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's a c � 7 as -► mos�+a O 0 "7 � L +*v a-+ go a=110 as z rt Cn s F+ 0 �—e�ibaa ...•f m rn e» —cCcs 04 OZOLS (Q ozoo mXW -SC c c z r+—g WF+ sm 0 tt m In arc-- s3 AXO4Q=t7 f CAC7 a a z X• �rF�0 .;y� + 2 0, -a a c 0 ca c m r* �+ g o — 4a xom "4 ? j z -t s m-ms or-4 00, '' pr�op m a as �f C 0 w's a C"7-%Caf+ a �r m c�m ce .• CONCRETE MECHANICAL MOBILE HOME Footings-Sefmk date by Ribbons date by Gas FON date by Foundation Wails date Set up `oe by INSULATION date 2--9 7 byL-� BG/SLAB Insulation Flo Final Flom Yr��-97 date by date by date 7by FRAMING Walls FIRE DEPT. date by PLUMBING date OTHER Groundwork Attic date by date by D.W.V. WALLBOARD NAILING S. 19 data by date by Water Line FINAL INSPECTION �I date by date by I date by i Permit No. bl pq9- MASON COUNTY oaf BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton,WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 Owner ��S►R A2 RA.n S-4-� W Phone# r 7-o6::r-99'2-7-6 l Site Address E. t'JS 2-A!a S 7"► 1 vjI j -3 Fire District# City „4 LLv ,.1 St Zip Directions to Job Site Lo t_L, o '5; e4-3 Owner Mailing Address Rk'n L`�1 ! R sn,� �Es -,.c =R9 %? City F @ DA if UJ N St IA./A'--Zip m Lien/Title Holder Address City St Zip #2 Contractor Name Contractor Reg# Address Expiration Date City St Zip Phone# #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well Connect to Sewer System? Name of System (If residential, proof of potable water is required ,f� 8 `t-A^ A4" L 2.22 O - S o "t #4 Parcel No. b Legal Description Vl" \ J� ' / l'e a #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other sq.ft. / #6 Use of building �f (i✓ Describe work #7 Type of Job: New Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year CT3 Make ;l V Model Length Width IL. Serial No. 1y1� #Bedrooms#Bathrooms C_Type of Heat Purchase Price$ #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: I o AJ River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other ��T�' Pa Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences A Structure Setbacks Driveways 1 V Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE ELOW J�o o,3L 0 NA 1vtD 1?i i LC-- 0 l s � -z— -t APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Lzo-d HI � r f �j f37- 9' et 12rb-2 Plumbing_Fixtures($3 35 each) Fee Mechanical Fixtures ($6.75 each) No. Toi is CIRCLE FUEL TYPE: Gas, Electric, Bath Ba s Heatpump, Other Bath Tubs No. Units Em Showers — Furn BTU Hot Water Htr — Heat p ps —Laundry Washer — nt Systems Sinks Spot Vent Fans Floor Drains No. Boilers/Compressors —Laundry Basins — HP _Dishwasher No. Air Handling Units —Disposal cfm# Urinals ire Protection Systems I _Other — Auto. Fire Alarm Sys 50.00 Fi Fire Supp. Sys 50.00 a k Permit Basic ee 16.75 — Auto Fi Sprink Sys 35.00 TO PLUMBING $ No. Other — Gas Outlets Wood, Gas, Pellet ve g \ NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 18O DAYS OR IF CONSTRUCTION OR Permit Basic Fee .75 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $ 4 MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27,AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ` ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNf �R�6-� X BY DATE 3�/2- ��7 DATE f DEPARTMENTAL REVIEW FOR OFFICE USE ONLY [Approved Cond. Hold Approval Planning: /n f s act" Environmental Health: Building Plan Review e vt Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other Other Building Valuation: TOTAL FEE