HomeMy WebLinkAboutBLD2018-00683 Remodel and Special Inspection - BLD Permit / Conditions - 6/28/2018 A& Inspection Line(360)427-7262
coy MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County
4:.
615 W Alder St
Shelton, WA 98584
'854 RESIDENTIAL BUILDING PERMIT
BLD2018-00683
OWNER: GREG HATTON RECEIVED: 6/28/2018
CONTRACTOR: LICENSE: EXP: ISSUED: 8/6/2018
SITE ADDRESS: 143 E MERRIMOUNT RD UNION EXPIRES: 2/6/2019
PARCEL NUMBER: 322355201002
LEGAL DESCRIPTION: MERRIMOUNT BLK: 1 LOT: 2
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
REMODEL 50% OR MORE WITH ADDITIONAL 472 SQ FT COVERED E BROCKDALE RD, CONTINUE ONTO E MCREAVY RD, R ON E DALBY RD,
DECK R ON WA-106.
General Information Construction&Occupancy Information Square Footage Information
No.of Bedrooms: 2 Type of Constr.: V-B
Type of Use: SF Insp.Area: No.of Bathrooms: 2 Occ. Group: R-3 Lot Size:19,602 Deck:
Type of Work: REM Fire Dist.: 6 No.of Stories: 2 Occ. Load: Building:1,120 Garage-Attached 1,120
Valuation: $ 139,707.36 Building Height: 32 Occ. Status: Seasonal Basement: CovDeck 472
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: S 10.0 Ft. Shoreline: Ft. Water Body:
Rear: N 50.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Shoreline Desig.:
Side 1: E 22.5 Ft.
Year: Serial No.: Side 2: W 11.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 2 Heat Pump 1 Plan Check Fee AMP 6/28/2018 $791.54 S1201800000001
Lavatories 3 Ventilation Fan 2 EH Plan Review AMP 6/28/2018 $215.00 S1201800000001
Bath Tubs 1 Exhaust Hood 1 Planning Review Fee AMP 6/28/2018 $240.00 S1201800000001
Showers 1 Ventilation System 1 Building State Fee DEK 7/6/2018 $6.50 S1201800000001
Water Heaters 1 Dryer Vent 1 Building Permit Fee DEK 7/6/2018 $ 1,217.75 S1201800000001
Clothes Washer 1 Mechanical Permit Fee DEK 7/6/2018 $71.60 S1201800000001
Kitchen Sink 1 Mechanical Base Fee DEK 7/6/2018 $28.50 S1201800000001
Dishwasher 1 Plumbing Permit Fee DEK 7/6/2018 $ 101.90 S1201800000001
Hosebibs 2 Plumbing Base Fee DEK 7/6/2018 $24.70 S1201800000001
Total $2,697.49
BLD2018-00683 Please refer to the following pages for conditions of this permit. Page 1 of 7
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Mason County Community Services
Building Division
SPECIAL INSPECTION & 615 W Alder Street
Shelton, WA 98584
1854 TESTING AGREEMENT 360.427.9670 ext. 352
www.co.mason.wo.us
(All references are per the 2015 International Building Code)
Projec�Name: ('fib!(� N/ K!'�''�"tnc G Project Address: IY3 � cc��A16��0V`7 R�
Building Permit Number: ,3c, �� 8 — 8 Date Issued:
BEFORE A PERMIT CAN BE ISSUED: The registered Design Professional in responsible charge shall fill out the Agreement
and include the name and address of the company or inspector. Two (2) copies of this form are to be submitted to the
County prior to the issuance of a building permit. If changes are made as to who will perform the special inspections a new
form shall be submitted and turned into the Building Permits& Inspections Division for approval.
STATEMENT OF SPECIAL INSPECTIONS: In addition to this Agreement, a "Statement of Special Inspections" shall be
provided per IBC 1704.3. This Statement shall be made as part of the approved plans, and be placed in a conspicuous
location,such as the first page of the construction plans or the first page of the structural sheets.
SPECIAL INSPECTORS: All special inspectors shall be approved by the Building Division prior to performing any duties. The
special inspector shall provide proof of certification as a special inspector for each inspection item and be licensed by the
State of Washington.
SPECIAL INSPECTION REPORTS: Special inspection reports are to meet the requirements of IBC 1704.2.4. Copies of each
report are to be sent to the address listed in the letterhead noting the Project Address and Permit Number. A final report
shall be submitted stating that all special inspection and structural testing items were completed and are in conformance
with the approved design drawings and specifications. Items not in conformance, unresolved items, or any discrepancies in
inspection coverage (i.e. missing inspections, periodic inspections when continuous was required, etc.) shall be specifically
itemized in the final report.
Areas requiring special inspection: Name of Agency: Address&Contact Information
❑ Unapproved Fabricators(IBC 1704.2.5)
Other than Structural Steel (IBC Table 1705.2.2)
❑ Steel floor&roof decks
❑ Welding of reinforcement
❑ Cold-formed steel
Structural Steel
❑ Welding(Per N5.4 of AISC 360-10)
❑ Details(Per N5.7 of AISC 360-10)
❑ High-strength bolts(Per N5.6 of AISC 360-10)
Concrete Construction(per IBC Table 1705.3)
Reinforcement,embeds,anchors
❑ Formwork
❑ Materials
❑ Shotcrete
❑ Post-tensioned/Pre-stressed Concrete
❑ Erection of precast concrete
Page 1 of 3
n.. -
Mason County Community Services
Building Division
SPECIAL INSPECTION & 615 WAlderStreet
Shelton, WA 98584
I854
TESTING AGREEMENT 360.427.9670ext. 352
www.co.mason.wo.us
Areas requiring special inspection: Name of Agency: Address&Contact Information
Masonry Construction (IBC 1705.4)
❑ Prior to Construction(Article 1.15,TMS-602)
❑ As Construction Begins(Article 1.19.2,TMS-402)
❑ Prior to Grouting(Table 1.19.2,TMS-402)
❑ During Construction(Per TMS-402&TMS-602)
Wood Construction
❑ High-Load Diaphragms(IBC 1705.5.1)
❑ Wood Trusses>60ft(IBC 1705.5.2)
❑ Soils(IBC Table 1705.6)
❑ Driven Deep Foundations(IBC Table 1705.7)
❑ Cast-in-place Deep Foundations(IBC Table 1705.8)
❑ Helical Pile Foundations IBC 1705.9
❑ Sprayed Fire-Resistant Materials(IBC 1705.13)
❑ Mastic&Intumescent Coatings(IBC 1705.14)
❑ EIFS(IBC 1705.15)
❑ Fire-Resistant Penetrations(IBC 1705.16)
❑ Smoke Control(IBC 1705.17)
❑ Structural Steel(IBC 1705.11.1&AISC 341-10)
❑ Structural Wood (IBC 1705.11.2)
Page 2 of 3
Mason County Community Services
" Building Division
SPECIAL INSPECTION & Shhee WAlrserStre
— _ lton, WA 3858
4
tsrR TESTING AGREEMENT 3b0.427.9670 ext. 352
www.co.mason.wa.us
❑ Cold-formed Steel(IBC 1705.11.3)
❑ Mechanical&Electrical Components(1705.11.4)
❑ Architectural Components(IBC 1705.11.5)
❑ Storage Racks(IBC 1705.11.7)
I
5�06,erPos,r a tsinc.,,w, (IBC1705.1,1) wi TWifto 21-a 64d Lam W
Orr k via Sft12
3F;344�Ta
❑ Other (IBC 1705.1.1)
Declaration by Architect Engineer - f1tr i
!, the design professional In responsible charge for this project, declare that the Oti use; `'
above listed special inspection and structural testing items are required for this
project in apordance with IBC ;pter 17.
Signature ` a.e r �j �i 35I'i � {
Declaration by Owner
1,the Owner a project,declare that the above listed firm(s)or individual(s)are hired by me to perform
special i ections and structur 7est�infojthe project pursuant to IBC 170 .=.
r
Signature tate
CONTRACTOR RESPONSIBILITY: Each contractor involved with the construction of wind or seismic force-resisting
_systems shall comply with the requirements of IBC 1704.4. The contractor is responsible for providing the
special inspector access to approved plans and contract documents at the job site. All special inspection records
shall be retained at the job site by the contractor and shall be made available to the Building Department upon
request.
Declaration by General Contractor
1, the General Contractor of the project, agree to comply with the "Contractor Responsibility' ;twins noted
above.
54gna Lure state
Page 3 of 3
...0 Co.. �
MASON COUNTY Permit No: '
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING• PLANNING•FIRE MARSHAL (360)427-9670 Shelton ext.352
il httr)J/www.6o.mason.w&us/community dev/ (360)275-4467 Belfair ext.352
ixsc 426 W Cedar Street,Shelton WA 98584 (360)482-5269 Elma ext.352 n�C
BUILDING. PERMIT APPLICATION T`C
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: *,4, �/�
NAME: Mr and Mrs Greg Hatton NAME: ���
MAILING ADDRESS: 19410 NW 30th Ave MAILING ADDRESS: 20,8
CITY:Ridgefield STATE: WA ZIP: 98642 CITY: STATE: ZIP:
PHONE: (360)921-0069 CELL: PHONE: CELL: ers EMAIL:' greg.hatton@kicind.com EMAIL:
L&I REG# EXP.
CONTACT: OWNER d CONTRACTOR❑ BELOW ry LOIN;
NAME:Rebecca Stephens.Foster&Williams Architects MAILING ADDRESS: PO Box 102
CITY:Shelton STATE: WA ZIP: 98584 PHONE: 360 426-0511 CELL: (360)427-6483
EMAIL:rebeccaaa fosterwilliams com
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) 32235-52-01002 FIRE DISTRICT
LEGAL DESCRIPTION(ABBREVIATED): MERRIMOUNT BLK:1 LOT:2
SITE ADDRESS 143 E Merimount Rd CITY Union,WA 98592
DIRECTIONS TO SITE ADDRESS Heading east on Highway 106:turn right on Menimount Road Driveway is on the left
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND D WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO fX
TYPE OF JOB: NEW D ADDITION ❑ ALTERATION X REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE.GARAGE ETC.) SFR
IS USE: PRIMARY❑ SEASONAL C( NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
DESCRIBE WORK Residential remodel
SOUARE FOOTAGE:
1ST FLOOR 1. 220 sq.E 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.fL
DECK sq.fL COVERED DECK 472 sq.fL STORAGE sq.fL OTHER sq.ft.
GARAGE 1.120 sq.fL ATTACHED 4/ DETACHED D CARPORT sq.fL ATTACHED❑ DETACHED❑
MANUFA� D HO ORMATIO - -4 COPIES THE FLOOR PLAfi,rRE UIRED
-� MO YEAR ENGTH �
IDTH BEDROOMS BATHS SERIAL NUMB
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 or owner's legal representative.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 IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42)
x 5/4/18
Signattir OWNER Date
DEPARTMENTAL REVIEW APPROVE D E DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
= — FEE'S = TOTAL-NALUATION. >- -
BUILDING PERMIT FEE FIRE ACCESS AND GRADE
PLAN REVIEW GEO-TECH REVIEW
PLUMBING&BASE FEE STORMWATER REVIEW
MECHANICAL&BASE FEE TOTAL FEES
WOOD/GAS/PELLET STOVE VIOLATION INVESTIGATION FEE
PLANNING REVIEW FEE VIOLATION FEE
�egoN co"
�� MASON COUNTY PERMIT NO.blAl$-01*83
y DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING• PLANNING• FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
-t Mason County Bldg. III, 426 West Cedar Street (360)275-4467 Belfair ext. 35
1R54 PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext.3
_ �V
PLUMBING & MECHANICAL PERMIT APPLICATION MFCF FD
OWNER INFORMATION: CONTRACTOR INFORMATIQ415 018
NAME: Mr and Mrs Greg Hatton NAME: ,Y
MAILING ADDRESS: 19410 NW 30th Ave MAILING ADDRESS: r&P.
CITY: Ridgefield STATE: NIA ZIP: 98642 CITY: STATE: ZIP: t
PHONE: (360)921-0069 CELL: PHONE: CELL:
EMAIL: greg.hatton@kicinb.com EMAIL :
L&I REG# UM
PARCEL INFORMATION: A
PARCEL NUMBER(12 DIGIT NUMBER): 32235-52-01002
LEGAL DESCRIPTION(ABBREVIATED): MERRIMOUNT BLK: 1 LOT:2
SITE ADDRESS: 143 E Merrimount Rd CITY: union,WA 98592
DIRECTIONS.TO SITE ADDRESS:Heading east on Highway 106,turn right on Merrimount Road.Driveway is on the left.
TYPE OF JOB
NEW ADD ALT V REPAIR OTHER USE OF BUILDING Residential Remodel
LOCATION OF FIXTURES/UNITS- IT FLOOR x 2'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 Heat Pump V
Toilets 2 Type of Unit No.of Units Fees
Bathroom Sink 3 Furnace
Bath Tubs I Heatpump
Showers Spot Vent Fan A I-
Water Heater Propane Tank
Clothes Washer r Gas Outlets
Kitchen Sinks i Wood/Gas/Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent i
Other Other 4,gfF f
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER I 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 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 OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X 4- k_— 5/4/18
SIgnaturd l/ `plicant Date
X Rebecca Stephens Ownerf9wners Re resentative ontractor
Print Name '
__ __._ -- --- _ ---------- _ __.._ _._ _ _. --_.__--
DEPARTMENTAL REVIEW APPROVED DATE. DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT Dcrlk G ?a<
PLANNING DEPARTMENT
FIRE MARSHAL
Hood Canal /
31/
tlol,
Hwy. 106 /
3 PLANNING
0•� 3104' \\
Q i \
\%
\\
% PLANNI
' NG
♦ All SETBACKS ARE MEASURED
♦ \ \ `250' FROM THE FURTHEST
_PROJECTION O�-THE BUILDING
£X N 18TG SEPTIC SYSTEM TO REMAIN \ i �^ \ ♦ __
-APPROX.LOCATION -----
EXISTING RESIDENCE
DEMOLISHED ♦ i
-APPROXPREVIOUSLYLOCATION
♦ \\ ♦ Existing Garage Remodel
` \ \ 1,120 Sa FT.GARAGE EXISTING
1,120 Sa FT.LIVING REMODEL
\ \ 412 SO.FT.NEW DECK OVER 30"14.
31`
EXISTING DRIVE -APPROX LOCATION
NEW ROOF LNE ABOVE TYP. \ \ / • \ ` g��F.
NEW DECK \ \ \\
EXISTING DECK TO BE REMOVED
EXISTING ROOF TO 13E REMOVED g
NEW ROOF TO STAY WITHIN
THE ENVELOPE OF THE EXISTING ♦ \ `!
ROOF THAT 18 REMOVED AND
FRONT YARD SETBACK TH18 BIDE \
E
e• \\ 0 '` de g 4.
V / P
00dopo
dOp
Merrimount Drive
o �
�Jd20Ig-oocoB
w
PARCEL NO.: Site an
32235-52-(D10(d2 ' ? Scale: 2(D'-O"
LEGAL DESCRIPTION: J /�
MERRIMOUNT 5LK: 1 LOT: 2 Fc NORTH
SITE ADDRESS:
143 E. MERRIMOUNT DRIVE FO
UNION, WASI-IINGTON W592 e 8
1S`� ?QJ8
NOTE,SITE PLAN PREPARED WITHOUT A
SURVEY TO LOCATE EXISTING FEATURES. @�S'
VERIFY LOCATIONS OF ALL EXISTING APPROVED
FEATURES AND PROPII LINES PRIOR
TO CONSTRUCTION. MASON COUNTY DCD PLANNING@@t
SITE PLAN REQUIRED TO BE ON SITE
CHANGES SUBJECT TO AP7RVALayCQDate G
Time Mr and Mrs Greg Hatton Parcel# 32235-52-01002 BLD# 18-601083
Mason County r
Department of Community Development S U I L D
I N .
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 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.
'Common 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 = 1,863
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections (example:
eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parkinq Areas 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
X _ above table
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) 1,863
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 Storniwater 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 f,r review and inspection as may be required.
ice,
X Owner gen ontractor(circle one)Date: 5/4/18 R
l
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read, ack*,,*Y!Y,e and sigD
the information provided on page 2 of 2. 8 8 ?0I8
Page 1 of 2 er
Name Mr and Mrs Greg Hatton Parcel# 32235-52-01002 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/l*ndex.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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