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(D (D 'G a r+N 0? - -• C r+0(Q-h -N (A-•'0 —.0 -7 Al r+(A'0 0•7 Al W O 0 7-:3 aG'71-3 N r+ r+ 0•-•a to 0 a : N-• -3 (DN(Q On 7 0 x • (QQ— -3 (A- (D :3 - r+ CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Ong date by Foundation Walls date by Set DP date by INSULATION date 3by BG/SLAB Insulation FlomFinal date by date by date by FRAMING Walls FETE DEPT. date by date by date by PLUMBING Attic OTHER Groundwork date by date D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPE date by date 3/ by I Jdate by .S' C' �✓O. GO�'!,p cl=T� /vlc�c ig,Jyc�ti i !I I 4 PERMIT NO.: BLD _T r MASON COUNTY I a BUILDING PERMIT APPLICATION � 426 W.Cedar/P.O.Box 166,Shelton,WA 98484 Shelton 360 427=9670 Belfair 360 276-446T-Elma: .360`: 824269'Seattle 206 464-6968 APPLICANT INFOR]NAT N CONTRACTOR IN O MATION Ownerear r Contractor Name PI-4 14!5iM1_- Mailing Address ,vo 1 17 ff Mailing Address city I I un State_ t�3 ZipCode City State Zip Code Phone(_,'&0}2)7'7^-b181 Other Ph.( ) Ph.( ) Other Ph.( ) Lien/Title Holder_G�oq Contractor Reg. # Address Expiration J 7 - SEPTICIWATER SYSTEM INFORMATION-Connect to New Septic Existing Septic �"" Connect to Sewer System Name a Sewer Sys em �'"'"` Well Water System Name of . Water Sy_st_em_JJar0X LAWeir C3rhPCLHy:,4& PARCEL-"INFORMATION-12 digit Tax Parcel No./a2205097001/ - % Fire District Legal Description Site Address(Please includ stre t rname, street number and city) Directions to site .3 # > + -/, �k t'l'► f v i e tnf 14 m r tl S / s Will timber be cut and sold in parcel preparation? (Yes/No) t> Is your property within 200' of the following: Body of Water(Name) © Saltwater Lake River/Creek T Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF'JOB New Add Alt Repair Other Use of Building Describe Work i No; of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st ;,,loor0 2nd Floor 3rd Floors Lott Basement Deck Otherl __ sq. ft, 3'(0 Garage Attached Detached Carport Attach d petached MOBILE HOME INFORMATION-Make' ode[��No­bf Model Year J Length Wid h l ` Serial o. Bedtooms Z. No, of Bathrooms Type of Heat Purchase rice"$� ReplaCerrlept Unit?(Yes Vo) Installer Name VI / H Certifica.'on No. /rt/SCaP NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK-OR CONSTRUCTION 11THORtZED IS NOT;COMMENCED WITHIN 106 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,r1epresents that the information provided is accurate,,and,grants employees of`Masgn County access to the above desFribed property and sttud-ttke3 for review"dg ;a.•t, inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFI6AVIT-1 certify than am currertly'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 j a( ito first obtaining approval. X7 77Date � _&L a te� � FOR OFFICI L. USE BEYOND THIS POI NT 1 Accepted by Date ubmittal Amount Due ! Receipt No, 41 M- Dep ; ::: : ;>;:;:«::<:>:::� � ' • :::::::::-: artment Occ Group Type Constr. �7 007" 161 f 5 de Planning.Department Environmental Health Department Public Works Department Fire Marshal Valuation $ , 0. ..:.. F-.:v n.-.... .........:.R.-w::::;•>: ::::. ::::. ::. :�>+2:Ly>ii::•i�i::•ry':ii;%i•)ii: Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee j l PIIbing & Base Fee Public Works Review Fee j echanical &Base Fee Other ,i Wood/Gas/Pellet`Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEBS � w vl r PERMIT NO.: BLD ' MASON COUNTY BUILDING PERMIT APPLICATION ,\b 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 1 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 64-6968 AFPLIC NT 1,NFORfAATION CONTRACTOR INFORMATION Owner Kcr 'E k t o, Ur .A t} ` Contractor Name 40(� Mailing Address Ply, i6l( 3 Mailing Address city-A, State_ Zip Code City State Zip Code Phone( t.;) 217 - t~;=161 Other Ph.L Ph.( ) Other Ph.0 ` Lien/Title Holder A Af Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septc Existing Septic Connect to Sewer System Name of Sewer System Well ' Water System Name of Water System r �.Jtt d�r7 ,L w PARCEL INFORMATION-12 digit Tax Parcel No./J7122t3'G 77104y / Fire District Legal Description Site Address(Please include stre t ame, street number and city) Directions to site J k 1 ' A 0 1 • 4 ,' Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) A/0 Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt_ Repair Other Use of Building Describe Work No. of Bedrooms No. of Bathrooms ' SQUARE FOOTAGE-1st Floor°_2nd Floor 3rd Floor Loft Basement Deck Other sq. ft."'1L G,a€age Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model err, , Model Year Length Width 14 Serial o. h No. of Bedrooms X 'No. of Bathrooms Type of Heat Purchase Price $17 k5T.G Replacement Unit?(Yes/No) !" Installer Name r #V1JV'j At •, Certification No. *1A1S :G NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION UTHORIZED IS NOT COMMENCED WITHIN 40 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-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 approv,4 first obtaining approval. a-" _ 621iDate "' T X t e` [yitel f'Via: FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date ubmittal Amount Due Receipt No. ..........................ill". > .: :;: •. Building Department Occ Group, Type Constr. Planning Department Environmental Health Department _ C� Public Works Department Fire Marshal ' I Valuation $f a:>...........................:.:::::.:.::::::.::::;:... Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other 6N v I-Je414 Ile SO' Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES r PERMIT NO.: BLD MASON COUNTY. BUILDING PERMIT APPLICATION ,\b 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 \ Shelton 60 27-9670 Belfair 360 275-6467.Elma 360 2.6269 Seattle 206 644968 APPLICANT(NFOR ATt N CONTRACTOR INFORMATION Owner a k' Contractor Name �. Mailing Address .t7• I Mailing Address Cit Allun State� Zip Code City State Zip Code Phone 2r1!1•C7181 Other Ph.( _ ) Ph.( ) Other Ph.( Lien/Title Holder ty 0q Contractor Reg.# Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic a•-- Connect to Sewer System Narpe of Sewer System Well Water System Name of Water System I' k) } PARCEL`INFORMATION-12 digit Tax Parcel No, / / Is Legal Description . Ah - Site Address(Please include stre t ame, street number and city) irections to site �f , - ~ ; Llf6 14 i 11} Jfwt 3 .0 s S Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200'of the following: Body of Water(Name) 0 Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 1TYPE OF JOB New Add Alt_ Repair Other Use of Building Describe Work No. of Bedrooms_J No. of Bathrooms '2 SQUARE FOOTAGE-1st Floor ' lv __2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. _ Garage Attached Detached Carport" Attached Detached ! I rT. -Make Model f ( ' '�' �12iglig Model Year 7 Length Wi h Serial o. No. of Bedrooms a Na, of Type of Heat Purchase Price$ I' + Iant'Lh*?(Y Installer Name + J h Certification NoA,4JAiAtS607.q NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION UTHORIZED IS NOT COMMENCED WITHW Ito 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,re jxesents 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 AFFI6AVIT-1 certify that-1 am curraltly registered as a Contractor Registration Law:RCW 18.27 and am aware of ordinance contractor in the State of Washington and that l an 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 pwn*.is Issued andall work conformance therewith. No changes shall be trade without first obtaining shall be done in Conformance therewilh. No flanges shal be made wOW awovol first obtaining approval. X t �, FOR OFFICIAL USE BEYOND THIS POINT / Accepted by Date ubmittal Amount Due Receipt No. 1 Sul din*Department OOW cc Group Ty Constr. Planning Department '/Z 0AA Environmental Health Department Public Works Department Fire Marshal Valuation$ .0' ♦ � f'-r 777 rPlan ing Permit Fee Site Inspection Review Fee UFC Plan Review Fee bing& Base Fee Public Works Review Fee hanical �Base Fee Other d/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTA4 FEES