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HomeMy WebLinkAboutBLD2011-00096 Final MFG Home with Covered Porch - BLD Permit / Conditions - 10/21/2011 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 ol$ RESIDENTIAL BUILDING PERMIT BLD2011-00096 OWNER: STEVE DAMERON RECEIVED: 2/7/2011 CONTRACTOR: ROCK HARBOR CONSTRUCTION 360-280-5898 LICENSE: ROCKHHC952RM EXP: ISSUED: 4/7/2011 SITE ADDRESS: 61 NE CREEKVIEW PL TAHUYA EXPIRES: 10/7/2011 PARCEL NUMBER: 223315000063 LEGAL DESCRIPTION: COLLINS LAKE#1 TR 63 PROJECT DESCRIPTION: DIRECTIONS TO SITE: NEW MFG HOME WITH COVERED PORCH. ST RT 3 TO BELFAIR, L ON ST RT 300/NORTH SHORE RD, R ON BELFAIR TAHUYA RD, R ON COLLINS LAKE DR, R ON CREEK VIEW PL TO SITE ADDRESS ON THE LEFT SIDE General Information Construction&Occupancy Information Square Footage Information No. of Bedrooms: 3 Type of Constr.: VB Type of Use: MH Insp. Area: No. of Bathrooms: 2 Occ. Group: R-3 Lot Size: Deck: Type of Work: NEW Fire Dist.: 2 No. of Stories: 1 Occ. Load: Building: Valuation: Building Height: 18 Occ. Status: Primary Basement: COV PORCH 192 Manufactured Home Information Setback Information Shoreline& Planning Information Make:CMH Length: 52 Ft. Front: E 333.0 Ft. Shoreline: Ft. Water Body: SEPA?: Unkn 20 Model:LACASA Width: 28 Ft. Rear: W .0 Ft. Slope: Ft. Shoreline Desi Side 1: N .0 Ft. 9.: ftttApplicable Year:2010 Serial No.: Side 2: S 20.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date Amount Receipt Mobile Home Submittal Fee GMM 2/7/2011 $264.25 S12011000 Plan Check Fee GMM 2/7/2011 $63.21 S12011000 EH Plan Review SJC 2/7/2011 $103.00 S72011000 Water Adequacy Plan Review SJC 2/7/2011 $103.00 S72011000 Building State Fee LDK 2/22/2011 $4.50 S12011000 Building Permit Fee LDK 2/22/2011 $141.00 S12011000 Mobile Home Issuance Fee LDK 2/22/2011 $264.25 S12011000 Total $943.21 BLD2011-00096 Please referto the following pages for conditions of this permit. 1 of 4 CASE NOTES FOR BLD2011-00096 CONDITIONS FOR BLD2011-00096 1) Approve" dimensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 2) Temporary erosion control measures must be implemented to prevent water q n�6'4 degradation of adjacent waters or wetlands. Silt fencing must be installed and maintained until upland vegetation has become established. X 3) All construction and demolition debris must be removed from the vegetation buffer and setback area after project completion. Proper disposal of constructlqrLdebris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X T� 4) Prior to final approval, all upland areas disturbed or newly Qreted by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection (silt fencing or straw matting). X 5) Developmen s all follow the buffer averaging and setbacks set forth in The Wetland Corps management plan dated December 2010. X 6) A Road Access Permit or Approval must be granted by the Mason County Department of Public Works. For more information contact Public Works, at (360)427-9670, ex . 0. The building permit will not be "finaled" until the permit holder can show proof that the access permit from Public Works has been "finaled" and a ed. X i 7) 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 p ntial risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800-647- 9 The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 8) 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 grante 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 plAr to any further inspections being performed or approvals granted. X 9) Owner/Agent i onsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 10) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X BLD2011-00096 Please referto the following pages for conditions o 2 of 4 a 1) Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified installer responsible for each major part of the installation. RCW43-63B.090 An approved Installer c ification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily located in plain site w hi three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each installer performed or in ed. certification number and signature of the certified installer responsible for each major part of the installation. WAC365-210 X� 12) If you are installing a manufacturing home and no longer have the installation manual for the home, you must use the instructions of the American National Standgrds Institute(ANSI). To order the ANSI instructions you may either get an order form from the Mason County Building Department or you can contact the ' e of Manufacturing Housing (360) 725-2800. X r 13) 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 Was ton. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revoc�o X 14) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. I further understand that this investigation will be sche as time al Until resolution of any/all problems no occupancy (Final Inspection)will be granted for the residence. OWNER/CONTRACTOR(indicate which) Signature X 15) This permit is for the p ent and installation of the manufactured home only and es not imply pproval or review for any other items indidcated on the plot plan. X 16) 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 intern io al codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspector shal made prior to requesting additional inspections. X 17) The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including installation in ions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be clearly marke t e installation instructions. X BLD2011-00096 Please referto the following pages for conditions of this permit. 3 of 4 18) Owner/applicant must obtain a seperate r it for the placement of any size propane tank serving a fixed appliance within a dwelling structure or unit prior to the placement of the tank. X 19) All property lines shall be clearly identified at the time of foundation inspection. X 20) 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 o ces and building regulations. X 21) All permits e ire 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 nted action from being taken. No more than one extension may be granted. X 22) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure these stru res meet the setback conditions listed. X 5� 23) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. A. Drainfield/ Reserve requires a 1 Oft setback from all footing/foundations. B. Septic tart) requires 5ft setback from all footing/foundations. C. No foun ti rains within 30ft, down gradient of drainfield/reserve area. 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 anytime after work is commenced. Evidence of tion 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 pr ress i tion.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described prope and str cture for rev ion. OWNER OR AGENT: DATE: BLD2011-00096 Please referto the following pages for conditions of this permit. 4 of 4 40 o 4 y CONCRETE MECHANICAL MANUFACTURED HOME y No Date B y Footings/Setbacks Gab Piping Ribbons n'I oIntenorDate By interior-Date By Date 6--.�� By3 rnExtenor Date By Exterior-Date B Set-up Z Point Load/Isolated Footings INSULATIONDate h — By/ I Date By BG f SLAB INSULATION � Data By FIRE DEPARTMENT < Foundation Wails Floors Owe By m Date By Data By DECKS -FRAMING walls Date By Date Ry Data By PROPANE TANKS PLUMBING VaultDato - y Date By OTHER Groundwork Attic Data By Date [3y Type- Date By DRYWALL D.w.� Type. Int Brace Wall Date By W Date By pate By FINAL INSPECTION 0 fD Water Line Fire Seperation N wCD Dale gy Date By Date v� 1 ._ By CD Pass or Request Inspect. c s Type of Insp. Fail Date Date Done By Comments m CD 6-11 Cn n L Ov— �. � 0. s �'L F/ ��/i/ ra►/l7` �v c 1 Permit# Il cc /C MASON COUNTY BUILDING II/ 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location 6"/C -A-AC V�/ i•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 compliance � lii/�✓�r'�I-� —��O �/2,G� /9�'�1'Old S`` TU �i c/i/� �=-�% c L Lvz.T,&-' . i i9'YT y- D 7- T vo214v iv vjj LTA 7- tI �� _ ��L G/�S% `�-Yo7Ti�i- 100, o 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 © OK to �,` �� /���� damage incurred by recent "natural/man made" ❑This is not a complete inspection disasters.This is NOTa Date- C---**'- /J Department'136-!fD CORRECTION NOTICE. Inspector^7-1? Permit# MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location L I C c,-,I " ; cJ PI This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed b low must be corr cted to ain compliance r v ' e st 2 62 c zcr C ' c 1jisn You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK Ca" 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 "natural/man made" ❑This is not a complete inspection disasters.This is NOT a Date 7�?Z—l/ Department - CORRECTION NOTICE. Inspector /,c,) rmit# MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE b Location e "0(, c is structure has been inspected by Mason County Building Department d the following VIOLATION of County Laws and Ordinances has been Jnd: Items Listed below must be corrected to gain code compliance i S T tom— C c 6 )u are he by notified that the above correctionsCshall be made =FORE PRO ING WITH ANY FURTH WORK Call for re-inspection when corrections are made before continuing Make corrections, items will be checked on next inspection OK to This is not a complete inspection Departments p re �t`' —/ -!/ Inspector Tl7 NUT MosV T 1 _ T A ,� 1 Permit 's/- MASON COUNTY ' BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location 6/ CiY66 AWLZZ 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 compliance / ) s°�TsQi�ir'�/� i � �i�r �" E t�,�fG' a s /a 1,y6/� 6-- ,,,¢L OQro C,+- lV/ �fi' Q1 G Ti9�'✓/� �"�`t�/�(//cri=co p Ldi{OG�ni d-�-fc�C� �c^/z,E a f 7-,�z /2' 'il'Gr9�7o� T� T,' 1,X/7 / OvF a, o v/,D/y aLK- W d- ' re-2 Y2---"6-1Ar ,9f2A You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK (a 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 damage incurred by recent "natural/man made" This is not a complete inspection disasters.This is NOT CORRECTION NOTICE. Date �^- ZC/- /�_ Department Inspector�T/� y V � � cm W j ` "` �.• � raj!_ C - W y N f a . 'A6A c• '�, ao .a d pp I 1 C CP - 3-43 .� 1 � qtg Or I I � s - 3�3 r c6u. SITE - �- a � COPY � o APPROVED MASON BUILDING INSPECTOR CHANGES SUBJECT TO APPROVAL LOX- DATE_2AAT1j4_ THESE PLANS MUST BE ON THE JOB SITE f)ccuments attached to approved plans: MR[Nf KMIQN Site plan: ;'Ian review checklist:_ _ Fanu° Engineering: Y(11 ) Lateral Number of pages 3-19-V4, a UST MEET ALL CURRENT ha'b'� + 2 cvv. � '�+� I1[NGN STATE CODES CHANGES SUBMIT CHARW'_7S FOR APPROVAL PR1OR TO PERFORMING.WOPK "a - r v Ct,..p� ,tea• '�� ,�.. � 1 x d • re''J.e" GAS- ��'C1 �' \� �G.1•''^� �e.3'T Ste- Slpsc..'wr� � 4.� IGw l�s �{•~o�.a . poO•&?- tV" o. e. olz � N w►1h 6 oll ��� L� Z �i C•►. w`1 Sea - Z 'rs THESE PLANS MUST BE 5epe, pit., p ON THE JOB SITE FOR INSPECTION �b0 1JE �r7, M-14 `G�V�G iW A WO . , ✓ s kA el � M 5 \i ZN YZ~ S�v �'ovcs d Pa rc�1� �+rstJ�� THESE PLANS MUST BE ! ON THE 10B SITE FOR INSPECTION ORIGINAL � r - ANNING r�.'.'!1■!'G��i■�'�i■�-li�llr■�t/�■■��■r%�Il��r�'; i�!.II;E � �r ti,:�■�tr>�o � . i■f %■\�■�■!�■r■r■rEl■\r■ ��1%tll � � _ -!■■sir■eWin �� ■■■■■11■�■�%%■■■ = it �1. '`�l �.��■� --`--:��G%:ll 1 • ORIGINAL LA CASA / /4/ / NamehAnlyrd ►'1 Parcel#0^2 3� —5O— Q'1�9� BLD#�2:� C156( � t MR6�10� Mason County a0 it —DUO�g �Ut?�t�C� OrGh C De arfm, nc Community Development Small Parcel Stormwater Management Application/Worksheet (page I 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'. '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. R A .s,`Nurface Type Length X Width y = Area " All dimensions in feet Buildings X = m X -1 = p Measurements for buildings are taken at the 'a X ' _ ( Z perimeter of the farthest projections(example: eaves/gutters) Pbrzlh X = Driveways X = rPaArkin X i = `3Z Length of drive begins at the right of way CIO XArea X L. �� X �� = 31�� Any paved, gravel or packed area per definition X _ above table Patios/Walks X = X = Any paved, gravel or packed area per definition X _ above table 4 Others X _ a X = X = e If the Total Impervious Surface Area is LESS THAN 2000 Square Feet, please read,acknowledge and sign below. Based Upon the informat' you ha e,,provided a Stormwater Site Plan IS NOT required for this development activity. Owner/Bui er/Agent A nowledges that submission of ina curate information may result in a stop work order or permit revocation, now gement of such is by signature below. I declare th t I am the owner,owner's legal representative,or the contractor. I rther ac nowledge that the information provided is accurat an employees of Mason County are granted access to the above- described property for review and inspection as may be required. X ��It l� / Owner/ gent/Contractor(circle one)Date: f the Tota Impervious Surface ea is GRE ER THAN 2000 Square Feet, please read,acknowledge and sign th ion p vided on e f 2. Page I of 2 Name Parcel# BLD# 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 14.48 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" PLEASEINITIAL 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 will 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. 1 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/Agent/Contractor(circle one)Date: Page 2 of 2 h _ Y< "�y+may A'"r.:" Kr s ��k _ ►F- - - ;�Y='� M : � BLD2011-00096,taken by LAW on 7.22.2011,#1 of 4.jpg� 0 7/2212 0 1 1 qr r r �- r BLD2011-00096,taken by LAW on 7.22.2011,#2 of 4.jpg 07/22/2011 Awa _ - tl,_ a 6LD2011-00096,taken by LPW on 7.22.2011,#3 of 4 jpg 0712212011 _ ... vim. .` '- 1 .' ••'� it F .. _ _ kt; BLD2011-00096,taken by LAW on 7,22 2011,#4 of 4 jpg 07/22/201 1 r a -r d y'. '..,t'y, �4�. v-: .t .�..�s�,.. ... aF,, 94,,,,. f� � � w ,'^"•^+'4`�°'r';a a3. '� `.�.` w. n ..,,e FKM,px .,• ,:r^R ..'xis, .. �,,r ��Ty( am'y �. 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Box 186, Shelton, WA 98584 A I Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.usjQ, APPLI ANT INFORMATION *22 CONTRACTOR I FORMATION Owne ' O ti o 19O N !Loj- 3 I Company Name o z ' `�-- Mailin Address I C C' Nt E 0 ✓I If jeLj tL Mailing Address ' City tate 1L`Zip Code City State ? Zip Code Phont- �C�_ 2-2-3 K Other Ph. Phone b Other Ph. Lien/Title Holder Contractor Reg. #(Zo e_i,4-t-f t-tC1_21LAA Exp. :;1 4)I E mail address E Mail Address Drivers Lic.# i DOB i Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATIM- 17 ninit Pnrral Ain a 2,q3 j S'p o O Ce,3 Fire District � Legal Description-Co1 t r1 S (-Pr&—=0=1 L.o-E Lv 3 Site Address(Please include street nape, stre number and city). Low V1 E - 1 r ctions to sit i -I-o b d 0 rn 110 re K. t ct_c - Will tim r be cut and sold in parcel preparation?Yes No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB- New Add Alt Repair Other PRIMARY f3FSIDENCE 0 5EASONAL ❑ Use of Building I Y-Iq Describe Work { �OrnE YIE(_kj/W1 ' No. of Bedrooms o. of Bathrooms�Z Square Foo a - For 2nd Floor ��A J �- t 3rd Floor Basement Deck Covered Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make (�.rvl Model e-=- "Year�L.,c Length�� idth _Serial No. 1 2 D No. of Bedrooms o. of Bathrooms_ Type of Heat � y i e� Purchase Price$ If�.�y 1 0 D Replacement Unit no Yes Installer Name (-ki t h e_ Certification No. *_ Da(,).3 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 the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required m an easement holder or any other parry in interest regarding this application or the work proposed in the application,I have obtained permissi n from em to apply for this rmit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided accurate and grants empl ees of Mason County access to the above described property and structure for review and inspection. PROOF CONTINU MON OF K IS BY MEANS F A PROGRESS INSPECTION. r �— �— � � x Date: ner. Owner Fi se ive/Contractor (indicate which one) ' FOfi OFFIC L U BEYOND THIS POINT Accepted by: Date f EPA� NTAL REVIEW APPROVED DENIED NOTES ilding Department s i( �anning Department Ovironmental Health Department. Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee I State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES