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HomeMy WebLinkAboutBLD2014-00072 Cancelled Dock - BLD Permit / Conditions - 8/30/2016 Ir 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.Q. Box 279 Moto Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2014-00072 OWNER: MIKE KURESMAN RECEIVED: 1/24/2014 CONTRACTOR: LICENSE: EXP: ISSUED: 3/14/2014 SITE ADDRESS: 181 NE MOUNTAIN VIEW DR TAHUYA EXPIRES: 9/14/2014 PARCEL NUMBER: 223195000095 LEGAL DESCRIPTION: WOOTEN LAKE TRACTS TR 95 PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW DOCK, FRESH WATER, WOOTEN LAKE ST RT 3 TO BELFAIR, L ON ST RT 300/NORTH SHORE RD. R ON HAVEN WY, R ON MOUNTAIN VIEW nR TO SITE ADDRESS ON THE LEFT General Information Construction &Occupanc Inf ation Square Footage Information No. of Bedrooms: Type o v tr.. VB Type of Use: SF Insp.Area: No. of Bathrooms: Occ. p: U Lot Size: Deck: Type of Work: ACC Fire Dist.: 2 No. of Stories: Occ. Lo Building: Valuation: $ 5,000.00 Building Height: Occ.lf&at Seasonal Basement: DOCK 440 Manufactured Home Information Setback Informatio Shoreline&Planning Information Make: Length: Ft. Front: Ft. SI Ft. Water Body: Rear: Ft. Slo Ft. SEPA?: Model: Width: Ft. Side 1: Ft. Shoreline Desig.: Year: Serial No.: Side 2: Ft. Comp. Plan Desig.: Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qtf Type By Date Amount Receipt Plan Check Fee GMM 1/24/2014 $ 73.00 S1201400000001 Planning Review Fee GMM 1/24/2014 $205.00 S1201400000001 Building State Fee MAU 2/13/2014 $4.50 S1201400000001 Building Permit Fee MAU 2/13/2014 $ 141.00 S1201400000001 Total $423.50 BLD2014-00072 Please refer to the following pages for conditions of this permit. Page 1 of 4 f ~ CASE NOTES FOR BLD2014-00072 CONDITIONS FOR BLD2014-00072 1) Dock facilities must be maintained in a safe and sound condition. X K4C 2) 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 NK 3) 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 Departmentprior to any further inspections being performed or approvals granted. 4) 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 vv-,,K 5) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building Department prior to any further inspections being performed or approvals granted. X YVI. 6) 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 revocation. X VV%K 7) 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. X )'N-`r_1 BLD2014-00072 Please refer to the following pages for conditions of this permit. Page 2 of 4 -8) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON CUUN I Y BUILDING DEPAR I MEN I AND I HE ADUP I ED 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. 9) All property lines shall be clearly identified at the time of foundation inspection. X 0A,1C, 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 non-compliant with Mason County ordinances and building regulations. X )h� 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 holder have prevented action from being taken. No more than one extension may be granted. X Y�k 12) 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 r''�Ir, 13) Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. x LItk 14) A Hydraulic Project Approval from the Washington State Department of Fish Wildlife must be granted prior to construction. For more information contact Habitat Biologists Gloria Rogers (Freshwater) at 360-753-2600 ext 249 or Margie Schirato (Saltwater) at 427-2179. x 'PA K 15) Applivant will follow conditions of Mason Environmental Permit when issued. x MK 16) The proposed project must be consistent with all applicable policies and other provisions of the Shoreline Management Act, its rules, and the Mason County Shoreline Master Program.X V11,K 17) Water quality is not to be degraded to the detriment of the aquatic environment as a result of this project. X vvt-K 18) Floatation for the structure shall be entirely enclosed and contained to permanently prevent the breakup or loss of the floatation material into the water. X M< 19) All construction and demolition debris must be removed from the site after project completion. Proper disposal of construction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X .1r BLD2014-00072 Please refer to the following pages for conditions of this permit. Page 3 of 4 • 1 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. rYti(<1�--ld (�,�..,., o.. 3 -- %4 - a o 1`i Signature Date Y+� Q. \ae I KAI g OWNER - REPRESENTATIVE - CONTRACTOR Print Name (Circle one to indicate) BLD2014-00072 Please refer to the following pages for conditions of this permit. Page 4 of 4 co o CONCRETE MECHANICAL MANUFACTURED HOME c Footings I Setbacks Date By Ribbons m Gas Piping � o Interior Date By Interior-Date By Dote Fly 0) NExterior Date By Exterior-Date By Set-up Z Point Load I Isolated Footings INSULATION Date By BG i SLAB INSULATION Date By Data By FIRE DEPARTMENT Foundation Wails Floors Date By m Date By Data By DECKS FRAMING Walls Date By Date By Data By PROPANE TANKS PLUMBING Vault Dates By Date By OTHER __ m Groundwork Attic Date By pate ey Type- Date By D.W.V DRYWALL Type Date 8y int Braze Wall Date B y � � Oat* By FINAL INSPECTION p m Water Line Fin Sopsntion ` N Date B Date By Date By 0 y � m s Pass or Request Inspect. o o i Type p of Ins . Fail Date Date Dane B Comments o Y Y (D V o N 0 v cn cu (n r O n O a o' CA O Cn N 3 VJ (D 0 _1 �{ FCET r. RECEIVED 17 oo FEB 12 2014 426 W. CEDAR S 1 PLANNING %iVC F po T S E�r fS�C1ci<� PLANNING: ALL SETBACKS ARE MEASURED l FROM THE FURTHEST PROJECTION OF THE BUILDING 1 APPROVED MASON COUNTY DCD PLANNING � SITE PLAN REQUIRED TO BE ON SITE i CHANGES SUBJECT TO APPROVAL BY Date ` 1 Oi 0 I .� 4L O AR� vC 'C1c, PIPE3 � I in dace i GoST t '1z xl, i U I O I I i f I _. LAB' l ar i X Zo . MUST t-, ' A'L CURRENT WASHIN&6N STATE CODES s V` THESE MUST BE ON "i"F;t JOB SITE FOR INSPECTION- CHANGES SUBMIT CHANGES FOR APPROVAL S PRIOR TO PFR7^p"t1"1G WORK t . I b KuR 0 114 PP X aO Af7 WALKWAY I r cn WP C U-r 1A) 1.1.4 t Fee DA 'cu 42 r- Oka ci 1 rTl z YEA 6&IH-Occ cur5ioc- -0904--itcoil) L r 6rBVJ6-OCM VL 65-8Wfl-OC F 6,8twO-A A,)6-tt 13e,4ce-c1' L W-454M OOCIAM re EA &8WH r Ate 'Ff '5 14 76r.+j,:'I Yll( &AW64PPIA6:6 L Fz- PL,4 r 4)d.5 li Q6 OF TA145 00 &A 6-4 t V, it X 7, t I - - 7&-F, 2' x &',occ ziAk: k?6 I f vv' ROA-r F6eA7 tv Ociv It,JV07-t 41 ' AL, /0-L tORdEP, HAACX&rS e2f ; w 3,WL Y.1-X Y CA 1.11,46-e f3vtr5 BUI LDING t NOTE: Alb ,fu rmallaa-&mtE y2-' CAt v WeX A/07- RECEIVED 8R.4ce.ers rw*f nol-'r FEB 12 2014 C,*tVc ncKw�ts�,�,e / i YA (r 4 t V,,lydO X A�V -2�72� 426 W. CEDAR -ST, a Gm 10 D L RCVD i.04!` dblesNFQ /�X CAQReA1;E (ELT 1�/.� °xr�.�,►..t+•;� :may»�- II!'' • t OL P1+4TE LARK A fiE �' 7 40 th'trc,►a,r;.a ,s, ELK ,rk " F .{Yp� T k' 4C iG 1 .. _. .. f.:: a•., '.>.' : ,n�'�i�4'"�'__ VVV ffJ _ _ ,,. 60 vN a uj � .� -To P V'I E-Al PAL FA (� t A L it CARR+A,SE i^" 9 ,y � a � �+ Rr#'i��� r°i�7�'�K�° �i ,�Ar*:�����'� li�cK: -� , ,- Rvi✓rl� y''owl tJsURIF •1tlAfS NAVe PLU < !')tfAi,:=.0 •r'.4ct �.VJG - _• . r f .ter z�, ac • } �� � ' - I•� �. (� f ,.. t;• MUST 1,AEET A!L CURRENT u WASHIHGTO4 STATE CODES CHANGES C CJ THESE MUST BE SUBMIT CHANGES FOR APPROVAL ON I HL J..-,i SITE II PRIOR TO �, .� `)R`11NG WORK r1 FOUR :NSPEGTION. 6 e:,^eH 3 x 6 x ao, pr car 9 -Q35 "' -I n4cii W H-OCiL lo"x/-J"y 5�0urs1D�c-o�tjL-,(E-N) bq e.AC9 / ", � GAIN•CAa� A�r 30�, K5 p curi) no '-f cry WH'7C 9 9k5- -1N51DE600FR �� Y,+-y- , 7. crpc.v.�AR/� E 3DCT .1 /� euT� I��•, LAcoi ! -A .3"X 3 x d Hoer' ,RNGLE (jR,4C�r' •�-��. I , ^uT L "'ho'eft-M,40e FUR a I p(SMr l-LAr woef1FR . �g I � A gout W �-W �� x s o( HOLE WA°SNER POT E 6Y oeH / 6� � HEX tv%`'r Ja u _ X X oR j OR !. fckYF041' N ,Q b� &ACN /� 6e4LV GxK w4sm! "7ia�1 60 EkCN /X2 , FoR E60 Wrlovo} t 6a EQ %x 5 L-4c, ,gocr 6A4v, Ace Floats by Premier Materials ' Regular, Documented Quality Checks... Why are Virgin Grade Raw Materials Required? Virgin grade raw materials are critical to making the best quality, longest life, lowest cost flotation that meets all of the Marine Industry Standards. Standard-compliant flotation made with virgin materials Is environmentally safe and accepted for green building projects. Flotation encasements(shells) made with properly cured,virgin grade resin have a consistent standard wall thickness,the structural strength to absorb impacts without failing,and a life expectancy of 40 years. Virgin resin is environmentally safe because it meets FDA 21 standards and will not leech chemicals into the water. Virgin EPS foam is best suited to forming a low water absorbing, bead-free and void-free fill when properly pre-expanded and steamed inside a float shell. This solid block of foam adds strength to the float, absorbs less water should a shell be damaged, and eliminates loose EPS beads from escaping the shell and polluting the water. Using non-virgin,off-spec and/or regrind materials can negate many(if not all)of the benefits/values of virgin materials... structural strength,40 year life expectancy and environmental safety. Non-virgin materials Introduce anomalies in the manufacturing process that can cause weak shell walls,chemical leeching of dyes used to color regrind resin, incomplete foam fills that leave loose beads and voids inside the shell, and foam blocks that will absorb water well above the standard. Non-virgin materials can lead to shortened life expectancy, early float failures,and higher cost flotation. StandardsWhat are the Values and Benefits of Marine Industry ASTM D1998-04 Falling Dart Impact Test Encasement Wall Thickness Standard -validates that virgin grade resin is being used eliminates weak wall floats with early failure potential -that molding process is complete and properly done provides insurance policy against unnecessary repair costs - indicates float wall strength meets or exceeds standards ensures floats will hold up to pre and post install abuse -contributes to float 40 year life expectancy contributes to 40 year expected life 7-Day Hunt Water Absorption Test Certified,Tank-Tested Buoyancy Ratings foam fill will aid in maintaining buoyancy if float damaged greater accuracy in selecting float sizes and quantities no waterlogged floats; no sagging or sinking docks minimizes costly re-Floats when design goals not met void-free foam supports outer shell walls,adding strength eliminates over and under buying of floats -delivers longer life and lowest float cost provides true cost of floats based on buoyancy delivered CHANGES THESE PLANS MUST BE SUBMIT CHANGLS FOR APPROVAL ON -!'HE JOB SITE PRIOR TO PERFORMING WORK F JQ2 I��Nt�.TIC�N• Properly Cured Outer Wall Made with Virgin Resin Certified,Tank-Tested Buoyancy Ratings withstands impacts of 90 ftltbs plus without cracking accurate buoyancy ratings are the only way to ensure or shattering;meeting the ASTM D1998-04 Falling that the correct float sizes and quantities are matched Dart Impact Test standard for shell durability correctly to the dock system design criteria Premier flotation has passed at up to 180 ftlibs All Premier floats are tank-tested&certified ;r ( yarwrr Void-Free, Low Water Absorption EPS Foam Fill solid foam core without voids or loose beads that meets 0.150" Nominal Wall Thickness -_—--- or exceeds The 7-Day Hunt Water Absorption Test Consistent and Tested --� Premier floats consistently measure well no point must fall below minimum 0.125"wall thickness below the 3.0 lb/cuff minimum. Any Premier float with any spot<0.125"does not ship Completed Flotation Meets USACOE Regulation 33CFR Part 327.30 100%non-prorated warranty for minimum of 8 years against sinking,cracking, fragmenting,loosing beads;puncture and penetration resistant Premier warranty is 15 years with 1st 10 years at 1000/c non-prorated Ace Flotation Manufactured by Den Hartog Industries. www.scottcomarine.com ■ 800.932.9414 toll free .r Wood • Hardware Our hardware is made with 1/4"high-strength steel then hot dipped galvanized.Since we do our fabrication in-house,we can also make custom hardware to fit your specific needs. _. (SUS"I BE ON fHE JOB S:TE FOR ASaEOTION. 4 1 7 ® 9 10 11 6 1. WH-OCE 8 CHANCES ° SUBMIT CHANGES FOR APPROVAL 5 PRIOR TO PERFOR',V :n .d 'RI( 3 2. WH-OCM 3.1 WH-OCF 4.1 WH-IC 5.1 WH-SM 6. WH-SF *440 7.1 WH-A 8.1 WH-B 9. P-3 10.1 WH-W 11.1 WH-CRS Dock Kit Plans,Parts Lists and Do-It-Yourself instructions are available on our website. www.scottcomarinexom 0 800.932.9414 toll free r " � MITCHELL LUMBER JAN 29, 2014 * QUOTE *** PAGE: 2 CUSTOMER CASH3 SHIP TO CASH CUSTOMER KURESMAN - FLOAT -DISCOUNTED- BELFAIR WA 98528 QUOTE# : KUR011400 TERMS : DUE ON RECEIPT SLMN : MP EXPIRES : 02/05/14 ATTN OF : ENTERED : 01/29/14 ------------------------------------------------------------------------------- QUANTITY DESCRIPTION PRICE EXTENSION ------------------------------------------------------------------------------- 64.00 EA NUT HEX GALV 1/2"- 13 0. 170 PER 10.88 64.00 EA WASHER LOCK GALV 1/2" 0.330 PER 21. 12 12.00 EA FLOAT POLY 24X48X12" ALL PURP 161.540 PER 1938.48 400# FLOATATION PER FLOAT *INCL 1 FLOAT PLUG PER FLOAT* (NO PLUG FOR TECHSTAR FLOATS) 60.00 EA LAG SCREW GALV 1/2X5" 1.340 PER 80.40 64. 00 EA 5/4X4 10' TK DECKING RAD EDGE 4.790 PER 306.56 7. 00 EA 5/4X4 14' TK DECKING RAD EDGE 6.690 PER 46.83 SUBTOTAL 3045,06 THESE F'LV-.' MUS7. 3E ON C H E JOB S'T E ------------- .O R ;N S P E:;T I O N. MERCHANDISE OTHER 0.00 TAX ( 8.50%)FREIGHT 0.00 0.00 TOTAL M-;7-9 3 MITCHELL LUMBER JAN 29. 2014 QUOTE *** PAGE: 1 CUSTOMER CASH3 SHIP TO CASH CUSTOMER KURESMAN - FLOAT -DISCOUNTED- TH!-SE PLC B'- BELFAIR ( 'N 'hu JOE, S'TE WA 98528 .,.. v r� QUOTE# : KUR011400 TERMS DUE ON RECw. ,,i3i0MN MP EXPIRES : 02/05/14 ATTN OF : ENTERED : 01/29/14 QUANTITY DESCRIPTION PRICE EXTENSION --------------------------------------------------------- --------------------- 61 X 20' (FLOAT) WALKWAY DBL ALL QTY/COST FOR 2 FLOATS 92.00 LF 3X6 R/L PT 20 GRND/CNT.40ACQ 1.990 PER 183.08 4/20' 1/12' 4.00 EA BRACKET FLOAT IC GALV 5X9X9" 18.030 PER 72. 12 4.00 EA BRACKET FLOAT OC END GALV 17. 480 PER 69.92 4.00 EA BRACKET FLOAT QNGL GALV 3X3X5 5.260 PER 21.04 8.00 EA WASHER PLATE FLOAT GLV1-1/2X5 2.690 PER 21.52 48. 00 EA BOLT CARRIAGE GALV 1/2X4" 1.220 PER 58.56 76.00 EA WASHER FLAT GALV 1/2" 0. 190 PER 14.44 48. 00 EA NUT HEX GALV 1/2"- 13 0. 170 PER 8. 16 32.00 EA 5/04 12' TK DECKING RAD EDGE 5.990 PER 191.68 5.00 EA 5/04 14' TK DECKING RAD EDGE 6.690 PER 33. 45 4.00 EA FLOAT POLY 24X48X12" ALL PURP 161.540 PER 646. 16 400# FLOATATION PER FLOAT *INCL 1 FLOAT PLUG PER FLOAT* (NO PLUG FOR TECHSTAR FLOATS) 2.00 EA FLOAT POLY 48X96X 12" 384.630 PER 769.26 *INCL 1 FLOAT PLUG PER FLOAT* 44.00 EA LAG SCREW GALV 1/2X5" 1.340 PER 58.96 44. 00 EA WASHER FLAT GALV 1/2" 0. 190 PER 8. 36 SUBTOTAL 2156. 71 10' X 20' FLOAT 140.00 LF 3X6 R/L PT 20 GRND/CNT. 40ACQ 1.990 PER 278. 60 6/20' , 2/10' 3.00 EA 2X6 10' PT GRND/CNT . 40 ACQ 10. 690 PER 32.07 4.00 EA BRACKET FLOAT OC END GALV 17.480 PER 69.92 4.00 EA BRACKET FLOAT IC GALV 5X9X9" 18.030 PER 72. 12 8.00 EA BRACKET FLOAT ANGL GALV 3X3X5 5.260 PER 42.08 16. 00 EA WASHER PLATE FLOAT PER 43.04 64. 00 EA BOLT CARRIAGE GALV 1 4" 1.2 .P R 78.08 20.00 EA BOLT CARRIAGE GALV It 3"lj`'` �� �-�D�T3�11�'� R 18.80 32.0 0 EA WASHER FLAT GALV 1/2" y *"k' `'ry 190 PER 6.08 TA flfl Dir IGjIus PLEASE VERIFY ALL LENGTHS ONLY THE MATERIALS LISTED ABOVE HAVE BEEN QUOTED INDIVIDUAL PRICES APPLY ONLY WHEN PURrHASING ENTIRE PACKAGE I�102oij/ 00070- A& T/qx 22.3/9 -So-o0o s �• 9 SIT E C°pY MUST A' L CURRENT WASHINGTON STATE CODES CHANGES Lj g_ SUBMIT CHANGES FOR APPROVAL i H E1 . 0 T PRIOR TO PERFORMING WORK Plans include p"9-'' ^" engineering documents that must remain attached to app oved plans Documents attached to approved plans: Site Plan ie;:!�> Plan review checklis • — " Engineering: Y Lateral Vertical Number of pages 7 REVIEWED FOR CODE COMPLIANCE MASON COUNTY BUILDING DEPARTMENT � /� 2 �d Dab Sox covy MASON COUNTY PERMIT N001G]26I OYo7oZ DEPARTMENT OF COMMUNITY DEVELOPMENT — BUILDING•PLANNING• �'$,4Q���T ) WWW.CO.MASOM �l V/ D360 427-9670 Shelton ext.352 �V IA h Mason County Bldg. III,426 West Ce ar reet (360)275-4467 Belfair ext. 352 PO Box 279, Shelton,WA 98584 360 482-5269 Elma ext. 352 4 FEB ' 2 2014 ( )B18' ILDING BUILDING PERMIT APPUCATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:MWE ctHa (o,41 KulZEsv►%Ao�4 NAME: MAILING ADDRESS: 51�oc, ow uyhw Q MAILING ADDRESS: CITY: .6pgm jE A-r.,4 STATE: bJ1t ZIP: •B3M CITY: STATE: ZIP: PHONE:3&o 6g2 -619 i CELL:36,!, cig, w7S PHONE: CELL.. EMAIL: iviikE k Ca? Kurc-sma.'-41 KS, CC,M EMAIL : L&I REG# EXP. PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) -3 1 vc>o9j5 FIRE DISTRICT LEGAL DESCRIPTION(ABBREVIATED) : SITE ADDRESS lei he, `m 4;,4T A 1,4 V I E w e- CITY 'rig tiN�O DIRECTIONS TO SITE ADDRESS IS PROPERTY WITHIN 200 �DI'L SALTWATER ❑ LAKE V PJVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES[] NO TYPE OF JOB: NEW :K ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) 'Dor C-1< IS USE: PRIMARY ❑ SEASONAL® NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS DESCRIBE WORK SQUARE FOOTAGE: J�)►A -4rnoon- - scco o0 1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. ft. BASEMENT sq. ft. DECK sq. ft. COVERED DECK sq. ft. STORAGE sq.ft. OTHER sq. ft. GARAGE sq. ft. ATTACHED ❑ DETACHED ❑ CARPORT sq. ft. ATTACHED ❑ DETACHED ❑ MANUF RMATION: *4 COPIES OF THE FLOOR PLAN MODEL DTH BEDROOMS BATHS SERIAL NUMBER 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 INSPEC ION INAC IVITY rF_THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. Signature of Applicant Date x W LC—H'A-C- 1_ urea sw• 1.4 OWNER / REPRESENTATIVE /CONTRACTOR Print Name (CIRCLE TO INDICATE) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT 0l3 PLANNING DEPARTMENT FIRE MARSHAL