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HomeMy WebLinkAboutBLD2011-00246 Final MFG Home - BLD Permit / Conditions - 5/7/2012 �► 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 Shelton, WA 98584 i� RESIDENTIAL BUILDING PERMIT BLD2011-00246 OWNER: M.J.SCOTT ENTERPRISES RECEIVED: 4/5/2011 CONTRACTOR: LICENSE: EXP: ISSUED: 5/10/2011 SITE ADDRESS: 291 NE MCKNIGHT RD BELFAIR EXPIRES: 11/10/2011 PARCEL NUMBER: 123213300000 LEGAL DESCRIPTION: SW SW EX E 725' PCL 1 OF BLA#96-07 M.C. DECREE#07-2-00814-8 PROJECT DESCRIPTION: DIRECTIONS TO SITE: MANUFACTURED HOME BEGIN NORTHJ ON OLD BELFAIR HWY 1/2-3/4 MILE TURN RIGHT ONTO MCKNIGHT TO ADDRESS 291 JUST BEFORE 2ND POND 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: Valuation: Building Height: 17 Occ. Status: Primary Basement: Manufactured Home Information Setback Information Shoreline&Planning Information Make:SKYLINE Length: 48 Ft. Front: S 60.0 Ft. Shoreline: Ft. Water Body: Rear: N 200.0 Ft. Slope: Ft. SEPA?: No Model:WEST RIDC Width: 27 Ft. Side 1: E 50.0 Ft. Shoreline Desig.: Not Applicable Year:2011 Serial No.: Side 2: W 40.0 Ft. Comp. Plan Desig.: Urban Growth Area Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Mobile Home Submittal Fee GMM 4/5/2011 $264.25 S12011000i Planning Review Fee GMM 4/5/2011 $205.00 S1 201 1 0001 EH Plan Review MRB 4/5/2011 $103.00 S62011000i Mobile Home Issuance Fee LDK 4/19/2011 $264.25 S12011000i Total $836.50 BLD2011-00246 Please refer to the following pages for conditions of this permit. Page 1 of 5 L CASE NOTES FOR BLD2011-00246 CONDITIONS FOR BLD2011-00246 1) A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at (360)427-9670, ext. 450. The building permit will not be"finaled" until the permit holder can show proof that the access permit from Public Works has been "finaled" and,approved. X 2) 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. T on signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 3) Owner/Agent is res o ible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 4) 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 a rt inspections being performed or approvals granted. X 5) THE FOUNDATION S STEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X 6) The"approved"site plan is required to be on-site for inspection purposes. If an inspection is reque led 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 Dep t t prior to any further inspections being performed or approvals granted. X 7) 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 or install rtification number and signature of the certified installer responsible for each major part of the installation. WAC365-210 X BLD2011-00246 Please refer to the following pages for conditions of this permit. Page 2 of 5 8) 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 of Manufacturing Housing (360) 725-2800. X 9) A Mason County tormwater 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 a I dging that all components of the stormwater management system have been installed as approved on the stormwater site plan. X 10) Owner/builder assumes all responsibility if drainfield/reserve are is encumbered. A. Drainfield/ Reserve requires a 10ft setback from all footing/foundations. B. Septic tank(s) requires 5ft setback from all footing/foundations. C. No foun i drains within 30ft, down gradient of drainfield/reserve area. X 11) The internatioTalode 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. Rq@ds are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such roads 31%W ith 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 revocation. X 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 p1lows. Until resolution of any/all problems no occupancy(Final Inspection)will be granted for the residence. OWN ER/CONTRACTOR(indicate which) Signature X _W� 14) This permit is for the placeme tallation of the manufactured home only and does not imply approval or review for any other items indidcated on the plot plan. X fJ BLD2011-00246 Please refer to the following pages for conditions of this permit. Page 3 of 5 1 ) 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 16) Placement of str must comply with standards set forth per the international codes regarding descending and/or ascending slopes. X 17) All changes to"a roved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regulatio i be reviewed and approved by Mason County prior to construction. X 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 Inspector shall be nor to requesting additional inspections. X 19) 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 clearly marked fts tallation instructions. X 20) Owner/applicant must obtain a seperate permit for th I ent of any size propane tank serving a fixed appliance within a dwelling structure or unit prior to the placement of the tank. X 21) All property lines shall be clearly identified at the time o foundation inspection. X Qk 22) All building permits shall have a final inspection performed and approved by the Mason CountyZIding 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 ordi 'am- 23) and building regulations. X All permits expire 1 0 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 exceedinq 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder have prevented ac ' being taken. No more than one extension may be granted. X BLD2011-00246 Please refer to the following pages for conditions of this permit. Page 4 of 5 24) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and flashi stall metal connectors approved for contact with the new types of pressure treated material. X 25) Retaining walls neede los—upport a surcharge a structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. X 26) By definition, propane tanks and heatpumps ar structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure these structures et the setback conditions listed. X 27) Landings and st irs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Approved Site "t ensure these structures are shown and meet the setback conditions listed. X 28) Approved pe dimensions and setbacks on submitted site plan and in accord with MEP2011-00014. Setbacks are measured from the furthest projection of the s X 29) All construction and demolition debris must be removed from the site after project completion. Proper al of construction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X 30) Temporary erosion control measures must be implemented to prevent water quality degra ti of adjacent waters or wetlands. Silt fencing must be installed and maintained until upland vegetation has become established. X 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 o the above described property and structure for review and)inspection. OWNER OR AGENT: DATE: r t✓U' 1 BLD2011-00246 Please refer to the following pages for conditions of this permit. Page 5 of 5 o CONCRETE MECHANICAL MANUFACTURED HOME o Date B y � N Footings /Setbacks Gas Piping Ribbons o Intenor Date By Interior-Date By Date By rnExterior Date By Exterior-Date B Sat-up Point Load J Isolated Footings INSULATION Date 30 I( By riG� m BG!SLAB INSULATION -- — Z Date By Data By FIRE DEPARTMENT M Foundation Walls Floors Date By 'U Date By Data By DECKS FRAMING Walls Date By N Date ey Data By PROPANE TANKS N PLUMBING vault Date By Data By OTHER Groundwork Aroc Type Dale By Date By Date By D.W.V DRYWALL Type. Int.Brace Wall Date By Date BY Date By r" m FINAL INSPECTION 0 m Water Line Fire Separation ON m Date By Date By Date 7 By (✓�� s Pass or Request Inspect. c Type of Insp. Fail Date Date Done By Comments CD CD o 0 Q o u't 1/ I L•SS /K 1 0 r. s Uf fD 3 m co m 0_ Building Permit # MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTI E Job Location 2 ,71 This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items Listed below must be corrected to gain code compliance 2`1/ � ©&> 2-,-/6 C->'---44 C'o 2- 6-->//-doh'y S� / /Y/= S �.mil/ '- •' �1� fa- i i /L lclAS � TO J �) �/�C/L� n,��'/�TJQ/;T/oy,.� �� l�= d.��--T,L���-/{f - .(�'�^�G�.t��/✓r/ r lam, v.✓1 i r z 7 Ld e 1 - You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Make corrections, items will be checked on next inspection OK to pc-Ltfy n f�X / Y� ❑ This is not a complete inspec ion Department �'B&4!5�7 Date //_ 3 c-1 ) Inspector '/ moos NnT MOOV THIV-- TLolm � ' " _ ermit# MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE )b Location his structure has been inspected by Mason County Building Department nd the following VIOLATION of County Laws and Ordinances has been Fund: Items Listed below must be corrected to gain code compliance _ cL- p ors �" y � ' s You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK Call for re-inspection when corrections are made before continuing ' ❑ Make corrections, items will be checked on next inspection ❑ OK to — ❑ This is not a complete inspection Department Inspector Date FILE .COPY PERMIT NUMBER: REVIEWED FOR CODE COMPLIANCE �� MASON COUNTY BUILDING DEPARTMENT Dateµ -1 (1 — NAME ON PERMIT: ADDRESS: Z`�I N e $Ae-t4%,� PARCEL NUMBER: 2321 33 004')� See Mason County Manufactured Home Checklist (attached) Review pages 9-12 for general requirements and a manufactured home inspection checklist. All decks, stairs and guards must meet minimum code requirements. Useful details and information are attached to the checklist. See also item numbers 1, 30, 31,32,33,34, 35, 36, 44, 49, 53, 55, 56, 69, 96, and 110. For information about skirting vents and crawl space access requirements see item #51 and #60. Site address must be posted see item #78. m a� w . a IL tr �� C L T- 7- --_ \ o►_l.RUN OAT COL P Ili 1f.4 1 �I lW— xI .' x CPfxti ) �SHrcRJ rl aEND APR 0 5 2011 Al _426 W. EDAR ST. } I �r BUILDI I G Ul m Q m �'u 4 ;FT ?ic F!ITPY m In r-t Dl\+7S10NS f..Y�W.(a . 4 Ut EH Ea? 1C• C,6?IU?7�t SWAS 11f •941 I. 6.'.VF,u30.N.VB •.6it alit k SC-li•�l i4T119 1; 1!7 lie 344 553 z0 0 F.�7UF:C-2e?-A N'/P.=-1b k OQIV7: I' Vi 1 i t 115' 345 571 rn It 11DAIC 1C Y'f![s AI.A_0 KK LEW k D;Ah IN,. 1 L W M G1 125 355}; 591 V RR CQ.UYK 1.-7C t 8-tt,t?Iki nimmu KC f ) •ek �f 110of SVX CD f 31 52B B12 at to(0,1 iS1Yt1 Emil." ,W,nw 0/3:,1Qt Mt,F I �ttir a�rs< Rv 1:AaUt CII n?F ACC yEltt .w- S111;1:T 143 5S1 DRA)41YC NUMBER t 183 635' PAOX IT.K-GYH DfSCRCP77ON 171 630 _i; 4d'B-?tK-2�04Ti °• a35'2 IRl 153e6,o L .� co M m 1227CT (28-08912) 81412010 1 002_4� 1 I _ .371 1-7 _. ApV _ . w -ENVIRONMENTAL _ HEALTH -- - TOPOGRAPHY PROFILE: 0 ►� RECEIVED ;sue APR 0 5 2011 C� Z- 426 W. CEpAR ST b� �i Direction: Scale: Approval: for office use Building Permit number: Building- Owner/Applicant: Date of Planning: aQplication: Env. Health: Name fm .zc� F— Tr`-k Rarcel# 1 Z3z 1—:33—60000 BLD# 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. '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 X _ perimeter of the farthest projections(example: 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 nspection as may be required. X l5/v Owne/Agent/Contractor(circle one)Date: If the To I Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign the information provided on page 2 of 2. Page 1 of 2 Name Parcel# 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: httpHwww.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 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/d ra infield 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: ()60)-427-9670 EXT.352 Mail: P 0 Box 1666, Shelton WA 98584 Physical: 426 W Cedar St, Shelton WA 98584 A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met prior to a request for final inspection of the building permit. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- described property for review and inspection as may be required. X Owner/Agent/Contractor(circle one)Date: Page 2 of 2 MASON COUNTY PERMIT NO. �� BUILDING PERMIT APPLICATIONS-`f % 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair(360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION ��// CONTRACTOR INFORMATION Owner MT SCc-rr Ewrty�4fzi.ses L-LCL % -,vnh 5(0;) Company Name Mailing Address 0, ?),o x 1 Z3 rd Mailing Address City _State)�, � Zip Code 9 8 S a b City State Zip Code Phone bv_2_75" 'SS Other Ph. Phone Other Ph. Lien/Title Holder J-144 Contractor Reg. # Exp. E mail address 55 c2 vk s1-v'uc.T(P vt vtucc"i L c y` E Mail Address Drivers Lic.# wVfJ -s H 7 Z Q DOB I I -Iq S3 Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic 5Ljr-,2011-w02 Connect to Water System Name of Water System Well— Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No I I - 3. 77 Fire Disgict ' Legal Description !' -7Z5' -,F swl f,w FX Tl2 1 k C 13LA -t ': 1 NI OZt� 4z�-07-2-UUb 1 `1- 5 3C- Site Address (Please include street name, street number and city) C Z ( `k K 1,4 &ElF-4I YL W o SZ8 Directions to site Zit C1N N DP1N ��ra �tp � }-�t�? 1Iw 1 ' z /.I MI � TU�LN IZ% C,ni oig 1%1 Cl<Mk6('�i_ A 2- Will timber be cut and sold in parcel preparation?Yes/ o 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 (R SEASONAL ❑ Use of Building Describe w-)rk No. of Bedrooms No. of Bathrooms I Square Footage - 1st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make 1<`i �� Model Ut z Z�ob� -LP) Year ?�11 Length_��Width L7 Serial No. _ No. of Bedrooms_ 3 No. of Bathrooms Z Type of Heat 1=oP. L) ti vE C-10-k Purchase Price$ 5-_, 75 5 c"— Replacement Unit? Yes/No Installer Name L It��� .44)-M;rs 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 parry 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 information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF F CONTINUA'RON OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: ner/Wn6s Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date ' _ DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department t-( 14 Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal