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Home My WebLink AboutBLD2017-00224 MFG Home - BLD Permit / Conditions - 4/10/2017 Inspection Line (360)427-7262 a°6�N COO MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352 Mason County 615 W Alder St Shelton, WA 98584 'x'' RESIDENTIAL BUILDING PERMIT BLD2017-00224 OWNER: RYAN & HEATHER BEAVER RECEIVED: 3/23/2017 CONTRACTOR: OIEN CONSTRUCTION 360-277-3163 LICENSE: OIENCI*132LS EXP.. 9/16/2017 ISSUED: 4/10/2017 SITE ADDRESS: 481 E UNDERLINE RD BELFAIR EXPIRES: 10/10/2017 PARCEL NUMBER: 122077590583 LEGAL DESCRIPTION: TR 58-C OF SURV 5/94-96 TR 3 OF SP#1556 PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW MFG HOME 48' X 26'.8" Hwy 106 to Rasor Rd, R at"T" onto Underline Rd almost to end on left side. General Information Construction&Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: VB Type of Use: MH Insp.Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck: Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:1,296 Valuation: Building Height: 16 Occ. Status: Primary Basement: Manufactured Home Information Setback Information Shoreline& Planning Information Make:SKYLINE Length: 48 Ft. Front: E 120.0 Ft. Shoreline: Ft. Water Body: Rear: W 153.0 Ft. Slope: Ft. SEPA?: Unkn Model:ARLINGTOP Width: 27 Ft. Side 1: S 22.0 Ft. Shoreline Desig.: hWtiApplicable Year:2017 Serial No.: Side 2: N 70.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Manufact. Home Submittal AMP 3/23/2017 $264.25 S3201700000001 Manufact. Home Submittal AMP 3/23/2017 $-264.25 S3201700000001 Manufact. Home Submittal AMP 3/23/2017 $264.24 S3201700000001 Manufact. Home Submittal AMP 3/23/2017 $0.01 S3201700000001 Planning Review Fee AMP 3/23/2017 $205.00 S3201700000001 Planning Review Fee AMP 3/23/2017 $-205.00 S3201700000001 Planning Review Fee AMP 3/23/2017 $205.00 S3201700000001 EH Minor Plan Review AMP 3/23/2017 $ 105.00 S3201700000001 EH Minor Plan Review AMP 3/23/2017 $-105.00 S3201700000001 EH Minor Plan Review AMP 3/23/2017 $ 105.00 S3201700000001 Manufact. Home Issuance SLC 3/31/2017 $264.25 S1201700000001 Total $838.50 BLD2017-00224 Please refer to the following pages for conditions of this permit. Page 1 of 6 CASE NOTES FOR BLD2017-00224 CONDITIONS FOR BLD2017-00224 1) 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 1-800-64,7-0982. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) All 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 Depart meptp�to any further inspections being performed or approvals granted. X 3) Owner/ gent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. 4) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the 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. x '� 5) The"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, then 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 Xuil i g Department prior to any further inspections being performed or approvals granted. 6) Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified installer responsible for each major part of the installation. RCW43-63B.090 An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily located in plain site within three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each installer performed of in5talled. certification number and signature of the certified installer responsible for each major part of the installation. WAC365-210 X P�-V t BLD2017-00224 Please refer to the following pages for conditions of this permit. Page 2 of 6 7) If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American National Standards Institute (ANSI). To order the ANSI instructions you may either get an order form from the Mason County Building Department or you can contact the Offfice of Manufacturing Housing (360) 725-2800. X .Y?, 8) 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. (IRC 2012 R905.2.8.5) X �L C 9) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical concrete work exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). X �-2e) 10) Carbon monoxide alarms, listed as complying with UL 2075 shall be installed in accordance with manufacturer specifications and in accordance with IRC Section R315. Alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on each level of the dwelling. EXISTING DWELLINGS shall be equipped with carbon monoxide alarms when alterations (including addition or alteration of fuel burning appliances), repairs"K� , or additions requiring a permit occur, or when one or more sleeping rooms are added or created. X 11) 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 rots onnect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X 12) All construction must meet or exceed all local ordinances and 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 rev cation. X� � S 13) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. I further understand that this investigation will be scheduled as time allows. Until resolution of any/all problems no occupancy(Final Inspection)will be granted for the residence. OWNER/CO NTRACTOR(indicate which) Signature X 14) This permit is for the placement and installation of the manufactured home only and does not imply approval or review for any other items indidcated on the plot plan. X BLD2017-00224 Please refer to the following pages for conditions of this permit. Page 3 of 6 15) Permanent Address must be posted and visible from the road Deck must be safe and meet code for year building permit was issued. Rebuilt decks are required to meet current code. All guardrails and handrails must be in good condition and meet code for year built or current code if replaced. Skirting must be vented 1:150 and backfill sloped away from unit 2% for a minimum of 5' around the perimeter of the unit Gutters and downspouts must be installed with splash blocks provided All exterior penetrations must be sealed HWT Pressure relief line and dryer vent must exit skirting a minimum of 6"with a maximum of 24" above grade. The unit shall have a minimum of 16"x24" crawl space access provided HOWEVER, if the unit has not received a set up inspection and is skirted, 4 panels centrally located (one on each side of unit) shall be removed by the owner/applicant prior to requesting the inspection. All conditions on the original or issued permit must be met If the unit was installed by a WAINS certified installer/contractor since July 1, 2003, CTED Installer Tags must be available It shall be the responsibility of the person requesting the inspection to provide the manufacturer specifications, ANSI Standards or approved engineered design for the installation of the unit and have them available on site for inspection. Each inspection required will be assessed a fee as adopted under Mason County current fee schedule. Re-Inspection fees will be assessed each time an inspection is requested and required items are not completed prior to the inspection being performed ENFORCEMENT PROVISION: Any manufactured/mobile home and/or appurtenant structures found non-compliant with any county or state regulation are subject to enforcement action and subsequent violation and penalties pursuant to the Mason County Code. X 9 � 3 16) 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 /� y,� X W 1\ V 17) 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. X �J_ BLD2017-00224 Please refer to the following pages for conditions of this permit. Page 4 of 6 18) 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 InspeGtq�Oall be made prior to requesting additional inspections. X W I�:) 19) MOBILE HOME PARK SETBACKS SHALL BE 15' FROM NEIGHBORING ACCESSORY STRUCTURES, 10' FROM PROPERTY LINES AND 5' FROM RIGH AY AS PER MASON COUNTY ORDINANCE#118-91. x 20) The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including installation instructions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be clearI ar ed in the installation instructions. X 21) All property lines shall be clearly identified at the time of foundation inspection. X 22) All building permits shall have a final inspection performed and approved by the 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. Xc 23) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit (older,h ,_,®revented action from being taken. No more than one extension may be granted. 24) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Apprpye � Plan"to ensure these structures are shown and meet the setback conditions listed. X RM 25) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM OR ROAD WA//eyes X 1-� 261 On-site septic system final installation required prior to temporary/final occupancy SWG2016-00358. X 27) Prior to final approval, all upland areas disturbed or ne Iy reated by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X BLD2017-00224 Please refer to the following pages for conditions of this permit. Page 5 of 6 28) Appr v per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X ' 29) Appli at' n,acknowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is RR-5. X 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 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�QF`180 YS WILL INVALIDATE THE APPLICATION. Signature Date I/ OWNER - REPRESENTATIVE - CONTRACTOR Print Name (Circle one to indicate) BLD2017-00224 Please refer to the following pages for conditions of this permit. Page 6 of 6 mom all 10110 � � » MINIM 1rintff r110, rnn�� I XR�1� ■s Fi lip - •. • ceps (ss-aiaesl s�sa�soae DI""G M �N BUIL" elk � � i Ob1101H DER e�tsi ( ds�a OW-3BYA2 F AV N 3 I~ J BEDUOIDW WV21Eb I'WN@ kf00W BE13HOOW ' Obi N e 77% I -- --- ----I'— y I I =_� --I-------Lr-A-- ��` EU dNid IKE U Ob obi 2 Obi -I-MW I bHO 1 O _ I 40. I d No.1 3 JS� K1ICHEN I BEDKOOW Q fi kf00W _ Q 9 }�i'fINDISA - --I ❑❑ r---1 = elivrr Dvw 1014VOIEU BV111 061 MIHDOM Obi MIHDOM Ibm.0N eou 2H0 jObI oN eo�aHo � 21 d SEE MASON COUNTY PLAN MIYIDOM MIHD MM REVIEW CHECKLIST for important code information and details that pertain to this VENT structure. The numbers marked on plans correspond to the same item number in the checklist. AT 1 Sq Ft Per 300 Sq Ft `'{a''f5j `E'7,y$, 571-5�, S9, �o o� fob,69 , �� ,-18, 79, ` q , wvA 76- o-5-B -5 4. FILE REVIEWED FOR COPY Documents c approved plans: CODE COMPLIANCE Site plan: MASON COUNTY Planrevi.vvco� -ri;`;-- � BUILDING DEPARTMENT Engineering: '' Q Lateral Vertual ��, Date 'S 3 lei - (�c�•.� S MUST MEET CURRENT WASHINGTO -.a ATE CODES VENT AT 1 Sq Ft Per 3W Sq Ft THESE PANS MUST BE ON THE JOB SITE FOR INSPECTION. CHANGES SUBMIT CHANCF-S F 7" n.PPROVAL PRIOR TO D -" WORK f % % Name QMKA a " Parcel# 2�d — _I�5�3 BLD# ZO 11 —60 LZ 4 � i eil Mason County Department of Community Development „ Small Parcel Stormwater Management Application/Worksheet (page I 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 surface 2. '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 { X X = Measurements for buildings are taken at the X _ perimeter of the farthest projections (example: eaves/gutters) X = Driveways 120 X y ' = l0 d X = Length of drive begins at the right of way X = Parking 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 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) ZILcl1,lS2 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 develAment activity. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or p� tign. Acknowledgement of such is by signature below. I declare that I am the owner,owner's legal representative,or th contract�rt+. IV/� further acknowledge that the information provided is accurate and employees of Mason County are granted acce ove- O described property for review and inspection as may be required. $' !f '2 ,01 X Owner/Agent/Contractor(circle one)Date: S A try If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read, acknowledge and A the information provided on page 2 of 2. Page 1 of 2 Namck ja,a4 jafkA6dlt"Parcel# �p (1�' S Ucj`lsJ 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: hgp//www.co.mason.wa—us/code/connnissioners/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) d&OK 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 prop for revie d inspection as may be required. X Owner/Agent/Contractor(circle one)Date: 3 Page 2 of 2 ASON coU a� MASON COUNTY COMMUNITY SERVICES Ia2()11-60 PERMIT ASSISTANCE CENTER: Permit No: ` e •BUILDING •PLANNING •FIRE MARSHAL 615 W. Alder St - Shelton, WA 98584 Phone Shelton:(360)427-9670 ext.352 • Fax:(360)427-7798 Phone b� ^60)275-4467• Phone Elma:(360)482-5269 RECEIVED ` CEI V ED BUILDING PERMIT APPLICATION BAR p PROPERTY OWNER INFORMATION: CONTRACTOR INFO ON: NAME: A(,L,/(�J pu fit/<�/�[�i!21' NAME: ;en � er street MAILING A DRESS: PQ 8(a �;n�� MAILING ADDRESS: CITY:3e1.ra-`,r STATE:W1 ZIP: 5� CITY . —STATE: 111c�- ZIP: q k13 PHONE#I: �53'S(o l• �-I 3 5 a PHO 3Ir�()•S130. �fob5 CELL: PHONE#2: (oU o?3 1• [04s�/b' EMAIL EMAIL: yn a I.Awyl L&I REG#Cal ,1/6I It 132L 5 EXP. CONTACT PERSON : OWNER/ CONTRACTOR ❑ OTHER❑ NAME: i' MAILING ADDRESS: P12 l ,,Z 30 S L/ CITY: *a1a STATE: U)j ZIP: �R-5,2 PHONE:--- CELL:,a3 EMAIL: � i "`1— PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 1a�;?a - .S- ��S�4� ZONING LEGAL DESCRIPTION(Abbreviated)Ali-i(c f 3S�i�� /u� ,�<n,/,S�C� FIRE DISTRICT SITE ADDRESS 6/5/ J. �(l4(�;Z(i'�C , /C�c� CITY, B0Irg_ � DIRECTIONS TO SITE ADDRESS �,f-ds he if ; !b El-aL Aide-riderd ✓ 1-, IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ❑ IS PROPERTY WITHIN 200 FT: (Check all that apply): na SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑ TYPE OF WORK: NEW A ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)ke Sly e at Ce IS USE: PRIMARY/ SEASONAL ❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS HEATED STRUCTURE? YES (Whole Bldg),Z YES (Part[s]of Bldg) ❑ NO ❑ DESCRIBE WORK (Valuation/Project Bid Amount: $ ) SQUARE FOOTAGE: 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❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE SJ�u L_i h� MODEL /—t 4-m YEAR (Z—LENGTH t WIDTH�_� BEDROOMS 3 BATH SERIAL NUMBER 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. EN V IRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW ❑ EXISTING ❑ PLUMBING IN STRUCTURE? YES X 1 NO ❑ If yes, attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES NO[] EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS ,3 TOTAL BEDROOMS 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 _ �/.�31