from Public Works has been finaled and approved.
* Concrete encased grounding electrodes must be installed and used at each new building or structure that is built upon a
permanent concrete foundation. In Mason County the electrical code is regulated by Washington State Department of Labor
& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-
4000.
* Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site
plan. Please check your"Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed.
Printed by:Genie Mcfarland on:01/13/2020 10:54 AM
Page 3 of 4
Mason County
Mason County - Division of Community Development
615 W.Alder St. Bldg.8
Shelton,WA 98584
360-427-9670 ext 352
www.co.mason.wa.us
GARAGE/ STORAGE BLD2019-01196
All building permits shall have a final inspection performed and approved by Mason County Building Department prior to
permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property
records on file with Mason County as being non-compliant with Mason County ordinances and building regulations.
* Application acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel.
RR5
* Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or
given an equivalent type of erosion protection (silt fencing or straw matting).
* This structure is approved as unheated space.
To be considered unheated space the area may be provided with a heating system that does not exceed maxium output of 1
watt per square foot., or 3.4 Btu/h per square foot. A permit and approval is required prior to installation of any heating
system.
When a heating system exceeds 1 watt per sq. ft(or 3.4 btu/h per sq.ft)the heated space shall be insulated in accordance
with the energy code in effect at the time of permit application.
I hereby certify that I have read and examined this application and know the same to be true and correct.
All provisions of Laws and Ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to give authority to violate or cancel
the provisions of any other state/local law regulating construction or the performance of construction.
Issued By:
Contractor or Authorize A ent: L� Date: �• 13 Z�
Printed by:Genie Mcfarland on:01/13/2020 10:54 AM
Page 4 of 4
615 W.Alder St.Bldg 8,SHELTON,WA 98584
t MASON COUNTY SHELTON:360-427-9670,EXT 352
COMMUNITY SERVICES
r BELFAIR:360-275-4467,EXT 352
Building,Pla wng,Environmental Hwith.Community Health
ELMA:360-482.5269,EXT 352
" www.co.mason.wa.us
INSPECTION CARD AND CERTIFICATE OF OCCUPANCY**
To schedule an inspection call or visit http://www.co.mason.wa.us/community-servicestbid-inspecUon.php
Permit Number BLD2019-01196 Date Issued 01/13/2020 Issued By
Project NEW DETACHED POLE BLDG
Site Address 401 NE Toonerville Dr
Applicant CATHERINE A MAY
Contractor
Contractor Phone
Primary Code UPC IBC,IRC,IFC,IEC,IMC,& Type
Permit Type GARAGE/STORAGE Occupancy
-APPROVED PLANS MUST BE ONSITE FOR ALL INSPECTIONS.
-DO NOT PROCEED BEYOND EACH STAGE OR COVER WORK UNTIL APPROVAL IS GRANTED.
-THIS CARD MUST BE POSTED IN A CONSPICUOUS LOCATION,FRONT OF THE PREMISES IS BEST FOR MAKING ENTRY.
-ALL PERMITS EXPIRE 180 DAYS AFTER THE PERMIT IS ISSUED OR 180 DAYS AFTER DATE OF LAST INSPECTION.
-OWNER/AGENT IS RESPONSIBLE FOR REQUESTING ALL INSPECTIONS THROUGH FINAL INSPECTION.
"THIS STRUCTURE MAY NOT BE USED OR OCCUPIED UNTIL ALL APPROVALS ARE GRANTED."
PRIOR TO CALLING FOR FINAL INSPECTION,ALL CONDITIONS OF THE PERMIT MUST BE MET
Public Works Access/Driveway Other
Health Septic Well
Deptartment
Planning Site Inspection
Department
Fire Marshall Fire Apparatus Access Fire Sprinkler
Auto Fire Alarm Hood and Duct
Other Final
Building Building Official: Community Services Designee
Department
Concrete Setbacks FT — Slab
Footing Perimeter I) Point load Footing
Footing Interior Footing Decks/Porches
Foundation Stem Walls Other
Rough-in Groundwork Plumbing Framing /E7
Groundwork Mechanical Plumbing
Groundwork Gas Pipe Mechanical
Gas Piping Shear Wall Nailing
Underfloor
Other
Insulation Slab Ceiling
Floor Vaulted Ceiling
Walls Vapor Barrier
Other
Wallboard Interior Wall Brace Panels Fire Walls
Nailing
Other
Final Building 17-3tr-&r7o >Z-
Manufactured Setbacks Setup
Home
Concrete Foot/Runners Final
Other
PLANNING
OCT 212020
615 W. Alder Street
7 � �Ie ® i°° ® 5Q° dress: 4�9L .�.��n� �F�a � �elri� amp: May T ���
rc
Taus is not a surve1j;all propertij lines/boundaries Piave been demonstrated bij the Owner(s)and/or their A6 n f(s)• �
1k
APPROVED z
MASON COUNTY DCD PLANNING �
SITE PLAN REQUIRED TO BE ON SITE
C N SUBJECT TOAPP VA
By Date O! 03 Zo Z C) I v! aQ C_(�
S L#
+6' 600`1: _ ��• ` -
-- 0 - 24"' Loamy Medium Sand
PLANNI 1G: , 24 m 48'g: Medium Sated & .
ALL SETBACKS ARE MEASURED w Gravel 15%,
_ FROM THE FURTHEST {`
c�
RQjf-CTION OF 5L# 2
-H 0 - 24"-Loamy Medium Sand
co
• i i' cr) „
El i� ` 24 - 46- .1, edium Sand &
X SL#4 F.P, Gravel 15%
Will SL# 3
i + m
`• 1i
� 0 24" Loamy Medium Sand
��ried X SL# 3
P°wee _ J 24 - 36" Medium Sand &
Drwew^ �, 1WWI
;! _ ' Gravel 15%
cr) al
w co W 00 -r SL# 4
Z \ a CV m
\ {{ 0 24" Loamy Medium Sand
�FUf o-
ioc- Water Line -
24 32" Medium Sand &
1 A ri� j v Gravel n
IN' ® �OSeaRk
IF
+ +0
ED
5100333. F
+4 600 t __,--
Name - i}I"tF9TNE 1K4-Y Parcel#.2 02—Yl—000y0 BLD#2_6J'J' 61 Pq(P
Mas4 ►ty
11;Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
{
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development,or redevelopment',with more than 2,000 square feet of impertn CT sftrfa20
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces yy�sl llc���ll�.•r����I fL�e�jv to ent
including construction,installation or expansion of a building or other structure,and/or replacement 41m�z4ioG's'§� (;Afi"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 = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways /1/ X =
X = Length of drive begins at the right of way
X =
Parking Areas /U ZA X =
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others Al1A X =
X If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area(sum of all areas)
If the Total Impervious Surface Area is L S THAN 2_00)LS �uar Feet,please read,acknowledge and sign below.
Based Upon the information you have provide a Storm ater Site an 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. Z
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surface A ea is GREATER THAN 2000 Square Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
Name Parcel# BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14, Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
httpHwww.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
100 W. Public Works Dr
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 400
415 N. 6th St—Bldg#8 lower level
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:
Page 2 of 2
MASON COUNTY COMMUNITY SERVICES Permit 1Vo_lilvtotiut I -t� I t I u'
PERMIT ASSISTANCE CENTER:
•
.BUILDING •PLANNING •PUBLIC HEALTH•FIRE MARSHAL OCT 21 2019
3 � 615 W.Alder Street,Shelton,WA 98584
rl 615 W. Alder Street
Phone Shelton:( J427-9570 ext. 352•Fax:(3ti0)427-7798 Phone
B IfA f* 275-4467•Phone Elma:(360)482-5269
' BUILDING PERMIT APPLICATION
PR OPERTY OWNER INFORMATION: CONTRACTOR INFORMATION 2 1 20�Q
�?�Y NAME: C2 W ht r A
MAILING ADDRESS:
MAILING ADDRESS:"Qt ;/7 4 e" Ile 121% ZIP:
CITY: STATE:
CITY:�R? STATE: w+-_ Z� -- PHONE: CELL:
PHONE#1: ,(tD 7/2~6 9.78 EMAIL :
PHONE#2: L&I REG# EXP.
EMAIL: Mtn 11,
OWNER CONTRACTOR❑ OTHER❑
PRIMARY CONTACT: EMAIL
NAME CITY
STATE ZIP________
MAILING ADDRESS
CELL 3bD Z10"$917
PHONE "' ?!U 7l3 —
PARCEL INFORMATION:
. 2��2— 0401jjj ZONING
PARCEL NUMBER(12 Digit Number) Z f 2- FIRE DISTRICT
LEGAL DESCRIPTION(Abbreviated) 11 riL-Q L IKe 1t�ee,�>; 'r' ` ' `fie 2 CITY
SITE ADDRESS Ll C1 ' V W<ST of I�aHTrn 'Twx/v LcF e� Td 'CovivkRvzu� i�.c /llf:
DIRECTIONS TO SITE ADDRESS Jr
Ma 1; H6M e o i L Fff
GREATER THAN 14%: YES❑
IS THE PROJECT WITHIN 300 FT OF SLOPE(S) Check all that apply):
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING:
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW ADDITION ❑ ALTERATION ❑
REPAIR❑ OTHER ❑
r `:
USE OF STRUCTURE (Residence,Garage,Commercial Bldg,Etc.) aQ.vNUMBER OF BATHROOMS
L�
IS USE: PRIMARY ❑ SEASONAL ❑ NUMBER OF BEDROOMS
HEATED STRUCTURE? YES (Whole Bldg) ❑ NO YES (Part[s]of Bldg) ❑
DESCRIBE WORK 13v4,1t,
SQUARE FOOTAGE: (proposed) sq ft. BASEMENT_.sq.
ft•
1 ST FLOOR sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR
DEC sq.ft. COVERED DECK /V !I sq.ft. STORAGES sq.ft. OTHER q
K
GARAGEJ000_sq.ft. Attached[I Detached��
CARPORT Alsq.ft. Attached❑ Detached❑
TION: *4 COPIES OF THE FLOOR PLAN REQUIRE
3 MODEL_ — &_��
LENGTH
MAK SERIAL NUMBER
W TH 3a——4--- BEDROOMS_ BATHS
ENVIRONMENTAL HEALTH: EXISTING
SEW AGE/SEWER SOURCE: SEPTIC [Pr SEWER❑ /
NO If yes, attach completed Water Adequacy Form
PLUMBING 1N STRUCTURE? YES ElNO�� EXISTING SQ.FT.
PERIMETER/FOUNDATION DRAINS PROPOSED? YES [I TOTAL BEDROOMS�_
EXISTING BEDROOMS�1 -- PROPOSED BEDROOMS A/A
OWNER acknowledges that submission finaccurate and Ite rotor declare thion may result in a S
at I am entitled itoto rece work ive a this rder rpermit and permit �o do the work aseproposeddgement�l have is by
signature below.I declare that I am the owner
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this proj above described ect. The owner or legal
representative, represents that the inform a This r erm Uappl cation becomesided is accurate and nts null&vio'd f workoyees of nason County access to or authorized construction is not commencedwfh property 180
and structure(s)for review and inspect P
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THISWi MI IS CAUSE BY TIHE APPLICATION TIO BE EXPIRIED(MASONIS
PERMIT APPLICATION OF 180 DAYS OF M COUNTY CODE 14.08.42)
X Date
Signature of OWNER Must si nod lo the OWNER
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT J I-y,ZO
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH