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Home My WebLink AboutBLD2023-01415 Replacement SFR - BLD Permit / Conditions - 12/1/2023 M�SoN COU `i EH Setbacks WA GIS Web Map ( A.) Drainfield/Reserve requires 10'setback from footing/foundations tp B.)septic tank(s)requires 5'setback from all footing/foundations Flo�tt>4{�A. C.)No foundation/Perimeter Drains within 30ft,downgradient of Drainfield/Reserve area D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within l�>ter• 50ft,down gradient of Drainfield/Reserve area �' 11» EH APPROVED Rhonda Thompson 11/30/1113 I t F j "I 4 ;1 t c.r� `�: Wes- '0" Planning Setbacks ilk*f 9'r-• I �� '• Front(South):25' Sides:20' Rear:20' all setbacks measured from the farthest ` projection of the building I 'subject to EH setbacks PLN Approved 11/22/2023 c 041 aoa 0.1iN Mason County Community Development t Gavin Scouten c 004 1um o.lela° _-- - ) All Changes Subject to Approval c v v n a o��•v -- _ - 665 O J2 I '{' r Name MICHAEL LAMONT Parcel# 32135-43-00050 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: http//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" PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A) V 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: (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 building permit that states, in part,that all conditions the stormwater site plan will be met prior to a request for final i ection of the building permit. Owner/Builder/Agent Ac o ledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgem u by signature below.I declare that I am the owner,owner's legal representative,or the contractor. I further acknow a information provided is accurate and employees of Mason County are granted access to the above- described pro r and inspection as may be required. X Owner/Agent/Contractor(circle one)Date: Page 2 of 2 Name MICHAEL LAMONT Parcel# 32135-43-00050 BLD# Mason County Department of Community Development Small Parcel Stormwater 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 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 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. Page 1 of 2 MASON COUNTY Shelton(360)427-9670 ext.352 b. DEPARTMENT OF COMMUNITY SERVICES Belfair(350)275-4467 Mason County Bldg._8, 615 W. Alder Street ' A 98584 Etma(360)482-5269 Shelton W j"W " www.co.mason.wa.us REQUEST FOR BUILDING PERMIT EXPEDITION Date: 'a�"a.� Permit No.:ZO 2023 -bl` 15 Name: Mi&h&Q1 > Umbn_� Mailing Address:V�'� -- (3 Oh4-4.yn, WA Parcel.Number 32135 -43 - wo5o Site Address: I� — 6h&k4, LJA �. Request due to: ❑Medical Hardship Fire Damage 0 Other Explanation of Hardship:—HbVhrE' -4Z)4—&,L LD112"2 DUF 1.& ��t✓� fin.-+rr.�l. nn tA�� i�� I�' ��'' . Must include supporting documents.This may e a letter from a doctor,insurance claim report,report of fire damage from appropriate fire district represen tiv r other relevant documentation. I(WE)understand the intention f is f to determine and document justification for expedition of a building perm it to after or reconstruct e above named property: / Signature Owner/Agen C OFFICIAL USE ONLY Request: PApproved F!Denied Date: Request denied for the following reasons: Signature: Director of Community services Central Mason Fire and EMS Central Mason Fire and EMS INCIDENT Incident Number Incident Date NF IRS Number Incident Type 22-SF3060 O5/0912022 0003070 021)-fare in mobile home used as fixed residence IMP Station Shift District 23D05 Station St A-Shift Area 3(Lake Umalck/)oltns ►ralrle/Deer Creek) Initial Dispatch code Alarms workinaFlre? COVID-19wesa factor Critical Incident Critical Incident Team Temporary Resident Involvement Marardous Materials Released Action Take (11)-Extinguishment by fire service personnel I& AID Aid Gruen Pece cec. (1)-Mutual aid received Aidee Agency Their Incident Number Aiding Agenaes 10 LOCATION Locator type (1)-Street address Address 5171 East STATE ROUTE 3,Shelton,Washington,98584 Cross Street,USNG,or Directions Latitude Longitude Census Tract 0.00000000 0.00000000 DetectorAlerted Occupant Property Use Mixed Use (419)-1 or 2 family dwelling lO TIMES PSAP P.ecei sec Dispatch Notified Time Alarm Time 20:24:55,05/09/2022 20:24:55,05/09/2022 20:24:55,05/09/2022 PRINTED ON 8/2/2023 AT 10:33 AM INCIDENT 22-5F3060 • 1 OF 8 46 Central Mason Fire and EMS 0 TIMES Arrival Time Woteron Fire Time At Patient time 20:36.00.05M12022 Loss Stop Time Controlled Time Last Unit Cleared time 21:S4:00,05/09/2022 Total On Scene Time Total Incident Time 1 in 18 mins 0 sec 1 in 29 mins S sec ® COUNTS ^du."c A-.d Pecelved? No Suppression: EMS: Other: t'n.-"-a*a, Personnel Apparatus Personnel Apparatus Personnel 4 8 2 4 2 2 $j LOSS Property: Content `�'1 tosses Estimated Content Losses 5D00 S00 e'er F-:;e ty value Estimated Content Value PERSON/OWNER Owner: Name Business Name Phone Insurance Company Total lnsuranoeAmount Address AUTHORIZATION Report Writer: !gar■a Employee Number Assignment Authorization Date NEVA, BRYCE 909 Officer In Char=e: Ndme Employee Number Assignment Authorization Date YATES,GREG 432 Quality Control: Name Authorization Date PRINTED ON 8/2/2023 AT 10:33 AM INCIDENT 22-5F3060 • 2 OF 2 Central Mason Fire and EMS INCIDENT NARRATIVE CMFE responded to the report of a residential structure fire.On arrival find a 1970's double wide mobile home with light smoke showing out of open front door, home owner on the roof with a garden hose attempting to put out fke around the chimney. 503 establishing Hwy 3 command,declaring offensive strategy. E58 performed a long driveway lay Into residence,approx.700'Crews from E58 stretch a single 1 3/4"attack line through the front door for fire control,fire located In the ceiling above the wood stove and around metal stove pipe where It exits through the roof.Fire extinguished and ceiling overhauled,checking for extension.M51 crew ordered to the roof to complete chimney fire extinguishment,M51 removed the upper section of metal stove pipe and used a PWE down the chimney to ensure fire extinguished.PPV fan set up at front door to clear the residence of smoke and to check for hidden hot spots with none located.Crews performed salve and overhaul,moving all burnt ceiling material to front of residence.514 began Investigation.Fire determined out,with no extenslon.All CMFE units clear with command dissolved B/C Created By YATM GRFG Q Unit Reports E58 Responding From Priority (1)-Suppression Emergent Enroute Time Arrival Time 20:27:05,05/09/2022 20:27:50,05/09/2022 20:51:13,05/09/2022 va',ent Tmic Clear Time in District Time 21:54:00,05/09/2022 Action. , Personnel JEFFSNYDER DARREN PORTER JOSH DEEMER F503 S<. Responding From Priority (0)-Other Emergent 5 spatch lime Enroute Time Arrival Time 20:27:05,05/09/2022 20:27:31,05/09/2022 20:36:00,05/09/2022 At Patient Time Clear Time In District Time 21:54:00,05/09/2022 Actions Taken: Personnel GREG YATES M58 uu- Responding From P rlori t� (2)-EMS Emergent PRINTED ON 8/2/2023 AT 10:33 AM INCIDENT 22-511`3060 • 3 OF 8 1 Central Mason Fire and EMS M58 Response Delays Dispatch Time Enroute Time Arrival Time 20:27:05,05/09/2022 20:27:50,05M9/2022 20:51:13,05/09/2022 At Patient Time Clear Time In District Time 21:54:00,05/0912022 Actions Taken: Personnel M"AEL ST WERRE,TODD WARD E54 Use RespondingFrom Priority (1)-Suppression Emergent Pesrnnse Deiac� D�s{a:ch Time InrouteTime Arrival Time 20:27.05,05/09/2022 20:29:13,05/09/2022 20:36:58,05/09/2022 At Patient Time Clear Time In District Time 21:54:00,05/09/2022 Actions Taken Personnel EUNICE RANDALL,SAMANTHA STROMBACH M51 SE Responding from Priority (2)-EMS Emergent Response Delays Dispatch Time EnrouteTime Arrival Time 20-27:05,05/09/2022 20:29:55,05/09/2022 20:51:13,05/09/2022 At Patient Time Clear Time In District Time 21:44:50,05/09/2022 Actions Taken: Personnel JORDAN BUSSARD,ABEL DEFFINBAUGH E57 Use Respondi rig From P norvth (1)-Suppression Emergent PRINTED ON 8/2/2023 AT 10:33 AM INCIDENT 22-SF3060 4 OF 8 1 4. Central Mason Fire and EMS E57 Response Delays Dispatch Time fnroute Time Arrival time 20:27:05,05/09/2022 20:29:10,05/09/2022 20:36:41,05/09/2022 At Patient Time dear hnlhr in District lime 21:54:00,05/09/2022 Actions Taken Personnel BRYCE NEVA,JEREMIAH MILLER F514 UW Responding From Priority (0)•Other Emergent Response Delays Dispatch Time EnrouteTime Arrival Time 20:27:05,05/09/2022 20:30:00,05/09/2022 20:38:21,05/09/2022 At Patient Time Clear lime in District Time 21:54:00,05/09/2022 Actions Taken: Personnel KEITH REITZ Unit Narrative CMFE units were disptached for a residential structure fire.I went en route with the initial dispatch,when i arrived I was assigned to investigation.I started my investigation by interviewing the property owner. Michael Lamont(DOB:7/22/68)-Stated he saw the ceiling on fire,and called 911. Lamont said he hasn't had any recent electrical issues in the house.Their hasn't been any recent work done to the house,or fire place area.Lamont cleans his chimney himself, but hasn't cleaned It in a while.He has insurance on the house,but couldn't remember what company it is through I continued my Investigation by going inside in the house,and investigating the damaged area of the house.I started in the least burned area of the house,and moved toward the most damaged. In the bedroom next to the fire place, I found damage to the attic and ceiling area of the room, protected areas on the back side of the roof structure indicated the fire started toward the fire place.I moved to the living room area,where the fire place was.The roof trusses showed greater fire damage on the sides facing the chimney.There was no signs or evidence of incindiary devices found in the area of origin.There was no electrical in the area of origin.Crews investigated the chimney from the roof and said there was a lot of heat Inside the chimney still.I concluded from my interviews and investigation that the cause of fire was a chimney fire that spread to the cedar ceiling cover by radiation and conduction.Scene was released to the home owner.Keith ReitzDepury Fire marshal 514 Created By.REITZ.KW H TS6 Use Responding From R,,or,1, (1)-Suppression Emergent Response Delays PRINTED ON 8/2/2023 AT 10:33 AM INCIDENT 22-SF3060 • 5 OF 8 ` Central Mason Fire and EMS TS6 Dispatch Time f nnvulr lime Arrlval time 20:27:03,OS/09/2022 20:44:00.05/09/2022 20:51:04,OSM912022 At Patient Time c leTr lime In District time 21:52:17,OSM9/2022 Actions Taken Personnel JAa>e scmF&6ER ® Fire Module p S"INpo Alarms Acres Burned Resident Units in Bldg Build ingsinvolved 1 Hydrant Identifier Estimated Water Usage ta IGNITION Area of Origin (73)-CAN and floor assembly,crawl space between stories Heat Source 04)-CamkxCed heat from another fire Kern First Ignited Fireconaned to Item? (16)-Mtterior ceiling covering or finish Type of Material First Ignited (63)•Sam wood.including all finished I urn ber Cause of ignition Factors Conitributing to Ignition 1 (NN)-Nate Human Factors Contributing to Ignition (IQ-None bLAgeof Person involved Gender of Person involved $s EQUI MENT Equipment involved in Ignition (123)-Ar"ABCO,iftuert/stove Equipment Power Source Equipment Portability (41)-Wood,papa (2)-Stadomy Brand Model Serial Number Year PRINTED ON 8/2/2023 AT 10:33 AM INCIDINT 22•SF3060 • 6 OF 8 • Central Mason Fire and EMS eI STRUCTURE Structure Type (2)-Fixed portable or mobile structure Stories Above Grade StoriesBNowGrade Building Status 1 0 (2)•In normal use Length Width Total Square Feet Storyof Fife Origin 40 ft Is R 600 sq ft 1 Fire Sprean (2)-Confined to room of origin Item Contributing Most to Flame Spread Type of Materlal Number of Seorfes with Detnap Minor Damage Significant Damage Heavy Damage Extreme Damage Total Stories T PROTECTIVE SYSTEMS Presence of Detector Detector Type N)-Undetermined Power Supply Detector Operations Effect ivenes(/Fai 1 ure Reason) Presence of Auto Extinguishing System System Type (N)-None Present Operat,en aofSpriniders Reason for System Failure •. Investigation ® AGENCY REFERRED TO Phone Number rr'crr ORI FID FDID QI CASE INFO Case Status Avali.of Material First Ignited Property Ownership (2)-Investigation dosed (2)-Available at scene (t)•hivate Laboratories Used (N)-None Initial Observations (3)•Doors locked PRINTED ON 8/2/2023 AT 10:33 AM INCIDENT 22-5F3060 7 OF 8 • . Central Mason Fire and EMS �1 CASE INFO Other Inveolgative Info ® INVESTIGATION INFO Entry Mmhc c Extent of fire Involvement on Arrtvg Incendiary Device Container Incendiary Device Witlon Deitch IrKsndlary Devcee Fuel INVESTIGATION REMARKS T PRINTED ON 8/2/2023 AT 10:33 AM INCIDENT 22-SF3060 • 8 OF 8 PeCm�l�1IFTrA�U(� MASON COUNTY COMMUNITY DEVELOPMENT V 21 023 Permit Assistance Center,Building,Planning 615 W. hiLlt✓r Street BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: MICHAEL LAMONT NAME: LEXUS CONTRACTING GROUP LLC CZ MAILING ADDRESS: 5171 E STATE ROUTE 3 MAILING ADDRESS: 122D7 NE 8TH ST Z CITY: SHELTON STATE: WA ZIP: 9e584 CITY: BELLEVYE STATE: WA ZIP: 98005 PHONE#1: 907-450-9248 PHONE:425-T70.7918 CELL: 425-770-7919 PHONE#2: EMAIL: LEXUSCONTRACTING.OFRCWMAILCOM f EMAIL: MICHAELLAMONT@AK-GRAVEL.COM L&I REG# LEXUSCG775JR EXP.p4/1925 ��e PRIMARY CONTACT: OWNER❑ CONTRACTOR❑+ OTHER❑ „�,� NAME DON HERBERT EMAIL DON@LCG4.LC.COM REBUILD MAILING ADDRESS 12207 NE STH STREET CITY BELLEVUE STATE WA ZIP 98005 PHONE 426-770-9872 CELL 425-770-9872 cc PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 32135-43-0005o ZONING LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT SITE ADDRESS 5171 ESTATE ROUTE 3 CITY SHELTON DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO❑ SNOW LOAD:_-psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkall that apply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) RESIDENTIAL HOME IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS --9� NUMBER OF BATHROOMS. HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s]of Bldg)❑ NO❑ DESCRIBE WORK REPLACING MODULAR HOME WITH NEW BUILD DUE TO FIRE SQUARE FOOTAGE:(proposed) 1ST FLOOR.J800 sq.ft. 2ND FLOOR sq.ft 3RD FLOOR sq.& BASEMENT sq.ft. DECK sq.& COVERED DECK(iIb sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE sq.& Attached❑ Detached❑ CARPORT sq.& Attached❑ Detached❑ MANUFACT *4 COPIES OF THE FLOOR PLAN REQUIRED* MODEL 7n;� BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑� EXISTING❑ PLUMBING IN STRUCTURE? YES' NO❑ If yes,attach completed Water Adequacy Form PER[METERNOUNDATION RAINS PROPOSED? YESX NO[] EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS�_ TOTAL BEDROOMS OWNER acknowledges that submissl 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 owner and 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 n ssary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that t ' formation provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and s ection. This permit/application becomes null&void 9 work or authorized construction is not commenced within 180 days or if construction work is u ended for a period of 180 days. PROOF OF O TION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT P OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) X Signa O (Must be signed by the OWNER) T `Date DEPAR NTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT L PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH Permit No: (. �Z3 -jet . MASON COUNTY COMMUNITY DEVELOPMENT IMFPermitAssistance Center, Building,Planning PLUMBING & MECHANICAL PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: MICHAEL LAMONT NAME: LEXUS CONTRACTING GROUP LLC MAILING ADDRESS: 5171 ESTATE ROUTE 3 MAILING ADDRESS: 12207 NE 8TH STREET CITY: SHELTON STATE: wA ZIP: 98005 CITY: BELLEVUE STATE: wA ZIP: 98005 1st PHONE: 907-450-9248 PHONE: 425-770-7919 CELL: 425-770-7919 2nd PHONE: EMAIL, : LEXUSCONTRACTING.OFFICE@GMAIL.COM EMAIL: MICHAEL.LAMONT AK-GRAVEL.COM L&I REG# LEXUSCG775JR EXP. o4 /19 / 25 PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number):32135-43-00050 Zoning: LEGAL DESCRIPTION(Abbreviated): SITE ADDRESS:5171 E State Route 3,Shelton WA 98584 CITY: SHELTON DIRECTIONS TO SITE ADDRESS: TYPE OF JOB: NEW F- ADD=ALT=REPAIR=OTHER=USE OF BUILDING LOCATION OF FIXTURES/UNITS—1 ST FLOOR=2ND FLOOR=BASEMENT=GARAGE=OTHER > PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UN Type of Fixture No.of Fixtures Fees Fuel Type:Electri PG=Natural Gas=Ductless= Toilets Tie of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heat Pump Showers �r� Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove $• Dishwasher �— Kitchen Exhaust Hood Hose bibs far— Dryer Vent 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. 1 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 Signature of Owner Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT Z 6c' /(.Z PLANNING DEPARTMENT FIRE MARSHAL Rev:1/27/2016 1BN