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BLD2018-00604 Final SFR - BLD Permit / Conditions - 7/31/2018
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Fail Date Date Done By Comments 0) (D C) o AOL - ? 0(D in 0 0 0 Cn 0 (n -1310's4le LJA Le- - -------------------------------------------- W7- 9.011al stow, Dt-*� (D 0 Schaller 22330-33-00020 Site Plan 1 6/9/2018 NE Tahuya Blacksmith Rd 516ft — roperty 48f Corner W Symbol Stl eet Address: 1050 NE Tahuya Blacksmith Rd,Tahuya Wa 98588 N Septic Key: Attenuatio 1. Audio-Visual Alarm Zone I 2. Cleanout E 420ft 3. 1200 Gallon Septic Tank 60ft 2 Compartment with Effluent Filter D 4. 1200 Gallon Pump I V E D r Chamber RE E Drain 5. Valve Control Box Field 50fiI JUN 11 2018 360ft e w 60ft a © 615 W. k1der Street y 1 5 f 300ft t Storm Water Direction, APPROVED $P p p®V GC® Parcel has minimal "� /'� I—f� amount of storm water d MASON COUNTY DCD PLANNING that drains down each 1 SITE TE PLAN REQUIRED TO BE ON SITE side of the driveway 240ft- - e C N S SUBJECTTO APP OVA B Date 20 PLAN14ING180ft PLAN j ALL SETBACKS ARE G. FROM T EASURED lzoft-- R JECTION OF TUN HEST Np Buil ling Clearing Site 140'x 0' BUILDING (p sr o vs' us' xis• d im T 4 60ft- - Garage/Shop Future House 60ft x 40ft ' 80ft x 40ft PUD3 ansformer PUD3 nderground Intern t Location Curtain Drain& 3SIZ5A3 Power/Interne 230 Downspouts Well, % H atPump 10ft from each p o a Perm/Te Power property line Q' 20 tl 15ft Wideii Driveway I 060 ft 120 ft 180 ft 240 ft 281 ft 300 ft 326 ft -Pjld2(Dlb-00(a0y �r � 3 f Jeff& Tina Schallgr _ 22330-33-00020 ��1�—del Name . , Parcel# BLD# ,�`� Mason County ' `EC EIVC BUILDING Department of Community Development J Small Parcel Stormwater Management Application/Worksheet (page Of&) n,,, Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building Vli appli�'�Cos � made for residential development,or redevelopment',with more than 2,000 square feet of impervious surface2. 'Redevelopment 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 70 X 50 = 3500 X = Measurements for buildings are taken at the X _ perimeter of the farthest projections(example: eaves/gutters) X = Driveways 340 X 15 = 5100 X = Length of drive begins at the right of way X = Parking Areas 140 x 83 = 11620 Any paved, gravel X = or packed area per definition above table X = Patios/Walks X Any paved, gravel X = or packed area per definition above table X = Others 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) 20220 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. Page 1 of 2 NameJeff& Tina Schaller Parcel# 22330-33-00020 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: 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) X 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/Budder/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- descri p perty r re ew an inspection as may be required. g X t�AOwner/Agent/Contractor(circle one)Date: //J IF I Page 2 of 2 I MASON COUNTY DEPARTMENT OF COMMUNITY SERVICES BUILDING DIVISION ' ,., SHELTON (360) 427-9670 BELFAIR (360) 275-4467 Elma (360) 482-5269 C41., I`t FAx: (360)427-7798 WEB SITE: www.co.mason.wa.us 615 W ALDER STREET, SHELTON 98584 2015 International Energy Conservation Code, as amended by WAC 51-11 4 cc' ) Effective July 1, 2016. Ventilation code provisions are located in the 2015 International Residential Code (IRC), 2015 International Mechanical Code (IMC), & 2015 International Building Code A complete energy code application form will include information that clearly identifies compliance methods for heat sizing, thermal envelope, and whole-house ventilation. This form includes compliance instructions and information needed. Energy code compliance information, forms, worksheets, and educational information is also available on the Washington State University Extension Energy Program (WSU-EP) website. To access the website go to http://www.energy.wsu.edu/BuildingEfficiency/EnergyCode.aspx . The website includes a heat system sizing calculator. Submit a completed heat sizing calculator worksheet when the building permit is submitted. In addition to the heat sizing calculator the website has helpful compliance information and worksheets for prescriptive and component performance options along with a glazing schedule. INSTRUCTIONS: Complete the Mason County Energy Code application and submit with a heat sizing calculator available on the WSU-EP website, see item #4 below: 1 Identify the compliance method. The most common and simplest approach is the prescriptive method for energy code compliance. See prescriptive table R402.1.1 located in the instructions. The Performance Alternative approach referenced in IECC Section R405 may also be used for energy code compliance. For more information contact Mason County Building Department staff at (360) 427-9670 ext. 352 or WSU Energy Program at (360) 956-2042. Compliance must be shown on your construction drawing in addition to this application. 2 Identify the whole-house ventilation compliance method. A ventilation system must be installed in accordance with The International Residential Code, Section M1507. The most common ventilation methods include a whole-house ventilation system using exhaust fans (M1507.3.4) and a whole-house ventilation system integrated with a forced-air system (M1507.3.5). Other ventilation systems include whole-house ventilation system using a supply fan (M1507.3.6) and whole-house ventilation system using a heat-recovery ventilation system (M1507.3.7). Ventilation openings are required in each habitable room in accordance with M1507.3.4.4. If you need additional information we recommend that you discuss with your heating and ventilation system professional. In addition Mason County staff will be happy to discuss the options if you are not sure which compliance option will work for you. 3 Identify the Additional Energy Efficiency Requirements listed in Table R406.2. The drawings included with the building permit application must show and identify which options have been selected and the point value of each option. Each one and two-family dwelling unit and townhouses are required to achieve the following minimum number of credits: a) Small dwelling units: less than 1500 sq. feet of heated or cooled floor area and less than 300 sq. ft fenestration area (skylights, doors, windows, etc). Additions to existing building that are greater than 500 sq. ft. of heated floor but less than 1500 sq ft of area. Requires 1.5 credits b) Medium dwelling units that are not included in (a) above (small dwelling), OR (c) below(large dwelling) Requires 3.5 credits EXCEPTION: Dwelling units serving R-2 occupancies shall require. Requires 2.5 credits. I (R-2 occupancy is Residential occupancies containing sleeping units or more than two dwelling units where the occupants are primarily permanent in nature, including: Apartment houses, Boarding houses (non-transient) with more than 16 occupants, Congregate living facilities (non-transient) with more than 16 occupants, Convents, Dormitories, Fraternities and sororities, Hotels (non-transient), Livelwork units, Monasteries, Motels (non-transient), Vacation timeshare properties.) c) Large dwelling unit is a dwelling unit that exceeds 5,000 sq. ft. of heated or cooled floor area. Requires 4.5 credits. d) Additions less than 500 sq feet. Requires .5 credits 4 Must provide a completed heating/cooling system size worksheet to verify compliance to IECC R403.7. The calculator/worksheet is available on the WSU-Energy Program website at: http://www.energy.wsu.edu/Documents/Heat__Sizing_code%20specs_final_2015.xls. Staff may be able to assist with preparation of the worksheet. 5 Must meet the prescriptive option for all fenestration products. Products shall comply with the required U- factor listed in Table R402.1.3. Windows, doors, and glazed doors shall have a tested U-factor or .30 or less. When using the small dwelling option for energy credits(a) or Performance Alternative approach you must provide a fenestration schedule that identifies the square feet and U-factor of each item. Fenestration is defined in the IECC as skylights, roof windows, vertical windows, opaque doors, glazed- doors that include products with glass and non-glass glazing materials. 6 Identify on the construction drawings the location and fuel type of the heating system, water heater, location of exhaust fans (bathroom, laundry, kitchen, etc.) and R-factor of proposed insulation for walls, floors, ceilings, and concrete slab floors on the building plans. 7 Not less than 75% of all permanently installed lamps in lighting fixtures shall be high efficacy lamps. High efficacy lamps are defined in IECC Chapter 2 and are considered compact fluorescent lamps, T-8 or smaller diameter linear fluorescent lamps, or lamps with a minimum efficacy 60 lumens per watt for lamps over 40 watts, 50 lumens per watt for lamps over 15 watts to 40 watts, and 40 lumens per watt for lamps 15 watts or less. If you need assistance please contact Mason County Community Development at(360) 427-9670 ext. 352 or WSEC compliance information and code text is also available on the WSU-Energy Program website at: http://www.energy.wsu.edu/BuildingEfficiency/EnergyCode.aspx Prescriptive Requirements °,t for Mason County Climate Zone 4-C, Table R402.1.1 Fenestration Glazing U-factor Area% Vaulted Wall Wall Slab d on Option of Floor Vertical Skylight Ceiling Ceiling i Above int I,"below grade Floor Grade Qndudes doors, b Grade windows,etc. R-10,2 ft R-21 10/15/21 int+ Heated slabs 4C Unlimited 30 .50 R 49 R-38 int k.' TB require require R10 full slab. " Log &solid timber wall with a min. avg. thickness of 3.5"are exempt from the above grade wall insulation requirements. All footnotes are available on WSU-Energy Program Website @ http://www.energy.wsu.edu/BuildingEfficienc /y EnergyCode.aspx 2 MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT WSEC/Ventilation Code Compliance Application Submit with heating/cooling system size worksheet (see instructions #4) Owner: Parcel#: Type of project: Jeff& Tina Schaller 22330-33-00020 New Garage Total Sq. Ft. 1s'Floor: 2"d floor: Heated Basement: of heated area:: 800 800 Heating System Type: O Electric wall heater O Electric Central Furnace O LPG Furnace O Heat Pump with electric furnace O Heat pump with gas furnace X Ductless Heat Pump O Boiler, specify fuel type: ------------- O Other: Specify: Q�5- zll-��—---------------- Prescriptive Option Table R402.1.1 (see table on previous page) Compliance ❑ Component Performance, R402.1.3 - Calculation worksheets required Method Must Check one:: ❑ Other (specify):_____________ Check one Whole House Ventilation system ❑ Whole House Ventilation Ventilatio usin exhaust fans&window or wall Integrated with a Forced Air El Other,describe:_ fresh air vents(M1507.3.4). If using System (M1507.3.5) n System window vents be sure to order -- ----- - windows with vents. 30 ' 4 Referencing Table R406.2, "Additional Residential Energy Efficiency Requirements,"all residential units must develop credits as specified in Table 406.2. Identify and describe which option(s)will be used to comply. If the table is not attached to this form you can access the table on our website at: http://www.co.mason.wa.us/forms/Community Dev/iecc wsec.pdf Additional a) Description: Small dwelling units: less than 1,500 sq. feet of heated or cooled floor area and less than 300 sq. ft fenestration area (skylights, doors, windows, etc). Energy *Including additions to existing building that are greater than 500 sq. ft. of heated floor Efficiency Requirem but less than 1,500 sq ft of floor area. Requires 1.5 credits ents b) Medium dwelling units that are not included in (a) above (small dwelling), OR (c) below Energy {large dwelling) Requires 3.5 credits credits EXCEPTION.Dwelling units serving R-2 occupancies shall require. Requires 2.5 required: credits. See page two for description. c) Large dwelling unit is a dwelling unit that exceeds 5,000 sq. ft. of heated or cooled floor area. Requires 4.5 credits d) Additions less than 500 sq feet. Requires .5 credits (Fenestration is defined in the IECC as skylights, roof windows, vertical windows, opaque doors, lazed-doors that include products with glass and non-glass glazing materials. Describe Energy Credit Option(s): Using Option Oa ad C ,+tS &)tJed-, tut FvQ, e2S►d." 1-al. L)Se., number(s): '38 le re;C k,111vt 3 FENESTRATION'SCHEDULE USE FOR ENERGY CREDIT a) SMALL DWELLING OPTION & COMPONENT PERFORMANCE COMPLIANCE List all windows, doors, skylights. (If needed, attach an additional sheet) 'Fenestration is defined in IECC Chapter 2 as skylights, roof windows, vertical windows, opaque doors, glazed-doors that include products with lass and non-glass glazing materials. Manufacturer Location U-Factor Size Quantity Total rough opening) Square Feet 3e ; . ', �' x Z 17 y FT ,j v ql XZ Te Iz' 3 I F— Total Fenestration: windows, skylights and door area Energy Credits 4 � N copN� MASON COUNTY COMMUNITY SERVICES Permit No: I'EJ 1 O/ { ' 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)2754467•Phone Elma:(360)482-5269 JNtl �D BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 6+' ME NAME: Jeff&Tina Schaller NA :Greg Morgan(Morgan-Built Homes 1e' MAILING ADDRESS:820 Pth Ave S.W. MAILING ADDRESS: 10233 Yates Lane NW Str CITY:Puyallup STATE:Wa ZIP:98371 CITY:Bremerton STATE:Wa ZIP:98312 eet PHONE#I: 253-625-0653 • PHONE: CELL: 360-801-4140 PHONE#2: 253-208-8476 EMAIL: g[lagiMmo[gan-built-com EMAIL.:jeffschaller@hotmail.com L&I REG## 0RGABH876LC EXP._6_/_/-JR PRIMARY CONTACT: OWNER❑ CONTRACTORZI OTHER❑ NAME Greg Morgan EMAILgreglU7morgan-built.com MAILING ADDRESS 10233 Yates Lane NW CITY Bremerton STATE Wn ZIP G$312 PHONE CELL 360-801-4140 PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number)22330-33-00020 ZONING RR5 LEGAL DESCRIPTION(Abbreviated)N1/2$1/2 GOVT LOT 4 E OF RNV FIRE DISTRICT d SITE ADDRESS1050 NE Tahuya Blacksmith Rd cITY Tahuya PUG DIRECTIONS TO SITE ADDRESS West on WA-300, Cont. on NE Northshore Rd. Right onto NE Belfair Tahuya Rd Right onto NE Tahuya Blacksmith Rd. between 1000-1120 IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO M] IS PROPERTY WnMN 200 FT OF THE FOLLOWING: (check all that apply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW X] ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) Garage W/Bathroom, Shower IS USE: PRIMARY 5j SEASONAL❑ NUMBER OF BEDROOMS_0 NUMBER OF BATHROOMS 1 HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s)ofBldg)X] NO❑ DESCRIBE woRKConstruct Garage for Vehicle Storage, General Storage, Personal Protects SQUARE FOOTAGE:(propose+ezisting) 1ST FLOOR sq.& 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECK sq.ft. COVERED DECK sq.ft. STOR�P.GE-0-0-0 sq.ft. OTHER sq.ft. GARAGE 1 WOC�sq.ft. Attached❑ Detached® CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERL4LNUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC] SEWER❑ / NEW® EXISTING❑ PLUMBING IN STRUCTURE? YES® NO❑ If yes,attach completed Water Adequacy Form PERRvIETER/FOUNDATION DRAINS PROPOSED? YES NO❑ EXISTING So- .FT. 0 EXISTING BEDROOMS 0 PROPOSED BEDROOMS 0 TOTAL BEDROOMS0-2,400 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 1 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 pernitlapplication becomes null&void if work or authorized construction is not commenced within 180 days orrf 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 PERMI APP ICA ON OF 80 DAYS OF MORE WILL CAUSE THE APPLIC TION TO BE EXPIRED.(MASON 1 / COUNTY CODE 14.08.42) x 1 'Signature of OWNER(Must be sinned by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT —OIE C_ 7,z ,IS PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH goN co�N MASON COUNTY COMMUNITY SERVICES . Q;l C� �lb -00690 PERMIT ASSISTANCE CENTER: Permit No. •BUILDING •PLANNING •FIRE MARSHAL RECEI 615 W. Alder St-Shelton, WA 98584 ED www.co.mason.wa.us Phone Shelton:(360)427-9670 ext. 352- Fax.(360)427-7798 JUN txs� Phone Belfair.(360)275-4467- Phone Elma:(360)482-5269 l ' 20i� PLUMBING & MECHANICAL PERMIT APPLICATION 615 W-Alder Street OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:Jeff Schaller NAME: Greg Morgan(Morgan-Built Homes) MAILING ADDRESS:820 9th Ave S.W. MAILING ADDRESS: 10233 Yates Lane NW CITY: Puyullup STATE:Wa ZIP: 98371 CITY: Bremerton STATE: Wa ZIP: 98312 1'PHONE: 253-625-0653 PHONE: CELL: 360-801-4140 end PHONE: 253-208-8476 EMAIL : gregC)morgan-built.com EMAIL: L&I REG# #MORGABH876LC EXP. 6 /_aj 199 PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number): 22330-33-00020 Zoning: RR5 LEGAL DESCRIPTION(Abbreviated): N 1/2 S 1/2 GOVT LOT 4 E OF RM SITE ADDRESS: 1050 NE Tahuya Blacksmith Rd CITY: Tahuya DIRECTIONS TO SITE ADDRESS: West on WA-300, Continue on NE Northshore Rd, Right onto NE Belfair Tahuya Rd, Right onto NE Tahuya Blacksmith Rd, parcel is between 1000 and 1120. TYPE OF JOB: NEW X ADD ALT REPAIR OTHER USE OF BUILDING LOCATION OF FIXTURES/UNITS— 1 ST FLOOR 2ND FLOOR BASEMENT GARAGE_OTHER PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS Type of Fixture No.of Fixtures Fees Fuel Type:Electric LPG Natural Gas Ductless X Toilets ( _ Tyne of Unit No. of Units Fees Bathroom Sink 1 _ Furnace Bath Tubs _ Heat Pump Showers 1 Spot Vent Fan Water Heater 1 _ Propane Tank Clothes Washer �_ Gas Outlets Kitchen Sinks _ _ Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hose bibs 4 _ Dryer Vent Other _ 1____ ____ Solar Panel Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER acknowledge 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 contractor.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 authorized agent 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 OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PE MIT APPLICATION OF 180 DAYS WILL INV DATE HET;PLIC IX ]Vb6nAure of Owner Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT —0C L I-Z4.(g PLANNING DEPARTMENT FIRE MARSHAL Visit us on-line: http://www.co.mason.wa.us/community_dev/ Rev: 1/27/2016 JBN