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Home My WebLink AboutBLD2014-00575 MFG Home - BLD Permit / Conditions - 8/11/2014 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 279 04 Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2014-00575 OWNER: ROBERT FRIZZELL RECEIVED: 6/25/2014 CONTRACTOR: LICENSE: EXP: ISSUED: 8/11/2014 SITE ADDRESS: 31 SE HAYES WY SHELTON EXPIRES: 2/11/2015 PARCEL NUMBER: 319023490090 LEGAL DESCRIPTION: TR 9 OF SE SW TR D OF SP#633 PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW MFG HOME SE ST RT 3, L ON CRAIG RD, L ON COLE RD, L ON LYNCH RD, R ON ROUNDTREE WY, GRAVEL RD JUST PAST GENIE'S. RD WILL TURN TO THE LEFT, STAY STRAIGHT, AROUND THE FIELD, FIRST DR ON THE LEFT General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 4 Type of Constr.: VB Type of Use: SF Insp.Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck: Type of Work: NEW Fire Dist.: 4 No. of Stories: Occ. Load: Building: Valuation: Building Height: Occ. Status: Unknown Basement: Manufactured Home Information Setback Information Shoreline&Planning Information Make:SKYLINE Length: 68 Ft. Front: N 100.0 Ft. Shoreline: Ft. Water Body: na Rear: S 200.0 Ft. Slope: Ft. SEPA?: No Model:1281 CT Width: 27 Ft. Side 1: E 130.0 Ft. Shoreline Desig.: Not Applicable Year:2012 Serial No.: 2F91-0149-E Side 2: W 55.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Manufact. Home Submittal GMM 6/25/2014 $264.25 S1201400000001 Planning Review Fee GMM 6/25/2014 $205.00 S1201400000001 EH Plan Review MRB 6/25/2014 $200.00 S7201400000001 Manufact. Home Issuance MAU 7/24/2014 $264.25 S2201400000001 Total $933.50 BLD2014-00575 Please refer to the following pages for conditions of this permit. Page 1 of 5 CASE NOTES FOR BLD2014-00575 CONDITIONS FOR BLD2014-00575 1) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. A. Drainfield/ Reserve requires a 1 Oft setback from all footing/foundations. B. Septic tank(s) requires 5ft setback from all footing/foundations. C. No foundation drains within 30ft, down gradient of drainfield/reserve area. X (_ 2) On-site septic system final installation required prior to temporary/final occupancy. 3) 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. The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X JL_ F_ 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 any further inspections being performed or approvals granted. X �L-� F 5) Owner/Agent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 4:�- F- 6) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, FIRM-NATIVE SOIL. X o�� 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 installed. certification number and signature of the certified installer responsible for each major part of the installation. WAC365-210 X ' r BLD2014-00575 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 .National contact the�Offfice of Manufacturing Housing (360) 725-2800. x r 9) 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 revgcatE.' X �� 10) This permit is for the placement and installation of the manufactured home only and does not imply approval or review for any other items indidcated on the plot plan. X � 11) Permanent Address must be posted and visible from the road Deck must be safe and meet code for year building permit was issued. Rebuilt decks are required to meet current code. All guardrails and handrails must be in good condition and meet code for year built or current code if replaced. Skirting must be vented 1:150 and backfill sloped away from unit 2%for a minimum of 5' around the perimeter of the unit Gutters and downspouts must be installed with splash blocks provided All exterior penetrations must be sealed HWT Pressure relief line and dryer vent must exit skirting a minimum of 6"with a maximum of 24" above grade. The unit shall have a minimum of 16"x24" crawl space access provided HOWEVER, if the unit has not received a set up inspection and is skirted, 4 panels centrally located (one on each side of unit) shall be removed by the owner/applicant prior to requesting the inspection. All conditions on the original or issued permit must be met If the unit was installed by a WAINS certified installer/contractor since July 1, 2003, CTED Installer Tags must be available It shall be the responsibility of the person requesting the inspection to provide the manufacturer specifications, ANSI Standards or approved engineered design for the installation of the unit and have them available on site for inspection. Each inspection required will be assessed a fee as adopted under Mason County current fee schedule. Re-Inspection fees will be assessed each time an inspection is requested and required items are not completed prior to the inspection being performed ENFORCEMENT PROVISION: Any manufactured/mobile home and/or appurtenant structures found non-compliant with any county or state regulation are subject to enforcement action and subsequent violation and penalties pursuant to the Mason County Code. X BLD2014-00575 Please refer to the following pages for conditions of this permit. Page 3 of 5 12) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordinance or regulation, must be reviewed and approved by Mason County prior to construction. XC 13) 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 made prior to requesting additional inspections. X � 14) 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 ma the installation instructions. r d i X F 15) All property lines shall be clearly identified at the time of foundation inspection. X 1 16) 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 County ordinances and building regulations. X �' 'F 17) 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 have prevented action from being taken. No more than one extension may be granted. X 18) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors, and flashing. Install metal connectors approved for contact with the new types of pressure treated material. X IP7 19) Landings and stairs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Approved Site Plan"to ensure these structures are shown and meet the setback conditions listed. X p- 20) Prior to final approval, all upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X F- 21) Approvedper dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X BLD2014-00575 Please refer to the following pages for conditions of this permit. Page 4 of 5 22) 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 OR ROAD WAY. X 1� 23) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure these structures meet the setback conditions listed. X lii7 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. Signature Date 121 OWNER - REPRESENTATIVE - CONTRACTOR Print Name (Circle one to indicate) BLD2014-00575 Please refer to the following pages for conditions of this permit. Page 5 of 5 -- ---- tL i �{ - - ll r -Al rAm - - - - - - fR6M�+FE f�RTHE� __ - - -- - �------�-- - ---- ZED -- - ------ -- -- ----- -- - -r--'- -- -- -- ---- --- -PLA -N.,, fcOUl'.E 3 TO BE ON SITE_ �.0 _ C; �« r S� t�T TO APPRb�lAG 4. fi.W .:CEDAR S� i -�----- — 'elf '— ----------------_.------ - -- -- RECEIVED JUL 2 2 2014 ElffRBIT A BLA# ' W CEf?AR ST Page 8 of 8 PART OF THE SOUTHEAST QUARTER SOUTHWEST QUARTER PLANN114G SEC. 2, TWP. 19 N., R. 3 W., W M., MASON COUNTY, WASHDVGTON 8R. L yNC� R� BASIS OF BEARING: SURVEY FILED IN VOLUME 22, PAGE 62, RECORDS OF MASON CO. WASHINGTON HA YES WAY GRAPHIC SCALE L10 a ,00 Zoo 400 31 IS E r r IN FEET ) `D 1 inch = 200 ft. NO' SW CDR. SE COR. TRACT D A TRACT D S88'15'42"W BLA FOR: L13 6 _L_1_2 143.31' HILLSIDE FOUR D'S LLC OLD LINE L2 i L1 SHELTON. WA. 98584 o i N w; 3 , Z Resultant Lot Sizes: �" : Ln o 1 = 3.68 Acres m L4 2 = 5.24 Acres 'r o ZE ::;E ►� ;' 3 = 1.04 Acres m '- 4 `- 0° g z w 00 �,, rn m 5 � � 2 SE `NCH RD :11 o ca TO v, L 14 L7 EE N88'15'42"E 379.46' ^� NEW LINE Z LANE ® G RAGE w o rn A SW COR. APN 319023400031 0 SE si HOUSE NO v 3 2 1224.70' 627.00' 11 10 N88'15'42"E N88'15'42"E DRAIN FIELD TO LINE TABLE �-BE ABANDONED LINE LENGTH BEARING LEGEND L1 82.81 S88*15'42"W O FOUND 5/8" REBAR AND CAP."NORRIS LS L2 60.50 S88'15'42"W 11918" PER SURVEYS FILED IN VOL. 22, L3 136.13 NOi 44'18"W PAGE 62 AND VOL. 26, PG. 43 L4 82.81 S88'15'42"W O FOUND SIMPSON TIMBER HEXAGON MON. L5 136.13 N0144'18"W L6 182.30 N0144'18"W ® EXIS77NG SPRING-WATER SOURCE L7 141.18 N88-15.42-E L8 318.44 SO2'07'19'E * - APN 319023400040 L9 347.51 NO2 07'19"W —— ——= OLD LINES L10 242.71 S88'12'11"W L 11 347.28 N023010"W L12 240.40 N881542"E L13 25a69 S88'15'42"W DATE APPROVED: 1�71�i A 70f f A in I Ur- 14XU 95 c ------------ L -Cs -7-7f Al >7A-- A I ro�un'v Dept Heiafth m6sok n�-J—L-- _7 -Y Ji 4- L -L-j -4- -71 -t-.Ali Li +7nl L L Planner: race A Ian Rebecca PLANNING MASON COUNTY PLANNING INTAKE CHECKJJST Owners Name: b I Date: 7-22-Zo► Project: YIE m Commercial ?: yes no Site Plan: , 2-North Arrow Property Dimensions: Q442, x L.0 La 5 Irregular Shape ? yes no - Streets and Driveways shown 1-0 Road Frontage Name: - All Existing Structures Shown ith setbacks and use. Identified Surface water(streams,ponds, shoreline,wetlands,natural/historic drainage, defined drainage) ,2r'foPography (slopes) SI►,jL - zslo�e unni n npeA um Structure Setbacks (direction/setback): F: n /Ljo R- ts _/off Sl E / 1-30 S2lc) / 55 ,,-tl Utility and Drainage Easements: yes no (if yes enter condition#5022) tether Easements ,, 'Accessory Appurtenances: propa;Xtank/ Heat�ump .i Does site plan show landings a all exits ? �jariance applied for: yes no Parking spaces allotted: yes no ,2-r—ounty Access Permit Needed (add condition#0010) ,�a'State Access Permit needed (add condition#0020�z ❑ Standard Planning conditions: #5019 and #700 ❑ Are there any impediments (dogs/gates) that may restrict access to your site? yes(:no:) ❑ If yes, do we need appo' es no ❑ Is site clearly marked? Addre s Name Other UGA'S ALLYN/BELFADUSHELTON Rural LAND DESIGNATIONS GC PF R-1 R-1P RC 1 RR 25 AGRICULTURAL POS FR R-2 R-IR RC 2 jkR 5 LTCFL BI GC-CI R 3 RI RC 3 RR 10 IN-HOLDING HC LTA E R-5 RT RMF RR 20 TRIBAL D T mu I R 10 RT/RTC RNR 71 2014 MHP BP i VC RAC NR 426 W CEDAR S Critical Areas: (streams,ponds, shoreline,wetlands &steep slopes) Shoreline Designation: �<N/A ❑ Urban ❑ Rural ❑ Conservancy ❑ Natural Water Body: SEPA: yes no unknown Flood Plain: yes no unknown Map # Aquifer Recharge: yes LO)unkno,,7,m Map# Tazs/Cases• RLC/SPI: n nn i 6 year Reforestation: yes eno Eagle Nest Tag: yes noOther/North Bay Sewer: yes MASON COUNTY RESIDENTIAL PLANS SUBMITTAL CHECKLIST Owner's Name: 6 bPJ1.T 'fT'I -2,- Date: 1•Z a-2.0 l 4 Reviewed By. Documents: n V 3uilding Permit Application Completed Stormwater Chec ✓Planning Intake Checklist Completed, j rte plan includes:Allowable building area,roof ov hangs,decks,etc. VFire Apparatus Access Road info required? Yes/ T�o _Energy Code Application Form-O Electric wall heater O Electric central furnace O LPG Furnace O Heat pump with electric furnace O Heat pump with LPG furnac O Boiler(heat type ) O Ductless Heat Pump i Other. Specify: 'I"�� M tc Pt hamcal/Plumbing Application-WATER HEATER FUEL TYPE/LOCATION ee o ow load. Seismic:_D2_ Stoc an-approv snow load: eismuc. 2 an actured Homes-4 FLO Foundation Type: ANS ethodC5 Engineered footing/foundation Basement Decks: Covered? ncovered er 4 x 6 d over 30"?LAA& ,Construction plans required. Cons tion PZ _ COMPLE ETS _Plans Legible _ ecognized Scale _Elevation _ rocs _Foundation Plan _Roof Framing Plan _Floor Plan-Use of rooms noted(all floors) _Floor Framing Plan-all floor levels including loft,crawlspace,etc. (<200 S.F. ??-stairs?) —Deck Framing Plan,incl cov.porch framing Plan Details: _Roof framing details,truss lay-out may be needed (Hip and girder location shown) _Wall Framing-Does bearing-wall height exceed 10'?(Engineering may be required) _Floor framing: Floor joists(size&spacing): ,Floor _Window headers. Typical header. er: _Foundation:footing size,reinforcement _Concrete Walls-Does Concrete Wall Height Exce Engineering may be required see details) _Landings at all exits?Less than 30"above ? Y/N _Heated By Furnace-Location OfFumace Fuel type: _Fireplace/Stove Informatio own-Fuel Type? Location(s): _Window Sizes M on Plans Braced anels(shear walls)marked on plans or lateral engineering? CO2NL\,fENTS: h EO W 64 ,,,,- ENGINEERING REQUIRED Braced wall panels/brace wall lines are not marked on plans(R602.10) Amount and location of bracing does not meet minimum required in Table R602.10.1 PUILDING DESIGN CRITERIA: All notes and details required as a result of theengineered analysis shall be transed onto propos building plans. W-md 85 MPH, Exposure B (unless proven otherwise). Seismic Zone: Snow_ps£ - ----IRREGULAR BUILDINGS R301:22:2.2------ --- - --- — - - - -- --- -- -- ---- - -._ .. .. Irregular portions of structures shall be designed in accordance with accepted engineering practice. A portion of a building shall be considered to be irregular when one or more of the following conditions occur: RECEIVED Y �D 1)Exterior braced wall line or BWP cantilevered or offset by more than 4' 2)Roof or floor is not laterally supported on all edges 2A)Portion of roof or floor extend more than 6 ft.beyond the braced wall line. JUL 2 2 2014 3)End of BWP extends more than 1 ft over an opening more than 8 ft in width below. 4)Opening in a floor or roof exceed the lesser of 12 ft.or 50%of the least floor or roof dimension. 426 W, CEDAR S1 5)Portions of floor level are offset vertically 6)Shear wall lines do not occur in two perpendicular directions. 7)When a story above grade is includes masonry or concrete construction(exc: fireplaces,chimneys,and veneer). When this applies the entire story shall be designed.In accordance with accepted engineering practice. HApermit tech building checklist.doc Revised 11-29-2007 MASON COUNTY PERMIT NO: )0 2Q14 DEPARTMENT OF COMMUNITY DEVELOPMENT s BUILDING•PLANNING• FIRE MARSHAL _ = WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 Mason County Bldg.III;426 West Cedar Street (360)275-4467 Belfair ext.352 T? rssa PO Box 279,Shelton,WA 95584 (360)482-5269 Elma ext.352 r&u BUILDING PERMIT APPLICATIOB U I L D I IV OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: !2�b�Y� �.; F-f az il NAME: MAILING ADDRESS: na MAILING ADDRESS: CITY: s L,t l -,. STATE: u A- ZIP: y ,� CITY: S T ZIP: PHONE: — CELL:_3 G D-Y4C�- 2)- PHONE: CELL: EMAIL: �,,�,=sFv;�z�tl ��,�.1 . `l r, EMAIL �- L&I REG EXP. PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) '3 j ej D 2_�,q 9 p0 9Ca FIRE DISTRICT 3 LEGAL DESCRIPTION(ABBREVIATED): SITE ADDRES S 31 -SE 142<,,, tJr n CITY DIRECTIONS TO SITE ADDRESS j k 1 p I Z v�n y� (�s�L IS PROPERTY WITHIN 200 FT: SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM❑ DOES PROPERTY HAVE SLOPE(S)WITHIN-00 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO TYPE OF JOB: NEW;< ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS Zj NUMBER OF BATHROOMS_ DESCRIBE WORK n El l) DYV i4orn e SQUARE GE: I LOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft BASEMENT sq.ft. ECK sq.ft- COVERED DECK sq.ft.STORAGE sq. OTHER sq.ft. GARAGE sq.ft. ATTACHED❑ DETACHED ❑ CARPORT sq.ft. A S ❑ DETACBEtJ ❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN MAKE S k,, ,.e- MODEL /Z,] CT- YEAR DLO 12 LENGTH r�_ WIDTH Z BEDROOMS y BATHS SERIAL NUMBER ;,r R 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. l 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 INVAL//II�DAT^E�THE APPLICATION. Signature of Applican Date X 17e-N +' > , ' OWNER/ REPRESENTATIVE /CONTRACTOR Print Name (CIRCLE TO INDICATE) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TA TM15N6 IbNS BUILDING DEPARTMENT PLANNING DEPARTMENT �� `-SoN coed - P MASON COUNTY PERMIT NO. j�LI DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING•PLANNING•FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 � Mason County Bldg. 1111426 West Cedar Street (360)275-4467 Belfair ext.352 PO Box 279,Shelton,WA 98584 (360)482-5269 Elma ext.352 r-4u BUILDING PERMIT APPLICATION P LA N N I OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: 2�io�,-��i��r:w F,-,`zzz i! NAME: MAILING ADDRESS: 7 o i Sr MAILING ADDRESS: CITY: Sl J-611 STATE: i,)A- ZIP: 9 6.5 g-/ CITY: ST ZIP: PHONE: CELL:3&o-LI9G-S'7J A PHONE: CELL: EMAIL: cie,n:'�F_--V-v;7zz1Jo1 •1 '1 c_.s; EMAIL. L&I REG EXP. PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) '3 i cj O 2 j q 9 OC7 9 Ca FIRE DISTRICT 3 LEGAL DESCRIPTION(ABBREVIATED): SITE ADDRESS 3 1 SE > � 142.,I,; cJA CITY DIRECTIONS TO SITE ADDRESS I J k Q, i d i l h (� IS PROPERTY WITHIN 200 FT: SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES[] NO ff TYPE OF JOB: NEW K ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(R-smENcE,GARAGE ETC.) IS USE: PRIMARY❑ SEASQNAL❑ NUMBER OF BEDROOMS L/ NUMBER OF BATHROOMS�2 DESCRIBE WORK n EAU m F6t 1-8 nn e SQUARE MOT21GE: 1 LOOR sq_ft. 2ND FLOOR sq.ft. 3RD FLOOR MENT sq.ft. ECK sq.ft. COVERED DECK sq.ft.STORAGE 7sq�. OTBER sq.ft.GARAGE sq.ft. ATTACHED ❑ DETACHED ❑ CARPORT SIgEIZ❑ DETACHED ❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN MAKE S l/ MODEL Z- ] C:T� YEAR 9.O 12 LENGTH r$,' WIDTH 2 BEDROOMS �/ BATHS 2 SERIAL NUMBER ;- FQ 1 O1 qcl-L 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 1 am the owner, owners legal representative, or contractor. l 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 o /> I , �L� . oJ`I Signature of Applican Date OWNER/ REPRESENTATIVE /CONTRACTOR Print Name (CIRCLE TO INDICATE) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS / 1F r f" BUILDING DEPARTMENT PLANNING DEPARTMENT S