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HomeMy WebLinkAboutBLD2005-01607 Final MFG Home - BLD Permit / Conditions - 5/4/2006 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 Ir Shelton, WA 98584 flo RESIDENTIAL BUILDING PERMIT BLD2005-01607 OWNER: RICHARD MYER RECEIVED: 9/13/2005 CONTRACTOR: STATEWIDE MANUFATURED HOME LICENSE: EXP-. ISSUED: 10/13/2005 SITE ADDRESS: 120 E CLONAKILTY DR SHELTON EXPIRES: 4/13/2006 PARCEL NUMBER: 321275400042 LEGAL DESCRIPTION: LAKE LIMERICK 5 TR 42 PROJECT DESCRIPTION: DIRECTIONS TO SITE: Manufatured Home Lake Limerick General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 2 Type of Constr.: Typeof Use: MH Insp. Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck: Type of Work: NEW Fire Dist.: 5 No. of Stories: 1 Occ. Load: Building: Valuation: Building Height: 14 Occ. Status: Seasonal Basement: Manufactured Home Information Setback Information Shoreline& Planning Information : y Make:fleetwood Length: 44 Ft. Front: S 165.0 Ft. Shoreline: Ft. Water BodSEPAy: 32 Model:sun river Width: 23 Ft. Rear: N .0 Ft. Slope: Ft. Shoreline Desi Side 1: E .0 Ft. g" Year:2005 Serial No.: Side 2: W 32.0 Ft. Comp. Plan Desig.: Plumbing Fixtures FEES Mechanical Fixtures Type Qty. Type e By Date Amount Receipt Mobile Home Submittal Fee KKK 9/13/2005 $214.50 S22005 Planning Review Fee KKK 9/13/2005 $155.00 S22005 Building State Fee ARC 9/23/2005 $4.50 S12005 Mobile Home Issuance Fee ARC 9/23/2005 $214.50 S`IMM EH Plan Review KS 10/6/2005 $100.00 S12005 EH Plan Review CEW 10/13/200 $75.00 S12005 Total $763.50 BLD2005-01607 Please refer to the following pages for conditions of this permit. 1 of 5 CASE NOTES FOR BLD20 0 5-01 607 CONDITIONS FOR BLD2005-01607 1) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. 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 1-800-647-09 2..The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 3) The internationnl code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150'from an approved access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where such roads connect with a county maintained public road or to another fire apparatus access road which connects to a county maintained public road. X 4) 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 5) All appr6Ged 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 Departure r' to any further inspections being performed or approvals granted. X 6) In accor ance with international codes and Title 14, Mason County Building Code, "Standards for Fire Apparatus Access Roads," all new structures that require an address shall have approved numbers or addresses located at the beginning of long driveways when the address is not clearly visible from the access road. The numbers shall also be plainly visible and legible from the street or road fronting the property and shall contrast with their background. Mason County Building Department requires that this be completed prior to calling for any site inspections. A re-inspection fee based on rates as adopted by the jurisclicti d the international codes will be assessed if the owner and/or contractor fail to post the address on site prior to requesting inspections. X BLD2005-01607 Please referto the following pages for conditions of this permit. 2 of 5 7) 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 a r d documents will result in failure of required building inspections. X C 8) THE FOUN ATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X 9) The"approved"site plan is required to be on-site for inspection purposes. If an inspection is regU"d 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 rtme .prior to any further inspections being performed or approvals granted. X 10) Any retails�, 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 o '! tal certification number and signature of the certified installer responsible for each major part of the installation. WAC365-210 X 11) If you are installing a`1w6nufacturing home and no longer have the installation manual for the home, you must use the instructions of the American National Standards Institute (ANSI).To order the ANSI instructions you may either get an order form from the Mason County Building Department or you can contact the Offfice of Manufacturing Housing (360) 725-2800. 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 W ngton. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit re cati nr% X 13) REQUIRED-04SPECTIONS (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 per fees to resolve any questionable practices or problems that have been discovered. I further understand that this investigation will be scheduled as 'me allows. Until resolution of any/all problems no occupancy(Final Inspection)will be granted for the residence. OWNER/CONTRACTOR(indicate which)Signature X 14) This permit is for the p!a ejn nt and installation of the manufactured home on and does not imply approval or review for any other items indidcated on the plot plan. X BLD2005-01607 Please refer to the following pages for conditions of this permit. 3 of 5 15) 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 projectc;_�)' .� X 16) All changes to"a ro d" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regyla n, st be reviewed and approved by Mason County prior to construction. X 17) CONSTRUCTION MOCESS 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 intern tonal codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector sh II b de prior to requesting additional inspections. X 18) The installati6Wpermit 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 in the installation instructions. 19) All property lines shall be clearly identified at the time of foundation inspection. X 20) All building permits shall have a final inspection performed and approved by the Mason CountyLming Department prior to permit expiration. The failure to request;"al al inspection or to obtain approval will be documented in the legal property records oh file with Mason County as being non-compliant with Mason C un o finances and building regulations. X I 21) All permits e' ire 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�` nod not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder have pkeve _'d action from being taken. No more than one extension may be granted. X i -- 22) Pressure trd wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and fl ng. Install metal connectors approved for contact with the new types of pressure treated material. X BLD2005-01607 Please referto the following pages for conditions of this permit. 4 of 5 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 owneror 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 i ction. OWN ER OR AGENT: DATE: � ✓ �J V J BLD2005-01607 Please referto the following pages for conditions of this permit. 5 of 5 MASON GOURTY DEPARTMENT OF COMMUNITY DEVELOPMENT Permit Assistance Center SHELTON (360) 427-9670 BELFAIR (360)2754467 Elma (360)482-5269 FAx: (360) 427-7798 WEB SITE: www.co.mason.wa.us P.O. Box 186, SHELTON 98584 2004 Washington State Energy Code (WSEC) 2003 Ventilation and Indoor Air Quality Code (VIAQ) effective July 1, 2004 Code Compliance Application Form The following information will be required for the WSEC and VIAQ plan review: 1. Complete the Washington State Energy Code/Ventilation and Indoor Air Quality Code (WSECNIAQ)application located on the reverse side. 2. Complete the window and door schedule on the reverse side. Include all windows, skylights, sliding glass doors, french doors and any door that is more than 50% glass. Use rough opening dimensions of the windows and doors. Information about the U-factor of the window will also help to expedite the energy code review. If you are complying with the WSEC by prescriptive path and are using the area weighted average method you must include your calculations. 3. On your building plans note the location and fuel type of water heater, location of exhaust fans (bathroom, laundry, kitchen, etc.) and R-factor of insulation proposed for walls, floors, ceilings and slabs, 4. Questions? Call Mason County Community Development at (360) 427-9670 ext. 352. Additional WSEC and VIAQ compliance information is available on the internet at: http://www.energy.wsu.edu/code/ Prescriptive Requirements 0,1 for Group R Occupancy Climate Zone 1, Table 6-1 Glazing Glazing U-factor Door Wall Wall Wall Area%of Ceiling Vaulted Above interior° exterior Slab' Option Floor 11 U_ s 2 Ceiling3 Grade below 4 Below Floors on 10 Vertical Overhead Factor 12 grade Grade Grade I 12% .35 .58 .20 R-38 R-30 R-15 R-15 R-10 R-30 R-10 II* 15%* .40 .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10 IV Unlimited Single Family Res C.4O .58 .20 R-38 R-30 R-21 R-21 R-10 R-30 R-10 (R-3)Only *Reference Case/Call (360)427-9670 ext.352 for footnote information. Log&solid timber wall with a min.avg.thickness of 3.5"are exempt from the above grade wall insulation requirements. MASON COUNTY DEPARTMENT OFt�MMUNITY DEVELOPMENT WSEC/VIAQ Compliance Application Owner:�G�3 �� Telephone: Parcel#: Z<2 Oex��iLJ Type of project ( ) New Residence ( )Addition ( ) Remodel Total Sq. Ft. I st Floor : 2" floor: Heated Basement: of heated area:: Z�-F— Heating System Type: Electric wall heater O Electric Central Furnace O LPG Furnace O Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type: O Other: S ecif Glazing Prescriptive Option see reverse side circle one: I II IV Percentage: Compliance Method O Component Performance , Chapter 5— Calculation worksheets require Check one:: O Systems analysis, Chapter 4 [vents Y Whole House Ventilation system O Whole House Ventilation using a Heat Ventilationing exhaust fans&window or wall fresh air System (VIAQ 303.4.1� Recovery Ventilation System (VIAQ 303.4.4) Check one Whole House Ventilation Integrated O Whole House Ventilation using an inline th a Forced Air System (VIAQ 303.4.2) supply fan. VIAQ 303.4.3) Window & Door Schedule (If needed, attach an additional sheet) Total Manufacturer Room/location U-Factor Size Quantity Square Feet Windows: Windows: Total Sq. ft. Doors: Doors: Total Sq. Ft Total window and door area Total window &door area /(divided by) total sq.ft of heated area = %of glazing 08/21/2005 12:29 999833153315 RICK & CANDI MYER _ PACE ,al MLS Northwcst Reports (502) Page 5 of 5 Vacant Land Client Detail Report 4 1 N C Labe w ig .ir - t<. LMn#Ysp� 24155M Lot �0 BOW Prtae t Gonna Mason ,t ftle 44-Ree-,eve Own 1 Ac Am ,r1 Mato A u/i f l i r b l e P Lake Lln►eridt S Coesanursny Lake Lxn nick Z,anlne Resldenrid MW 23 (irN: SA Nlnhoot in/anaaron: 1lseeeerment Fees: khooi Difew Shelton Taff Year 2004 maatantlsry Unknown Ebmhi mr Annual Taxes 778 Jr.High Unknown Jnr sr.Explapoon High Sohool Sheaon Hipp Aweeearewt ylAiter ftworwAmb t➢aa MCA Avubsboo iealar Alot Avad" welsr GOrIM1101nAy WrN Tupountablit vaNable e,Sapft-As fltdlC view TWT609W Lot Dulaft DwW End SYNC Mwprvnretawm WOWA*WK wA6whv A fOOMe Tevwo Cash Uut Hood Mtf ema0m Ridtt of Way 8fvw saplk Synanr Insbow Yes Sepbe Dws4n AppNed For I i W Apwv Ito.Gadeas. 2 SepVc Deeign Apprw Ot Soft Pwwlltfr Awn& S"fla Oasii*n Expko Dt SON Tot Orr leplk sestets Type Otreatlone-Smith on Hwy 3 past Deer Creek Slone,lot on Mason take"ftN~poknp under Vessel,take a tell at ties T Featum:Cams Gnnde Tknbw,PSN6soy Cleared kVa%Wny Ran 5da:Heavy wooded lot w*IN12 Storeys Shed and 314 bslh abaClnsd to rear,also a 12x,2 Gazelle All hoodups on property M%k has a 2 bedroom soptie installed.AS personal property wi be wftoved before dosing Cash out only.Mob4 okvy 5 years old and nasrar,OmMi be some wrlrnoea Pteeagad py;Joseph G KaNy/VAndermew!IM Lot Slaw And Square FoohWe Are ENMneles- Won"ation From Reliable Sources,Sus Mot duMrnMed. http://tocaW.nwirds.cot iscriptsh Wgispi.dU,?APPNAME—L.ocator&PRGNAME—MLSLo... 5i11/2005 Al--.-24 2005 WED 0,3:53AM I D: PAGE: Pier 1 Pier 2 Pier 3 �.�...... .....r.. �.. c o}�c c c7` Single blocks, Double-Interlocked blocks, Steel or concrete maximum height of 38 inches maximum height of 80 Inches manufactured pler Concrete grouting w �---- Steel reinforcing ban i` For piers exceeding 80 Inches In height,the concrete blocks should be filled with concrete grouting and steel reinforcing bars should be utilized. �t Figure 4-1 —Typical footing and pier Installation >r . 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VIA a M� o+ MUST- SONBUILDING THESE THENOB SITE BE CHIC B[lILDO ON S SUBJECT lQ sPECT OR FOR INSPECTION ROV ` ..� DATE ac zMEET�la 411.CURRENT musl O AT N STE CODES W CHANGES SUBMIT CHANGES FOR APPROVAL PRIOR TO PERFORMING WORK v 0 _ O 0 a fi 1 APPROVED lFf 17 3 �i �/ MASON COUNTY DCD PLANNING i1�sS:�vr G f SITE PLAN REQUIRED TO BE ON SITE 00J RANGES SUBJECT TO AP ROVAL BY Date �` 'irct qFCPLANNING: oavr��G S�J ALL SETBACKS ARE MEASURED FROM THE F PROJECTION OF THE BUILDING go 94 I . �'7 A 6A ` � hz eottD `00 , Sum [� Dl�,�G�`�dfJ OFF 4S RW4 iz/w 52& CA..,H4 g cyell6 LNG- un�� Pw,&�t-NO, -' 3�-1�.17sy 000U2. ` 49f T- 00 So-z � Awrao Af*T =4 0 its v ts+�d f;`-lw Q5 �►�Q`r 0/7 C. 6-,vo20 )w 50 JNIa11f19 341 A NOIl03f0»d 9 b 1S3Hl8nJ 3H1 ds 3S 1111 �2� 03HnSd34 384 5YiO d : DNINW-1 I©' L _ --� 00 _ ��.�►�S � ozcoi 9h 80 t 2:3EOd :aI WHLT:TI Nf1S SOOc-TT-d3S " r. :C.' '4' .s. .'•je•s•` ?'yr:-.l•aY�.'•iT'1;',;�•'�• .:n.: .�.'•:":W•...li'�fl'��`.�.r��:�. '•:'',.%. ;d. .a. 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T �+itYlE t 1 rMl1rY1i N►W be difconnoc d DumaS permit 0 . © Yac ' •=` ( ' 10 �w iref nt str Am State Eh¢trkg Wwk p Q oriilrlll�� � '.-�. Ulfrdxt;tpuna • . �,, , . �""","p'.,r..w.""'.'�^.:;.: 1 : r� Addit' ►n teieirNnt(i IplNt .My future toad I Affit t1 thaat tl�e abut i"fa=*tion is tact to the best.of my knowledge,end that I have been pjcMdtad iv P` D 3's Service Ex�Policy,Service Rules"d Replations,and Customer Information Pay ka�. t rs d that ch9M9O& tt she in the above information or attached drawings may increase the am xr.'qW for PUS 3 to provide,sp�vice and may be et to a 1tviisian fee. 3> O�Th.Y Date'Rd$ft - '; ' A�38►ied m Date LO Prlrrimy •` 'fit: '' O l� FiW.Check Dace Rena&' * !Yi1l - .. .:Y'•f:Y•� ' .w 'i. .. •:L.s•I�.�•'.'_S•• ; I 'R-'11f'.. " .aw•A��:' 1 :^h 1r..•Ay —'IC•..$I.Y.ii•• r +i f: Y'X•Y 'V'�.•°"'� �.�.^:•.,. .f.' :,v":��,.?l"rC:. .','.( p SEP-11-2005 SLM 11:IBM ID: :4 J MASORCCONTY: PUBLIC U TILM OOTRICT NO. 3 MELMN,Wk M%4-W43 SEP-11-2005 SUN 11:17AM ID: PAGE:2 Request To Revise An _ -Plan Permit Number: BLD200_ - Parcel Number :2 - 3.. Q�^ ya, phone Number da ime Project Address �� C �Urgkjc— > Mailing Address \zz;4 ,E Z- Please provide a complete, detailed description of the proposed revisions to the approved plans: Are two sets of the revised plans or addendum indicating the changes included? a Yes ❑ No Are the approved site plans included? 0 J;/tr, v � �} �� � ❑ Yes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? Pf-Yes ❑ No If Yes,Has the engineer or architect approved this revision? F:-4,c T-u/)IW)8-Yes ❑ No Is a stamped and signed approval included with this request? ❑ Yes ❑ No j (Note:No structural changes to a"designed"plan will be approved without the written consent of the engineer and/or architect of record) -r�(MtpDoes the proposed revision modify the footprint or locatio e? 0 Yes ❑ �jv No If Yes, Is a revised site plan,with all new setback > ��i ded with this request? � j OCT 0 b 2005 ElYes ❑ No Additional Information: Applicant's signature Date:_ /L��r� 5 Office Use Only f Received by: Date Sent Assigned To Approved By Date Original Valuation: $ Additional Valuation: $ PQh Sq.Ft. x$ $ Sq.Ft. x$ $ L EL l Total New Valuation $ Additional Fees: -�— Additional Planning Dept. $ New Setbacks: Front / Rear / Additional Plan Review $ Additional Building Permit $ Side1_ / Rear / Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. $ Other $ Total Amount Due: $ Amount To Be Paid Up-Front$ T.; dmi ReYtSed SRG 8=003 771�7'7777 7777 71 MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar- R 0. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 AAVLC On the web www.co.mason.wa.us APPLIqANT IjNFOR ATIP14 CONTRACTOR INFORMATION tN46"Y,"i 60�) - Company Namol��Jme /WUM2UjM Owner ??A Am A - A Mailin 1V/U0AA5kAC-`% dys, MailiDg Address El f7 lip tate Lj,64, Zip Cod & State Zip Code City,(aeeAP-U&y 1A 1 .aelok AYI-111 - -oq,& Phone Other Ph. Phone t rP Lien/Title�Iold er Contractor Reg. *54A7"F-El Z Exp-/--2'Q-Q(,a E mail addres's P4 %arl-. rr. E Mail Address Drivers Lic.# &bdn1'7g DOB Drivers Lic.#ft-5&Fj:32Lg L_ DOB_L��d SEPTIC /WATER SYSTEM INFORMATION - Connect tPN'ew Septic Existing Septic— Connect to Water System Name of Water System Lkaj��e Well Sewer Systena-ALO- Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No.. V�a- —Fire District Legal Description �-Ak )'jMF-kjCk6: jX !�"3' Site Address (Pleaae include street name� street n I urliber.and city) CL,6&AAaL 7-Y Directions to site '�Jbc� Q'I .A PA S:T- b r-Lf-Z-K cz&41:� —1 nA Mf�5 CAI \/Vill iimber'be cut and sold in parcel preparation?Yes/No I Is property within 200'of Saltwater i Lake �fy 6 River/Creek Pond Wetland--,��.Seasonal Runoff .,' , Stream__4&)--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_9tPer PRIMARY RESIDENCE [:] SEASONAL E:] e—sc 'VI �—� Use of Building ribe Work L4 No. of Bedrooms No. of Bathrooms -L Square Footage- 1st Floor 0 Ag —2nd Floo 3rd Floor Basement Deck—Covered Deck—Other —Sq. ft. Garage— Attached —Detached — Carport Attached — Detached MANUFACTURED HOME INFORMATION7Make �2 Model i :-:.-,,—Year No. of Bedr p. of Bathrooms Length QV Width Serial No. ooms 0). Type of Heat E�- r-T-RIC Purchase Price$ A�b Y). ('Y2 Replacement Unit?tes) No ell Installer Name Certification --- 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 information 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 SOF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS W LL INVALIDATE THE APPLICATION. Date: 3bve Contractor) (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department No -ri" 4 e(? Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee q. Site Inspection Plan Review Fee EH Review Fee Plumbinq & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee /VO Pre-Paid at Submittal ,Valuation $ TOTALFEES