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Date By Date By FINAL INSPECTION Water Line Date e' —fZ— By' , Date By Date By �~ /9-d>57 6-13 i, &c,C / C,-� IL cy► �S ��trJ �C S tit X-- � C O O N O � O � o 0 o � cn y O to 01* r 0 h FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD 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 r$b der dh,•�s L,SW_%zl-) 1 /Pt Company Name Mailing Address t I S07 AJoak C.,,k PY,,,�X A) Mailing Address City g0411 State tvy Zip Code ISO 1 City State Zip Code Phone (aot�) 'YIa-0L177 Other Ph. Phone Other Ph. Lien/Title Holder �//4 Contractor Reg.# Exp. E mail address Lis ek)03 lie f E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System .tiff - 4-a g t-v -I' 5e-- I-e, Z'.'re) Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. t,2a i`7 a at v oo1 a Fire District Legal Description_AJ% ,u'J% ex s/- Qav ?-e 13 5/i37 1591/l C S.�/e ele 3 Site Address (Please include street name, street number and city) f 59 'A L S-kk dle 5 s471 L, 1,4 WVy Directions to site__ <-- 4-E—rl ,gyp 7--/ Will timber be cut and sold in parcel preparation?Yes/ o Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye TYPE OF JOB - New d Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building T4e1,r &4i4dt��5 Describe Work Q-LJ 4-kwtef /y Al --ymo.o&/e, Q0,,.•,fD/- 9- ct`:ize/s No.of Bedrooms No. of Bathrooms Square Footage - 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. 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 permis- sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica- ion or the work propo ed in a application, I have obtained permission from them to apply for this permit and conduct the work proposed. X Date: Owner/ wne s Representative Contractor (indicate which one) _-FOR OFF I USE BEY T INT Accepted by' Planning P Ck# Date Bld PdReceipt DEPARTM L REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Buildinq Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Plan ing Review Fee Mechanical & Base fee Other 0— Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION ;D_�' 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 T$ awa." Chr;S j,,< ''Atid 1/.;LIL.Sit0 Company Name Mailing Address 11SQ 7 4ha dn edie 86,,s .J Mailing Address City r, // State f, Zip Code ���r 1 City State Zip Code Phone Cam) yla-0479 Other Ph. Phone Other Ph. Lien/Title Holder A4.M Contractor Reg.# Exp. Email address L,s t , camevr/- let 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 .L1/4 - 4- Asa •' Sr�� ��� • •:�d Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description ,-JYA A,.'A1yq ex KI An.► re R 174,17 i5' eA- 3 Site Address (Please include street name, street number and city) 19I W / t� S"*ft g k S sL/V^ t,A Directions to site :�;- x Y e <e C+ d,ireAsec e, <L.f T I Will timber be cut and sold in parcel preparation?Yes/ o 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?YesAp TYPE OF JOB - New A@dl Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building L. et._-A,40*.�.h..;s Describe Work-4-A-? -%,La11 lz41 No.of Bedrooms No. of Bathrooms Square Footage- 1st 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. 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 permis- sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion or the work propo ed in a application, I have obtained permission from them to apply for this permit and conduct the work proposed. X - _^i.( Date: '3//,?k Owner/ wne s Representative Con ractor (indicate which one) FAR OFFIQtAL USE BEYONq TM PPINT i Accepted by• Planning Pcl , '`-Ck# Date /J. Bld Pd W Receipt No -_, DEPARTM L REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department 41L W. 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/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES 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 ra p Company Name Mailing Address 115507 dk,0, A- e AY.-,.x A) Mailing Address I City_36fli N State WZip Code sin, 1 City State Zip Code Phone 12Q&,) IiJa-04/79 Other Ph. Phone Other Ph. Lien/Title Holder A4.44 Contractor Reg.# Exp. E mail address to—ecd. At t 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 .4- Na a /"., .,rd Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. r;��.L?-23ooc�3� Fire District Legal Description J& 't'l jyd ex <1 Amj Szruer 5/is7 i art/ 5,4Ae Qk 3 Site Address (Please include street name, street number and city) I q j 441 /-' S"AAr 8�k S .4,,/V, .4 fe-V Directions to site at4a 9k d,nm,hec sL.f 7-- Will timber be cut and sold in parcel preparation?Yes/ o i 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?Ye o TYPE OF JOB - New d Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building T Describe Work q-,J 11AA'f f ftr �� +� ��� `� 4C•�,/s j o.of Bedrooms No.of Bathrooms 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. 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 represehtative,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- sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion or the work propo ed injhe application,I have obtained permission from them to apply for this permit and conduct the work proposed. X '_^i' Date: -TA210`� Owner/ wne s Representative Contractor (indicate which one) F.,faR OFFICIAL USE BEY T INT �j Accepted by Planning Pd2&� '"6k# Date Bid Pd Receipt No. — DEPARTME L REVIEW VE NIED . NOTES Building Department Planning Department Environmental Health Department - ff Public Works Department Fire Marshal FEES 411L W. CEDAR S Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee �' Plannin Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES 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 t ,l L) ®waw c".k,., L :st L,!f"' Z r/.s,s`S I;, �_ . .t" Company Name Mailing Address I L-0 7 zkl ° r~,a b -+) Mailing Address City' / State Lu4 Zip Code f City State Zip Code Phone C wl � l/ln- �i 27 Other Ph. Phone Other Ph. Lien/Title Holder - ! Contractor Reg.# Exp. Email address c < ;.:<-_'-'. �,_.,,E }A t 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 d0i—�4 Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) 1 Y w !k At r'.. Directions to site �, , 4 t"f , - c:r-, f 7- { Will timber be cut and sold in parcel preparation?Yes/ o 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?Ye o TYPE OF JOB - New dd Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building I aw Describe Work No.of Bedrooms No.of Bathrooms Square Footage- 1 st Floor 2nd Floor ° 3rd Floor Basement Deck Covered Deck Other Sq.ft. Gara a 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. CVVNER/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 permis- sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion or the work proposed in he application,I have obtained permission from them to apply for this permit and conduct the work proposed. r r r "ii1 . b Date: X Owner/Owners Representative,/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT f Accepted by:'%Planning Pd Ck# Date Bld Pd ' Receipt No:�' -- DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department 'E_ Y_ S. Planning Department Environmental Health Department °i,�, 0, Lt1J 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 L Pre-Paid at Submittal I'i Valuation$ TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT N04�� Z4wV--D®5'7 PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 Shelton (360)427-�670•Belfair(360)275-4467•Elma(360)482-5269 n the web www.co.mason.wa.us APPLICANT INFPRMATIOR CONTRACTOR INFO AT ON Owner (rfi Company Name Mailing Address Mailin Address P 3V,0 City State Zip Code City tate Zip Code Phone Other Ph. Phone — O h r Ph.LAI,- 6 Lien/Title Holder Contractor Reg.4� Exp. E mail address E Mail Addresslam Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to 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) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric LPG Natural Gas— Heat Pump_ Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank 7� Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/PelletStove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee3 TOTAL PLUMBING TOTAL MECHANICAL Y1 GINNER/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 th ;:ngN his permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accura a loye of n County access to the above described and structure for review and inspection. PROOF OF Y ME OF A PROGRESS INSPECTION. 7 X Date: Owner wners Representative/Co act r (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 Group—Type Constr.- Planning 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 \ 3 3 k \ CN KKK / C) � 2 / � Q AE o * n - cr. \ � � wuiw % ® % c2 C) > = 2 W 2/ � ° a � $ � w & — w S R e � E Q c m U LL E U 2 ƒ 2 .. .. g . c 6� E " c c T 0 � f$ § 2 a 0o k2 0 � q � v f § $ 2 2 . .� ¢ o CL 2 k / .z &2 7 . ® LL ad § 2 ® . f / � £k ® ' ®0 z f $ M2f LU ° / tom \ U 0 � k \ k \ � dot 2 / \ E § W o » ƒ nr - - E &� ° � � m k m � k k D 2 ; M u i 1.0 � w U) tax,� £ � / � � $ C.) w i § LU > _ m a V f 2 L 0 O \ . 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