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Fail Date Date Dane By Comments co 0 FORM MUST BE COMPLETED IN INK PERMIT NO.: D�Z � ✓� PLEASE PRESS HARD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 a fC Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICA NFORMAT / NT R INF0RMATIOA�—�'� Owner G�/f fr « a( cto Mailing re ailing Address City tate ip Code ity State Zip Code Phon 3S-� Ph.( ) Ph.( Other Ph.L� Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to Ne Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit T x Parcel No. Q o� / I I / LQDOS Fire District o� Legal Description r I n Site Address(Please incl de street name, street nu ber and city) ti Directions to site Will timber be cut and sold in parcel preparation? (Yes/No) G Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New d Alt epair Other Use of Building Describe Work �� C—ems No. of Bedrooms No. of Bathrooms SQUAfRE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-]certify that I am currently registered as a Contfactor 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 therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X te X Date FOR OFFICIAL)USE BEYOND THIS POINT C,I r-- ed --h Date 1 �l Ibmittal Amount Du Receipt O'G —� :< <: ::> t� PARTNtENTAIw:REVIEf<:: AP�RtE#� t? Ni.. . ...... _ OUNDITi 31 + al Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ xm Y......r:. .:.: .. ... 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 ( ) s l3$ PERMIT NO.: BLD -06 MASON COUNTY 12- 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 APPLICA NFORMAT / �— DNT R INFORM.TI Owner ,ter �I`.ii � _ Mailing re ailing Address City . State +tip Code SZ City State Zip Code P h o n 5 -<�- ZXrr Ph. Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Add ress_______Z Expiration SEPTICIWATER 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 T x Parcel No. Ia3a / �� / CPdUSc� Fire District c� Legal Description r hC no Site Address(Please include street name, street number and city) %•' Directions to site e.— Will timber be cut and sold in parcel preparation? (Yes/No) eS Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ j TYPE OF JOB New d - Alt epair Other Use of Building I Describe Work No. of Bedrooms No. of Bathrooms SQUAIRE FOOTAGE-1st Floor 2nd Floor I 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached t MOBILE HOME INFORMATION-Make Model 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. 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: i { 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 f 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 therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without i approval. first obtaining approval. 10 X Date C X Date � FOR OFFICIAL USE BEYOND THIS POINT C—ccepte�d�yi 1L - Date } 5() a)bmittal Amount Du Receipt t �� ...:......::.:. . :::::::....::::: EP##RTME ITA ;R ) li1f.:::;::.:> APPROVED D NIEp>: UNDITl N +t;?a S ;:: Building Department Occ Group Type Constr. x) Planning Department 3 Environmental Health Department Public Works Department I _ Fire Marshal I i Valuation $ ........::: a ......:.:......: ..... :: .... 1 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 ( ) f{ 3 TOTAL FEES i I HERMIT NO.: E3Ll) O p013$ MASON COUNTY �IS 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 APPLI7CA . �INFORMATIOPK" NTIjAcC FORMATIOAIOwner '�" cto Mailing Address x ' •� "' ailing Address City .�•' p City State Zip Code �.�--� ..�'`r`�.:, S ate «di Code ,� Phone( ) 2 'Kr Ph.�� Ph.( Other Ph.0 Lien/Title Holder 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. .. , 9� 1 / 1�� / �� '`.��.� Fire District Legal Description Site Address(Please include street name, street number and-city) 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) ,. , -�` Saltwater 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 Building Describe Work -:. ,j= ' 7. No. of Bedrooms No. of Bathrooms SQU E FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement ;::Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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-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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date to ' » f , X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted b_y�. }I Date I J-�-�� . mittal Amount Due _Receipt : . Q .. C:: f N ~pAAI RT 7 Jil ........... Building Department Occ Group Type Constr. Planning Department Environmental Health Department U Public Works Department Fire Marshal Valuation $ SEE . 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 Folation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION IRIS 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICA NFORMATIIQh0000* ,�"" NTA INFORMATI N-_�' Owner **.40o'4 "+ i �` {srr t"r`cf to� Mailing res ailing Address City /'resr�' State ip Code City State Zip Code P h o n ,P ;,S -C !W r Ph.0 Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration / / E TIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System > Well Water System Name of Water System IRCEL INFORMATION-12 digit T x Parcel No. IQLde7 Fire District Diitrect al Description + I P �3 , e Address(Please include street name, street nu ber and c"t ) ions to site sR° - c c . Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) /"' Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ 1TYPE OF JOB New Ado Alt CgLRepair Other. Use of Building Describe Work No. of Bedrooms No. of Bathrooms SQU E FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement wDeck Other sq. ft. Garage Attached Detached. Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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-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 conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X ._ ,s '" `� to X Date FOR OFFICIAL USE BEYOND THIS POINT cc�"by 11[_ Date 12- 51 mittal Amount Dua I Receipt : ; ...:.. « :.:.,.:::::..:::.:<:..::::.:..:....:.:.. ::>:<::>: . .:: .. ............ ... ..... N .: �N:APPOVED T. V Bi D ;..:Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ I Building Permit Fee Site Inspection Plan Review Fee EH Review Fee I kPlumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other I Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTALFEES