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HomeMy WebLinkAboutBLD2024-00329 SFR, Garage - BLD Application - 3/11/2024 MASON COUNTY Permit No: i/ d 2o2�t- �� �� COMMUNITY DEVELOPMENT RECEIVED Permit Assistance Center, Building,Planning MAR 11 7-u24 BUILDING PERMIT APPLICATION 615 V` - r Street PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:Brett and Lori Vaughters NAME:Simpson Construction MAILING ADDRESS:20 East Case view Place MAILING ADDRESS: CITY:Shelton STATE:WA ZIP:98584 CITY: STATE: ZIP: PHONE#1:503-730-2790 PHONE: CELL: PHONE#2:321-503-7290 ENTAIL:SimpsonbuildersineCaYahoo.com EMAIL:bvaughters@wilsonconst.com L&I REG# EXP. PRIMARY CONTACT: OWNER Q CONTRACTOR❑ OTHER❑ NAME BrettR.v8wtf s EMAIL ""•'" MAILING ADDRESS 20 East Case View Place CITY Sheltm STATE WA ZIP98-%4 PHONE 503-M-2 o CELL 503-732-2nO i PARCEL INFORMATION: -04 PARCEL NUMBER(12 Digit Number) ,� J� (J[Ji ZONING Residential -yyr LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICTCentral Mason Fire SITE ADDRESS81 East Smith Cove CITYSherton DIRECTIONS TO SITE ADDRESS Hwy 3 North to East Pickering Road.Cross Bridge to Harstine Island On East Harstine Bridge Road. Make right on E.South Island DR. Make Right on E.Harstine Island Rd South and a left on E.Point Wilson Road.Left on Smith cove Way to lot 81 IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO Q SNOW LOAD:_psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all drat apply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Corrwrercial Bldg, IS USE: PRIMARY I] SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 3 HEATED STRUCTURE? YES FholeBldg)Q YES(PargsI ojrBldg)❑ NO❑ DESCRIBE WORKNew Construction of Residential Home with a detached Garage wood frame,metal roof and siding,poured concrete slab SOUARE FOOTAGE:(proposed) IST FLOOR1679 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT17 sq.ft. DECK sq.ft. COVERED DECK685 sq.ft. STORAGE sq.ft. OTHER 178 sq.ft. GARAGI sq.ft. Attached❑ Detached CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOOR PLAN REQUIRED" 7MAKE MODEL LENGTH TH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC Q SEWER❑ / NEW© EXISTING❑ PLUMBING IN STRUCTURE? YES Q NO❑ If, es,attach completed Water Adequacy Form PERRVIETERTOUNDATION DRAINS PROPOSED? YES( NOD EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3 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 pmjecL The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property anri etn vrh rtprcl fnr rmriwu anti insrwnfim Thic nonnitrannliraiinn twmmac ni ill R vniri fi wnrk nr ai dtv ii7xi mnctn vfinn is not r manrrl wBhin 1 Rn PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTMTY OF THIS PERMIT APPLICATION OF 180 AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON TY CODE 14.08.42) x Signature offOW11TER(Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS(NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH Permit No:Dlet ZD Z A —WU 1 MASON COUNTY COMMUNITY DEVELOPMENT } C` Permit Assistance Center, Building,Planning PLUMBING & MECHANICAL PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: v NAME: NAME: MAILING ADDRE : MAILING ADDRESS: CITY: STATE: ZIP: CITY: STATE: ZIP: I S`PHONE: PHONE: CELL: 2°1 PHONE: EMAIL : EMAIL: L&I REG# EXP. PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number): 0(� y(� — QCLJ Zoning: LEGAL DESCRIPTION(A breviated): SITE ADDRESS: CITY: DIRECTIONS TO SITE ADDRESS: TYPE OFAB: /� NEW=ADD=ALT=REPAIR=OTHER=USE OF BUILDING 51 IL LOCATION OF FIXTURES/UNITS—IST FLOOR=2ND FLOOR=BASEMENT=GARAGED OTHERO PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS Type of Fixture No.of Fixtures Fees Fuel Type:Electric=LPG=Natural Gas=Ductless= Toilets Type of Unit No.of LJnits Fees Bathroom Sink Furnace --�—� Bath Tubs o�— Heat Pump 1 Showers —�— Spot Vent Fan Water Heater Propane Tank Clothes Washer ��� Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hose bibs Dryer Vent Other 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 PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X c3- m -24 Signature of Owner Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE I TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL Rev.1/27/2016 JBN � o LEGEND CALIBER EH Setbacks ---- " SEI C DEE161' faRslolllty-N*w Construction•Rapair A.)Drainfield/Reserve requires 10'setback from footing/foundations 9 FaOPEVTYCORNEt B.)Septic tank(s)requires 5'setback from all footing/foundations 165 Tupleo Way C.)No foundation/Perimeter Drains within 3011,downgradient of .r � Poulsbo,WA 98370 Drainfield/Reserve area / TN o t.3%509.7900 D.)No Cut Bank(s)(greater than 5tt and over 45 degrees)within / TEST iE�NO—E ro<rror.uc reon 5011,down gradient of Drainfield/Reserve area APPROXIMATE LOCATION / WATERMETER OF WATER LINE DRAINFIELD J APPROXIMATE LOCATION \ (Io%e51 CO® CLENOIR OF POWER LINE / RESERVE AREA EH APPROVED (2s«sosTJ Rhonda Thompson 04IO2/2024 PLAN NOTES I.TNSISNOTASURVEY.SITEFEATUES \ ARE BIgOaDAESON Lb®er THE DS THAT H / CAUSER ENSE PROFEPTIC SSI ONLCNECUN YOR TNATA LICENSEDE SED TOS T Wt)4S.EST ii \ LOTALWAYS UNEEE USED TOSS CONKERS,SSfAa19+ / LOT IRES AND VALIDATE ELEVATIONS j \ � ITT IST1E REUOSWTr(FTNE OMER(5) / AND/Ut TIER AGENTS TO PROTECT THE RESERVE *` PROFESSIONAL DATE JUN OSTRav10E�Nq TOMVEI TEST HOLES APY E%NRATIOJ DAI'c:ANE Id aIIr \ R15 THE L ALHEALTH JURISDICTION HAS COWL EEDTHEIR EVALUATION J ALL SEPTIC COMPONENTSACKFRC WLVATER U TO MVNTNNAIa4'SETSICNFACM Al wATEa LINES PORON \ SOIL EVALUATION PROFILES N� / SOL tvAWATl01 DATE AT,930.20r PRO101ED THREE SEDROW \ Thin 0-12' rm,wnlm J, SINGLE LY RESIDENCE r palMan 17-74'•mtlwm loves r<xreranm ^EviEw;iaf /�\\ S• / <�rlAn<Iwn / � 7jj' I / Es.a TH r+, o•LJ• rnnpalV // \� i � � (Mlmry) Il'•N' <�I<oamr yr e;rnh / \ O / / reannnelora ' \PORCH \ ✓ / rod \ % / TH rI o.a• wnIu co /' / / Itnmd a'N• meti ro mrmrrw.;..wa �2 PLN SETBACKS ?� ty I=GA"ON I rV� •4r j SEPTIC TANKe Front (SWW):25' Project: m� GARAGE / / r Sides: 7' Vaughters Residence 81 E Smith Cove Way Rear: 20' Shelton,WA 98584 / all setbacks measured from the farthest 90 projection of the building Date: September 7,2023 `subject to EH setbacks Sheet Name Site Plan SITE PLAN 1 yrc• o to Ja Ia N �tf= '�;fV PLN Approved Sheet Number 0 024 SD-2 Mason Countyty Community Development Gavin Scouter, All Changes Subject to Approval PAGE 2 OF 4 s Thank you, Ben Walker Olympic Heating & Cooling 360-42aa- 945 Aj6A&i&" o-1 L-�fiCa-AA C-14W,14E 828 E Hiawatha Blvd.Shelton,WA 98584 (360)426-9945 DATE. February 26.2024 Contractor#: OLYMPHC986BA TO. Brett and Lori Vaughters Jobsde Address 81 E Smith Cove Way Same Shelton.WA 98584 PHONE 503-730-2790 We hereby submit specifications and estimates for: 1 EQUIPMENT LOCATION Utility Room&Outside 2 EQUIPMENT FOUNDATION Galvanized Sheet Metai&Equipment Pad 3. EQUIPMENT Trane TAM9A0C48V41 DA Variable Speed Air Handier Trane 4TWL9048A1000A XV19 Side Discharge V/S Heat Pump 4, ACCESSORY EQUIPMENT 15KW Heat Strip 5 CONTROLS Trane XL 1050 Thermostat 6 SUPPLY POWER TO EQUIPMENT. By Homeowner 7, CONTROL WIRING Included 8. SUPPLY DUCTWORK. 6 Down;11 Up 9, RETURN AIR DUCTS 1 Down: 1 Up 10.AIR BALANCING Included 11,DUCT INSULATION: As Per Local Code 12.REFRIGERANT LINES: Included 13 CONDENSATE LINES: Included 14,GAS PIPING N/A 15 CARPENTER WORK: Cutting of Holes 16.REGISTERS AND GRILLES. Included(Designer Colors Extra) 17.DESIGN AND ENGINEERING Included 18 FLUE VENTS NIA 19 PERMITS By Homeowner 20.OTHER 1 Fresh Air, 1 Sid Range Vent,1 Dryer Vent.Duct 5 Exhaust Fans 11 Month Maintenance Included 10 Year Parts and Compressor Warranty Included.3 Year Labor Warranty Included. We propose hereby to furnish material and labor-complete in accordance with the above specifications for the sum of: $32,680.74 Optional Equipment:In Addition to the Base Price Trane Zoning-Two Zones..........................$2,600.00 Int_ Main floor and Daylight Basement Trane Clean Effects Air Cleaner................ $1,777.00 Int Indoor Air Quality........................................S780.00 Int_ Global Plasma Solutions Bipolar Ionizer TERMS:95%Upon Rough-in;5%Upon Trim All prices quoted on this proposal do not include sales tax. Cash discount when paid in cash/check upon completion of work: 10% All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon request of homeowner/contractor and will become an extra charge over and above the estimate. Owner to carry all fire,tornado and other necessary insurance. Our workers are fully covered by Workers Compensation Insurance. Agreements contingent upon strikes,accidents or delays beyond our control. Acceptance of Proposal The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above This proposal is valid for thirty(30)days from date of proposal. Authorized Company Signature Z�2 Ben Walker,Comfort Specialist Signature: Date of acceptance. Signature: Of NoticetoOwner.pdf Trane TruComfort Variable Of speed.pdf 11 ,, Trane CleanEffects Air pdf Cleaner.pdf 1.4 MB Tap to Download pdf Global-Plasma-Brochure.pdf 2.6 MB Olympic Heating & Cooling LLC 828 E Hiawatha Blvd*Shelton,WA 98584 (360)426-9945 CONTRACTORS REGISTRATION MOLYMPHC98613A NOTICE TO OWNER IMPORTANT•READ BOTH SIDES OFTHISNOTTCE. CAREFULLYPROTECT YOURSELF FROMPAYM TWICE Date: Customers Name: Jobsite Address: From:Olympic Heating&Cooling,LLC AT THE REQUEST OF:Olympic Heating&Cooling,LLC Members THIS IS NOT A LIEN:This notice is sent to you to tell you who is providing professional services,materials,or equipment for the improvement of your property and to advise you of the rights of these persons and your responsibilities.Also take note that laborers on your project may claim alien without sending you a notice. OWNER/OCCUPIER OF EXISTING RESIDENTIAL PROPERTY Under Washington law,those who furnish labor,professional services,materials,or equipment for the repair,remodel,or alteration of your owner-occupied principal residence and who are not paid,have a right to enforce their claim for payment against your property.This claim is known as a construction lien. The law limits the amount that alien claimant can claim against your property.Claims may only be made against that portion of the contract price you have not yet paid to your prime contractor as of the time this notice was given to you or three days after this notice was mailed to you Review the back of this notice for more information and ways to avoid lien claims. COMMERCIAL AND/OR NEW RESIDENTIAL PROPERTY We have or will be providing professional services,materials,or equipment for the improvement of your commercial or new residential project In the event you or your contractor fails to pay us,we may file alien against your property.A lien may be claimed for all professional services,materials,or equipment furnished after a date that is sixty days before this notice was given to you or mailed to you,unless the improvement to your property is the construction of a new single-family residence,then ten days before this notice was given to you or mailed to you. Sender: Olympic Heating&Cooling,LLC Address:828 E Hiawatha Blvd;Shelton,WA 98584 Telephone: 360-426-9945 ig descri i n of professional services,materials,or equipment provided or to be provided: IMPORTANT INFORMATION ON REVERSE SIDE IMPORTANT INFORMATION FOR YOUR PROTECTION This notice is sent to inform you that we have or will provide professional services,materials,or equipment for the improvement of your property.We expect to be paid by the person who ordered our services,but if we are not paid,we have the right to enforce our claim by filing a construction lien against your property. LEARN more about the lien laws and the meaning of this notice by discussing them with your contractor,suppliers,Department of Labor and Industries,the firm sending you this notice,your lender,or your attorney. COMMON METHODS TO AVOID CONSTRUCTION LIENS:There are several methods available to protect your property from construction liens.The following are two of the more commonly used methods. DUAL PAYCHECKS(Joint Checks):When paying your contractor for services or materials,you may make checks payable jointly to the contractor and the firms furnishing you this notice. LIEN RELEASES:You may require your contractor to provide lien releases signed by all the suppliers and subcontractors from whom you have received this notice.If they cannot obtain lien releases because you have not paid them,you may use the dual payee check method to protect yourself. YOU SHOULD TAKE APPROPRIATE STEPS TO PROTECT YOUR PROPERTY FROM LIENS. YOUR PRIME CONTRACTOR AND YOUR CONSTRUCTION LENDER ARE REQUIRED BY LAW TO GIVE YOU WRITTEN INFORMATION ABOUT LIEN CLAIMS.IF YOU HAVE NOT RECEIVED IT,ASK THEM FOR TT. This contractor is registered with the state of Washington,registration no OLYMPHc986BA,and has posted with the state a bond for the purpose of satisfying claims against the contractor for breach of contract inc ne gent or improper work in the conduct of the contractor's business.The expiration date of this contractor's registration i1s� You can look up this information online at: https://fortress.wa.gov11ni/bbip/Search.aspx and put in our name or registration number. THIS BOND OR DEPOSIT MIGHT NOT BE SUFFICIENT TO COVER A CLAIM THAT MIGHT ARISE FROM THE WORK DONE UNDER YOUR CONTRACT. This bond or deposit is not for your exclusive use because it covers all work performed by this contractor.The bond or deposit is intended to pay valid claims up to$12,000 that you and other customers,suppliers,subcontractors,or taxing authorities may have. FOR GREATER PROTECTION YOU MAY WITHHOLD A PERCENTAGE OF YOUR CONTRACT. You may withhold a contractually defined percentage of your construction contract as retainage for a stated period of time to provide protection to you and help ensure that your project will be completed as required by your contract. YOUR PROPERTY MAY BE LIENED. If a supplier of materials used in your constriction project or an employee or subcontractor of your contractor or subcontractors is not paid,your property may be liened,to force payment and you could pay twice for the same work. FOR ADDITIONAL PROTECTION,YOU MAY REQUEST THE CONTRACTOR TO PROVIDE YOU WITH ORIGINAL'LIEN RELEASE'DOCUMENTS FROM EACH SUPPLIER OR SUBCONTRACTOR ON YOUR PROJECT. The contractor is required to provide you with further information about lien release documents if you request it.General information is also available from the state Department of Labor and Dries. NOTICE REQUIRED UNDER RCW 64.50.050 CHAPTER 64.50 RCW CONTAINS IMPORTANT REQUIREMENTS YOU MUST FOLLOW BEFORE YOU MAY FILE A LAWSUIT FOR DEFECTIVE CONSTRUCTION AGAINST THE SELLER OR BUILDER OF YOUR HOME.FORTY-FIVE DAYS BEFORE YOU FILE YOUR LAWSUIT,YOU MUST DELIVER TO THE SELLER OR BUILDER A WRITTEN NOTICE OF ANY CONSTRUCTION CONDITIONS YOU ALLEGE ARE DEFECTIVE AND PROVIDE YOUR SELLER OR BUILDER THE OPPORTUNITY TO MAKE AN OFFER TO REPAIR OR PAY FOR THE DEFECTS.YOU ARE NOT OBLIGATED TO ACCEPT ANY OFFER MADE BY THE BUILDER OR SELLER THERE ARE STRICT DEADLINES AND PROCEDURES UNDER STATE LAW,AND FAILURE TO FOLLOW THEM MAY AFFECT YOUR ABILITY TO FILE A LAWSUIT. I have received a cot)v of this disclosure statement. Lt00wav r+ Nam PA t2 Parcel# WO I`I -fb -Olyffiz BLD# 2024 - 6662�61 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) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed in t eir 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- describe property for review and inspection as ay be required. X Owner/Agent/Contractor(circle one)Date: Page 2 of 2 Name Parcel# BLD# Mason County 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 impervious surface'. '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 = X = Measurements for buildings are taken at the perimeter of the farthest projections(example: X = eaves/gutters) X = Driveways X = 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) 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 I of 2