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Eff � Ef § \ D } 2k � 7E CL cm _ JE ƒ a § CD CL CD # \ § / § 0 ® J \ % ! n E m � \ % § + « E co r vONCRETE MECH NI AL ^ MANUFACTURED HOME � �' Footings f Setbacks Date ?� �D� By._&_/�-- Ribbons O Gas Piping o Interior Date s/Z�167 8y Interior-Date By Date By Exterior Date By Exterior-Date By Z Set-u p a Point Load f Isolated Footings INSULATION Date By 0 BG/SLAB INSULATION Date By Data By FIRE DEPARTMENT Foundation Wails Floors Date By Date By Date /Z- �p-®� By-�VW DECKS FRAMING Walls Date By Dated717 LO-7 By!Bl� Data YS 17 07 BY314PROPANE TANKS PLUMBING Vault Date By OTHER Groundwork Attic Dale By Date By Type: Date By o.W.V DRYWALL Type_ Int Brace Wall Date By 100 Date .0 Bv~11( Date By FINAL INSPECTION v w water Linq�j J, Fire seperation IVo Date (X B t Date By Date % —��y - c Bv� 'S� CDy 4 ` Pass or Request Inspect. c Type of Insp. Fail Date Date Done By Comments CD ov�► 4z,- 1 �-?�(-o`7 �-ZZ I " N O Z Q _._. N ,13 -� / 0 a ACCESS & GRADE INSPECTION PERMIT #: ADDRESS 71 A 9 r n4 h --B�Ac S x, INSPECTOR j DRIVEWAY ACCESS Length: Width: t Z rf Size of turn-around: Condition of shoulders: Vertical clearance: need post at end of driveway with reflective address numbers GRADE,OF DRIVEWAY — �� %, OF ROAD % ROAD ACCESS Length: Width: / Surface: Condition of shoulders: Vertical clearance: X BURN PERMIT REQUIRED 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 (continue remarks on back) MASON COUNTY PERMIT NO. `�' T 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 i APPLICA T INFOR TIO CONTRACTOR INFORMATION Owner Q V Company Name Maili Addr s Mailing Address Ii City, State Zip Code City State Zip Code ! Phone � Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address or • . C+GVtL E Mail Address Drivers Lic.# DOB —7-55 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System �/' Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No 22-3041 7,6 0 Fire District Legal Description 00 Site Address(Plea§.p include street n me, street number and city W Directio s site 00 le �r - yr �i ON tA/' :.X- � o TPA/ u ik Will timber be cut and sold in parcel preparation?Yes Is property wit 'w 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluff% �— 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 Repair Other PRIMARY RESIDENCE ❑ SEASONAL Use of Building Describe Work �4 No. of Bedrooms No. of Bathrooms i Square Footage 1st Floor �O 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. 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 propehanstructure for review and inspection. This permit/application becdfnes null & void if work or authorized construction is not commenced80 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS RS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 AY WILL INVALIDATE THEA`PPLICATION. X Date: /Y d Owne /owkbrs Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department CO3 Fire Marshal L I t FEES Building Permit Fee 3-7'7-9 Site Inspection Plan Review Fee a 5- EH Review Fee Plumbing & Base Fee q L00,' 2Z Planning Review Fee Mechanical & Base fee 7 -,1 ems•30 Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee 4IL92 S" -200 Pre-Paid at Submittal Valuation $ ,3 3[od 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)275-4467•Elma(360)482-5269 n the web co.mason.wa.us APPLICA T INFORMATION CONTRACTOR INFORMATION Owner av 4t- Pot, Company Name Mailin Add es. 45I C 54 L t- A/ Mailing Address City�� tate_A A Zip Code. — City Mate Zip Code Phone 15 a�� Other Ph Phone Other Ph. Lien/Title Holder M-vWe, Contractor Reg.it. Exp. E mail address dj2C 19q,2 �' AgAhlrj. 1110At E Mail Address Drivers Lic.# b © DOB - -5 S Drivers Lic.# DOB SEPTIC INFORMATION - Connect o New Septic Existing Septic Connect to Sewer System Name of Sewer System p'&L4- - aces-DD/`IS PARCEL INFORMATION- 12 Digit Parcel No. .2.230 Fire District Legal Description Site Address (Please include street name, street number and city) 7 - Directions to site a.. '/ 1e)CIC -e P (ao " o '� o✓ .' Is property wit ' 200'of Saltwater Lak River/Creek Pond Wetland Seasonal Runoff—stream—Slopes or Bluffs > 15% TYPE OF JOB - New Add -Altt—Repair Other Use of Building Location of Fixtures/Units- 1st Floors end Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electri LPG_ Natural Gas_ Heat Pump_ Toilets �_ Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers T— Spot Vent Fan Water Heater Propane Tank Clothes Washer G utletsp v, Kithen Sinks = as/PelletStovef° � Dishwasher en Exhaust Hood Hosebibs Dryer Vent / r Other Other S , Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OMVER/BULDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.AcWxWedgement 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 wdl grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF TKNV OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date:INSPECTION. `7 Z(5wnerj0wniW 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 Grou T e 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