Loading...
HomeMy WebLinkAboutBLD2009-00543 SFR, Replace MFG Home, Final - BLD Permit / Conditions - 12/1/2011 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. III 426 W. Cedar P.O. Box 186 Ig Shelton,WA 98584 loo RESIDENTIAL BUILDING PERMIT BLD2009-00543 OWNER: NICHOLAS JOHNSON RECEIVED: 7/6/2009 CONTRACTOR: LICENSE: EXP: ISSUED: 11/18/2009 SITE ADDRESS: 4671 E STATE ROUTE 302 BELFAIR EXPIRES: 5/18/2010 PARCEL NUMBER: 122285002002 LEGAL DESCRIPTION: SISSON BEACH BLK: 2 LOT: 2 PROJECT DESCRIPTION: DIRECTIONS TO SITE: New residence to replace existing manufactured home. Along State Route 302 about 4.5 miles east and north of Allyn. General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: VB Type of Use: SF Insp.Area: No.of Bathrooms: 3 Occ. Group: R3/U Lot Size: Deck: Type of Work: NEW Fire Dist.: No. of Stories: 2 Occ. Load: Building:2,707 Garage-Attached 592 Valuation: Building Height: Occ. Status: Primary Basement: cov entry 36 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: W 280.0 Ft. Shoreline: Ft. Water Body: type F stream g Rear: E 25.0 Ft. Slope: 10.0 Ft. SEPA?: No Model: Width: Ft. Side 1: N 10.0 Ft. Shoreline Desig.: Not Applicable Year: Serial No.: Side 2: S 10.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Plan Check Fee TW 7/6/2009 $1,282.94 S12009000 Hosebibs 2 Fireplace 1 Planning Review Fee TW 7/6/2009 $205.00 S12009000 Kitchen Sink 1 Furnace<100K 1 EH Plan Review TW 7/6/2009 $103.00 512009000 Laundry Tray 1 Ventilation Fan 5 Water Adequacy Plan Review TW 7/6/2009 $41.00 §12009000 Lavatories 5 Heat Pump 1 Building State Fee DLC 7/30/2009 $4.50 512009000 Showers 1 Dryer Vent 1 Building Permit Fee DLC 7/30/2009 $1,979.35 S12009000 Water Closets (Toilets) 3 Mechanical Permit Fee DLC 7/30/2009 $176.70 S12009000 Water Heaters 1 Mechanical Base Fee DLC 7/30/2009 $28.50 S12009000 Bath Tubs 2 Plumbing Permit Fee DLC 7/30/2009 $145.40 S12009000 Clothes Washer 1 Plumbing Base Fee DLC 7/30/2009 $24.70 S12009000 ADJUST--Plan Check Fee DLC 7/30/2009 $3.64 S12009000 Total $3,994.73 BLD2009-00543 Please referto the following pages for conditions of this permit. 1 of 5 CASE NOTES FOR BLD2009-00643 CONDITIONS FOR BLD2009-00543 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 1-800-647-0982. 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 Department prior to any further inspections being performed or approvals granted. X ?-� 3) Owner/A�gent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 4) Applicant must contact Utilities to arrange a pre-construction meeting onsite prior to demolition of the existing structure and sewer facilities. X 5) 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 Department for to any further inspections being performed or approvals granted. X -/'/. 6) 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 7) 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 Building Department prior to any further inspections being performed or approvals granted. X BLD2009-00543 Please referto the following pages for conditions of this permit. 2 of 5 8) Washington State Energy Code Compliance has been approved using the following: Heat Type: Electric or other fuels, Compliance Method: Prescriptive option IV, Window(Max U-Factor):0.35, Skylight(Max U-Factor):0.58, Doors (Type/Max U-Factor):0.20 or less, Wall insulation R-21, Floor insulation R-30, Ceiling Insulation R-38, Vault Insulation R-38 (see exception), Slab Insulation R-10. Exception: R-30 insulation may be installed, up to 500 sq. ft., in single rafter or joist vaulted ceilings where the distance of the top of the ceiling and the underside of the roof sheathing is less than 12-inches and there is 1-inch vented airspace above the insulation. X 9) Per 2003 IRC-SECTION 1609 -WIND LOADS - 1609.1 Applications. Buildings, structures and parts thereof shall be designed to withstand the minimum wind loads prescribed herein. Decreases in wind load shall not be made for the effect of shielding by other structures. Per FIGURE 1609 BASIC WIND SPEED (3-SECOND GUST)the wind speed for Mason County is 85 MPH. X 10) Per IRC -SECTION R905- REQUIREMENTS FOR ROOF COVERINGS - R905.1 Roof covering application. Roof coverings shall be applied in accordance with the applicable provisions of this section and the manufacturer's installation instructions. X 11) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement of any development activities. "NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other, parcel. You may also wish to consult with the septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contractor is acknowledging that all components of the stormwater management system have been installed as approved on the stormwater site plan. X 7J•� 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 revoc ion. X 13) Any changes in proposed construction shall be reviewed by the engineer or architect of record and submitted in writing to the Mason County Building Department prior to construction. All engineering and/or architectural documents are a part of the approved set of plans and shall remain attached thereto. If documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted. X BLD2009-00543 Please refer to the following pages for conditions of this permit. 3 of 5 14) 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. X 15) 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 �7 16) 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 Inspectorshall e made prior to requesting additional inspections. 17) All property lines shall be clearly identified at the time of foundation inspection. X 18) 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 C ordinances and building regulations. X ; �oun 19) 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 holder h vented action from being taken. No more than one extension may be granted. X 20) Approved per dimensions and setbacks on submitted site plan, approved by the environmental permit MEP2009-00047. Setbacks are measured from the furthest projection of the structure. X -,�2- 21) Retaining walls needed to support a surcharge such as structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. X 22) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report. All applicable recommendations and specifications shall be applied to the development on this site. Any deviation requires stamped written approval from the registered design professional responsible for the report/assessment, and may require special inspection by same. Structures and /or land modifications (grading, cuts, fills, etc.) required in the geotechnical report/assessment, may require a separate permit. The geotechnical report shall remain attached to the approved building plans. X --1J q BLD2009-00543 Please referto the following pages for conditions of this permit. 4 of 5 23) - The applicant shall follow the site plan for the new residence and native plantings that were part of the buffer reduction approved by the Mason Co. Hearing Examiner on Oct. 8, 2009; work on the residence and plantings must commence withn two years on Oct. 8, 2011. X 24) An inspection performed by a representative of the geologist, Envirotech Engineering, or their authorized representative, shall be completed on-site prior to the footing pour to verify that earthwork and foundation installation activities comply with the Geotechnical report recommendations. Reports shall be submitted to the Mason County Building Dept., PO Box 186, Shelton, WA 98584, prior to the footing and final inspections and available for inspection. X —/v� This permit becomes null and void if work or construction authorized is not commenced within 180 days,or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation of work is by means of a progress inspection.The owner or the agent on the owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. OWNER OR AGENT: L�ti� DATE: BLD2009-00543 Please referto the following pages for conditions of this permit. 5 of 5 t o CONCRETE MECHANICAL co�j MANUFACTURED HOME Date B y 77,1"3 CD Footings /Setbacks Gas Piping Ribbons O Intenor Date By Interior-Date By Date By 0 wExterior Date LZ-.I By Exterior-Date B _� Point Load t Isolated Footings INSULATION Date By . SG f SLAB INSULATION - 0 Date By Data By FIRE DEPARTMENT = Foundation Walls Floors Date By L Date By Data 7- - By DECKS N FRAMING Wails Date _ By Date 7 ' By Data By PROPANE TANKS PLUMBING Vault Datu gy Data gy OTHER Groundwork Attic Date By Type Dale By Date By D,w.v DRYWALL p r Type. �± Intl Brace Wall Date By I) Orate 2,E7— CJ By Date By r FINAL INSPECTION v v Water Line 1 Fire Separation Date 1►�(� By Date By Date _ / By O m cD Pass or Request Inspect. c 0 Type of insp. Fail Date Date Done By Comments CD 0 g CAI �� L'�// 0 1 CD AID A-79 71,7 7- 11- 7-13_ ,E 107fT-,,", c�ocv zv� M t 02 C� EK'Vtroteak eVV9'bKterwi,9 ceotechv�%cal° Ew,/�rowv�tewtal°praiwaae°Roadway February 16, 2011 Nick Johnson 4671 E. State Route 302 Belfair,Washington 98528 RE: Foundation Assessment for Property Located at 4671 East State Route 302, Belfair,Washington Dear Mr. Johnson, Envirotech Engineering (Envirotech) completed a site visit and conclusions for the planned foundation bearing strata for a typical single family residential structure located at the referenced address. The site visit was conducted on February 16,2011 in order to observe the soil conditions, and assess the suitability of the founding soils for use as bearing strata. Information pertaining to the project was provided by Mr. Johnson, owner of the property. Information collected from site observations, and field testing was completed by Michael Staten with Envirotech. In addition, envirotech completed a geotechnical report for this property, dated September 8, 2009. The foundation bearing soils appear to be relatively undisturbed native soils, consisting of primarily a Poorly Graded Sand (SP) with silt. The fines content exhibited low plasticity indicating some clay content. A curtain drain was constructed approximately 5 feet upslope from the planned house in order to divert ground water away from the residence. The bearing stratum was field measured to be competent. Relative density was assessed by measuring the resistance of hand tools within several locations of the designated building foundation. It is concluded that the existing bearing soils and conditions are suitable for a structural pressure of no more than 1500 psf for foundation widths of at least 16 inches at the current excavated depth of about 12 inches. The foundation system may undergo a maximum of 1.0 inch total settlement, and a maximum differential settlement of 0.75 inch. The conclusions presented above were derived from engineering judgment using geotechnical standards in conjunction with the information collected from the site visit and owner of the Project. Excessive free moisture should be prevented from entering the foundation excavation prior to the placement of concrete. If excessive moisture is permitted within the excavation, or the founding subgrade is significantly disturbed prior to constructing the concrete footings, an additional geotechnical inspection is required. PO gox 984 Belfair, WC1&kLV 3tOVL 98.528 Off: 360-2Yt5-9374 aeLL: 360-689-6045 FRY: 360-2y'5-4789 ewvLratecti@geotecH�.;.ca��w fo.�ow�. If you have any questions or need any further assistance,please contact Michael Staten at 360-275-9374.I Sincerely, Envirotech Engineering CLYpF WASy��c-9J. ?I101 �A FG/STERN �SSIpNALE�G` Michael Staten, P.E. Project Director Page 2of 2 I Suiitte 212 Washington Si. Portland,OR 97216 CIVIL — STRUCTURAL ENGINEERS Tel. 503-254-6292 Fax 503-254-6761 July 11, 2011 Project: Mascord Plan 22154 4671 E Hwy 302 Belfair, WA 98528 Subject: Missing 33 Foot Long Coil Strap — Lateral Engineering j 3 It has been reported to me that the specified CMSTC16 strap over the Dining Room and Hall was not installed. After reviewing the lateral engineering design, the strap was intended to drag the diaphragm loads to the shearwall when the Great Room is constructed two stories tall. If the house is constructed with a Games Room upstairs instead of the two story Great Room, then the strap is not required. With a one story Great Room the CMSTC16 strap is not required. Questions or comments regarding this letter are to be addressed to Todd Rowell at 503-254-6292. �T. A �irif V �sMAY21 Z 10570 SE Washington St. Suite 212 CIVIL — STRUCTURAL ENGINEERS Portland,OR 97216 Tel. 503-254-6292 Fax 503-254-6761 July 11, 2011 Project: Mascord Plan 22154 4671 E Hwy 302 Belfair, WA 98528 Subject: Missing 33 Foot Long Coil Strap— Lateral Engineering It has been reported to me that the specified CMSTC16 strap over the Dining Room and Hall was not installed. After reviewing the lateral engineering design, the strap was intended to drag the diaphragm loads to the shearwall when the Great Room is constructed two stories tall. If the house is constructed with a Games Room upstairs instead of the two story Great Room, then the strap is not required. With a one story Great Room the CMSTC16 strap is not required. -Questions or comments regarding this letter are to be addressed to Todd Rowell at 503-254-6292. RECEIVED JUL 12 2011 426 W. CEDAR ST. boo�p 0"kSR. =`.► v Ce S MAY 21, Z Co r��c r Evw' rotech �wg�weer�wg c-jeotechvL, ac(L- Ewwi,roowvtwtat o DraLwage rz.oadwo� November 11,2011 Nick Johnson 4671 E. State Route 302 Belfair, Washington 98528 RE: Foundation Assessment for Property Located at 4671 East State Route 302,Belfair,Washington Dear Mr.Johnson, Envirotech Engineering(Envirotech)completed a site visit and final geotechnical inspection for the new single family residential structure located at the referenced address. The site visit was conducted on November 8, 2011 by Michael Staten with Envirotech. Previously, Envirotech completed a geotechnical report for this property, dated September 8, 2009, and a foundation inspection report, dated February 16, 2011. Based on observations from our site visits, and foundation testing, it appears that the project has been completed within general compliance with our recommendations in the geotechnical report. We were not at the project site full time, and can only certify our observations and selective testing. Some of the cleared areas have not been fully established with vegetation, but appears to be in a condition where vegetation will be easily cultivated. Trees that were removed from the ascending slope were probably a danger to the residence. Existing vegetation and new trees on the hillside should be left undisturbed in the future until trees become a threat to life or property. If you have any questions or need any further assistance, please contact Michael Staten at 360-275-9374. Sincerely, Envirotech Engineering �pEy CLYDE S 0 WASk4 r0�+ 43045 <v4 �sS�ONALE�Gl Michael Staten,P.E. Project Director Po�ox9g4 Selfai-r, Wasl�%wgtow98.528 off: 360-2�593�4 Cell.: 360-C'O9-604.5 Fax: 360-2y'5--4789 ewv�rotech@geotec�v.�cal,�w fo.cow. MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 005� 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 Cyr l+ On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. #_ 9/-/•Ivf-Y5'-�r" -Exp. E mail address E Mail Address film bsl E Drivers Lic.# DOB Drivers Lic. # •SO r►s4'-., '113G.L)$ DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site jwn wto �_(Asr Will timber be cut and sold in parcel preparation?Yes/ No Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit? Yes/ No Installer Name Certification No. 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 the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the informaticn provided is accurate and grants employees of Mason County access to the above described property and structure 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 OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVE DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee �1.7 - Site inspection Plan Review Fee f '` EH Review Fee Plumbing & Base Fee S Planning Review Fee Mechanical & Base fee / C k 2Z�� Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ 2 -95 306 . 0-7 TOTAL FEES i MASON COUNTY PERMIT NO. PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar-P.O. Box 186, Shelton,WA 98584 Shelton (360) 427-9670-Belfair(360) 275-4467- Elma (360) 482-5269 50:�)t On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner -.r yj 1( Johnson Company Name °) -4 Mailin Address Mailing Address >� uY 3r. City r tate W�Zip Code City Zns 3�at Zip Code Phonew��-96 � i5 Other Ph. WO-215-3105T Phone Other Ph. Lien/Title Holder Contractor Reg.#(,yr-/ycG ls's- f Exp. Email address —� h � E Mail Address � L . c, Drivers Lic.#J0 " 2 DOB 0 22 $ Drivers Lic.# A,�„S01a`/3b D R DOB 3 SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System r "� `' PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description �,&GtA 131 k. y LUt. 2 Site Address (Please include street name, streei number and city)41,011 - ' Directions to site -r '' U 0. o G N e. miles, J4 2- Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream— Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units - 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNVS Type of Fixture \.No. of Fixtures Fees Fuel Type:Electri LPC Natural Gas_ Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace i Bath Tubs �' 2 Heatpumps 1 Showers Spot Vent Fan -,S Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Woo Gas/PelletStove Dishwasher Kitc en Exhaust Hood Hosebibs Dryer Vent I Other Other UU Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL 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 the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permA and conducythe work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason.CqA�y access to the above described property and structure for review and inspection. PROOF OF CONTINUATION OF WORK IS.BY MEADS,06� �Q,GRESS INSPECTION. X / Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES Ij L) q ol >e d3 �X 179�14) f JCoCA ItL mow✓ .© x 3 ycDO 1 �� (