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"•sT ertn:wrs a!!hie 9-e:.:t Tftr ag..s,eil Vtri&lag.F.n�teer�;,I�i ata �r14i•� h.JHinl�IIl:I�—gMlT'17TM T:PF,—TF.R—P4? H,P:F,L1 /bT/P,A Im p C`nt7v' o, �� Ofg, pz x YEA Y C 5 lip \f j \ � `� � r, HN; IU) lo ME ^r RL Iz ifl IL rw �' m WILLIAMS SCOTSMAN eRIQD3 EwGMERINc,INC. qi u _ MO�LILAR 5.�l=�-'NG FY UNC A70N co B R IQ Q$ 5TANDARL? FOUNDATION nF- irA;l_� )�� � � Y 4 �2]d tSit-LiCO _ PO 20z WRI 'E017—ICANC ES71I om l `9 'V'.V CAM C'hG N=. S'CFL£: T�rRe`"in,.�-WyD3—Jor C"Mol.3naI•a!_c used tiC✓ 5.i.2 04 CWOZA=0 -wl AS NCTEG A:cry�rakt a-:t!ms m :nm?"in;ago.;?: .^it�e+c�varro+;Gaon E-1q�s7ke•.'.r,,eo. C� i Z7 PL 1, .18,55 Z 0 D 0mm CO 0r �o0 (ri cn O me �oz -i o c) � D y rZ @®@(96 ZO m (n (n D C D C cn m0 r -0 r m mFr ; r ; D > * = X = --i -i I -� n = 0vx -o = 0 0 > 0 o �umNG � WCC) D 0 k rn m(n r w m X mZ O n (AD m D I 0 O = .- El i M N O m 0 Z 0 D 0 C) M m z = zon Om � � 0 -D C� 0 C/) m � � _ r O = N C)CIO a x o ' X n o C P'l X � � O - Z i FILE COPY 0 0 (aoob -C)C:)(::) Documents attached to approved Plans: 44ffli-tevtcr-r�k I i s t Pages 6> Engineering: y N Lateral Vertical Number of pages------ C 111i"i N GLE ),J b j, j FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. Q©rn;dACD%�- PLEASE PRESS HARD BUILDING PERMIT APPLICATION c�cc 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 INAORMAT N CONTRACTOR INFORMATION4 Owner 9 IWC- Company Name D� IM - 6ff6-.1nr ,n/L Maili Addre s Mailin Address N1 O• , �c �3 3 9 9 Ci tate City R fl State w Tn c`.r,rtp�` ty 1 _Zip Code .� Phone 2 Other Ph 2 S 3-`Ib5^46 Z& Phone ^2 Other Ph.2C ^YoS'!.6 (o Lien/Title Holder Contractor Reg. .0hcil 49c-G Exp. Zb-1--o C E mail address E Mail Address Drivers Lic.# DOB 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 INFORMATION- 12 Digit Parcel No. - Fire District Legal Description E T Zl wl T W A• IISC14 CO. Site Address(Please.nclude street na;ne, street number and city) A L Fi41t2 W • Directions to site lam rogMeSt W i w RP. ,4 + Will timber be cut and sold . parcel preparation?Yes/ Is property within 200'of Saltwater Lake -River/Creek- NO Pond Al,"0 Wetland No Seasonal Runoff_&_o Stream-A40 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 - New_ Add Alt Repair . Other PIVA13Y RESIDENCE E] SEASONAL E]Use of Buildings �!� Tic�i Describe Work atSPRTcI i�I . RRSf-J ,��c_c • No.of Bedroom" No.of Ba hrooms Square Footage- 1 st Floornd Floor 3rd Floor Basement Dec Covered Deck Other _Sq.It f2 Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make W"'I ;-4mS-St-ol's&'A,NModel d ff/c z T�G9i Year Length —Wifith�Serial No. Z-Vr� M S D g� No.of Bedrooms No.of Bathrooms Type of Hea �, C ' PLArchase Price$ 7D000-0 Replacement Unit? Yes 49 Installer Name /2t Go+ 0E Certification No. OWNER/BULDER Aclvwwledges 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 easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission m o apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is d nts employees of Mason County access to the above described property and structure for review and inspection. PROOF OF R BY MEANS OF A PROGRESS INSPECTION. .-- X Date: Z r/Owners Re resent tive/Contractor indicate which one FOA OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department G Environmental Health Departmen 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 State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT No. -A`�r:�;���� BUILDING PERMIT APPLICATION 426 W.Cedar• P.O. Box 186, Shelton,WA 985$4 i ' Shelton(360) 427-9670• Belfair (360) 275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us APP4IC T 0. N CONTRACTOR INF RMATION Owner Company Name t �+ Maili Addre s Mailin Address City tate Zip Code City State "Tp Code Phone. Other Ph Phone Other Ph. Lien/Title Holder Contractor Reg. Exp. — ' ti E mail address E Mail Address Drivers Lic.# DOB 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 INFORMATION.- 12 Digit Parcel No. 'W - Fire District j Legal Description Site Address (Please'nclude street na e, street number•and city) 1 Directions to site a' Will timber bd cut and sold A ilarcel prepa��[[ation?Yes Aa Is property within 200'of Saltwater Lake jW River/Creek. Pond (© j Wetland AID Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or of sr enforcement ?Y TYPE OF JOB,-New Add Alt Repair.Oth r PRAY SI ENCE` FJi►SONAL Use of Building `"' Describe Work+� "� a s- V am �* No.of Bedroom No.of Ba h ornsAfif Square Footage- 1st FI o nd Floor 3rd Floor Basement Dec Covered Deck Other _ Sq.ft. 112,2 Garage Attached Detache3 40 Carport Attached Detached MANUFACTURED HOME INFORMATION- Makei` 't - odel Year_ Length _W' th _Serial No. 7-V& 8�i ►frtis &t No.of Bedrooms No.of Bathrooms 1 Type of Hea Purchase Pricg$ _ D&P-'" Replacement Unit? Yes 49 r staller Name t` Certification No. V*ER/BOLDER Admwledges submission of inaccurate information may result in a stop work order or permit revocation.Admowledgement of h isby 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 mit 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 an easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission fro o apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents.that the information provided is a nts employees of Mason County access to the above described property and structure for review and inspection. PROOF N OFWRKJB 9Y MEANS OF A PROGRESS INSPECTION. X Date- c „ r/owfiers Re resent tive/Contractor indicate which one FOfi OFFICIAL USE BEYOND THIS POINT ° ~ Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Joe Planning Department r Environmental Health Departmen Public Works Department Fire Marshal FEES Building Permit Fee Site Ins ection 3` Plan Review Fee EH Review Fee Plumbing &Base Fee Planning Review Fee Mechanical&Base fee Other Wood./Gas/Pellet Stove Fee State Fee Violation'Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO. Corr��C BUILDING PERMIT APPLICATION p�c� 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 APPLICA T RM N CONTRACTOR 1N1! RMATION Owner 9 IAI G Company Name &At&& _ G Maifi Addrg s Maifin Addr ss7AR City tate _Zip Code City State' • '` {p Code Phone Other Ph Z�' " Phone Other Ph. "' j Lien/Title Holder Contractor Reg. Exp. /6-1--ft4o E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# i DC)B ` SEPTIC/WAT R SYSTEM INFORMATION - Connect to New Septic Fxisting Septic AM Connect to Water System Name of Water System Well Water System Name of Water SygteT PARCEL INFORMATION- 12 Digit Parcel N I --7-c-db ire District Legal Description s� I Site Address (Please include street na e, street numbeand city) f Directions to site r Will timber biTcut and sold A Ilarcel preparation?Yes/ Is property within 200'of Saltwater �t�`U Lake fliver%Creek` N2D Pond_tY Wetland Np Seasonal Runoff Stream S{apes or Bluffs �►�15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcwmt ec kjo t?Y TYPE OF JOB,-New Add Alt Repair . Other PR A Y RE�S1�1Q 'N_C_E_ SEASONAL ,❑ Use of Building IDescribe3Work �' ilifG +� • No.of Bedrooms No.of Ba hrooms Square Footage '1st F.0 nd Floor 3rd floor Basement Dec Covered Deck Other1�Sq.ft e Attached Detache Carport Attached Detached All IIt11UFACTURED HOME INFORMATION - Make dt1 tAMtIc-.StnT'SIN+pWModel YearZ Length. —Wi th. 9 Serial No. 26 V&in s lo ato No.of Bedrooms No.of Bathrooms Type of Heat PLirchase Price$ e0 9- Replacement Unit? Yes/ 9 Installer Name A&&a C#tg C.4 Q&ej IAJC Certification No. CMER/BU LDER 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 tarn 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 fr em o apply for this permit and conduct the work proposed.The owner or agent on owners behalf,represents tat the information provided is d is errloyees of Mason County access to the above described property and structure for review and inspection. PROOF OF O NO R BY MEANS OF A PROGRESS INSPECTION. X Date. O r/Ow hers Re resen ive/Contractor indicate which one FOK OFFICIAL USE BEYOND THIS POINT "" Accepted by: Date DEPARTMENTAL REVIEW APPROVED' DENIED NOTES Building Department r11q i2 c, Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee bo Site Inspection Plan Review Fee EH Review Fee ,• Plumbing&Base Fee Planning Review Fee Mechanical& Base fee Other Wood/Gas/Pellet Stove Fee State Fee Viol'ation`Fee Pre-Paid at Submittal L`` Valuation$ TOTAL FEES Mason County Permit Assistance Center Planning Intake Checklist Owners Name: /U c`,r � d� i tz r Date: ' i_r C, 5- Project: `_ Reviewed By: Commercial Development: ES_"NO Comments: Planner: GBM TSC �jb4��KJM SNG BJR Site Plan: INorth Arrow 9 Property Dimensions: X Streets and Driveways Shown.Road name: f c,z V l� ❑ All Existing Structures shown with setbacks ❑ Well Location, Septic and Drain-field Shown with setbacks o Identify all surface water(streams,ponds, shoreline,wetlands, etc.) ❑ .. Topography(slopes) Proposed Structure Setbacks (Direction/Setback): F: (_J /-3/4;R: _,E-_/�3 S1: "'t" / S2:5. / ❑ Utility and Drainage Easements: Yes No (if yes enter condition#5022) ❑ Other Easements ❑ Accessory Appurtenances ❑ County Access Permit Needed(add condition#0010) ❑ State.Access Permit Needed(add condition#0020) Standard Conditions to be added to all Building permits that planning reviews: #5019 and#0700 Are there any impediments that may restrict access to your site? (dogs/gates) Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: �j`N_ot Applicable ❑ Agricultural ❑ RR 2.55 1020 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy ❑ Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT rban Growth Area ❑ MPR ❑ Unknown ❑ Unknown Water Body(type of water if unnamed): SEPA: YeCNo-_-Unkn wn Flood Plain: YES O Unknotown Map# Aquifer Recharge: YES NO Map# Tags/Cases: - RLC/SPI Case: X 6-Year Dev. Moratorium: YE"Oy� Eagle Nest Tag: YES( NO Other YES NO Addressing: Check box if needed ❑ Reviewed by: Revised:07-12-2005 IAPLANNING\CHARELL&RENEETLANNING INTAKE