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Date By Date By FINAL INSPECTION Water Line Date 6 ►7 06-- By ",!_ Date By ..: ``` Date By 02 �� o�( - oz ►B t � - o ,d cu-%s- � 5 -, Me pa ,u r r Cam ' Ict 10 21 Ou 12 l / tjJt � "� G � � L-�... r t:�->Jc=c._ �[`del �r,.�, irA f rez d,) P ^ l 1 t' Aar ( J l 1 MCI 0 cS t '{"�1,,. C.. �. � 1! �t0. •"`C..GJ L. "t i ?i "� .'' `O^ V` �Irr N 0 FORM MUST BE COMPLETED IN INK 0 J LEASE PRESS HARD PERMIT NO.: BLD MASON-COUNTY �— BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275.4467.Elma 360 482-5269 Seattle 206 464-6968' APPLICANT INFORMATION CONTRACTOR INFORMATION Owner . Llyza of,k—eqr, NrISj:EST !SAtuX5 Contractor Name t7Wtvcry Mailing Address_ho8or Mailing Address City(Zo4Aes-Mr- State S610—` Zip Code 0,66a City State Zip Code Phone(-,hbolder .U2�o OtherPh.(?,c )cad_ _ 1� lPh.(_� Other Ph.(_� Ph.(--- Address Lien/Title Holder I.IntJ6 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 Water System PARCEL INFORMATION-12 digit Tax Parcel No. 12Ztq / 23 / t00000 Legal Description Fire District 5 9 p Po2fi1 tI N OF N W t l b l .a T Z'L Nl 12 t w l w. Site Address(Please Include street name, street number and city) , "0 Goora >Zwg �nTu Directions to site Will timber be cut and sold in parcel preparation? (Yes/No)�_ Is your property within 200' of the following: Body of Water(Name) (,DON Liras Saltwater NO 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 Buildin C �rw�` FIB L� Describe Work 2a;tN xI N No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor NoaB 3rd Floor Loft Basement Deck Other Garage Attached Detached Carport Attached Detached s4• ft. BILE HOME INFORMATION-Make Model Model Year Leng Width Serial No. No. of Bedrooms No. of Bathrooms Type of at Purchase Price $ Replacement Unit ?(Yes/No) j Installer Na a 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. f 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 conformanItberewites shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without appro ,p first obtaining approval. X Date 6 1206 0 X Date �1 f2Lcrt! lJ, ram`RJ3&Om&FOR OFFICIAL USE BEYOND THIS POINT I Accepted by Date Submittal Amount Due Receipt No. Building LepLaTent Occ Gro Type Constr Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ I Building Permit Fee 7EHReview ection Plan Review Fee Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal TOTAL FEES RM MUST BE COMPLETED IN INK 0 J RLEASE PRESS HARD PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION lot" �� 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467.Elma 360 482-5269 Seattle 206 464-69611 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner;;umn or.ern GNzi-s-r T n� � Contractor Name CZWr*--M Mailing Address h0 8or SZ—I Mailing Address CitylZorsma,s, ,i State wp,. Zip Code 1156-1&_ City State Zip Code Phone(-J,bD )115-Ml o Other Ph.(-16a cad� Sj� Ph.( Other Ph.c_ Lien/Title Holder 1471j6 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 Water System PARCEL INFORMATION-12 digit Tax Parcel No. _ 12'Ltq / 23 / &0000 Fire District S Legal Description Pa2fitO>J of NWtlb ccr� Ig7,N, �tW 1 w,Ak Site Address(Please include street name, street number and city)_ ? 230 Goow I�1Lwe Directions to site H Will timber be cut and sold in parcel preparation? (Yes/No)-- Is your property within 200' of the following: Body of Water(Name) GOON LAIGt3 Saltwater NO Lake_ Bluffs River/Creek Pond Wetland Seasonal Runoff Stream Slopes or PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Describe Work Repair Other Use of BuildinQiiwc�L�t *+�2,5 Ll-F R.Furl1 m N v No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor No4a 3rd Floor Loft Basement Deck Other Garage Attached Detached Carport Attached Detached sq. ft. BILE HOME INFORMATION-Make Model Model Year L e n g Width Serial No. No. of Bedrooms No. of Bathrooms Type of at Purchase Price $ Replacement Unit ?(Yes/No) Installer Na a Certification No. i 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-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 t erewit . o ch nges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without appro Q first obtaining approval X Date O �� X Date i. AALI" 4.) c-"&""FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. Building Department ( t? Occ Group- Type Constr. ! Planning Department Environmental Health Department Public Works Department Fire Marshal i Valuation $ I Building Permit Fee Site Inspection Plan Review Fee EH Review Fee -- i Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee "Violation Pre-Paid at Submittal ( ) PIN TOTAL FEES (� IfNlf�l�ii111fI�IlYI`I`II fARM MUST BE COMPLETED IN INK `+✓ PLEASE PRESS HARD PERMIT NO.: BLD ' MASON COUNTY pow zm/- q7 BUILDING PERMIT APPLICATION bid 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467.Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner .0 �'u eF. a5 .rJO,I 1 0&.�. x.aF-La-T � TE, Contractor Name 12U/Ivclz Mailing Address honor C; -1 Mailing Address City1zoccrrrst r_ State W_ Zip Code G� Da City State Zip Code Phone(-&Ar )2L1 -El o Other Ph.(3)cad_�t� Ph.(- � Other Ph.( Lien/Title Holder t4ty S Contractor Reg. # Address Expiration SEPTICNVATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water ystem ARCEL INFORMATION-12 digit Tax Parcel No. 1?iZ1}9 / (pOp0O egal Descriptio *4 Fire District 5 Site Address(Please include street name, street number and city) IV G Directions to site Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) GOON LAIG6 Saltwater NO Lake_River/Creek Pond Bluffs Wetland Seasonal Runoff Stream Slopes or PERMANENT RESIDENCE Q SEASONAL RESIDENCE❑ 1TYPE OF JOB New Add Alt Repair Other Use of Building Describe Work I LFArt x1,5 u No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor NoN>< 3rd Floor Loft Basement Deck Other Garage Attached Detached Carport sq. ft. p Attached Detached BILE HOME INFORMATION-Make Model Model Year Leng Width Serial No. No. of Bedrooms No. of Bathrooms Type XNS Purchase Price $ Replacement Unit ?(Yes/No) Instal Certification No. NOTICE: THIS PERMIT BECOMES NULL d,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 [appro onformance t erewit . o ch nges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without first obtaining approval Date 12wi X Date 'r A(141`v w' `'`R130"FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No, lPC 'TE�....REVI .............::,:.... . ....: :>:::::::. :;:;.;:.::.::.;>.;::;:;.;:.:;:.:.;;:.;:.>;;:.::.;:.>;; . : .;;...:...:........:::::::::::::::::::::................ Building Department T1±DI .: ..Q..pE Occ Group- Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) r .... TOTAL FEES i