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Home My WebLink AboutBLD2003-01596 Final SFR - BLD Permit / Conditions - 1/16/2008 Inspection Line(360)1127-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352 Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2003-01596 ' OWNER: JULIO FIORINI RECEIVED: 11/12/2003 CONTRACTOR: LICENSE: EXP: ISSUED: 12/22/2003 SITE ADDRESS: 3021 E MASON LAKE DR EAST GRAPEVIEW EXPIRES: 6/22/2004 PARCEL NUMBER: 222335200087 LEGAL DESCRIPTION: MADINGS SUNNY SHORE ADD#6 TR 87 EX A-B-C 3021 E MASON LAKE DR E GRAPEVIEW PROJECT DESCRIPTION: DIRECTIONS TO SITE: SFR HWY 3 TO MASON BENSON RD, TO MASON LAKE DR. RIGHT ON MASON LAKE DR, APPROX. 1 MILES ON RIGHT General Information Construction &Occupancy Information Square Footage Information No. of Bedrooms: 2 Type of Constr.: VN Type of Use: SF Insp.Area: No.of Bathrooms: 3 Occ. Group: R3 Lot Size: Deck: 1,195 Type of Work: NEW Fire Dist.: 5 No.of Stories: 1 Occ. Load: Building:1,389 Valuation: Building Height: Occ. Status: Seasonal Basement:1,002 cov porch 48 Manufactured Home Information Setback Information Shoreline&Planning Information Make: Length: Ft. Front: S 97.0 Ft. Shoreline: 64.0 Ft. Water Body: Rear: N 0.0 Ft. Slope: Ft. SEPA?: I Model: Width: Ft. Side 1: E 7.0 Ft. Shoreline Desig.: Urban Year: Serial No.: Side 2: W 7.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Dishwasher 1 Exhaust Hood 1 Planning Review Fee KS 11/12/200 $150.00 S12003 Hosebibs 4 Furnace<100K 1 Plan Check Fee KS 11/12/200 $685.98 S12003 Kitchen Sink 2 Ventilation Fan 4 Adjust Plan Check Fee DLC 11/21/200 $50.96 S22003 Laundry Tray 1 Heat Pump 1 Building State Fee DLC 11/21/200 $4.50 S22003 Lavatories 3 Dryer Vent 1 Building Permit Fee DLC 11/21/200$1,133.75 S22003 Water Closets (Toilets) 3 Mechanical Fee DLC 11/21/200 $72.35 S22003 Water Heaters 1 Mechanical Base Fee DLC 11/21/200 $23.50 S22003 Bath Tubs 3 Plumbing Fee DLC 11/21/200 $105.00 522003 Clothes Washer 1 Plumbing Base Fee DLC 11/21/200 $20.00 S22003 EH Plan Review CEW 12/5/2003 $75.00 S22003 Public Works Review AT 12/10/200 $39.22 S22003 Total $2,360.26 BLD2003-01596 Please referto the following pages for conditions of this permit. 1 of 5 CASE NOTES FOR BLD2003-01596 CONDITIONS FOR BLD2003-01596 1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There ar tential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-64 9 . The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 2) 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 De p a for 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 inspect io re-inspection fee based on rates as adopted by the jurisdiction and the Uniform Building Code will be assessed if the owner and/or cont ctoor 'I to post the address on site prior to requesting inspections. X 4) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be loc;ftbdd within 25' of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your pro ect. X 5) 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.Count—y ordina and building regulations. X BLD2003-01596 Please referto the following pages for conditions of this permit. 2 of 5 6) 1997 UBC Chapter 17, Section 1701. In addition to the inspections required by UBC Section 108, the owner or the engineer or architect of record acting ' as the owner's agent shall employ one or more special inspectors who shall provide inspections during construction on the types of work listed under UBC Section 1701.5. The special inspectors' duties & responsibilities shall be as specified in 1701.2 and 1701.3. Welding pegrfeymed on site shall be performed by a certified welder. The special inspection report shall be submitted to the Mason County Building Dept. prior to-thejrami inspection. X 7) 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 beanged or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans grrsit o e duration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. X L� 8) Washington State Energy Code Compliance has been approved using the following: Heat Type:_€ ctric or other fuels Compliance Method: IV Window (Max U-Factor):0.40 Skylight (Max U-Factor):0.58 Door yp -Factor):0.40 or less, Wall insulation R-21 , Floor insulation R-30 , Ceiling Insulation R-38, Vault Insulation R-30, Slab Insulation R-10 X 9) 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 do ments are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be char a be collected by the Building Department prior to any further inspections being performed or approvals granted. X 10) All construction must meet or exceed all local ordinances and the 1997 Uniform Building Code requirements as adopted and amended by Mason County and t to of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would r It p A-revocation. 11) All chang"'approved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance or re at own; m e reviewed and approved by Mason County prior to construction. X 12) The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the"rm Codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Ins p or made prior to requesting additional inspections. X 13) All property lines shall be clearly identified at the time of foundation inspection. X 14) 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 fopa p riod not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit /ad X 'hav pr ed action from being taken. No more than one extension may be granted. X �. BLD2003-01596 Please referto the following pages for conditions of this permit. 3 of 5 15) - Wate i ' nat to be degraded to the detriment of the aquatic environment as a result of this project. X 16) Proper erosion and sediment control practices must be used on the construction site and adjacent areas to prevent upland sediments from entering shoreline waters. Erosion control measures must be in place prior to any clearing, grading, or construction. These control measures must be effective to prevent soil from being carried into surface water by stormwater runoff. Sand, silt, and soil will damage aquatic habitat and are considered pollutants. Any discharge of sediment-laden runoff or other pollutapollutants to waters of the state is in violation of Chapter 90.48 RCW, Water Pollution Control, and WAC 173-201A, Water Quality Standards for Surface Waters of the State of Washington, and is subject to enforcement action. Any work in or adjacent to waterways that will adversely affect water quality must receive specific prior authorization from the Department of Ecology pursuant to WAC 173-201A-110. A short-term water quality standards modification may be issued if the proponent agrees to a number of specific construction practices and techniques designed to minimize water quality impacts. All areas disturbed or newly created by construction activities must be revegetated using bioen r' t niques, clean durable riprap, or some other equivalent type of protection against erosion when other measures are not practical. X 17) All upland areas disturbed or create by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X, 18) The proposed project must be consist I applicable policies and other provisions of the Shoreline Management Act, its rules, and the Mason County Shoreline Master Program.X 19) All construction and demolition debris must be removed from the beach after project completion. Pr I of construction debris must be on land in such a manner that debris cannot enter or cause water quality degredation of State waters. X 7 20) Temporary erosion control measures must be implemented to prevent water dility"I r dation of adjacent waters or wetlands. Silt fencing must be installed and maintained until upland vegetation has become established. X ' 21) Approve er dimensions and setbacks on submitted revised site plan. X 22) Pro �,struc�cture(s)�must�mai,*ntain a minimum of a 7' setback from all property lines, easements and 25'from all County and State Road right of ways. X 23) The approval of this project is subject to the recommendations and specifications outlined in the attached geotechnical report or assessment. Structures and/or land modifications (grading,cuts, fills, etc.) required in the geotechnical repot'/assessment, may require a seperate permit. The geotechincal report/assessment shall remain attached to the approved building plans. X 24) The subject property fronts Mason Lake. Mason Lake is regulated under the Shoreline Master Program and the Mason County Resource Ordinance. Regulations require building and buffer setbacks from shoreline. The shoreline setback from OHWM is 64' (as noted in spi2003-00091) The common line se!4pck is determined to be 69'on the south side and 92' on the north side. No more than 10% expansion of existing home is allowed between the 64' and co n line. x BLD2003-01596 Please referto the following pages for conditions of this permit. 4 of 5 25) Per the Mason County Resource Ordinance, the 64' setback (as described in the Shoreline Setback Condition) allows for a 15' building setback (the area most war , closest to the residence)with the balance of the shoreline buffer to remain undisturbed. x This permit becomes null and void if work orconstruction 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 wati of work is a rogres jnspection within the 180 day period. Final inspection must be approved before building can be occupied. OWN ER OR AGEN _ DATE:/ ��Z — 4-51 BLD2003-01596 Please refer to the following pages for conditions of this permit. 5 of 5 oar CONCRETE ME CH NICAL ft�C MANUFACTURED HOME Footings / Setbacks Date 7 By 6�L5 Ribbons Date '3 (ttoV By�2 Gas Piping Date By Foundation Walls Date B y Set-up Date 3 ZZ By t-�lS INSULATION Date By B G / Slab Insulation Floors Final Date y oq ByLLkL Date By Date By FRA IN it gC Walls FIRE DEPT Date b S' By V1 L5 Date Q( �` fit,, By Date By PLUMBING Attic OTHER Groundwork Date Q( O` By Date �Z. OU By WALLBOARD NAILING D''XV'V. Date By Date ` By6%S FINAL INSPECTION Water Line Date OWN. By Date By `IP of INspEc onl fQUFb7" DNS�prcf�pv �7CD Xr B� GoMnnEu t 3 t l C�II (, s J�10 CD- S t t k( tr S� " vow DEck �r�p 0 0 wy 0 40 L5 t:.9 - cdyo RAWs s (Z)184V Cn DEc(4 ` �21�00qzZlewl �r s �r o a °S � L odd Pccs o 3y VierErr z cei i in All rdo AVI not ha✓e w'` � H w V�✓�7Cu Q � — Ll ��i oZooL) Cc. << L5 O 705- L � o l3 P ll RsS�fj z ag 04010 S O I �1 Not$ Mason County Dept. of Community Development Mason County Bldg. 3 426 W. Cedar P.O. Box 186 (360)427-9670 Local (360)482-5269 Elma Shelton, WA 98584 (360)275-4467 Belfair Notice to Obtain Final Inspection November 14, 2007 RECEIVED MASONCOUNTY JULIO FIORINI WV COMMUNITY DEVELOPMENT 30330 9 TH AVE S 3 ® 2�0� O FEDERAL WAY WA 2534%lVQ)CEDAR 5T. -_ Kim Knapp Support Staff Ed.553•Knappk@co.mason.woo.us Sheffon( -9670 Case No.: BLD2003-01596 Erna )482- 269 Elora r(36 4825-269 MASON COUNTY BUILDING ILl, Parcel No.:--22233.5200087 __._ AXr'36o1627-U25�' 426 W.Cedar• P.O.BOX 186 Project Description: SFR www.co.masonmo.us SHELTON, WA 98584 The Mason County Department of Community Development is currently reviewing all permits that are expired and have not been approved for occupancy and use. Pursuant to Mason County Code, Title 14 Building and Construction, a permit and final inspection for this type of activity is required under the 2006 International Building Code and your property is currently in violation status of occupancy and use. Please contact our office to make the necessary arrangements 21 days from the date of this letter. Failure to contact our office to make the necessary scheduled inspections will result in enforcement actions. To bring your site into compliance, you must schedule an inspection. One (1) $64.00 site investigation fee will need to be paid prior to inspection along with any outstanding fees currently due on your building permit. For every inspection required after that, you will be charged $64.00 again, per inspection until final inspection and conditions are met. To schedule an inspection, please call (360) 427-9670 ext. 262. If you should have any questions regarding this notification, please contact me at (360) 427-9670 ext 359. Sincerely, Terry Ryan Mason County Department of Community Development Cc: Property File /�//� /�/�Lls� /ter/` �� f•r��C—c T� � �C./ November 14, 2007 BLD2003-01596 4 r ti ON-STA MASON COUNTY �P5 c DEPARTMENT OF COMMUNITY DEVELOPMENT M "s ° Planning Division ~ 0 T P 0 Box 279, Shelton,WA 98584 J Y 0 (360)427-9670 1864 NOTIFICATION OF INCOMPLETE APPLICATION December 09, 2003 JULIO FIORINI TO BE KEI'T IN THE- 30330 9 TH AVE S PARCEL FILE FEDERAL WAY WA 253-941-61 Parcel No.: 222335200087 Project Description: SFR Dear Applicant: You have submitted a permit application (case no. BLD2003-01596) for proposed construction or development in the county. Upon review of your application, I have determined that the contents of the application are incomplete or do not provide enough detail for review. Therefore, review of your application will not proceed until the necessary information is provided (see the comment section of this letter for details.) Once the information is submitted and the application is complete, I will continue to process your application accordingly. If the additional information is not provided to the County within 180 days of this request, the application shall expire and no further action on the proposed development shall take place. Please contact me at (360) 427-9670, ext. 363 if you have questions. Sincerely, Diane M-Jones Land Use Planner Mason County Planning Department 12/9/2003 1 of 2 BLD2003-01596 _ J NOTIFICATION OF INCOMPLETE APPLICATION 12/9/2003 Case No.: BLD2003-01596 Comments: Pursuant to building permit Bld. 2003-01596 and per site preinspection spi 2003-00091, a few clarifications are needed: 1. Please include placement and dimensions of existing home on the site map. Also describe the shoreline commonline on the site map. The shoreline commonline is determined to be 92' on the northern side of the property and 69' on the southern side. 2. As noted, on the preinspection, in accordance with Fish and Wildlife provisions of the Mason County Resource Ordinance, total home replacement is allowed in the exisiting footprint of the pre-existing home, plus ten percent. The determined 64' setback, recognizes the exisiting footprint of the home and the straightening of the north corner of the home. As stated, the proposed straightening of the home would be considered under the provisions of the ten percent expansion. No more than a 10% expansion is allowed between the 64' setback and the common line. Please verify that no more than 10% expansion is being proposed in the aforementioned area of: on the southern side 64' to 69' and on the northern side, including the straightening of the house from 57' to 64' and then the common line of 64' to 92'. If the proposed remodel exceeds 10% within this area, per the Fish and Wildlife Chapter, a resource ordinance variance may be necessary. Expansion/remodel of the home beyond the common line is permitted. 12/9/2003 2 of 2 BLD2003-01596 I � MASON COUNTY PERMIT NO. j BUILDING PERMIT APPLICATION �� 426 W. Cedar - P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair(360) 275-4467 • Elma (360) 482-5269 On the Web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner _3';,t j I o Contractor Name Mailing Address QC- - 7t*" Mailing Address City FeLlerul State Zip Code ']SO0.5 City State Zip Code Phone Other Ph. ( 121) I}71+-4•' 2Z{ Phone ( ) Other Ph. Lien /Title Holder Contractor Reg. # Exp. Email Address Email Address SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION - 12 digit Tax Parcel No. 22.2. / Z / Uc� Fire District Legal Description - ( • (-Ar4%_Lj�p� f kl m#Go Travf* $] ex A-e-C. Site Address (Please include street name, street number and city) ')02-1 E J:�% U Directions to site }--lt aujcuo J tc Lj�i gon 4 , Will timber be cut and sold in parcel preparation? (Yes/No) Is property located within 200' of saltwater Lake ✓ River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE ❑ SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action? (Yes/No) Or Describe Work F04y,'lit ~:�icleCuL No. of Bedrooms No. of Bathrooms .3 SQUARE FOOTAGE - 1st Floor 2nd Floor 3rd Floor Loft Basement //002 Deck 1 2., O8 Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit? (Yes/No) Installer Name 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 INSPE T N. THE OWNER OR AGENT ON OWNER'S BEHALF, REPRESENTS THAT THE INFORMATION PROVIDED IS ACCUR f ANTS EMPLOYEES OF Mason COUNTY ACCESS TO THE ABOVE DESCRIBED PROPERTY AND STRUCT �EVIEW AND INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURINFO� RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS B T1ABELM.WAY:Xg C�v' Sal OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am r� l regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Wash i tp`zd rat am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulatin% e work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be made without first obtaining approval. with. No changes shall be made without first obtaining approval. /aRL 1TtSaT FQr_-r-fon.iijl'S X - Date z G X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by, Planning Pd /i6O" Ck# 103 Date Bld Pd. � Reciept No. Vi a00 - )� DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department A aka fy Occ GroupT "e Constr. — Ca ZCJ03 " Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee f 5D a - , / EH Review Fee ocar Plumbing & Base Fee n. Planning Review Fee Mechanical & Base Fee 70 Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal TOTAL FEES 0 Z� PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton,WA 98584 Shelton(360)427-9670 Belfair(3601 175-4467 Elma(360)482-5269 APPLICANT INFORMATION CONTRACTOR INFORMATION OwnerJtd i O (=iori r1 Contractor Name V' Mailing Address Mailing Address City.`- der-, I LJ StateWA Zip Code 9$00 Z, City State Zip Code Phone 2 :l 9'f•/• Other Ph. 2( `')5 )_414-41+2- • Ph.(_ Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 digit Tax Parcel No. 222-3 / �5 2 / 00c S7 Fire District Legal Description M c"Ji i f Y 5 --�)LyNnY S/OPe. Nc�Q 1 ti are!' (o -rbk t 8 7 -Tw— X - A-P-�-�-• Site Address(Please includWstreet name,street number and city) 3021 E M a!,61 Lakes Directions to site I+l CA M 3 -� !`�ate••E,� Rd! �'t.,�P- er t� t-A M1,4 ,, L�.k p, EY t ask..# 6r M��5 . l,n.k tom. i r�.nn ati I ht�Q. A-f- Is your property within 200'of the following: Body of Water(Name) HA&4--^ �-- i... Saltwater Lakes River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New ✓ Add Alt Repair Other Use of Building -- Ic- cAr7� I Keskl Location of Fixtures/Units 1st Floor 2nd Floor Basement_Garag Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump Toilets -3 Type of Unit No.of Units Fees Bathroom Sink 3, Furnace I Bath Tubs ,:71 Heatpumps Showers Spot Vent Fan Water Heater I Propane Tank Clothes Washer j Gas Outlets ��... Kitchen Sinks 2. Wood/Gas/Pellet Stove Dishwasher I Kitchen Exhaust Hood Hosebibs Dryer Vent \ J Other 1. er ; Other Vbt `, d rn�}- V I I-uri•F ; inl Base Fee Base Fee n� 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-1 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. Alt-r-N rTec-T r p� (=/pt2{f�� first obtaining approval. X X/�r_- �sQ/ Date I X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. OEP IR7MFNVTAE REV[EVY APt'ROVEO C3ENIED GONDITIONV CODES 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