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A .P CA I i iI N N I »..+ram. ..�or.w ■r�ry 02/18/2004 17:10 3602756224 MCFD2 BELFAIR PAGE 02/02 r"l6%p%ay.vv. aPX%MaA vss% wiUVY Cl '0 XD m A c x XOmmz-0 aom a CA $ �� m $9 p0mca-I v 3 mZ zy O — CL _. C �� riMZ0 o w -4 0 tSron a, m �r=t1=1rn r 3 rn c`a'Om Is goo q� Ow CA Im Z Age Its O ��r $ $ �, �Flq m 5 �1mAcz Pr iWEP. � m � m -�z� = a n pm�mD w gm m g mm,.��n azi gym. 1Dyp� � g �>10 � OO 2n > ° Af WOR iF O S o m cicmmao aIs ° � � D ■ Q � �Soa� . (aQ o o fA�j eo Rs mac— o � .�c _CD g Es Z' D �3 A �y CONCRETE MECHANICAL MANUFACTURED HOME N o Footings / Setbacks Date By Ribbons o Date By Gas Piping Date By o Foundation Walls Date B y Set-up 1 Date By INSULATION Date By B G / Slab Insulation Floors Final Date By Date By Date By FRAMING Walls FIRE DEPT Date 3�s''":�'4K By7??, Date -� ��_oy By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILING D.W.V. Date By Date By FINAL INSPECTION Water Line Date By Date By MEN= `jill= Date By 40, O y to O o Z 0 o O o Z ~ y �C d a W 0 w MASON COUNTY PERMIT NO. -c o BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton,WA 98584 Shelton (360) 427-9670 9 Belfair (360) 275-4467 Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Mailin Add r e w Mailing Address City State L/&Zip Code City State Zip Code Phone A_!2 C- ' -/I Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION Connect to New Septic Existing Septic 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 'f- Site Address (Please include street name, street number an city) Directions to site i r t Will timber be cut and sold in parcel preparation?Yes/(9 Is property witriin 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 TYPE OF JOB - New d Alt Repair Other PRIMARY RESIDENCE SEASONAL Use of Building vibe Work No.of Bedrooms No.of Bathrooms � Square Footage- 1st Floo r 2nd Floor 3rd Floor - Basement Deck Covered Deck Other Sq.ft. Garaged Attached Z Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model ; " Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchaq4,Price$ Replacement Unit? Yes/No Installer Name Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocatidh,,•' Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractol: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 obtainedlthe permis- sion from all the necessary parties.If,permission is required from any easement holder or any other party in interest regarding this a lira- tion or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proIosed. X G*.._ Date:_ y Owner/ ±fsRe resenta i Contractor (indicate which one) FOR OFFICIAL USE'BEYOND THIS POINT Accepted by; Planning Pd Ck# Date Bid Pd Receipt No. t DEPARTME REVIEW APO D NIED N TES 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 7 Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT No. 0(<1r,,( ., ,: 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, # Company Name Mailin ddr, w Mailing Address City State Zip Code City State Zip Code Phone ;2,'.T • 211O her Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address - E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB' SEPTIC/WATER SYSTEM INFORMATION- Connect to New Septic - Existing Septic 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 � ,4. Site Address,(Please include street name, street numbe and city) lie Directions to site f {' 1. 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°fo la this permit.subnnittal the result of a Stop Work Notice,Correction Notice or other enforcement Actio0 ' TYPE OF JOB - New d`LV Alt_ Repair Other PRIMARY RESIDENCE WSEASONAI [] Use of Building ' - cribe_Work — fl No.of Bedrooms No.of Bathrooms « Square Footage- 1 st Floa 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage_ Attached Detached Carport attached Detached MA14UFACTURF-D 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 Acknowledges submission of inaccurate information may result in a stop work order or permit revocaoCK Acknowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractof.I further declare that I am entitled.to receive this permit and to do the work as proposed in the apption.I declare that I have obtained°thp permis sion from all the necessary parties.If,permission is required from any easement holder or any other.party in interest,regarding this-oplica- tion or the w propos in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. X Date: Owner tiers Re rep toW Contractor (indicate which one); FOR OFFICIAL USE BEYOND THIS-POINT Accepted by-10IJ Planning Pd Ck# pate Bld Pd Receipt No. pEPARTME REVIEW APPROVED DENIED NOTES Building Department Planning Department .►� Environmental Health Department Public Works Department Fire Marshal F_ ES Building Permit Fes -.51te,jriqlpeetion j Plan Review Fee = EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical & Base fee Other Wood?Gas/Pellet Stove Fee State Fe Violation Fee Pre-Paid at Submittal Valuation$ TOTAL KEES MASON COUNTY PERMIT 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 INFORMATION CONTRACTOR INFORMATION Owner All Company Name Mailinci ddr s t»= Mailing Address City State /� , Zip Code S, City State Zip Code Phone a2 2- fF Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address ' E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic 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'll + '" � L Site Address (Please include street name, street number and city) IlSio Directions to site—Al. 1_ ,) ' i Will timber be cut and sold in parcel preparation?Yes/AM 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?Y o TYPE OF JOB - New Ad Alt Repair Other_ PRIMARY RESIDENCE SEASONAL ❑ Use of Building -- s, t, cribe Work No.of Bedrooms No.of Bathrooms_1 Square Footage- 1 st Floor 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_ Price$ Replacement Unit? Yes/No Installer Name Certification No. CWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocatiob. 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- sionfrom all the necessa.y parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed. X Date: , C, Owner wners Re resentati Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTME L REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department 19 2 D Public Works Department Fire Marshal FEES 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 Valuation$ TOTAL FEES