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CD'+ ? o a 0 o Q � 0 a -+ � 0 a� 0 0 0 g oa 0 0 7 = N a m n 0 -a m a m � �,, " — -* 0 CD 0 m -z Cn O v p �-. -» O 0 c a -_ C g 0 0 aco CD 3 0 � 003 � a 0 0 � o a� a m z Q _ -n v o a m 90 0 cu 0 =F -a (c 0 (D a -� < -h-a � o 9 CA) � a 'a -Oa m 0 .0 w c CD a °« a o m -, n'ocn m o0 °, a' 0 CD cm <' 0mm a� acn s m o CD m v m v m CD N CD o 1 N c ' m o < o' — a MECHANICAL MOBLEHOME ' Foottnp ® Sejac k date by PJ)b0^s r date Gas PWq ame by Set Ficxwatlei�YJalls dateby up by dde by INSULATION date BG/SLAB kwulation Floors Final dde by date date L FRAMSNG Walls FIRE DEPT. date by date by date by PLUMBING Attie OTHER roundwork date by date by WALLBOARD NAILING D.W.V. date by date by FINAL INSPECTION Water LineJda to by date by date by C--' r4 t IV , C � r eSs y �56r� ^5 7 ^ ' 9 i � - PERMIT NO.: BLD MASON COUNTY { BUILDING PERMIT APPLICATION _a 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 Shelton 360 427-9670 Belfair 360 275-4467.Elma 360 4825269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INF9 AA I Owner el L-�- -• Contractor Name Mailing-Ad ress � Mailing Address City _ f'CI+ ,.�t�te Zip Code City State ;Zip Code PhoneL2! ) 5� v Other Ph.(2D&) - © Ph.(_� Other Ph,4F ) N Lien/Title Holder Contractor Reg. # Address N A Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic ,,Connect to Sewer System Name of Sewer System Well Water System Name of 3 W ter System Wdo h",nrt� Sady, CC Cra 141 I 6A - PARCEL I FORAfli 1 0-12 S�0±a�,RarIli ._ 1 / re District Legal Descrip..;1 K p"t' ' Q�1 d7 • Site Address(Pleas i clu streW , streett nu bar a it ) Dirertio Ao site 7 AA Will timber be cuf and sold in parcel preparatio ? (Yes/No) W" J tt 7 Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE^ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair_Other Use of Building Describe Work No. of Bedrooms-1 L o. of Bathrooms-o-ze SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Y r Length J" Width_2,_7Serial No. AV Z tj At X No. of Bedrooms tk t r o Type of Heat Purchase Price $ t� Replacemen -nit e Installer Name Certification No. a of NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 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-]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 approval. first obtaining approval. X , Cx' / dt- (,� Date • G� / X Date FOR OFFICIAL USE BEYOND THIS POINT C �7 Accepted by ? Date. Submittal Amount Duet.W 72 Receipt No.� ..: : ..:...:... ...:.....:.......:.::......: . .::::::::. fJ..........:...:.. . :><<''> . : EPR 'MI: RED. #f>: :;.;. .. : APPRQv.>w#� DNtI~D:. . 1131T!'7hJ G+ > Building DepartmenFw Occ Group Type Constr. Planning DepartmentLQ a- ` -0 Environmental Health Department Public Works Department I Fire Marshal Valuation $ .:....:::.:::::..:::...:: :.::::::::.:... .:.. . : : :::::::: Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee N Plumbing & Base Fee Public Works Review Feef. Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO.: BLD 0 `"" • MASON COUNTY BUILDING PERMIT APPLICATION I-22 426 W.CedaNP.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275.4467.Elma 360 2-5269 Seattle 206 64-6968 JAPPLICANT1NIFORMATION CONTRACTOR INFMJJ� Owner t.« Contractor Name Mailirtg..Ad ress �! Mailing Address City 1—,c A e e& 1 t&St to� Zip Code City State Zip Code Phone( �_pther Ph. .� Ph.( ) Other Ph.( Lien/Title Holder #4 I Contractor Reg. # Address N Expiration SEPTICIWATER SYSTEM INFORMATION-Connect to New Septic Existing Septic_ Connect to Sewer System Name of Sewer System Well Water System Name of Water System f PARCEL INFOR TON-12 Ig t Ta rcel N F District I Legal Description .1y� 1 'n�ki"�- hd991-A. Site Address(Please includq street name, street number and cit ) Dir�esctionrs�to site wrx -+i ito Will timber be cu and sold in parcel pre aratio ? (Yes/No) trl�, tt Is your property within 200' of the following: Body of Water(Name) -;-*S�Itwate Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Other Use of Building Describe Work ,,/ ice A e oz om pX-J! � t4 o* .�_. .. ►"y'#�r ��.t 4 „I �. en VT'.^�'-.^�ll��'�^r II No. of Bedrooms_ o. of Bathrooms * SQUARE FOOYkdE-1st Floor_ 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make '- Model Model Year�� Length Width Serial No.♦ r No. of BedroomsNo. of g°atfir6lorR� Type of eat ,. Purchase rice- r" Replacementtlnit ?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 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-I 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 appro . .'-, first obtaining approval. X 4, Date X {..p Date FOR OFFICIAL USE BEYOND THIS'POWT n Accepted by ;`, Date Submittal Amount Due, /I Receipt No. .:: :::..:::.: .:iaPPRC? El ::.:,[ E:NI>w :...:.........:::......:....::..:.:.CNA # 1:: i `. ..:.... .................... Building Departmen Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation :::::::: .............:::::::::.:.:::::::::.::::.:.::::.::::::.:::.,:::......:::::::::.:::::::.:::::... ...... BuildinPee.:::::. rm� Fe .Site.lns Inspection g p Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee A Mechanical &Base Fee �p Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO.: BLD 2�✓V MASON,COUNTY BUILDING PERMIT APPLICATION ' 426 W,CedorlP.O.Box 186,Shelton,WA 98684 Shelton 360 427-9670 Belfair 366 278-4" Elnia 360 24268 Seattle 206 4-6968 " AFPLIC�k: I• II�1FOiRMA710N CONTRACTOR INFOUVIA j Owner, n LG..C.. Contractor Name CJJ C Mailil�-Ad ress Mailing Address lCity- f tote ( Zip Code City State Zip Code Phone( )�3��r ther Ph.(oj¢� _ Ph.( ) Other Ph.( ) Lien/Title Holder Contractor Reg. Address Ig A Expiration k SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic-Existing Septic—V Connect to Sewer System Na a of Sewer System Well Wat rb System Name of Water System - 410 + W i PARCEL INFOR ION- 2 it T r / / Fire District Legal DescriptiM K �.90I 8 Site Address(Pleaw 'incit stree na e, street number and ci ) ire�t. igto site "�''p ' 1+� s Will timber be cul and sold in:parcel preparatio ? (Yes/No) + yn d Is your property within 200' of the following: Body of Water(Name) Sal water Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDEN SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Other Use of Building' Describe Work �' No. of Bedrooms.,,,2ZNo. of Bathrooms SQUARE F AGE-1st Floor nd FT667 3rd Floor loft Basement Deck Other sq. ft. _ Garage Attached Detached Carport Attached Detached [Installer BILE HOME.INFORMATION-Make Model Model Year gth Width "_Serial No. No. of Bedrooms No.of a e of Heat Purchase Price $ Replaceme nit?(Yes/No) Name_d p ea., S 2JKd Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 160 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 for 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 reviewand 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 AFFIDAVIT4 certify that I am currently registered as a Contractor Registration LawACW 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 appro I. i G first obtaining approval. I rt . Date X Date - FOR OFFICIAL USE BEYOND THIS POINT Accepted by Datk _{XSubmittal Amount Duel Receipt No. .... ... ..:I ..:R .. 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PlanReview Fee UFC Plan Review Fee Plumbing &Base Fee Public Works Review Fee Mechanical&Base Fee Other . Wood/Gas/Pellet Stove fee j; Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES