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D rn Footings!Setbacks Ribbons 0 Gas Piping o interior Date v;Y-v7 By / Interior-Date By Date By m Exterior Date By Exterior-Date B Set-up INSULATION Q° Point Load l Isolated Footings Date By p BG f SLAB INSULATION ---—- ---- M Date By Data By FIRE DEPARTMENT D Foundation Wails Floors Dane By A Date _r- -a7 By%� Data By DECKS y FRAMING Waits Date By Date By Data , �- �y PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Date By Date By Type_ Date By D.W.V DRYWALL Type: Int.Brace Wall pate By W Date CJ By o , Byf7� FINAL INSPECTION Water Lin �Jj Fire Separation 2�/I C Date By �/ Date By Date r `� C By ! C) m � Pass or Request Inspect. N s Type of Insp. Fail Date Date Done By Comments v, 14-2 Yo7 -46.r-7 T �SCc-'/09/-•-- � v CD Cn yl a 8 7, a o� STE/n lye� cn m llvloi drip cC 1 t::i-r,al ' + 9 z.t o 7 2s a ►3T,� SAS . i rum,( 1► 30 0� i2 'P o� �"i` O h S4dcG2 Pi" C ��,) � MASON COUNTY PERMIT NO.�DO6"020q/ 0o3 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 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner '044-9L'E't P• U��G-l�l Company Name ���t' ��'t`'• Mailing Address TEL- -s. 7Z%+T1A Cl , Mailing Address I 13 � City�WV-ft-uvt�L State ItP. Zip Code gt3°O CItyC J!'c �.l'P� State��Zip Code`�8 53 t Phone 7*3-33+*- 111 S Other Ph.Z53-131—o532- Phone 6b• 6 - 1 41 Other Ph. Lien/Title Holder-�tkVXK COUX lbha r.— Contractor Reg.# E mail address VALLD4Pso t�V N.ww► E Mail Address Drivers Lic. p W V NP DOB $ 54- Drivers Lic.# DOB SEPTIC/WATER .SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Water System Name of Water System Well--2L_Water System Name of Water System PARCEL INFORMATION-12 D!git Parcel No c, Fire District Legal Description_12-- ?- tava Site Address(Please include street name,street number and city) 1i 3- Directions to site�,'k.� yoc- ' -tc, Z6 Srd Will timber be cut and sold in parcel preparation?Yes Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit subrnittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y o TYPE OF JOB-New Add Alt__Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building 29"OA 5k0*W— describe Work 'N -s viem-S%. t o No. of Bedrooms_ T No.of Bathrooms Z Square Footage- 1st Floor �+ 2nd Floor 0 3rd Floor © .Basement c' Deck O Covered Deck 0_Other 0 Sq.ft. Garage-± $%' Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. OWNER/BUILDER Aclnowledges submission of inaccurate infomtatbn may result In a stop work order or permit revocation.Admowledgement of such is by signature belaN.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the wori:as proposed in the application.I declare that I have obtained the pemiission from all the necessary parties.If permission is required from any easement holder or any other party in Interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF CONTINUNrION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. x Date: 1 Z O 6 Owner/Owner.;Representative/Contractor Indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW AP ROVED DENIED NOTES Building Department Planning Departmeni Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fei) s • Planning Review Fee Mechanical&Base fail 3 • (S Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee /VO EAI?F Pre-Paid at Submittal Valuation$ Z q$ , 2a TOTAL FEES MASON COUNTY PERMIT NO. 2-15e(t PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O. Box 186,Shelton,WA 98584 Shelton(360)427-�7 tn� Bel 02 bw75-4467•Elma(360)482-5269 wewco.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner $1i=-Ps`OVE't P• Company Name tilt-ly� lko'ti''�S Mailing Addres-413E+ S- Z$`k"Rt Clt- Mailing Address 1 2 « A--W(41- 7—�Q CityV"e*-"-`''State !!'0" Zip Code C State Zip Code 1 gS3 l Phone 2573, 3 3 4— l%t ia Other Ph.7,3;3-'t 14 —053 Z Phone, ° ��a—� tQ`4`� Other Ph. Lien/Title Holder %.+ez5- _ "3*551 Contractor Reg.AS"106*19S xp. Z �o E mail address 2 at'% �' v' E Mail Address Drivers Lic.# p 1463 *310 DOB I It k Drivers Lic.# DOB SEPTIC INFORMATION -Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No, I, Z 3,k 2'Z a' Fire District Legal Description TV.. 'Z e F ttw '%A w Site Address(Please include street name,street number and city) �3E�c�,`1--►`•'1f'` Directions to site Sl1Crc T a Z4,.$V3 N Vc aLb Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB-New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Tvoe of Fixture No.of Fixtures Fees Fuel Type:Electric X LPG_Natural Gas_Heat Pump_ Toilets Z Type of Unit No.of Units Fees Bathroom Sink 2— Furnace Bath Tubs I Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other t Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and stricture for review and inspection. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X ��--.1� Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bid Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group—Type Constr. Planning Department Environmental Health Department FEES Plumbing&Base Fee Site Inspection Mechanical&Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES I Request To Revise An Approved PIan Permit Number: BLD200 _ C 2 Name F� r c4 J ma-k,,r� Parcel Number 1 a 3 !(� _ �� S • Project Address _�-�- Phone Number da Mailing Address Please provide a complete,detailed description of the proposed revisions to the approved plans: - Are two sets of the revised plans or addendum indicating the changes included? Yes Are the approved site plans included? ❑ No Are the.revisions clearly and accurately identified on the plans or addendum? � Yes ❑ No Does the plan contain an en " , gweer s or architect's lateral or vertical analysis? ❑ yes ,� No Is a if es,Has the engineer or architect approved this revision? ❑ Yes ❑ No stamped and signed approval included with this request?f ❑ Yes ❑ No Note:No structural cl�on es to a"designed"Wien�11 be ved w;th�,,,��t,,c�tt� t of the eaQmeer and/or archrtert of rrrnrd� Does the proposed revision modi - l the footprint - with�new setback dimensions structure? �Yes If Yes,Is a revised site ❑-No P.an' nsions included with this request? Additional Information: a Yes ❑ No Applicant's signature brae use or,ty - Date: Date Sent Assigned To ftPmved By Date B. Original valuation: $ P. Additional Valuation: $ CAI qA Z _ Sq.Ft. x� $ E.H �- @ sq.Ft x r S I O Total New Valuation S P. � -- Additional Fees: Additional Planning Dept. $ �1e+_adcs: Front / Rear Additional Plan Review $ Additional Building Permit $ Side1 / Side2 / Additional Plumbing S Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept S = Other S Total Amount Due: $ Amount To Be Paid Up-Front$ Kvibw sac vamm Request To Revise An Approved Plan Permit Number: BLD200 - � zoo > Name Parcel Number_ 12 1_t� zZ- _ uDd a(� Phone Number da ime (__ Project Address n�� s�� ailing Address z s . 2 Please provide a complete,detailed description of the proposed revisions to the approved plans: . rz Are two sets of the revised Mans or addendum indicating the changes included? ❑ Yes o No Are the approved site plans included?_ ❑ Yes ❑ No Are the revisions clearly and accurately identillO&Gn the plans or addendum? ❑ Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes O No If Yes,Has the engineer or architect approved this revision? O Yes ❑ No Is-a0vinped and signed approval included with this request? ❑ Yes O No PI6�e No structural khan es to a"desi ed"plan will be aroved without the wnttea consent of the eagtneer and/or arch�te ct of nr�rd? Does the proposed revision modify the footprint or location of the structure? dyes ❑_No If Yes,Is a revised site plan, _With all new setback dimensions included with this request? Yes ❑ No Additional Information: Applicant's signature ,—�� ��L,L Date: orrice use only Reoeived by: --- Date Sent Assigned To Approved By Date B. I Original valuation: Additional Valuation: $ P Sq?Ft x$ $ Sq.Ft x$ $ otal New Valuation $ P.W. Additional Fees: Additional Planning Dept.. $ New Setbacks: Front /Rear / Additional Plan Review $ Additional Building permit $ Side1_ / S1de2 / _ Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. Other $ e Total Amount Due: $ Amount To Be Paid Up-Front$ r«r in;r aevnna sac wunow Request To Revise An Approved Plan Permit Number: BLD200 I j - C'' C-,. c� 5 Name f c( Parcel Number ? / - - - j� Phone Number da e Project Address 6' l Mailing Address Please provide a complete,detailed description of the proposed revisions to the approved plans: . Are two sets of the revised plans or addendum indicating the changes included? ❑ Yes ❑ No Are the approved site plans included? o Yes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? ❑ Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ yes ❑ No If Yes,Has the engineer or architect approved this revision? ❑ Yes ❑ No Is a stamped and signed approval included with this request? ❑ Yes ❑ No tNote:No structural chances to a"desi¢ned^Dian will be ved without the written consent of the emmLneer and/or amlutect of mmed Does the proposed revision mo dify the footprint or location of the structure? ❑ Yes ❑ No If Yes,Is a revised site plan,.with all new setback dimensions included with this request? ❑ Yes ❑ No Additional Information: Applicant's signature Date: Office use only Reoalwd by: Date sent Assigned To APP ovod By date B. Original Valuation S Additional Valuation: S P. Sq.Ft x S $ Sq.Ft x$ S •H• �� �—� Total New Valuation S P.W. Additional Fees: Additional Planning Dept. $ New Setbacks: Front / Additional Plan Review $ Rear / Additional Building Permit $ Side1. / Side2 / Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. S Other S Total Amount Due: S Amount To Be Paid Up-Front S Ted Liu Revised SRC warm �i— lIx e" ^? CD i 1 o ® CP f rF E O n Omcn T -n D ME t , '''i',7tis '-s��' �, il.ee .Te'+` `. r •`(,`'�1�T"4,Fc. d _U) CO _ �SrN �, k }t a63v C- m m ( � ■ a 4 � 5K m t eta -�•. Q'� .,) ;a 4� y�0 Ch —s V1 (' +^ i (D Q f '5 yID ri cD y1 � 0- o � add co �03o , Z Cn com m 0 D —Mr zxX ?J m� -n m D Z C 'T1 rn = gym — rn � m Z G� cn m = CM > cn �- rn L _ G; v ID oyvto (Dca su �. 0$voDO Les Nl �n i v! �R y L ZH. N a , Z cc z� r //��� CL ma X °°� 0 Lt z pLp4R SP0E'j,�ppjM,N�H FME 6V 1� G FRO \pNOF SH 4C a m