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'_ ..�_ ^F M i. ..�, ...�._.,l- --(�'�+••;•!}�}tzf.l.. ,L..r i.�. 1'�' , `'�L- i , � l � •%._-elf; + �_�.W� a.. �-.'� � � } _ -.• ,.._.�._.._y ii y _ i +..�^ . p s } t TOPOGRAPHY PROFILE: - I �f"aU� l� { La wd ►S `'� a r uw Direction: Scale: Approval:for office use Building Pen nit number: 60 #AoV Building: n Sh0-I 4,n u6G Planning: Owner/Applit;ant: n1�, r'�Of1 1[n� ►rlS 1�, $ �v,;k-LI Date of application: Env. Health: Parcel Numt-er._. 3 2 1 3 T` ! 0O 'I�L t c �� o / ►n�t� �� r:r/• a�feSS t° FORM MUST BE COMPLETED IN114K MASON COUNTY PERMIT NO. V20a4)f)_? PLEASE PRESS HARD BUILDING PERMIT APPLICATION K. � 630-7 426 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 INF 9RMATION Owner Company Name Mailing Add, s E• Mailing Address City State Zip Code City •State z Zip Code Phone ° 7.Q3q Other Ph. Phone (00 - Other Ph. Lien/Title H61der Contractor Reg. LPL S IZ 1.�i� E mail address E Mail Address a Drivers Lic.# DOB Drivers Lic.# EAUwtl k& M2 FOB J 10-11=-W-- SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer Systern Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description ff Site Address(Please include street name, street number and city) o Directions to site ✓ L an o 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 Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add'7'- Alt Repair Other_ PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building a L Describe Work v►dd)1I10 A oy1 NXt�-}Ttiw clou't�a►P. No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement D Clover d 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 property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEA FA � CTIO�fVWA OF THIS PERMITAPPLICATIONOF180DAYSWILLINVALIDATETHEAPPLICATION. X PRODate: T�2��Qf:: Owner/Owners Representative ontract (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by:6101A I, Date - -� DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department -CQ I - Fire Marshal hY1Z- ,2 FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base We Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES FORM MUST BE COMPLETED IN MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 _ S Shelton (360) 427-9670 - Belfair(360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us Z� APPLICA T INFORMATION CONTRACTOR INF RMATION Owner Company Name Mailing ddr s Mailing Address City tate Zip Code City i Vl b !State—� Zip Code Phone ° �- 0 Other Ph. Phone Other Ph. Lien/Title older Contractor Reg. L°l. S 1 1, g. D� E mail address E Mail Address a Drivers Lic.# DOB Drivers Lic.# Be(Aft4L&Z 02PvOB 0— 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. Fire District Legal Description Site Address(Please include street name, street number and city) o Directions to site L Will timber be cut and sold in parcel preparation?Yes/do Is property within 200'of Saltwater Lake River/Creek )ond 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'71- Alt Repair Other,�_ PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building r^+� C' Describe Work t 0 Vl -,Aetxl as AQr71dIP� No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor 2nd Floor 3rd Floor Basement D C�o�vemd 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 property and structure for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEAN FAPR EC:TIOl`5WA9RVlTYOF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X Date: `I-2�I — 0- Owner/Owners Representative ntract (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: v in i Date - -� DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department oZ p sic o5-6 Planning Department Environmental Health Department b2 Fire Marshal ,.: FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base f e Other Wood /Gas/Pellet'Siove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. R2lDA.f62 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 APPIL ICAtff INFORMATION CONTRACTOR INF RMATION Owner KO r' Company Name Mailing Addr s Mailing Address City ti State Zip Code City : State_ & Zip Code Phone Other Ph. Phone 2(o Other Ph. Lien/Title Frolder Contractor Reg. "T�w1rEfaC.9S 1 Z Idl 1,6} f Email address E Mail Address a Drivers Lic.# DOB Drivers Lic.# Uw�l�'IM 2 0206 n RD —! SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic x Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address(Please include street name, street number and city) O Directions to site_±1M1 3 . -Ner% L eki MAK® /rr� �4ir� 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% 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 RESIDEI`4CE ❑ SEASONAL ❑ Use of Building ��r�►G Describe Work Add►t10 N ey1 l�iY1 Nw Qor , No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement D C5oveer. d Deck Other Sq. ft. Garage Attached Dfetac=hed =.._I 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 subrDission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signatufo N, elow. I declare that I am the owner,owners legal representative, or the contractor. I further declare that I am entitled to receive this permit aln4 o do the work as proposed in the application. I declare that I have obtained the perrfiission 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,.-m4 conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants loyees of Mason County access to the above described property and structure for review and inspection. This perm it/appIication bebdnAs null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 18d days. PROOF OF CONTINUATION OF WORK IS BY MEA FA RO ECTIO A OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: Owner/Owners Representative ontrac (indicate which one) OFFICIAL USE BEYOND THIS POINT Accepted by: omitg Date - D 'ARTMENTAL REiftlrW APPROVED DENIED NOTES Building Department llijc5•d Planning De artment�.4` S(3l0 Environmental Heal! '=epartment Fire Marshal " y`. ; FEES BuildingPermit Fee Site Inspection Plan Review Fee Al, EH Review Fee Plumbing & Base Fee . .." Planning Review Fee Mechanical & B Other` ;' -/ . 1 t©we Fee,f State Fee Sf t Violatiort Fee" °, .�, , , �, Pre-Paid at Submittal �:'` Valu ,9t $ r; *; TOTAL FEES y. MASON COUNTY PERMIT NOJ,_� � BUILDING PERMIT APPLICATION 0/ > � ,`( 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 ha - Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us OU APPLICANT INFORMATION CONTRACTOR INFORMATION f Owner 9 ' " Ay1i jj1 . Company Name 0AbfV1Qk Y Mailing Addre s� (,� - o ., is Mailing Address City State_I-AZip CodeSSK4J City -1w r b State11 ; il& Zip Code Phone Other Ph. Phone WN 2 Lrw( Other Ph. Lien/Title Holder k Contractor Reg. -T2t� -(aL 53 I Z- ok jo-+- E mail address E Mail Address < a+ -0,5 r Drivers Lic.# DOB Drivers Lic.# &I LA n4 L&&L?�OB fa-I — . 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. Fire District Legal Description Site Address (Please includ street name, street number and city) o Directions to site 41-yin L are WAS 0 h U ke AW 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 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 a� �u�L Describe Wor ddif 1011 -A P--y5ib 4 c C law.- No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor 2nd Floor 3rd Floor Basement &ttached Cve.reZdDeck Other Sq. ft. Garage Attached M ' '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 perrtiission 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 property and structure for review and inspection. This perm it/appIication becombs null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEAN$ FAPRO N ECTIONa�JfIn� ITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X i --- Date: H-�--L, 0 Owner/Owners Representative ntract (indicate which one) O OFFICIAL USE BEYOND THIS POINT Accepted by: c'r Date DePARTMENTAL REVIEW APPROVED DENIED NOTES Buildin Department ! f = L'"`.. •t:. t I. �: .�,t r.. Planning Department Environmental Health epartment ;'4{ ,,:; .CO ( ' Fire Marshal 4. ri,.i / r - FEES Building Permit Fee Zp t Site Inspection Plan Review Fee i ': EH Review Fee Plumbing & Base Fee k Planning Review Fee Mechanical & B Other Wood'J Cs/ P Ilet ove Fee. w*" State Fee Violation Fee Pre-Paid at Submittal TOTAL FEES Valuation $ _, i