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Home My WebLink AboutBLD2001-00429 Final SFR - BLD Permit / Conditions - 11/21/2001 5-q6o 73 nspection Line (360)427-7262 E MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352 Mason County Bldg. 3 426 W. Cedar P. . Box 186 Shelton, WA 98584 i 3cn c 1 e, L.0 b- P►"-8 T/2 -� RESIDENTIAL BUILDING PERMIT BLD2001-00429 ` OWNER: JAME IOVINELLI 360-308-0111 CONTRACTOR: ADAI HOMES RECEIVED: 05/09/2001 SITE ADDRESS: YA ISSUED: 06/19/2001 PARCEL NUMBER: 322027590073 EXPIRES: 12/19/2001 LEGAL DESCRIPTION: TR G-3 OF SP#2377 SEE SURV 3/6 PROJECT DESCRIPTION: DIRECTIONS TO SITE: RESIDENCE, ADAIR HOMES STOCK PLAN 101 TO FIRST SHELTON EXIT TURN RIGHT, TURN LEFT ON BELFAIR HWY, NORTH SHORE RD LEFT, DEWATTO LEFT, NE TEELAKE RD, RIGHT SITE ON RIGHT General Information Construction & Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: V-N Type of Use: SF Insp. Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck: 24 Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building:1,920 Valuation: $100,494 Building Height: 17 Occ. Status: Basement: Manufactured Home Information Setback Information Shoreline & Planning Information Make Length: Ft. Front: S 180.0 Ft. Shoreline: Ft. Water Body: Rear: N 25.0 Ft. Sloe Ft. SEPA?: Model: Width: Ft. p Shoreline Desi Side 1: W 115.0 Ft. g•° Year: Serial No.: Side 2: E 15.0 Ft. Comp. Plan Desi .: Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Ventilation Fan 4 Plan Check Fee KLW 05/09/200 $47.00 56230 Hosebibs 4 Dryer Vent 1 Building State Fee MEC 05/16/200 $4.50 56584 Kitchen Sink 1 Building Permit Fee MEC 05/16/200 $999.35 56584 Lavatories 2 Mechanical Fee MEC 05/16/200 $36.25 56584 Water Closets (Toilets) 2 Mechanical Base Fee MEC 05/16/200 $23.50 56584 Water Heaters 1 Plumbing Fee MEC 05/16/200 $75.00 56584 Bath Tubs 2 Plumbing Base Fee MEC 05/16/200 $20.00 56584 Clothes Washer 1 EH Plan Review CEW 06/12/200 $50.00 56584 Planning Site Inspection SAL 06/13/200 $70.00 56584 Special inspection SAL 06/13/200 $70.00 56584 Total $1,395.60 BLD2001-00429 Please refer to the following pages for conditions of this permit. 1 of 3 CASE NOTES FOR BLD2001-00429 i CONDITIONS FOR BLD2001-00429 1) Approved per dimensions and setbacks on submitted site plan. X Ail2) 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 in the amount of$47.00 per hour(minimum 1 hour) will be charged and must be collected by the Building M ment prior to any further inspections being performed or approvals granted. X 3) In accordance with the Uniform Building Code, all sites shall have approved numbers or addresses located in such a position as to be plainly visible and legible from the street or road fronting the property. 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 jurisdiction and the Uniform Building Code will be assessed if the owner and/or contractor fail to post the address on site prior to requesting inspections. X 4/ ivy 4) The plan review check list and corrections, along with the Energy Compliance Worksheet (when applicable) 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 of approved documents will result in failure of required building inspections. X 5) All construction must meet or exceed all local ordinances and the 1997 Uniform Building Code 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 occupanky yypuld result in permit revocation. X 6) Proposed structure or portions thereof with an prR. t* over 30" in height from grade line, must maintain a 5' separation distance between adjacent structures and that furthest projection. X_ t�"1/_ 7) All changes to "approved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance, tegulation, must be reviewed and approved by Mason County prior to construction. X1/` BLD2001-00429 Please refer to the following pages for conditions of this permit. 2 of 3 8) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance _ y with the Uniform Codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspectors II made prior to requesting additional inspections. ' X _ ,L 9) All property lines shall be clearly identified at the time of foundation inspection. X_ A-4 10) 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 Xn-co plia with Mason County ordinances and building regulations. 11) 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 h X der ave prevented action from being taken. No more than one extension may be granted. 12) Water quality is not to be degraded to the detriment of the aquatic environment as a result of this project. X 13) 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_�, nit YP 14) The Washington State Clean Air Act prohibits the burning of any construction or demolition debris in an outdoor fire. KIl 15) A minimum 25 foot building setback will be maintained from the existing wetland, a minimum 15 fo natural vegetated buffer will be reestablished around the wetland and the mitigation plan submitted will be implemented immediately. X 16) This application is subject to Buffer and Landscaping requirements as established under Mason County Ordinance 1.03.036.X 17) Proposed structure or any portion thereof greater than 30" in height fr de line, must maintain a minimum of 5' setback from all property lines, easements and 10' from all County and State Road right of ways. X -1 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 buildin can b o cupied. OWNER AGENT: /1"Q DATE: v BLD2001-00429 Please refer to the following pages for conditions of this permit. 3 of 3 E MECHANICAL MOBILE HOME ! FcotlW,15-Setback date Fbbbons date by Gas Piping data by Fal:::tatkxt Walls date Set UP rste by INSULATION date by ,BG/SLAB Insulation Fk>ors Final date by date by / lZ date by FRAMING FIRE DEPT. date 2, G� by �Z Walls date by _car f1 PLUMBING date �l by Attic OTHER Groundwork date by date by D.W.V. WALLBOARD NAILING � date —/ '�� by date e--/ ' / by Tel Water Line FINAL INSPECTION date by date �� _ _p by T�42 date by LV O � Awf:,%(2E OF SIC-,, ffJ514 FN(;�P '-A 4t- 7 LA. PU 'COP IC)\)MaLL\ 1763 Cop,?,z,-t u , 1 322oZ 7 C1001 i c- --70 3b 10 7-7. r- j ++ `- i y N Cr C) Lo k-0 (7- o L R C), 6. SEPTIC, TANK cl 4D Olt C:F 18-7 ?1-07 -PLM4 FOR: 11(o'J 0 R QS F-T T)P, ff(IRMATKIR UP THIS PLO] PLAP 4kS BEEN PROVIULU AND REVIEVIED RY THE PROPERTY OWNEFOYHO,FY SIGNING BELOW:1.1 ACKNOWLEDGES AND AOCEM FULL RESPONSIBILITY FOR ITS ACCURACY AND COMPLETENESS:2.)IS RESPONSIBLE IC'ENSURE THAT THE (00) o I I I IMPROVEMENTS TO TH ITF TAKE PlJCE IN CONFORMANCE WITH THIS PLAN:3.)WILL STAB H All I HE CORNER IRONS,LOI LINES AND CODE E REQUIRED SET ACK EQUIRED OF THIS P"OVERTY ANY CHANGE(S)TO I HI'- PLAN UST B PR PROVED 6 Y THE CV-A"FROMENTAL AGENCIES WITH TEP- L f\V- JURIS CTIO. TH ORTGAGE LENDER AND TI-I F CONTRACTOR AND -BF-L-v-p"jk 1-'J\ DOC EN#D. OWNER, DATE WF—R SATE Lp 0 3b EX 15 T I N& 0 In C T L R, 7ANK;r, APPR`OVED 3- MANN BUILDING INSPECTOR CHANGES SUBJECT TO A 0 AL -Vf I 22 DATE CHANCES 7;,R'0A 1 SUBMIT CHANGES FOR APPROVAL PRIOR TO Pll_'1 VVORK THESE PLANS MUST BE ON THE JOB SITE FOR INSPECTION. I--," Ix) 2 tom- -PL-At-A Fop", V)Q_ THIt ff(10111010N OV.I HIS 110 1 PLRPHAS REEN PROVIULumC RENIIEVIED By fHE PROPERTY OVINFP kYllo,l'Y SIGNING BELOW:1.) XKNOWLEDGES AND AMMSFULL RESPONSKRILITYFOR ITS ACCURACY AND COMPLETENESS:2.)IS RES M- NSIDLE"C,ENSURE THAT THE IMPROVEMENTS TO TH -SIT,' TAKE PUIXE IN CONFORMAPJCE'AfITH MIS 17 E N� PLAN:3.)WILL�STAB H Al-I I HE CORNER IRONS,LOT LINES AND CODI REQUIRED SETBACK [')UIR100r_-jIjISp,-()[,rRT)' ANY CHANGE(S)T(�)HI'- 7 1 L-rn v'_�L PLAN MUST PT PR 'FR�'VE0 C I HE(".111 y .1-10NIENTAL 11GEPCIES WITH UIs RS CTION,TH iORTGi-%[ LENDIR�jll)TI-If CONTRACTOR AND F_ C E D. OWNER DATE DATE f w WATTSUN 5 . 5 COMPLIANCE REPORT 04/30/96 FILE: C: \\WATTSUN5\\1920-96 .WS HOUSE ID: -------------------------------------------------------------------------------- -------------------r------1-�,-�--------------------------------------(------{----------- Site : �(�( I�� LLB u ""1l '"-� Ck Analyst : ��a�I l l I,n() I t M Jurisdiction: ��,/ � �� ► 1 IYlC, Utility: Homeowner: Jo-m ovk e'-\�\ House Type : Single Family Floor Area: 1920 ft2 (30) 3U�5-G�\ t Builder: ADAIR HOMES INC Weather Data: Portland, OR 2303 93RD AVE SW Climate Zone : 1 ( OLYMPIA WA 98512-9156 ------------------------------------------------------------------------------ The PROPOSED design *COMPLIES* with REFERENCE PROPOSED COMPONENT PERFORMANCE 320 310 Btu/hr-F ENERGY BUDGET *** *** kWh/ft2-yr ------------------------------------------------------------------------------ ------------------------------------------------------------------------------ REFERENCE DESIGN Reference Component Value X Area = UA ------------------------------------------------------------------------------ Floor U-0 . 029 1920 55 . 7 Glazing @15o U-0 .400 288 . 0 115 . 2 Doors U-0 . 200 56 . 0 11 . 9 AG Wall U-0 . 058 1338 77 . 6 Ceiling, Attic U-0 . 031 1920 59 .5 Infiltration ACH-0 .350 14784ft3 ( 94 . 7) ---------------------------- Reference UA 320 -------------------------------------------------------------------------------- PROPOSED DESIGN COMPONENTS Component Description Value X Area = UA ------------------------------------------------------------------------------ Floor R19 vented Joist 16oc U-0 . 041 1920 78 . 7 Glazing @11% **NW WINDOW VINYL W/ARGON U-0 .400 179 . 0 71 . 6 **NW WINDOW SGD-VINYL-LOW E U-0 .400 40 . 8 16 . 3 Doors **STANLEY METAL FLUSH 1/2 LITE U-0 .240 18 . 0 4 . 3 **STANLEY METAL PANEL U-0 .240 20 . 0 4 . 8 **STANLEY FLUSH FIRE DOOR/ METAL U-0 . 220 18 . 0 4 . 0 AG Wall **R-19 + R-4 FOAM BAORD T-111 U-0 . 050 1406 70 . 3 Ceiling R38 blown Attic STD baffled U-0 . 031 1920 59 .5 Infiltration Standard Air Sealing ACH-0 . 350 14784ft3 ( 94 . 7) ---------------------------- Proposed UA 310 Struc Mass Light Frame, Sheetrock walls M- 3 .000 1920 5760 -------------------------------------------------------------------------------- I -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- WATTSUN 5 . 5 COMPLIANCE REPORT 04/30/96 FILE: C: \\WATTSUN5\\1920-96 .WS HOUSE ID: ------------------------------------------------------------------------ HEATING/COOLING/VENTILATING SYSTEMS PROPOSED Heating System Type : Electric : Zoned System Efficiency: 100 Modified Efficiency: 100 s Design ACH: 0 . 60 Design Load(at 47F dt) : 22178 Btu/hr Total Load: 22178 Btu/hr System Size (Output) : 9 .5 kW (150%) Average Annual Heat : *** kWh Annual Cost : $ *** Ventilation System: Integrated Spot & Whole House Cooling System: NONE SEER: 0 . 0 ( ) Cooling Load (at 8F dt) : Btu/hr System Size ($Over) : tons (@125%) Annual Cool Requirement : kWh/yr Solar Access : Partially Shaded -------------------------------------------------------- - ZING ORIENTATION PROPOSED PROPOSED South ***ft2 North ***ft2 Southeast *** Northwest *** East *** West *** Northeast *** Southwest *** Eff S Glz : ***% -------------------------------------------------------------------------------- 1991 WASHINGTON STATE ENERGY CODE AND VENTILATION AND INDOOR AIR QUALITY SINGLE FAMILY RESIDENTIAL APPLICATION Site dress X x �� l 1? Parcel #��7 C.O�_j Lot r Subdivision _ ]New Residence [ ]Addition [ ]Remodel Area (sq. ft.): 1 st Story 2nd Story Basement Compliance Method [ ]Prescriptive -- Indicate option (see attached sheet) [ )I ( )II [ jIII [ jrV [ IV [ IVI [ IVII [ IVIII -- Attach[ ]Component documentation and calculations [ ]Systems Analysis -- Attach documentation and calculations Heat System Wlectric (Electric Resistance) [ ]Forced Air [ ]Wall Heater [ ]Other (indiUle) [ ]Baseboard [ ]Radiant Make Model Size (KW) (�JOtt�r [ ]Gas ce ( ]Oil Furnace [ ]Heat Pump ( ]Other (ind;.ls) Make Model Size (BTU) AFUE HSPF Ventilation System [ ]Non-Heat Recovery Ventilation [ ]Spot and Whole House ]Central al Ducted Irate rate[ J g d with Furnace Whole House Fan: Make Model Size (CFM) •[ ]Heat Recovery Ventilation [ ]Air to Air Heat Exchanger [ ]Heat Recovery Heat Pump Make Model Size Attach 1) Window Schedule 2) Heat Loss Calculations Radon A three=rnonth etched track radon'monitor will be provided (by builder). ACKNOWLEDGE: (buiWeeo signalum) MASON COUNTY BUILDING DEPARTMENT WINDOW SCIILDUL� WINDOWS (group same size windows on one line) How Brand Model U-Value Many Size Area (Sq. Ft.) f TOTAL WINDOW AREA (A) SKYLIGHTS How Brand Model U-Value • Many Size Area (Sq. Ft.) TOTAL SKYLIGHT AREA (g) TOTAL GLAZING AREA (add A+B) (C) DOORS (from heated space to unhealed space) How Brand Model U-Value Man Size Area S . Ft. TOTAL DOOR AREA 1 ADAIR HOMES INC. SINCE 1969 BEAVERTON 1111 SW 170 May 3, 2001 AVE. BEAVERTON.OR.97006-4220 SALES (503) 645-3547 Lj CONST (503) 645-1156 Mason County Building Dept h AY 4 2C01 FAX (503) 645-5986 PO Box 186 BEND Sh6hon WA 98584 li:. ' 00MM I111TY NVELOPM"T 63309 NELS ANDERSON RD. BEND, OR 97701-5743 SALES (541) 382-4068 Dear Otkia.l, CONST (541) 382-6924 1; FAX (541) 382-8989 OLYMPIA Pleasrrd enclosed a building permit application for James Iovinelli. He will be building a 1920 sq$home at=Tee Lake Pines Rd, Belfair, 2303 93RD AVE. SW WA. Enclosed are three sets of blueprints,plan check fee of$47.00, strip A, WA98512-9156 SALES (360) 352-85 71 map to site, approved septic design, adequacy f0�Plot plan, form ' CONST (360) 352-7641 and wattsun report. FAX (360) 943-0701 MEDFORD If I have forgotten anything or if your requirements have changed,please 541 B U S I N E S PARK DR. notify me at (360) 352-7641. SUITE A MEDFORD, OR 97504-4191 :7777 very our time and assistance. SALES (541) 732-1560 CONST (541) 774-8995 FAX (541) 774-8 847 '� �(CJ� � CALDWELL 1904 E. CHICAGO ST. Sarah Marshall SUITE C Administrative Assistant CALDWELL, ID 83606 Adair Homes Inc. BUS (208) 459-8274 FAX (208) 459-8289 BUSINESS CENTER 1111 SW 170- AVE. BEAVERTON,OR 97006-4220 PHONE (503) 645-4730 FAX (503) 645-9715 OR CCB# 593 WA # ADAIR H# 262RZ 'tiS0t1Ai u� F s ti r�Mlf[I f At4 AAA PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION �h 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICAM NFO MATT N CONTRACTOR I FORMATION Owner Contractor Name c cl- Mailin ddress Mailin ddress City State ip Code City State Zip Code Phone d II I Other P Ph.( &2D ) F - - Other Ph. Lien/Title Holder a Contractor Reg. # . RZ Address x Expiration L� SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic iL Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Fire District L Legal Description Site Address(Pleas i ude str et nam , stree numbey qnd cit Direc ions to sit ~�O (tri fx ` t I t Will timber be cut and sold 16 parcel preparation? (Yes/No) G 9h 1-tc; CK 090 Is your property within 200' of the following: Body of Water (Name) /V Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ 1TYPE OF JOB Ne Add Alt Repair Other Use of Building Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck QyO Other sq. ft. Garage_ � Attached Detached Carport Attached Detached MO IL OME INFORMATION-Make Model Model Year Leng Width Serial No. No. of Bedrooms No. of Bathrooms T e o Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer ame Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X- � ,f�J Date r OR OFFICIAL USE BEYOND THIS POINT Accepted by bat 'O/Submittal Amount Due Receipt 1\10'4—j DEPARTMENTAL REVI W APPROVED DENIED CONDITION CQp S Building Department Occ Group - 'Type Constr. Planning Department Environmental Health Department Public Works Department i Fire Marshal Valuation $ no,LACA40,0 FEES Building Permit Fee aS Site Inspection Plan Review Fee 00 EH Review Fee Plumbing&Base Fee �0 Planning Review Fee Mechanical&Base Fee 3G.a5 Ct ab Other Wood/Gas/Pellet Stove Fee State Fee 50 Violation Fee Pre-Paid at Submittal 06 ) TOTAL FEES MASON COUNTY PERMIT NO.: PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair(360)275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICA T R�Q�T ) CONTRACTOR INE,O�,,NLATION _ Owner J--r �fhl Contractor Namely V J 17e Malin A�dres p Maylirtg' �res� :> L° City1��f `bState Zi Code C i t V State ZipCode Phone OtheIPh. Ph. Other Ph. : Lien/Title Holder ' Contractor Re # / ►' tt7 Address aUCX Expiration / / Ulf SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMAT N-12 digit Tax Parcel No. Fire District Legal Description I�- Site Address(Please inclu stre r e�,str�get. u er and cit Qir�e ions to site 0� � % �-+' tffl" L� 1 .. .. Is your property within 200' of the following: Body of Water (Name) N`> Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New 1% Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No. of Units Fees Bath Basins Furnace Bath Tubs Heatpumps Showers i Vent Fans Water Heater — Propane Tank Laundry Wsher�— Gas Outlets Sinks Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other �-4�._ Other _ I_ Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X N_ Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTM€NTAtiiREIItEW:; :::. RPPROVQ; D1^NIEt} :??' CONDITIQM :' Building Department Occ Group Type Constr. Planning Department Other Other £ES Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES