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HomeMy WebLinkAboutBLD2021-01429 SFR with Attached Garage - BLD Application - 5/24/2022 PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: Mt'--v K MO nxe-) NAME: Olt r MAILING ADDRESS: 00 -VJXYJJLPMAILING ADDRESS: CITY:A{P Yr!hn STATE: WA ZIP:6S2 CITY: I T�3T �T ZIP: s L.� PHONE#1: PHONE: � CIJ h PHONE#2: EMAIL : 1 11,E EMAIL:01 t Y V &I REG# EXP. PRIMARY CONTACT: OWNER f`� CONTRACTOR❑ OTHE ' r Street NAME ' EMAIL MAILING ADDRESS CITY STAR PHONE CELL 15 BIN G PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) /2?j ��]�`P]fop�� ZONING 12�S LEGAL DESCRIPTION(Abbreviated) ?? cJ�rt1 13 p 6ofno-f-1 ?a FIRE DISTRICT SITE ADDRESS / L DQJA Or, CITY ap,-�re,',r- DIRECTIONS TO SITE ADDRESS Jyt! !' j/-G A4 nf-- 50e)d k1d) i 7 c. o' 2. ©r' Dct(c 1 IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER ❑ LAKE RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑ TYPE OF WORK: NEW g ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) IS USE: PRIMARY ❑ SEASONAL NUMBER OF BEDROOMS- NUMBER OF BATHROOMS_ HEATED STRUCTURE? YES (Whole Bldg)K YES(Part[s]of Bldg) ❑ NO ❑ DESCRIBE WORK SQUARE FOOTAGE: (propose+existing) 1ST FLOOR/s3 g sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT o O sq.ft. DECK,3(g sq.ft. COVERED DECK sq.ft. STORAGE sq. ft. OTHER sq. ft. GARAGE:S4('L sq. ft. AttacheaXI Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER ❑ / NEW ❑ EXISTINGV PLUMBING IN STRUCTURE? YES ` NO ❑ If yes, attach completed Water Adequacy Form PERIMETERIFOUNDATION DRAINS PROPOSED? YES, 2 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) �r a�a 1 j ignature of OWNER(Must be signed by the OWNER) Date T MASON COUNTY COMMUNITY SERVICES Permit No: PERMIT ASSISTANCE CENTER: L R BUILDING PLANNING FIRE MARSHA E`,s(''� EIVED 615 W. Alder St-Shelton, WA 98584 www.co.mason.wa.us AUG 1 12021 Phone Shelton:(360)427-9670 ext. 352• Fax:(360)427-779$ Phone Belfair:(360)275-4467• Phone Elma:(360)482-5269b15 W. Alde-r Street PLUMBING & MECHANICAL PERMIT APPLICATIONBUILDIN OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: MAILING ADDR S: Glib A4/ AJ MAILRJG ADD ESS: CITY: TATE:,&0 ZIP: CITY: 1 S`PHONE: _ Z a 8 PHONE: CELL. 2°d PHONE: $It 'o EMAIL : EMAIL: L&I REG# EXP. i PARCEL INFORMATION: PARCEL NUMBER(i2 Digit Number): ��� ����©�3 (0 Zoning: LEGAL DESCRIPTION Abbreviated): Sv LO SITE ADDRESS: lqq D0. CITY: DIRECTIONS TO SITE ADDRES 'lei ai 1,0, 64K ' r 1 Qrl Del" 0 6 K 42 r►4 P1 ct. yj +i-csv,1 42C to I , TYPE Og JOB: NEW ADD ALT REPAIR OTHER USE OF BUILDING LOCATION OF FIXTURES/UNITS— I sT FLOOR 2ND FLOOR BASEMENT GARAGE OTHER PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNVS Type of Fixture No.of Fixtures Fees Fuel Type:Electric V LPG Natural Gas Ductless_ Toilets 3 Type of Unit No.of Units Fees Bathroom Sink '� _ Furnace Bath Tubs Heat Pump I Showers Spot Vent Fan 5 Water Heater Propane Tank Clothes Washer 1 Gas Outlets Kitchen Sinks / Wood/Gas/Pellet Stove Dishwasher I Kitchen Exhaust Hood _I Hose bibs 02 Dryer Vent I — 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 F — / / '9,b;L l Signature of ner Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL Rev:1/27/2.016 1BN 1 �L'1D 02002� — C)by R,9 2018 Washington State Energy Code—Residential Prescriptive Energy Code Compliance for All Climate Zones in Washington p gY p Single Family—New&Additions(effective February 1,2021) 19 I L D'N G These requirements apply to all IRC building types, including detached one- and two-family dwellings and multiple single-family dwellings (townhouses). Project Information Contact Information Qa Instructions:This single-family project will use the requirements of the Prescriptive Path below and incorporate the minimum values listed. Based on the size of the structure,the appropriate number of additional credits are checked as chosen by the permit applicant. Provide all information from the following tables as building permit drawings:Table R402.1-Insulation and Fenestration Requirements by Component,Table R406.2-Fuel Normalization Credits and 406.3-Energy Credits. Authorized Representative Date g /1 2� All Climate Zones(Table R402.1.1)b R-Value a U-Factor'RECEIVED Fenestration U-Factor n/a 0.30 Skylight U Factor b n/a 0.50 SEP 1 U 1;2021 be Glazed Fenestration SHGC / / Ceiling e 49 i 0.026 615 W. Aid& Street Wood Frame Wall g,h 21 int 0.056 Floor 30 0.029 Below Grade Wall `•h 10/15/21 int+TB 0.042 Slab d,fR-Value& Depth 10, 2 ft n/a R-values are minimums. U-factors and SHGC are maximums.When insulation is installed in a cavity that is less a than the label or design thickness of the insulation,the compressed R-value of the insulation from Appendix Table A101.4 shall not be less than the R-value specified in the table. b The fenestration U-factor column excludes skylights. "10/15/21+5TB" means R-10 continuous insulation on the exterior of the wall,or R-15 continuous insulation on the interior of the wall, or R-21 cavity insulation plus a thermal break between the slab and the basement wall at c the interior of the basement wall. "10/15/21+5TB" shall be permitted to be met with R-13 cavity insulation on the interior of the basement wall plus R-5 continuous insulation on the interior or exterior of the wall. "5TB" means R-5 thermal break between floor slab and basement wall. d R-10 continuous insulation is required under heated slab on grade floors. See Section R402.2.9.1. For single rafter-orjoist-vaulted ceilings,the insulation may be reduced to R-38 if the full insulation depth e extends over the top plate of the exterior wall. R-7.5 continuous insulation installed over an existing slab is deemed to be equivalent to the required perimeter f slab insulation when applied to existing slabs complying with Section R503.1.1. If foam plastic is used, it shall meet the requirements for thermal barriers protecting foam plastics. For log structures developed in compliance with Standard ICC 400, log walls shall meet the requirements for g climate zone 5 of ICC 400. Int. (intermediate framing)denotes framing and insulation as described in Section A103.2.2 including standard h framing 16 inches on center, 78%of the wall cavity insulated and headers insulated with a minimum of R-10 insulation. Prescriptive Path-Single Family 2018 Washington State Energy Code-R 1 2018 Washington State Energy Code-Residential Prescriptive Energy Code Compliance for All Climate Zones in Washington Single Family-New&Additions(effective February 1, 2021) Each dwelling unit in a residential building shall comply with sufficient options from Table R406.2 (fuel normalization credits) and Table 406.3 (energy credits) to achieve the following minimum number of credits. To claim this credit, the building permit drawings shall specify the option selected and the maximum tested building air leakage, and show the qualifying ventilation system and its control sequence of operation. 1. Small Dwelling Unit: 3 credits Dwelling units less than 1,500 sf in conditioned floor area with less than 300 sf of fenestration area. Additions to existing building that are greater than 500 sf of heated floor area but less than 1,500 sf. 2. Medium Dwelling Unit: 6 credits All dwelling units that are not included in#1 or#3 3. Large Dwelling Unit: 7 credits Dwelling units exceeding 5,000 sf of conditioned floor area 4. Additions less than 500 square feet: 1.5 credits All other additions shall meet 1-3 above Before selecting your credits on this Summary table, review the details in Table 406.3 (Single Family),on page 4. Summary of Table R406.2 Heating Fuel Normalization Descriptions Credits-select ONE User Notes Options heating option 1 Combustion heating minimum NAECAb 0.0 ❑ , 2 Heat pump` 1.0 ALL,!/ 3 Electric resistance heat only-furnace or zonal -1.0 ❑ 4 DHP with zonal electric resistance per option 3.4 0.5 ❑ 5 All other heating systems -1.0 ❑ Energy Credits-select ONE Options Energy Credit Option Descriptions energy option from each P category 1.1 Efficient Building Envelope 0.5 ❑/ 1.2 Efficient Building Envelope 1.0 1.3 Efficient Building Envelope 0.5 ❑ 1.4 Efficient Building Envelope 1.0 ❑ 1.5 Efficient Building Envelope 2.0 ❑ 1.6 Efficient Building Envelope 3.0 ❑ 1.7 Efficient Building Envelope 0.5 ❑ 2.1 Air Leakage Control and Efficient Ventilation 0.5 ❑ 2.2 Air Leakage Control and Efficient Ventilation 1.0 2.3 Air Leakage Control and Efficient Ventilation 1.5 ❑ 2.4 Air Leakage Control and Efficient Ventilation 2.0 ❑ 3.1' High Efficiency HVAC 1.0 Q 3.2 High Efficiency HVAC 1.0 j] 3.3' High Efficiency HVAC 1.5 LJ 3.4 High Efficiency HVAC 1.5 ❑ 3.5 High Efficiency HVAC 1.5 NK 3.6' High Efficiency HVAC 2.0 ❑ 4.1 High Efficiency HVAC Distribution System 0.5 ❑ 4.2 High Efficiency HVAC Distribution System 1.0 Prescriptive Path-Single Family 2018 Washington State Energy Code-R 2 2018 Washington State Energy Code—Residential Prescriptive Energy Code Compliance for All Climate Zones in Washington Single Family—New&Additions(effective February 1,2021) Summary of Table R406.2(cont.) Energy Credits-select ONE Energy Credit Option Descriptions(cont.) energy option from User Notes Options each category •` 5.1d Efficient Water Heating 0.5 5.2 Efficient Water Heating 0.5 ❑ 5.3 Efficient Water Heating 1.0 ❑ 5.4 Efficient Water Heating 1.5 ❑ 5.5 Efficient Water Heating 2.0 ❑ 5.6 Efficient Water Heating 2.5 ❑ 6.1e Renewable Electric Energy(3 credits max) 1.0 7.1 Appliance Package 0.5 Total Credits fYi�� CLEAR FORM a. An alternative heating source sized at a maximum of 0.5 W/sf(equivalent)of heated floor area or 500 W, whichever is bigger, may be installed in the dwelling unit. b. Equipment listed in Table C403.3.2(4)or C403.3.2(5) c. Equipment listed in Table C403.3.2(1)or C403.3.2(2) d. You cannot select more than one option from any category EXCEPT in category 5.Option 5.1 may be combined with options 5.2 through 5.6.See Table 406.3. e. 1.0 credit for each 1,200 kWh of electrical generation provided annually, up to 3 credits max. See the complete Table R406.2 for all requirements and option descriptions. Please print only pages 1 through 3 of this worksheet for submission to your building official. Prescriptive Path—Single Family 2018 Washington State Energy Code-R 3 C) RECEIVED BUILDING SEP 10 2021 61 �(11. Alder Street " mmettt Federal law prohibits removal of this label before consumer purchase. EIIERCi UIDE Dishwasher BSH Home Appliances Corporation Capacity: Standard Model(s) SHV878ZD**SHX878ZD** SHVM78Z5**SHXM78Z5*' SHPM78Z5**SHE878ZD** SHEM78Z5**SHP878ZD** Estimated Yearly Energy Cost (when used with an electric water heater) S35 $26 $40 Cost Range of Similar Models 269kWh S27 Estimated Yearly Electricity Use Estimated Yearly Energy Cost (when used with a natural gas water heater) Your cost will depend on your utility rates and use. •Cost range based on standard capacity models. •Estimated energy cost based on four wash loads a week and a ONES national average electricity cost of 13 cents per kWh and natural / gas cost of$1.05 per therm. •For more information,visit www.ftc.govlappliances. • 9M1410692(om) • L 10 �0 �, 1 - ol �fa RECEIVED BUILDING SEP 10 2ki 615 �Pj. Alder Street U.S. Government Federal law prohibits removal of this label before consumer purchase. EFIER UIDE Refrigerator-Freezer BSH Home Appliances Corporation • Automatic Defrost Model B36CD50SN*, • Bottom Mounted Freezer • With through-the-door ice Capacity: 21.6 Cubic Feet EstimatedCompare ONLY to other labels with yellow numbers. Labels with yellow numbers are based on the same test procedures. Yearly Energy • $ 79 Models with co similar features $79 $87 0 All models $37 �94 Estimated656kWh Yearly Electricity Use ® Your cost will depend on your utility rates and use. Both cost ranges based on models of similar size capacity. Models with similar features have automatic defrost, bottom mounted freezer, and with through the door ice. Estimated energy cost based on a national average electricity cost of 12 cents per kWh. ftc.gov/energy RECEIVED SEV I U ni.; 61 5 W. Alder Street BUILDING Canada iENER UIDE Energy consumption / Consommation energetique CO 31 kWh per year / par anneeC) - This model/Ce modele i I 190 kWh 934 kWh Uses least energy/ Uses most energy/ Consomme le moins Consomme le plus d'energie d'energ e Similar models Compact condensing / Modeles similaires compared Compactes a condensation compares Model number WTG8403UC, WTG865H4UC, Numero du modele WT262700 Removal of this label before first retail purchase is an offence(S.C.1992,c.36). Enlever cette etiquette avant le premier achat au detail constitue une infraction(L.C.1992,ch.36). The ENERGY STAR mark on this EnerGuide label signifies that this is an energy-efficient appliance.Its energy performance meets or exceeds the Government of Canada's high efficiency levels.Use the / - r EnerGuide rating to determine how this appliance compares to other similar models. La marque ENERGY STAR®sur cette etiquette EnerGuide signifie que I'appareil est 6conerg6tique et que son rendement 6nerg6tique satisfait ou d6passe les niveaux de haute efficacit6 du gouvernement du Canada.Utilisez la cote EnerGuide afin de comparer le rendement de I'appareil avec celui d'autres modeles similaires. PECEIVET U.S.Government Federal law prohibits removal of this label before consumer purchase. SEp 10 2021 Canada� 13 U I L D IN t 61 EIIERG UIDE 11 Clothes Washer BSH Home Appliances Corporation ENER UIDE I Capacity Class: Standard Models WAT284001LIC,WAW285H1 UC, WAW285H2UC,WM262700 Capacity(tub volume):2.2 cubic feet Energy consumption / Consommation energetique Compare ONLY to other labels with yellow numbers. Labels with yellow numbers are based on the same test procedures. r�r� 00 ro 0 kWh 0 Estimated Yearly Energy • 84peryear / parann6e o (when used with an electric water heater) 00 - This model/Ce modele $ 1 0 60 kWh 170 kWh Uses least energy/ Uses most energy/ Consomme le moins Consomme le plus d'energie d'energ e Range$8 Cost of Similar Similar models Standard/Ordinaire Modeles similaires compared compares 84 • • WAT284000C,WAW285H1UC, Model number WAW285H2UC,WM262700 Numero du modele kWh Removal of this label before first retail purchase is an offence S.C.1992,c.36). Estimated Yearly Electricity Use Estimated Yearly Operating • Enlever cette etiquette avant le premier achat au detail constitue une infraction(L.C.1992,ch.36). (when used with a natural gas water heater) The ENERGY STAR®mark on this EnerGuide label signifies that this is an energy-efficient appliance.Its energy performance meets or exceeds the Government of Canada's high efficiency levels.Use the • Your cost will depend on your utility rates and use. r� / - EnerGuide rating to determine how this appliance compares to other • Cost range based only on standard capacity models. ® similar models. • Estimated operating cost based on six wash loads a week and a national average p g 9 � � - La marque ENERGY STAR®sur cette etiquette EnerGuide signifie electricity cost of 12 cents per kWh and natural gas cost of$1.09 per therm. que I'appareil est dconerg6tique at que son rendement 6nergetique satisfait ou depasse les niveaux de haute efficacite du gouvernement du Canada.Utilisez la cote EnerGuide afin de comparer le rendement ftc.gov/energy de I'appareil avec celui d'autres modeles similaires. Name/ 1 f-2/e/L�l Parcel# C 2 3 6-( — 7J�— /G(j 6 BLD# nq 2 Mason County Department of Community Development RIIJA i G Small Parcel Stormwater Management Application/Workshee (I la 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 unty websit hqp//www.co.mason.wa—us/code/commissioners/index.htm __i i J Please follow the links to"Title 14,Chapter 14.48 Stormwater Management". AU6 2 b Regulated activities shall be conducted only after Mason County Public Works approve ``''����t r site plan (Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copyOCNIA t �VMitsBc%cument 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. s 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 2eeientirety 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 prope for review and inspection as may be required. Owner/Agent/Contractor(circle one)Date: Z - Page 2 of 2 Name /�/L V x9A',) Parcel# /;;3 0 S- 73' ?00.�'6 BLD# RECEIVED Mason County AM 1 b 2,L,► Department of Community Development Small Parcel Stolmwater 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 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 q X 30 = L31 X = Measurements for buildings are taken at the i perimeter of the farthest projections (example: X = eaves/gutters) X = Driveways 0 X j X = Length of drive begins at the right of way X = Parking Areas X = 4 X = Any paved, gravel or packed area per definition above table X = Patios/Walks X = X = Any paved, gravel or packed area per definition y 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 f iew and inspection as may required. X Owner/Agent/Contractor(circle one)Date: b 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 I ez 0 G_2._ a✓tz-A vt-2-S 4- iS C� mss. (yo CIJC4.� PCP CI-) f> 0 perSe S L,/ ,.p 0 (,v�11 �a�-t.�-•mil � �w� �, �� 5 C�/d-2- d� C JCA-� e nos �. 77,..e- l�-2 0,1 � c-1 -� -� e.�c� i-� glace dUf►� �►�s�c�-►�� ��-�-�►� 5� �l +� �� bu� I of�� S,—�'-e 4 1 D�- �i � 1a3o � �003 �o V��9 C)oliD bwc- � (.0 - oc) 5 15 SCALE: 1" = 60' SITE ADDRESS: 144 DALY DR BELFAIR, WA 98528 I� 197' 60, _ 5 AN. pplrlar Ci i —5 PLA NING aao E LAN ING: 00, AL SETBACKS A E MEASURED ,' —5 Ff OM THE f URTHEST PR DJE CTION OF THE BUILDING 42 152' 11, 0' 0� -V 205' -5 ,0 a 1 5-34 -10 12 4' . 5' 16 100' env 2 as' -15 TIGER LAKE R