HomeMy WebLinkAboutBLD2010-01079 Final Detached Garage - BLD Permit / Conditions - 7/31/2015 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 186
` Shelton,WA 98584 '
RESIDENTIAL BUILDING PERMIT BLD2010-01079
OWNER: MIKE FULLAWAY RECEIVED: 11/18/2010
CONTRACTOR: 30 LICENSE: EXP: ISSUED: 1/4/2011
SITE ADDRESS: �2 NE HAVEN PL TAHUYA EXPIRES: 7/4/2011
PARCEL NUMBER: 223305000024-'�7
LEGAL DESCRIPTION: HAVEN LAKE TR. 24
PROJECT DESCRIPTION: DIRECTTI TO SI
28x36 DETACHED GARAGE + 8x28 loft(APPLICATION FOR A DPC ST 3 O AIR, O RT 300/NORTH SHORE RD. R ON
WAS ALSO TURNED IN WITH THIS CASE TO REMOVE THE LINE BE I T Y O AVEN WY, L ON HAVEN PL TO SITE
BETWEEN THE LOTS 24 &25 AD R S T I T
General Information Construction &Occupancy In do Square Footage Information
No. of Bedrooms: Type of tr.
Type of Use: SF Insp.Area: No. of Bathrooms: G U Lot Size: Deck:
Type of Work: ACC Fire Dist.: 2 No. of Stories: 2 oa Building:1,232
Valuation: Building Height: 23 C Sta s: Primary Basement:
Manufactured Home Info mation forma on Shoreline&Planning Information
Make: Length: Ft. ron • 25. Ft. Shoreline: 70.0 Ft. Water Body: HAVEN LAKE
70.0 Slope: Ft. SEPA?:
Model: Width: Ft. d 10.0 Ft. Shoreline Desig.: Urban
Year: Serial No.: Side 50.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Plan Check Fee GMM 11/18/201 $405.31 S12010000
Planning Review Fee GMM 11/18/201 $205.00 S12010000
EH Plan Review KKK 11/18/201 $103.00 S72010000
Building State Fee DLC 12/28/201 $4.50 S12011000
Building Permit Fee DLC 12/28/201 $623.55 S12011000
Total $1,341.36
BLD2010-01079 Please referto the following pages for conditions of this permit. 1 of 5
A
CASE NOTES FOR
BLD2010-01079
CONDITIONS FOR
BLD2010-01079
1) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure
these struc ures meet the setback conditions listed.
X
— :�-w
2) An approved Declaration of Parcel Combination must be recorded with the Mason County Auditors such that all structure to property line setback
requirements r velopment can be met.
X
3) Prior to final approval, all upland areas disturbed or newly cr ed construction activities shall be seeded,vegetated or given an equivalent type of
erosion protection (silt fencing or straw matting). X
4) Landings and stairs mist meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your
"Approved Site PI u e t ese structures are shown and meet the setback conditions listed.
X
5) The proposed project must be consistent with all applicable policies and other provisions of the Shoreline Management Act, its rules, and the Mason
County Shorelines a Pi gram.
X
6) Approved p� di i n and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure.
X
7) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES N INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD W
X
8) Temporary erosion control measures must be implemented to prevent water qualit gr dation f adjacent waters or wetlands. Silt fencing must be
installed and maintained until upland vegetation has become established. X
9) 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
1-800-64 -0 Th r on signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law.
X
BLD2010-01079 Please refer to the following pages for conditions of this permit. 2 of 5
10), 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 prio t ny fLiqher inspections being performed or approvals granted.
X
11) Owner/Agent is 21=?�
st the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28.
X
12) The plan review check list and corrections 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 v d cuments will result in failure of required building inspections.
X
13) This structure is approved as un-heated space. If at any time this building is to be used for anything other than what it is approved for, a change of use
permit shall bed,fqr, reviewed and approved prior to the change.
X e '
14) 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 RFEr
ted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the
Building D to any further inspections being performed or approvals granted.
X
15) WIND LOADS- Roof coverings shall be designed and tested to withstand the maximum basic wind speed. The basic wind speed for Mason County is 85
MPH.
X
16) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the
manufacturer's stallation ins trucbons.
X � VIIJi
17) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement,
inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the
owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel
prior to the commencement of any development activities. `NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater
Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes
an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are
responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system
of this, or any other, parcel. You may also wish V consu t with the s ptic design professional involved with the project. By calling for a final inspection of
the building permit the owner/agent/contrac c now �gingt t II omponents of the stormwater management system have been installed as
approved on the stormwater site plan. X
BLD2010-01079 Please referto the following pages for conditions of this permit. 3 of 5
l •
18) The international code requires a fire apparatus access road for every facility, building, or portion of a building that is more than 150' from an approved
access road. Roads are required to meet the minimum Mason County Fire Marshal standards for Fire Apparatus Access Roads up to the point where
such roads c ct ith county maintained public road or to another fire apparatus access road which connects to a county maintained public road.
X
19) This structure is limited to U-occupancy use only (private garages, carports, sheds, and agricultural buildings.) Any other use will be in violation of the
international co s and Mahon County Regulations unless a"Change of Use" permit is applied for, reviewed and approved.
X
0
20) 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 documents are removed, approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be
X charged and sh b co lect by the Building Department prior to any further inspections being performed or approvals granted.
21) 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. O cupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in
permit revocation.
X Ct VV
22) 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 located 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 project.
X
23) All changes to"approved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County
ordinance or regulati Musta reviewed and approved by Mason County prior to construction.
X
24) 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 inter tional cod s as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building
Inspector?a 1 m rior to requesting additional inspections.
X
25) All property lines shall be clearly identified at the time of foundation inspection. X
BLD2010-01079 Please referto the following pages for conditions of this permit. 4 Of 5
I
26), 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 Coun o i ances d building regulations.
X
27) 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 preve action f om being taken. No more than one extension may be granted.
X
28) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT
PROPERTIES NO INCREAS THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM
OR ROAD WA
X
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 building can be occupied. Proof of continuation of
work is by means of a progress i pection.The owner or the a nt on the owners behalf, reWthattheon provided is accurate and grants employees of Mason County access to
the above described propertya structure f review an ins ction.OWNERORAGENT: i DATE:
BLD2010-01079 Please referto the following pages for conditions of this permit. 5 of 5
A
N ,-CONCRETE MECHANICAL MANUFACTURED HOME C
o Date B y r
I? Gas Setbacks Gas Piping Ribbons D
o Interior Date By Interior-Date By Date By
o —
A Exterior Date z- 9-i/ By Exterior-Date B _ _ .t„p
Point Load N Isolated Footings INSULATION - _ pate By .
Date By Da J SLAB INSULATION By FIRE DEPARTMENT m
Foundation Walla Floors Date By
Date q I By,( Date By DECKS -
FRA I G Walls Date By
Date By Data By PROPANE TANKS
PLUMBING Vault Da1e �y.�_.
Date By OTHERAttic
J
Groundwork Dee By Type. 4f.-I �y
Dale By Date By�- \
D.w.v DRYWALL Type
Int Brace Wall Date By W
Date By Date By - FINAL INSPECTION 0
m Water Line Fire Seperation N
Date By Date By Date -,` By O
O
Pass or Request Inspect.
0 Type of Insp. Fail Date Date Done By ' Comments Co
m
a
v
8 � �
_
/ b
CL
-
N 47 tl T
CD
r
Fill C 7-7-if
4��ST G- rj �_fl;)
/ze�vr C, A-
CPA PA 7 /K 7 31 lis LAI:
0
Building Permit It lD '� � MASON COUNTY
f, BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location 2- Z- .�-'�� '"� P&
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliance
-',r'
C��/�>r/G�C O�. tee/ �'i4•t.��' �-�, .��—';✓� ;
r
You are hereb otified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK`� ,,tl.� �,F��`�`�l`�
U( Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
Lj
This is not a complete inspection Department '0L -� ~
Date - Z ~/ Inspector %
DO NOT R ;MOVE THI TAG
i
Permit# a-o ai MASON COUNTY .
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location Z Z 114y441- O�_
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
fund: Items listed below must be corrected to gain compliance
ti
cc-
i
2 J = - �D
L If
t - Ar-CL rJ7-0
OL
You are hereby notified that the above correction's shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
❑ OK to damage incurred by recent
❑This is not a complete inspection "natural/man made"disasters.This is NOTa
Date f r-/ j Department CORRECTION NOTICE.
Inspector
��� * N�L OT P imlor *V ' THIqx Tvamv
lit.
MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location 22
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items listed below must be corrected to gain compliance
o e .t ->
c��.� �✓!
y
You are hereby notified that the above corrections shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
❑ Call for re-inspection when corrections are made before continuing ❑ please contact our office
❑ Make corrections, items will be checked on next inspection regarding possible structural
0 OK to i� //�C� �!/, �'�/�C d/� r'�qv�/ .��' �� damage incurred by recent
"natural/man made"
❑This is not a complete inspection��ov� 414-1111�f�5k �. disasters.This is NOT a
Date 2-- q-1 / Department �'g�= L,�� CORRECTION NOTICE.
r�
Inspector �� ��� ��T `iP GiJ�� Cf-cc
Ltt'�.,
-PaAd4 L W,A, ZZ3�D�0oDDg' LOT Z \. .
Ad n.44 z z3 3 y o 0 0 o as - t-0 7 e- 'RBCE
s IVED�
.I� "ON 2 2010
AASOK' COON;ry
APPROVED
MASON COUNTY DCD P A NING 05:Ar:i.4
SITE PLAN REQUIRED TO BE 0. SITE
CHANGES SUBJECT TO AP R VAL� ,`�j�v"
By Date *0 Q` t -1 N -
J
14
Coef.0 rc�� 1 1
GAO
Q
ow
z �
L m I
w
Q I �,
U �- ` '�-� I Iti 2
�
CL ; w t'
0 0 4
cl- �0r
`b
PLANNING ,��;
Name Parcel# -ZZ"33D 5-00 O D Z� BLD#
i�tO Jaw zz33o5-64007-
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14,Chapter 14A8 of the Mason County Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
http//www.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to"Title 14,Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70). You will receive a copy of the Public Works document
entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan".This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details*are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system(see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at:
Phone:(360)-427-9670 EXT.450
Mail:P 0 Box 1850,Shelton WA 98584
Physical:415 N 6th St,Shelton WA 98584
If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system wiU not adversely affect the septic system of this,or
any other,parcel.You may also wish to consult with the septic design professional involved with the project. Mason
County Division of Environmental Health can be reached at:
Phone:(360)-427-9670 EXT. 352
Mail:P 0 Box 1666,Shelton WA 98584
Physical:426 W Cedar St,Shelton WA 98584
A condition will be added to the building permit that states,in part,that all conditions the stormwater site plan will be met
prior to a request for final inspection of the building permit.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agen ntracto (circle one)Date:
Page 2 of 2
II
Name ►-a&W!y F-X"-`"Parc�#/' Z71: l A 60 O 00 �LY- BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development,or redevelopment',with more than 2,000 square feet of impervious surface 2.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
ZCommon impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area "All dimensions in feet
Buildings X =
X = OD$ Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X
X = Length of drive begins at the right of way
X _
Parking Areas =
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area (sum of all areas) cc)
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owner's legal representative,or the contractor. I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
Owner/Agen ontractor circle one)Date: f l J-1/0
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet, please read,acknowledge and sign
the information provided on page 2 of 2.
Page ] of 2
Fi ULLAWAY LAMPHEAR & SAUVE PLLC
CERTIFIED PUBLIC ACCOUNTANTS
This material comes to you: OLOaDO-O)O77
❑atyourrequcst
❑for your information
5501 Pacific Highway East,Suite 1,Fife,WA98424
Seattle(253)838-8000 • Tacoma(253)952-3478 • Fax(253)926-0840
MASON COUNTY
BUILDING PERMIT APPLICATION PERMIT NO. I&9U(d . 0 16]c
426 W. Cedar• P.O. Box 186, Shelton, WA 96584
Shelton (360) 427-9670 • Belfair(360) 275-4467• Elma (360) 482-5269
APPLICANT INFORM TION
On the web www.co.mason.wa.us A
Owner I'ti'"�I e .f- ,�i +- r L- A CONTRACTOR INFORMATIQ
Maillop-Adqress Company Name p IV 5 1-4
City- c Mailin Address .D
Phone L4-5A-797. I C Z7 ZIP Code City State
.----�.—Other Ph. -Z Zip Code
Lien/Title Holder 3 hone h.
E mail address — ther P
Contractor Re #-g� ���CCg/u+
Drivers Lic.#
E Mail Address
DOB-- Drivers Lic.# W*tZAIFj,
SEPTIC/WATER SYSTEM INFORMATION - a'
Connect to New eptic. Existing Septic
Connect to Water System 9 Y Name of Water System
P
Well Water System Name of Water System
PARCEL INFORM TION- 12 Digit Parcel No
Legal Description tleK/ k- IFire District 2
Site Address (Please include street name, str et number and city) v�,y
Directions to site c;,�
Will timber be cut and sold In parcel preparation? Yes
Is property within 200'of Saltwater Lake l�g,2
Wetland Seasonal Runoff River/Creek—Pond_
Stream Slopes or Bluffs ) 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y
TYPE OF JOB - ew X Add Alt Repair Other
Use of Building -Q Describe Work- c.g X3 PRIMARY RESIDENCE LJ SEASONAL
No. of Bedrooms No. of Bathrooms —
3rd Floor --�-Square Footage- 1st Floor
Basement Deck Covered Deck 2nd Floor
Garage �d�ltached Other Sq. ft.
Detached ---X Carport Attached Detached
MANUFACTURED HOME INFORMATION -Make
Length Width Serial No. Model Year
Type of Heat Purchase Price$ No. of Bedrooms No. of Bathrooms
Installer Name Replacement Unit? Yes/No
Certification No.
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 the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OF CO---Sd �TION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X C /,✓ct 4.4ewrJ Date
Ow /Ow Representative ontractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted b YlC�I(�
P Y Date_
F
ARTMENTAL REVIEW A PROVE DENIED NOTES
ing Departmentning Departmentnvironmental Health Department X
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee fEH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical& Base fee Other
Wood/Gas/Pellet 5tove Fee State Fee
Violation Fees Pre-Paid at Submittal 0
Valuation$ (o�? f TOTAL FEES