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OC as ec o z -• a Z-1"en010 ea a.a �+ OMr+ a to -nm o m:raw a Wit 0 o ee mcn M m�aa -ram rr@ Vi 9DOC 3 SS '$*O r+ e+ tat G'C ca A M a Z— Sa • "CIA A-i 4 • O �+ AZ ®r am � m ace m Ch< v O=� � •a .r i oC mo �vzs m MCI) o vV %C co -M m OV) Q 0 Cm ..rrf a r g� zm 00 0 Q D mm o cn x C*) a X 0 a �' ° 0 � � D 3 z CA ?z acs (D OD _ � O CA � C c � C � � C D 670 z 10 Q OD Q C t'A C t" O fl F RETE MECHANICAL MOBILE HOME s-Setback date by Ribbons _3 — Gas Piping dateb tion Walls date b Set Up by date by INSULATION date Final BG/SLAB Insulation Floors date by date by date by FIRE DEPT. FRAMING Walls date by date by date by OTHER PLUMBING Attic Groundwork date by date by WALLBOARD NAILING D.W.V. date by date by FINAL INSPECTION date eer Line date "nL7 17 � , by 77 , date by by O lO(zzltr Permit No. ILL 9 S.-GG15 MASON COUNTY BUILDING PERMIT APPLICATION 3 � � 426 W.Cedar/P.O. Box 186,Shelton,WA 98584 427-9670/1-800-562-5628 (Calling From: Seattle 464-6968, Belfair 275-4467,Elma 482-5269) PLEASE PRINT #1 ner :De),W _ I Phone# S&o - N 2,&^75;L7 e Address--J Ca y o tc . 211 I LL I2I 5 Latt` Loom 1Z n AV Fire District# � E City SH'=i Tn a ISt t u Zip 9 A'"I j Directions to Job Site S 1-T p,-T .rA& mth d F L&kt I CO o Mbr-T 44 :5e,&x L&/g d t i1`� LA tr�_'Tj-4 E i►Z �12n��2 T!a 111=TT 'P rac T C]UT1..6T To Fc f` (WyTi.( °LYCLe Ci r3 FEr1CC Owner Mailing Address 16440 r= T HI I-ki-PS A ic>E -!, Ann-'b City S E zo i t St—WA _Zip Lienfritle Holder hl A - Address Clty St rp #2 Contractor Name T_ etc i)N C'o��nl'rRY �P05T �Ri4,yE T)p►MI N&S Contractor Reg#Z0rj,N e-p 1=n99 LT Address r s H t I-T»AY Rq Expiration Date_ / 3��$_ City Ly g U4 U)A n St LUG, Zip A037 Phone# #3 If septic is located on project site, include records. Connect to Septic?_� Public Water-Supply Well +� Connect to Sewer System?___bLo Name of System N /A (If resi tial,proof of potable water is required) #4 arcel No. co p 6gal Description Lc-),- � �1r/lipt ��'�- �1V #5 Building Square Footage: 1 st FI 2nd FI 3rd FI Loft Basement #Bedrooms #bathrooms Deck Other Garage Carport sil 8 D (Circle:Attached otjetache #6 Use of building�AtlZTcn�'I Describe work Repair Other - ' f Job. New Add Alt p ((� #7 Type o -t'CT #8 MOBILE/MANUFACTURED HOME INFORMATION fit". 19�b Model Year Make Model Installer Name: th Len9 Width o. Certification Number 1pNCE CENTER �` #Bedrooms #Bathrooms Type of Heat Purchase Price$ #9 WATER ON OR WITHIN Z00- OF THE PROPERTY [ ]SALT [ ]RIVER/CREEK [ ]POND LAXE [ ]WETLMD NAME OF BODY OF WATER ?t{ILL-PS -LAKFi -- - -_-Slopes/Bluffs rVI` NO Show following on the aRe plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water tines Topography Drainage Plan Wells Septic Systems Easements Proposed Improvements Name of Side Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW k r APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW r A / "4f k� i N p' r t S t 10' Plumbing Fixtures Egg [� hanic?I Fixtures No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other _Bath Tubs No UBM Fees _Showers — Fum BTU _Hot Water Htr — Heatpumps _Laundry Washer — Vent Systems Sinks — Spot Vent Fans _Floor Drains No. Boilers/Compressors _Laundry Basins — HP _Dishwasher No. Air Handling Units _Disposal _ cfm# _Urinals LN& Ere Protection Systems _Other — Auto. Fire Alarm Sys f Fixed Fire Supp. Sys — Auto Fire Sprink Sys Permit Basic Fee TOTAL PLUMBING $ No Other Gas Outlets _ Wood, Gas, Pellet Stove Propane Tank NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee WORKIS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT THE TAC R NTLYWASH EGIS ERDDI MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN RCW 18.27,AND AM AWARE OF THE MASON COUNTY BAN HEW RKFORWHICHTHE WAREOFTHE ORDINANCE IERM T SSI SUED ORDINANCE REQUIREMENTS FOR WHICH THIS PER- REGLI- LAT MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN T�HEREW�H NO CHANGESORK DONE SHALL BE MADE WITHOUT THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. X OWNER X BY DATE DATE-6 19,ni , q R Receipt No. Amount Paid DEPARTMENTAL REVIEW Cash Check Check FOR OFFICE USE ONLY Approved Cond. Hold proval Planning: IhAk Environmental Health: Building Plan Review Occupancy Group: Type of Const: Fire Marshal: Other: Fee Calculations: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Violation Fee Site Inspection Building State Fee UFC Plan Review Other i Other [[Bu:17ld:1nguation: TOTAL FEE Aff Receipt No. `1 Amount Paid gl DEPARTMENTAL REVIEW Cash Check Check # L FOR OFFICE USE ONLY APPrOVed Cond. Hold Approval Planning: Environmental Health: Building Plan Review Da, a3"q� U-/V- Occupancy Group: U-t Type of Const: t� Fire Marshal: Other: Fee Calculations: FEES Building Permit Plan Check At7 ao Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Violation Fee Site Inspection Building State Fee �. UFC Plan Review Other_ Other ----- Building Valuation: (o( TOTAL FEE Receipt No. Amount Paid DEPARTMENTAL REVIEW Cash Check Check FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental ealth: a Building Plan Review [' Occupancy Group: Type of Const: Fire Marshal: Other: Fee Calculations: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Violation Fee " Site Inspection Building State Fee UFC Plan Review Other . Other Building Valuation: TOTAL FEE