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Date By Date By FINAL INSPECTION Water Line Date,? /f 6 B y LOW-, Date By Date By jo !c 1'r/��' T �/11 t' oy O O � w y N O cn y O 0 A { FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION C^zoo3- 00�Z,05 426 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.H WML (-L.0.0 Company Name llt4 t -C44,3 c osr.. D,4 C Mailing Address 2- Mailing Address City/`tJ�CNL37M State Q A Zip Code City ej c 9Q5TR 2State UIA Zip Code!? 1 7 Phone f-E) RJ 1-fo 1 9$ Other Ph. 1 GO 710 ZTVO Phone 3 0 4371- (ol RA Other Ph. Z Lien/Title Holder /L[ t-- Df < Contractor Reg.#AA-4J 4CLgo7 .P Exp. Email address n C.. •e-%.4-+ E Mail Address Drivers Lic.#Nu e_ DOB z Drivers Lic.#jju1j_4 R,(A1(oA)8 DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic DC Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digqit Parcel No. Z 00 Fire District Legal Description J?m-c -A)J m A or' SP 17 ¢u. F o7jToo Site Address (Please includq street name, street number and city) 0 70 6 rArbr AtL.Jy Z ZELEq Z& IO}L Directions to si a Su ITS C" JiJ L1 rELL DFr CC C-211,10L&k 01,17-AJv ©F S�ae1D nI nI e.J A f C ei A6A Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater Lake River/Creek Pond w )O Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% A) CI) this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt_)<�kepair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building :6C-tF Describe ork L,t&r,F�" 7Z'y2A0Jr %��' �� T No.of Bedrooms - No.of Bathrooms fIM Square Footage- 1st Floor /`ZZ j 2nd Floor 3rd Floor Basement Deck Covered Deck Other 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 Replacement Unit? Yes/No Installer Name Certification No. O VNER/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 receiyfe this permit and to do the work as proposed in the application.I declare that I have obtained the permis- sion from sa A.If permission is required from any easement holder or any other party in interestrt� �f a- tion or I have obtained permission from them to apply for this permit and cond t r ed. Date: - DEC' 18 2003 Owner/Owner presentative/Contractor (indicate which one) WR OFFIrliff USE BEYjT I POINT 3ELFAIR OFFICE Accepted by�Planning Pd25Ck# Date ` I Bld Pd 1 1.5 Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Plannin Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION - f 426 W. Cedar • P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467•jEIma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner" Company Name t b. �' .... ' � ., ": A'I C . Mailing Address ,, Mailing Address ,a 4 �-, -. Cityr' / °':. LL�.. State :.t Zip Code ;`" City_1"'Jr °j t a rt State "_ Zip Code Phone / ` ' - ' Other Ph. Phone Other Ph. 71n Lien/Title Holder �'"1 tr Contractor Reg.# ft' c :f l �' Exp. E mail address `%=s'c : .t .f 3•t D r,., E Mail Address : £ + r'"z Drivers Lic.#­ 4_41,%1. . DOB 'x.,_ r,� 'x Drivers Lic.#1 f t.r r +±� DOB f SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic X Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Di it Parcel No. .. Fire District Legal Description - T " rt , 7 { �s. x Site Address Please inclucip street name, street number and city) } 2. Directions to site - t e IL s 1 J L 1,' f r?. per+C ! <., +'� C.Y at'--, �!jcj�'r�' { � • .A�x it A 4'- _JFC E C.rA Will timber be cut and sold in parcel preparation?Yes/R10 Is property within 200'of Saltwater Lake River/Creek Pond 3 ;; 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?Yes/No TYPE OF JOB - New Add Alt SL Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building L. r, Describe ork L j , ,Ll ti. "; 'M '" No.of Bedrooms r No.of Bathrooms jE I Square Footage - 1 st Floor 17 Z 2nd Floor 3rd Floor Basement Deck Covered Deck Other 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 Pricol Replacement Unit? Yes/ No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or perrhit 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 permis- sion from all the.necessn parties.If permission is required from any easement holder or any other party in interes di ca- tion or the work.proposed in the�appliEation, I have obtained permission from them to apply for this permit and con �'�ke�CTi�po�ed. r DEC 8' Date: r '`. !. 18 2ona Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT RELFAIR 0. Accepted by: + Planning Pd Ck# Date Bid Pd - E Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department C Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee PlanningReview Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION ('(ft1 Zc c3 - L)c c `� 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 N u rck-C.o j Gor•►S .!--o C ITompany Name 14wr 14 -CaJ CorJST. D1 C . Mailing Address P42 &OK 113Z Mailing Address City J`?,4.-J0.40MR- State Li Zip Code City MA/JCNC57LL�'ZState Zip Code!?81!;'17_ Phone 7,p g�1^ 19a Other Ph. 7(60 710 7,760 Phone 3 U) 9 21- (/!?53 Other Ph. Z Lien/Title Holder J4 t-- D<<K Contractor Reg.#flu 1t. 4 CL n Z%tE Exp. E mail address on nJ•0-0 E Mail Address Nu rr—kCo^3 /NC.C�_h Sn1 . GaM Drivers Lic.#/ C. DOB z 4n Drivers Lic.#H rr, 1Q�C..41�0AM DOB 2 SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Exisft Septic X Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. vo o Fire District Legal Description TfZ, ©l` A)-j 172 A fq r ,�P 1'7 3A F 0717c,0 Site Address (Please includg street name, street number and city) to 0 57-ATIr HL-or ?_L>'—Rrk: Directions to site StA I T�' C/ 1 n1 LI J'W OF iCE Cy,-,PL6k'ZZ sT'/Q.D OF S44)QLf ,v ,J i �.J N r c t NE eo mP r' AN Will timber be cut and sold in parcel preparation?Yes Idlu Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream I Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt__>CRepair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building '�CiF Describe ork L1 GT# T�yuA,JT ,h P2y✓�i�+ n/T No.of Bedrooms No.of BathroomsSquare Footage- 1st Floor 172-,1 2nd Floor 3rd Floor Basement Deck Covered Deck Other 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 Replacement Unit? Yes/No Installer Name Certification No. OWN,E:R/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 recei a this permit and to do the work as proposed in the application.I declare that I have obtained th mis- sion from sa s.If permission is required from any easement holder or any other party in intere� ifi0( ica- tion or I have obtained permission from them to apply for this permit and con IhtL�s pra sed. ��. Date: 2 —Ir- 03 DEC, 18 2003 Owner/Owner presentative/Contractor Aindicate which one) ���� �R OFFIg USE BEY IDS POINT C- BE Accepted bYE� __ �Planning Pd �' _Ck# Date f Bld Pd 5 Receipt Na DEPARTMENTAL REVIEW APPROV D DEN 1, NOTES Building Department V �t Planning Department Environmental Health Department Public WorksDepartment Fire Marshal i FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee PlanningReview Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar • P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 2175`14467 Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner P w Tt.l"' • t_ ..> C,w ,1 C . rfompany Name 14,-4 zt t- C �j e c,,r^s`T. 1-�C . i Mailing Address f 2 LLD -4� Mailing Address City/`?.Jt} = State A Zip Code.-/`14 2 City /t A/JG tPL-, .: State Zip Code 9 RILL.? I Phone '�_ :3 7�` 'f 1 Other Ph. �% 71 Q Z o Phone 3 go 1- ("1 99 Other Ph. / •Z 39ia Lien/Title Holder I.-- .L?r t K Contractor Reg.#4u rC.H C(.ro?rIf Exp. i Email address y­AC kL 14''',11 it Dh E Mail Address li-,Ir €-f Cc.,3 IfJL C _ h-A) . L OM Drivers DOB S"`1 Drivers Lic.# #w AG.9i'(yA1q DOB 2 SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existftg Septic X Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. �-'° "� Fire District Legal Description 1: D/__ TA, A tar= `r'4 )? 5, f� -= Site Address (Please include street name, street number and city) . 070 'r;r A Directions to site SuITK Cr /nJ L+TTL t)iCrlCC 6-1—P(ELY_1 ,.rA)o OF &4&) e-S 4 'tw` A4 '7k'LFAr(�, j N?CP rs Xii `r-a 1'uF Will timber be cut and sold in parcel preparation?Yes/A1 ,_ Is property within 200'of Saltwater Lake River/Creek Pond Aj 0 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?Yes/No TYPE OF JOB - New Add Alt )CRepair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building FI'"'' E Describe pork iE.. 6 NT 71,,vAJ7 No.of Bedrooms No.of BathroomsSquare Footage - 1st Floor 1 72 2nd Floor 3rd Floor Basement Deck Covered Deck Other 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 Replacement Unit? Yes/No Installer Name Certification No. 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 cont r.�I;further declare that I am entitled to recei a this permit and to do the work as proposed in the application.I declare that I have o r� �'PtT�IIrp�i sion from al 4he sa s.If permission is required from any easement holder or any other party in interest raga in t tion:or_tt1b ,I have obtained permission from them to apply for this permit and conduct t �rls,P Date: Owner/Owner presentative/Contractor (indicate which one) FOR OFFICIA USE BEYQNF T IS POINT Accepted by(. � Planning Pd Ck# i Date +i t Bld Pd f 'Receipt No. j I DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ 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)427-9670 Belfair(360)t75-4467 Elma(3601482-5269 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner CI-2 Contractor Name w - ST c- . Mailing Address Mailing Address Po Ok L. City /''bwCi ,stw,l2 State LA Zi Code 3 City 1�4iyCGIL33f�'YL State�l� Zip Code PhoneUbo ) !?I-�169Other Ph.(�bv ) 9/0 Z3AD Ph.Q&p )�� ther Ph.Cr&o ) 7 0-`Z-390 Lien/Title Holder V- Contractor Reg. # LkXh(CL.,07c-LP Address Expiration s/ tom/ 04 SEPTIC INFORMATION-Connect to New Septic Existing Septic 4,f Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. % 2 3 Z! / 3 2 / 0_0.5.0 Fire District Z Legal Description JR-!;- LJ S OF # o -C&o Site Address(Please include street name,street number and city) 7.+ 9'7V �74TE l#JY ; FeLFi41e_ 41B.5-L1B Directions to site�" (M C- OF _5 ^tA tL OFF(C4F Goy-,^Ck r.7�ST- A)0,e7-4 Oi=-.57"D El 9o4r- WeAW_ lrl ��ZFi4//� G.1/-f!G(� /S�LcSr ��� LF ©�crl T'YANn1C 4i; Is your property within 200'of the following: Body of Water(Name) Jy to Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt_j�_Repair Other Use of Building F7F-FILtT Location of Fixtures/Units 1st Floor __X _2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No.of El Fees LPG Natural Gas Heatpump Toilets Type.of Unit No.of Units Fees Bathroom Sink Qewj& Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer /K Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 there 'h. No chap a all be made without first obtaining shall be done in conf ance therewith. No anges shall be made without approval. first obtainin r /9•G�ate l 2-(s=01 '� Date Z FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. :: ili 1K.;:.XX ;:;>;;:.;;;:.;:.;:.;:.;:.;:.:.;:APPFti1VEa:::>::>::<:CTENIE#k::..:........................................... Building Department Occ Group Type Constr. fee- Planning Department 03 Other Other :::::::::::::::::::::::::::::.::::::::::::::::::::::::::.::::.;:.;:.;:<.;:.;;:.;:.;;:.;:;.;;:.:;.;:.;:.......;:.;:;;:;.;;:.;:.;:.;::;.: ...............................................::::::::::•:::::.::::::: :::::::•:::::::::•::::..:.;. :•;:;:;:;:;:;:;;;::. Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other i Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES THIS PARCEL INCLUDES PLANS, BLUEPRINTS OR OVERSIZE IMAGES - LARGE FORMAT IMAGES HAVE BEEN STORED IN FILE CABINETS) UNDER PARCEL NUMBER PARCEL # 3z - gocsa CASE # CcMUo3 - oow5