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Date By Date By I FINAL INSPECTION Water Line I Date&11716c - B yt-Oe-- D = Date By ate By 07.�� ��{ ' D Z I D 1?t2Db? SS dc' ty NaT EW I Ur-FR WI L- 2 CV /DEED � ►��F�S rl C a" tt". t N 0 ..�..� � ��G4 {�C i`ti �G: C✓�� . :7 t '\. f1..�.'.''� C_C"Y"( 1`i I' _,:�,(-" � r���/ O 1/1 T y 0 h r A6,:44*0 .t PERMIT NO.: BLD t MASON-COUNTY BUILDING PERMIT APPLICATION °M ac��_ �9y 426 W.Cedar/P.O.Box 86,Shelton,WA 985" i Shelton 360 27-9670 Belfair 360 275-446 'Elma 360 $2-526 Seattle 206 4-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner6&,"-W fir, j j ja ►jZi r ng' I.&T Lo ^�tz Q&e SA,1,1* Contractor Name kt Mailing Address ti6oh Mailing Address Citylzoz ' State w_ Zip Code !g3j City State Zip Code Phone( =.=a, Other Ph.(W,Q, S" Ph.(� Other Ph.( ) Lien/Title Holder..-HQw s Contractor Reg. Address Expiration / / SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of ewer System Well Water System- Name of Water System PARCEL INFORMATIQN-1� digit Tax Parcel No. 12Z1l / 7,S_/;_&odo0 Fire District �s Legal Description Ogiztt m 05 Nwia Id M . IX r AA Site Address(Please include street name, street number and city) ► } 23© Gnr w fZw�C�o t,4 Directions to site Will timber be cut a sold in pArceal'preparation? (Yes/Na) Is your property m witjOn 2p0' of the following: Body of Water(Nae) (oAQN, LAi&* Saltwater Nd Lake �/ RiverlCreek Pond Wetland-Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE Q SEASONAL RESIDENCE❑ TYPE OF JOB Nevv. Add Aft Repair Other Use of Building Des,C06 Work ."t4gggg eAlfinW, c f,G No of Bedrooms No. of Bathrooms SQLIARE FOOTAGE-1st Floor 4%j. 2nd-Floor f4o4j& 3rd.Floor Loft Basement, ^Deck Other sq,ft. Garage Attached Detached Carport Attached Detached ILE HOME INFORMATION-Make Model Model Year LQ R Widtty Serial No. No. of Bedrooms No. of Bathrooms Type of at . Purchase Price $ Replacement Unit?(Yes/No) Installer Na a Certification No. NOTICES THIS P RMIT RE40ME5'NtiLL vbl`D'IF WORK OR CONSTRUCTION AUTHORI$Eiy tS NOT'CbMMENCED WITHIN 480 DAYS OR IF. CONSTRUCTION WORK is SUSPENDED OR ABANDONED FOR PERIOD OF 180 DAYS AT ANY AFTER,THE WORK:IS.COMMENCED. PROOF-OF'CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project.�Acknowle�ginent of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt fr©m the requirements,olthe CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a Contractor Registration Law R!rtV 18.27 and am aware of the ardinaricil contractor in.the State of Washington and first I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work far which this permit is issued and all work conformance t erewi o changes shall be made without first obtaining shall'be done in conformance therewith. No changes shall be.made without approv firstbbtaining approval. t X Date V 2� 1 )( f Date �tRtrN 6 t, uIt�l►rc"tFOR 0 ICIAL USE BEYOND THIS POINT Accepted bpi. Da Submittal Amount Due DZ _ Receipt No. & t'.. ..... � i ...... A)F 1~ N t l ..............:. ......... Building De artrhent f7ccGrou Type'Con t Planning Department Environmental Heaith Department Public Works Department , Fire Marshal. 13 Vtluattt3tl$' Building Perrnk Fee1.. Site Inspection Plan Review_Fee EH Review Fee Plumbing A Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee` State Fee Violation Fee. Pre-Paid a#Submittal ( ) r TOTAL FEES � . 1l fir.'°�i1M s9r 0 PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION e 426 W. Cedar/P.O. WA Shelton 360 427-9670 aBelf r360 275-4467$ Shelton, 8 Elma(360 2-6269Seattle 2 O6 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Ownerl"s+u.rs ,t �iW- ,�+ t t; Contractor Name�•�—�.�..��--`�++-� �-c—�a�.G its �«..� Mailing Address_ fi j F,l,� Mailing Address Citylz4ze1k4z ..-,r State Zip Code`% !)4 City State Zip Code Phone(!S&a 2.3�412,l4t ,Other Ph.( S44,545 Ph.( ) Other Ph..( ) Wert`/Title Holder W Contractor Reg. # Y Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. %*27 14 iyd40 Fire District_ Legal Description Site Address(Please include street name, streef number Ad city) *,.� '7-It d, Gujue, Directions to site 'd?i►ill timber be cut and sold in parcelpreparation? (Yes/No) 1140 _ Is your property within 200' of the following: Body of Water(Name) Coptly LLA Saltwater NO " Lake_River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt_4 _Repair Other Use of Building & =� DOcrit Work . . Nd. pf edrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor w 3rd Floor Loft Basement Deck Other * sq. ft. Garage Attached Detached Carport Attached Detached BILE HOME INFORMATION-Make Model 1 Model Year Len�oat_ Width: Serial No. No. of Bedrooms No. of Bathrooms Typ Purchase Price $ Replacement Unit ?(Yes/No) Inst Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 1ttU 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 Count access to the above describ ed bed property and structures for review and inspection of this prdkct. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 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 therewft o changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without ap first obtaining approval X Date /�W If X Date '+ FOR OFFIC AL USE BEYOND THIS POINT III Accepted by, Datq Submittal Amount Due_ I Receipt No, Building Department Occ Group_ Type Constr. ,,Manning Department vironmental Health Department Public Works Department ttV Fire Marshal Valuation $ •� R 7Bulldingrmit Fee SiteInspection w Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee -- 7 7_ 4 Volation Fee Pre-Paid at Submittal TOTAL FEES PERMIT NO.: BLD • MASON COUNTY Lph12C��— y BUILDING PERMIT APPLICATION �d �� • 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467`Elma 360 82-5269 Seattle 206 64-6968 APPLIC,,ANT INFORMATION: CONTRACTOR INFORMATION Owner or.ykwds taizi-,ZgF L61u�& Qq !* Contractor Name L*&r4er4 ` Mailing Address t0OoA ft-i Mailing Address lCitytyz sMz State%L& Zip Code '1 City State Zip Code Phone( &) 10 Other Ph.('7 W)g Ph.( ) Other Ph.(� Lien/Title Holder jjagG Contractor Reg.# Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Wat r System PARCEL INFORMATION-12 digit Tax Parcel No. '1ZZ# / / &0000' Fire District ega! Description_: t�otr%OW 0iir ti'whlllb I tV 1 t+�►r �1y�,�1A. Site Address(Please include street name, streief number and Directions to site r own he Will timber be cut anti sold in pdreel preparation? (Yes/No) RD Is your property within 200' of the following: Body of Water(Name) (000t f LAI&* Saltwater NO Lake_ River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs . PERMANENT RESIDENCE SEASONAL RESIDENCE i] I TYPE OF JOB New Add Alt Repair Other Use of i Descri*Work ------------ No. of Bedroom M. o a t*oo s ARIA'FOOTAGE-1 s ` to nd oor W464 3rd Floor Loft Basement Deck Other sq. ft. k Garage _Attached Detached Carport Attached Detached g. ILE HOME INFORMATION-Make Model Model Year Leng Width< -Serial No. No. of Bedrooms No. of Bathrooms F Type o ' at Purchase Price $ Replacement Unit?(Yes/No) " Installer Na Certification No. t F E THIS PEttMIT BECOMES NULL&VOID IF WORK OR'CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180,DAYS OR IF RUCTION WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS'COMMENCED. OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent oh owner's behalf,represents that the ation provided'is accurate and grants employees of Mason►County access to the above described property and structures for review and tion of this prd)ikct. Acknowledgrnent of such is by signature below: I - 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 RbW 18.27 and am aware of the ordinance contractor in the State of Washington and that'l 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 tiller wit : o c , ges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without aP rw first obtaining approval. ° x�' i pate 84&&01 x Date A swov fib. u it;# FOR O ICIAL USE BEYOND THIS POINT Accepted by DaSubmittal Amount Due Receipt No. {E Ail'iLEIO "low, < ! .... .......... I i � :._::. .. .::::.:.....::..... Building Department Occ Group_ Type Constr. Planning`Department Environmental Health Department Public Works Department tk Fire Marshal �Y..„. r/8{ll+aTl'Ofl� 1 B uildingPermit Fee Site inspection l 77 ee EH Review Fee 7 se Fee Planning�ieview 1=ee Sue Fee Other lliit Stove Fee State Fee l Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES