HomeMy WebLinkAboutBLD2016-00657 Final Garage with Loft - BLD Permit / Conditions - 2/8/2022 Inspection Line (360)427-7262
*1854
, MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County
615 W Alder St
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2016-00657
OWNER: TIM WEBER RECEIVED: 7/12/2016
CONTRACTOR: LICENSE: EXP: ISSUED: 11/15/2016
SITE ADDRESS: 2100 E JENSEN RD SHELTON EXPIRES: 5/15/2017
PARCEL NUMBER: 321307590074
LEGAL DESCRIPTION: TR 7 OF SURVEY 4/74 TR D OF SP#801
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
NEW GARAGE WITH UPPER LEVEL LOFT STORAGE OUT JENSEN RD (E 2100 JENSEN RD) SHELTON
General Information Construction&Occupancy Information Square Footage Information
No. of Bedrooms: Type of Constr..- VB
Type of Use: SF Insp.Area: No. of Bathrooms: 1 Occ. Group: U Lot Size: Deck:
Type of Work: ACC Fire Dist.: 5 No. of Stories: 2 Occ. Load: Building:0 Garage-Detached 2,900
Valuation: $ 129,427.00 Building Height: 28 Occ. Status: Primary Basement:
Manufactured Home Information Setback Information Shoreline&Planning Information
Make: Length: Ft. Front: S 25.0 Ft. Shoreline: Ft. Water Body: na
Rear: N 110.0 Ft. Slope: Ft. SEPA?: No
Model: Width: Ft. Side 1: E 40.0 Ft. Shoreline Desig.: Not Applicable
Year: Serial No.: Side 2: W 20.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Water Closets (Toilets) 1 Ventilation Fan 1 Plan Check Fee JBN 7/12/2016 $755.14 S220160000000(
Lavatories 1 Woodstove 1 EH Minor Plan Review JBN 7/12/2016 $ 100.00 S2201600000001
Water Heaters 1 Planning Review Fee JBN 7/12/2016 $205.00 S220160000000i
Hosebibs 2 Building State Fee EAE 8/11/2016 $4.50 S2201600000001
Building Permit Fee EAE 8/11/2016 $ 1,161.75 S2201600000001
Mechanical Base Fee EAE 8/11/2016 $28.50 S2201600000001
Mechanical Permit Fee EAE 8/11/2016 $82.00 S2201600000001
Plumbing Base Fee EAE 8/11/2016 $24.70 S2201600000001
Plumbing Permit Fee EAE 8/11/2016 $32.30 S2201600000001
Total $2,393.89
BLD2016-00657 Please refer to the following pages for conditions of this permit. Page 1 of 4
i
CASE NOTES FOR
BLD2016-00657
CONDITIONS FOR
BLD2016-00657
1) Prior to final approval, all upland areas disturbed or new Teo by construction activities shall be seeded, vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X LIZ
2) Appro O pe dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X I'�
3) Applic 'on kpowledges that the structure is only permitted for a use consistent with the current zoning of the parcel. Zoning is Rural Residential 5.
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4) This structure has NOT been reviewed or approved as an Accessory Dwelling Unit(ADU): A second dwelling unit detached from an existing single-family
dwelling for use as a completely independent or semi-independent unit with provisions for c g,,J�j�ti,ng, sanitation and sleeping. ADUs are required to
meet the requirements under Mason County Development Regulations 17.03.029. X / �-/
5) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Ap ed Ian"to ensure these structures are shown and meet the setback conditions listed.
X
6) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these structures m
eetthe setback conditions listed.X R . ,
7) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
ORRTWAY. ,
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8) 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
1-800-6�098 1The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X moo/,_
BLD2016-00657 Please refer to the following pages for conditions of this permit. Page 2 of 4
9) 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
Departm�t Rcigr to any further inspections being performed or approvals granted.
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10) Owner/�erj is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
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11) THE Fn'JKlDATJON SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL.
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12) 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
Buildin ep�J(��ent prior to any further inspections being performed or approvals granted.
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13) A concrete encased grounding electrode must be installed and used at each new building or structure that is built upon a permanent concrete foundation.
In Mason County the electrical code is regulated by Washington State Department of Labor& Industries (L&I).
For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-4000.
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14) This structure is limited to U-occupancy use only (private garages, carports, sheds, and agricultural buildings.) Any other use will be in violation of the
intern ignaI odes and Mason County Regulations unless a "Change of Use" permit is applied for, reviewed and approved.
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15) 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
X arg�arshall be collected by the Building Department prior to any further inspections being performed or approvals granted.
16) 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�voc�tipn.
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17) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinap or nlation, must be reviewed and approved by Mason County prior to construction.
X
BLD2016-00657 Please refer to the following pages for conditions of this permit. Page 3 of 4
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
Inspec shall be made prior to requesting additional inspections.
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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 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 u rdinances and building regulations.
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21) 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 IQe N
vented action from being taken. No more than one extension may be granted.
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22) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners,
connect an lashing. Install metal connectors approved for contact with the new types of pressure treated material.
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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 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 permitlapplication 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 OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
al:tj�zz CC)
Signature 1 +n'� Date
EQ {O eN-� 1 v u- OWNER - REPRESENTATIV - CONTRACTOR
Print Name (Circle one to indicate)
BLD2016-00657 Please refer to the following pages for conditions of this permit. Page 4 of 4
Name Parcel# Z
Mason County
B U I L D I Nqepartment 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:
htto//www.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to "Title 14, Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a Stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document
entitled "Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan". This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of.the stormwater system adversely affects any septic system (see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASES L ITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLANT 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:
RE C E V
- Phone: (360)-427-9670 EXT. 450
Mail:P 0 Box 1850, Shelton WA 98584
JUL 12 2A 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
OwnerBadder/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_ ZI Owner Agen'Contractor(circle one)Date:
Page 2 of 2
I
Name Parcel
Mason County .
Department of Community Development
Small Parcel Stormwater Management Applicatio"lorksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment',with more than 2,000 square feet of impervious surface.
'Redevelopment means, on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials, and oiled,macadam or other surfaces which similarly impede the
natural infiltration of Stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please'Complete This`Table-
Surface Type Length X Width = Area *All dimensions in feet
Buildings X =
X = �J Measurements for buildings are taken at the
perimeter of the farthest projections (example:
X = eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parking Areas X =
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = If the total impervious area of the_proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater-Site Plan is Required
Total Impervious Surface Area(sum of all areas)-
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Pate 1 of 2
PL AtA INC,
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32 ) 30 _ �sf �oo-7q
A�;-� , ,DVED pn
MASON L�')U"'-i Y DCD PLANNING -ZD ed re le J
SITE PL V\1 i;L')UIRED TO BE ON SITE
CHAN: :. ::DBJECT TO APPROVAL RECEIVED
By_ _� — Date
JUL 12 2016
6-i5 W. Aider Street
100,
I '-C"EASEMENT
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NEW SEPTIC LINE 1 GRINDER PUMP STATION PER SEPTIC DESIGN
1 I DRYWE LEaE8PETIWEDE IL I/AO
LOCATE PER SITEO OPTION
I j -TIGHTLINE DOWNSPOUT DRAINS TO DRYWELL
v-/�5 ��V PARCEL OF CONSTRUCTION AREA
� � 32130-15-90074
I 20-0"SIDE YARD SETBACK
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OI ROOF OH.TYP.
PLANNING:
'EXIST.DRAMIELD 23 �� I ALL SETBACKS ARE MEASURED
'I 28'-C"FRONT YARD SETBACK FROM THE FURRTHEST
EXIST.SEPTIC -1 in
EXIST.SHOP - 28 ZS tea- PROJECTION OF THE BUILDING
{
'�}'• \ �� NEW CONIC.SLAB
� EXIST.GREASE TRAP i SEPTIC LINE
EXIST.RESIDENCE i
-�-NEW GRAVEL DRIVE
EXIST.WEI-0I I
I 100.0• I
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EXIST.CONC.GLAD — 75 f o O l I
/WALKS �� E06T.GRAVEL DRIVE ✓
210 D L ,1'e�►t�
I S'he lton,uh
I 30'-V EASEMENT
---- --- ----------- -------J PARCEL NO.:
- ------------------- DESCRIPTION:
-75-900 14
_ � � LEGAL DESCRIPTION:
TR '1 OF SURVEY 4/14 TR D OF SP 0801
SITE ADDRESS:
E 2100 JENSEN RD
SHELTON, WASHINGTON
Site Plan
Scale: I" 2 100'-0"
NORTH
C E I V D
JJL 12 2016
616 vy'. ,r der Street
12:01:41 PM
o� MASON COUNTY COMMUNITY SERVICES ALOZ65 �-
PERMITASSISTANCE CENTER: permit No
• BUILDING• PLANNING• FIRE MARSHAL Recv'd:
615 W. Alder St- Shelton, WA 98584 ��C�,v�®
Phone Shelton:(360)427-9670 ext. 352 Fax:(360)427-7798
las Phone Belfair:(360)275-4467 Phone Elma:(360)482-5269 JUL 12 2016
BUILDING BUILDING PERMIT APPLICATION 615 W. AJder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: b NAME: SCE WL e
MAILING AD SS: 2 9 MAILING ADDRESS:
CITY:'Sh2 STATE: Wo ZIP: 5 CITY: STATE: ZIP:
PHONE#1: 4/2 is - 7 5 3 3 PHONE: CELL:
PHONE#2: 41:.2G — 2 6 63 EMAIL :
EMAIL: L&I REG# EXP.
CONTACT PERSON : OWNER ❑ CONTRACTOR ❑ *OTHER/See Below ❑ l
*NAME: E AJ icft MAILING ADDRESS: y°%k)shP./fit Iyla-2��o�
CITY: /z P / o h STATE:Zda ZIP: BSS tl PHONE: 3 V7- 8,5 6' CELL:
EMAIL:
PARCEL INFORMATION: I't ANN13R_��
PARCEL NUMBER(12 Digit Number) 3a /3 d' 7eJ- 9DD ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS F a/DO r CITY She l740n _
DIRECTIONS TO SITE ADDRESS (R+. I-z,p o4 . 1
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO J
IS PROPERTY WITHIN 200 FT: (Check all that apply):
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM ❑
TYPE OF WORK: NEW 5( ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) &a r et 9 e 5�L o p
IS USE: PRIMARY ❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg ❑ YES(Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK(f 1') Q /Pro(Valuation�ject�BidAm�aunt: l�i�
SQUARE FOOTAGE:
1ST FLOORZ000 sq.ft. 2ND FLOOR 9°p sq.ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq. ft. Attached❑ Detached❑
,MANUFACTURED NOW, INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRE D*
\AE ODEL YEAR L TH
WIDT BEDROOMS BATHS SERIAL NU
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 or owner's legal representative. I further
declare that I am entitled to receive this permit and to do the work as proposed. 1 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 IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42)
Signature of OWNER Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PERMIT SPECIALISTS Intake: 7 121 0 Approved&Ready for Pick-Up:
Visit us on-line: http://www.co.mason.wa.us/community_dev/ Rev. 112712016 by JBN
�coa �_ MASON COUNTY COMMUNITY SERVICES
6LD2o►I� U
- )&5T
PERMITASSISTANCECENTER: Permit No:
•BUILDING•PLANNING• FIRE MARSHAL
r
615 W. Alder St-Shelton, WA 98584 RECEIVED
Phone Shelton:(360)427-9670 ext. 352 Fax:(360)427-7798
7. Phone Belfair. (360)275-4467 Phone Elma:(360)482-5269
1R JUL 12 2016
D I N%UMBING & MECHANICAL PERMIT APPLICATION 615 W. Alder Street
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: t L,,e e r-- NAME: S /. L=
MAILING ADDRESS: MAILING ADDRESS:
CITYS h e #".. STATE: l.Ju ZIP: y'Bsg`l CITY: STATE: ZIP:
1-PHONE: e7z G 7 S S 3 PHONE: CELL:
2nd PHONE: -60 1, a-E 5 3 EMAIL :
EMAII.,: L&I REG# EXP.
PARCEL IN-FORMATION:
PARCEL NUMMER(12 Digit Number): 3 a /_3 o--'7 t— 900 7 4' Zoning. ��5
LEGAL DESCRIPTION(Abbreviated):
SITEADDRESS: �F___ 2/ oo R C9 CITY: She #0"?
DIRECTIONS TO SITE ADDRESS: rf o i
TYPE OF JOB
NEW !/ ADD ALT REPAIR OTHER USE OF BUILDING
LOCATION OF FIXTURES/UNITS— I FLOOR 2ND FLOOR BASEMENT GARAGE iC OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG Natural Gas Ductless_
Toilets / Type of Unit No. of Units Fees
Bathroom Sink / Furnace
Bath Tubs Heat Pump
Showers Spot Vent Fan
Water Heater / Propane Tank
Clothes Washer Gas Outlets
Kitchen Sinks 4�zas/Pellet Stove.
Dishwasher Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Solar Panel
Other
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 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 OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X 0 /a /., T,
Signatur f Applicant Date
X ( �Aje—6e- Owner/Owners Representative/Contractor
Print Name (Circle one)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
Visit us on-line: http://www.co.mason.wa.us/community_dev/ REV_Y712016 JBN