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D I o'f• 'ten 00 lk a ='S>"ISze— Q o� CO QKA� Ri,— C 0• 00�r+' � osr 17oc oaocirs�• o rs 's 0 06 { to-� �C"--7�•? 1 Baca a • 00 0 9! c 0 [F(, ♦' HIV - ✓` low*"*Cvr (D p_a 0_ 1 _ T �w- •W x W "Ic 0 Wo+ ?i m = 'f1 1li�tr�rF•�+r+ /1 ®-� -row D C .°+ 0017ab0ane 0 n N "s Q a •a is c� Q -- O'Vs x—a cn 0+9 o—a— �p E. • sir---I=--a A ffi =r+*c o I «+a—mvl• �~ a o 0-1-7° z -uy - .90 a;;o fl3 •�'?• C • �"f13 r1eoQ +' i? is C o 0 r+ AA trams `z. o CL -•— •• —x4a coo* I j� 1 d i i I vin (vt � 0 I�i,�(,' y, 3 Permit No. MASON COUNTY BUILDING PERMIT APPLICATION 0 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 er Phone# v to Address � � Fire District# ity St Zip Directions to Job Site ,l"- �jal Owner Mailing Address oe City 14H VAJ Zip Lien/Title Holder I Address t� 1 ZaIP5 — city A/_�� St zd w—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 s (If residential, proof of potable water is required) _4� I #4 arcel No. ''// Legal Descr tion I - v 4 #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI&� 3rd FI / Loft/ x Basement / Deck #bed ooms_,;? #bathrooms Garage / Carport (Circle:Attached or Detached?) Other ft. / 'j #6 Use of building / �� ' Describe work #7 Type of Job: New Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model Year Make ` r Model !'ud , �' Z c, �Y Length 01-. Width / Serial No. / #Bedrooms #Bathrooms _Type of Heat Lkfri C--- Purchase Price$ ybn #9 Indicate by circlinalhe applicable source if any water is on or adjacent to subject property: River Pond reek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Indicate Directional b N, S, E, W Name of Flanking Street in relation t y of Ian ) Name of Fronting Street p APP CA T TO DRAW SITE PLAN BELOW N sP� rt4 L-vdd ' APPLICANT TO DRAV TQPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3 each) Egg Mechanical Fixtures ($6 each) No. Toilets CIRCLE FUEL TYPE: Ga , Electric Bath Basins Heatpump, Other Bath Tubs No. Units Fees j Showers _ Furn BTU Hot Water Htr _ Heatpumps ALaundry Washer _ Vent Systems Sinks _ Spot Vent Fans Floor Drains No.. Boilers/Compressors Laundry Basins _ HP Dishwasher No. Air HandlingUnits ADisposal cfm# A—Urinals Ng,, Fire Protection Systems Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ N. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COM- 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 OF THE 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. FWNER X BY DATE DATE Ft R o.. -F [AL USA ONLY ccepier!ICY Oat t DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: rn� 62� s Environmental Health: Building PlanReview C S Vol 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 ASON COUNTY EPARTMENT of GENERAL SERVICES ason County Bldg.III 426 W.Cedar .O.Box 186 Shelton,Washington 98584 206)427-9670 BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION September 10, 1996 (�� c;_0kq( Re: Permit # �-D°1 \ Dear Ek,,,Xcs c_& �y',Y\ � On °1 / I ot, /ctS this office approved for issuance the above permit number. Pursuant to the Uniform Building Code, Section 304, this permit, once approved for issuance, must be issued within one hundred and eighty days to stay valid. Failure to pick up the permit within the one hundred and eighty day time frame will void the permit and it will be necessary for you to re-apply for the permit thus, meeting all new review requirements. Further, the Uniform Building Code, Section 304 allows for the collection of the plan review fee if a plan review has been performed and the permit canceled. In the event that you no longer require the permit or choose to cancel the permit, the plan review fee due on this permit is $ ._. The check or money order 1 should be made payable to the "Mason County Treasurer" and submitted to this department for processing. Once the plan review fee is paid, we will return the plans to you and cancel the permit. If you wish to obtain your ,permit now, the amount due for your building permit is $ JILA .SU . Once received, we will issue the permit, either in the office or we can process the issuance through the mail . The permit will remain valid for a period of one hundred and eighty days. At the end of this one hundred and eighty days, an inspection will be required or a one-time only extension can be granted through a written request. However, all future extensions must be granted by progress inspections. If we receive no verbal or written response from you within 30 days we will then schedule an building inspector to go to the site and do an inspection. Please respond to this notification prior to October 15, 1996 . r - r. Sincerely i Trish Clerk III 1-800-562-5628 Ext 352 or 287