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ByL1� o) Footings/Setbacks Q '1 dY gT Gas pipl g Ribbons ,G L/1 o Interior Date By Interior-date BY Date By N Exterior Date By Exterior-Date By Sot_up ic Point Load!Isolated Footings INSULATION Date By 9 BG J BLAB INSULATION Date BY Date By FIRE DEPARTMENT Foundation Walls Floors Date By Date o By Data `11 D By DECKS F RAM I G Walls Date By Date I I ZI -� By Data By PROPANE TANKS PLUMh1Nb Vault Date By Date By OTHER Groundwork Attic Date e y date /e'�� � BY Type: „_.----_ Date By D.W.V DRYWALL Type: Date I ZI 7 B �- Int Brace Wall Date By W y Date _ -0- BLZ � r Water Line `1 Fire Sep'eratl u FINAL ( �J,��j o Date V By Data � � b By 4be at /? !2 T�� By y47C.— o y ID Pass or Request Inspect. Type of Insp. Fail Date Date Done By Comments c o :1L81z, ` oo V- -sS -i , o l a - -- a o t 4 P cH T�4 i t S 0-7 1 l IZl 1077 -R.T", - y. C hS a4-c l h f Z 7 l 130 0 7 -_� o tar 0 ACCESS & GRADE INSPECTION PERMIT #: 7--M( (Z ADDRESS INSPECTOR —� DATE: 1 to DRIVEWAY ACCESS Length: 117-`" Width: 1 Z Surface: Size of turn-around: Condition of shoulders: 17Z Vertical clearance: / need post at end of driveway with flective ad ress numbers GRADErOF DRIVEWAY % OF ROAD % ROAD ACCESS Length: Width: Surface: Condition of shoulders: Vertical clearance: (—::±)—BURN PERMIT REQUIRED Q RED FOR LAND CLEARING FIRE. ( ) LOT INSIDE SMZ, 4X4 FIRES ONLY. ( ) LOT INSIDE UGA, NO OUTDOOR BURNING PERMITTED. LOT TOO SMALL FOR: BURN PERMITS 4X4 FIRES. REMARKS FL� �144 5 (continue remarks on back AS qNOUNTY PER IT NO. 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 INFORM TION CONTRACTOR INFORMATION Owner Company Name - c.S Mailin Address 3 �o Mailin Address City Y State Zip Code City,,ef 'r State Zip Code 9�5� Phone 3,60-37-2--17®G Other Ph.360ec265_53/19 Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. 6 E mail address N. E Mail Address Drivers Lic.#_LLQLEADOB S�3- Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic,X Connect to Water System Name of Water System well /Xi Water System Name of Water System PARCEL INFORMATION-12 Digit Parcel No Fire District a Legal Description LiTk 4 1 Fe-e7 ✓i f Tor a {zao FL Site Address(Please' clude street na e,street number and city) �e Directions to�site Grce ill timber be cut and sold in parcel preparation?Yes/dp Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs ) 15% is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o t TYPE OF JOB-New Add Alt Repair Other PRIMARYAESIDENCE ® SEASONAL ❑ Use of Building ��S� %/� Describe Work p9 /e,ez d✓f d�t� No.of Bedrooms 2% No.of Bathrooms aYj Square Footage- 1st FI or 1 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. I 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/BUltDER 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 structure for review and inspection. PROOF OF CONTINUATION OF W IS BY MEANS OF A ESS INSPECTION. X Date_ -07 Owners Representative/Contract r indicate which onY Ara F O FICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee rnzi Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee t 3S• 3V Planning Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee • `Y Violation Fee O C AAC Pre-Paid at Submittal Valuation$ cg / 7Z TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT NO. PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar-P.O.Box 186, Shelton,WA 98584 Shelton (360)427-906n the web ww360) 275-n67 a Elma(360) 482-5269 us APPLIC NT INFO MATION CONTRACTOR INFORMATION Owner Company Name MaiIin Addres Mailing Address a 'f tate Zip Code City Mate Zip Code City Other Ph. ©� - Other Ph�� JGS'. .�� Phone Phone Contractor Reg.4 Exp. Li n/T' Hol E Mail Address E a' ad re s Drivers Lic.# DOB Dri rs Lic. DO SEPTIC INFORMATION - Connect to New Septic Existing Septic. Connect to Sewer System r er SystemFire District FORMATION- 12 Digit Parcel No. ption (Please include street name, street number and city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New dd Alt Repair Other Use of Building Location of Fixtures/Units - 1st Floor 2nd Floor Basement Garage—Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL Pump— Type o_ No. of Fixtures Fees Fuel Type:Electri LPG_ Natural Gas_ Heat Fees p Tvpe of Unit No.of Units Toilets Furnace Bathroom Sink Heatpumps Z Bath Tubs Spot Vent Fan T— Showers ---r— Propane Tank Water Heater Gas Outlets Clothes Washer Wood/Gas/Pellet Stove Kithen Sinks Kitchen Exhaust Hood Dishwasher Dryer Vent Hosebibs Other --'- Other Base Fee Base Fee TOTAL MECHANICAL TOTAL PLUMBING Acknowledgement of C N�/gULpp3 Acknowledges submission of inaccurate er owners information al representative,result in the contractowork .order further declare rmit that I a er����this f such is by signature below.I declare that I am the o e9 rties.If rmission is permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary pa Pe icati I have obtained required from any easement holderthis any otherpermit sand condluct the won interest rk roposed.this The owner or agent on oownelication or the work rsbe�half erepprresents that the information permission from them to apply a and structure for review and inspection. provided is accurate and grants employees of Mason unty access to the above described property p F CONTINUATION OFWOR BY 9V A PROGRESS INSPECTION / � Date: 6 X Owner w Representative/Contractor (indicate which one) FOR OF USE BEYOND THIS POIBNa Pd Receipt No. Accepted by: Planning Pd Ck# Date IDEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Grou T e Constr. PlanningDepartment I Environmental Health Department FEES Plumbing&Base Fee Site Inspection Mechanical&Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other TOTAL FEES Violation Fee