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S 2 C cr W D w p o N Z m 7 tr m t ZO'd SSzv4ZS90Z iCuQdwOp u0-AqO-A_L 61 :60 00-6Z-�aa i CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by RRbbons date by Gas Piping date ' Foundation walls dam by set up date by INSULATION date by BG/SL.AB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by date by PLUMBING Attla OTHER Groundwork date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by — 2 _O/ L date by 1 �o FORM MUST BE COMPLETED,IN INK �0 PLEASE PRESS HARD I NO.. MASON COUNTY LU U 7)r:Al, DEMOLITION PERMIT APPLICOWo (�S `� t) 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 �'N•CE/1t Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 ENT VVV APPLICANT INFORMATION CONTRACTOR INFORMATION l Owner Norbert van Dam Contractor Name Ft Mailing Address P0 Box 15232 Mailing Address City Seattle State WA Zip Code 98115 City State Zip Code Phone( 206) 527-3477Other Ph.( Ph.( Other Ph.(_ Lien/Title Holder Contractor Reg. # Address Expiration PARCEL INFORMATION-12 digit Tax Parcel No. 12 2 2 9 / 41 / 00020 Fire District 3 Legal Description The N 1/2 of the south 1/2 of government lot 4 , section 29 Site Address(include street name and city R_ 71 0 0 Grapeview Loop Rd Allyn WA 98524 Directions to site: a= avi r�u�_ T.° ri. Rr9 1 mile- Go West on rl i rt Yn' at 1�fanl P_ Point first rigRt or c in �riveway Is your property within 200' of the following: Body of Water(Name) ca eP Tn 1 Pt Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs If your project is located adjacent to or within an area that is listed above, it is advisable to contact the Dept. of Community Development regarding future development prior to demolition;since removal of an existing structure could affect future building locations. How will the debris be disposed of? Put in umps er s provided y mason County garba What is the use of the building being demolished? Single Family Residence 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 CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the 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 ordinance requirements regulating the work for which this permit is issued will be done in conformance there o changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtaining approval. be made without first obtaining approval. X Date 2,0I- 00 X Date Provide a plot plan indicating location of improvements and structure to be demolished. Gcra FOR OFFICIAL USE BEYOND THIS POINT/ Accepted by 4 � Date S bmittal Amount Due G) �1 Receipt No.��_ DEPARTM REVI W APPROVED DENIED CONDITION CODES Building Departme ld 7 A4CE� 7.46 e N C4t<<�f •>: Occ Grp Type of Con . Planning Department Fire Marshal FEES Building Permit Fee Other Violation Fee Other Site Inspection Pre-Paid at Submittal ( ) TOTALFEES i -g PERMIT NO.: MASON COUNTY DEMOLITION PERMIT APPLICATION JZ17 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 60 275-4467 Elms 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Norbert van Dam Contractor Name /-e Q-ef' Mailing Address PU 130x I bl 3 2 Mailing Address City Seattle State_EA Zip Code 98111115 City State Zip Code Phone( 206) 527 3477 Other Ph.(' ) Ph.( ) Other Ph.( Lien/Title Holder Contractor Reg. # Address — - Expiration PARCEL INFORMATION-12 digit Tax Parcel No. 12 2 2 9 / 41 / 00020 Fire District 3 Legal Description The N 1/2 of the south 1/2 of government lot 4 , section 29 Site Address(include street name and city E. 7100 Grapeview Loop Rd Allyn WA 96524 1. Direigns to site:rig,c t r. 1 - r zest x R,_ . Is your property within 200' of the following: Body of Water(Name) Case Tn1 Pi- Saltwaterx Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs If your project is located adjacent to or within an area that is listed above, it is advisable to contact the Dept. of Community Development regarding future development prior to demolition;since removal of an existing structure could affect future building locations. How will the debris be disposed of? u in umps er s provide y aCounty garr5a_ son f" What is the use of the building being demolished? Single Family Residence 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 j 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 CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the 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 ordinance requirements regulating the work for which this permit is issued will be done in con�77Date__�_Zfl' shall be made without and'all work shall be done-ih conformance therewith. No changes shall first obtaining appr be made without first obtaining approval. X yJ X Date Provide a plot plan indicating location of improvements and structure to be demolished. j FOR OFFICIAL USE BEYOND THIS POINT // Accepted by „�;��1 �� Date S bmittal Amount Due Ca6D Receipt`' f DEPARTM L REVI W APPROVED DENIED CONDITION CODES f Building Departme /A/ 7 QG? P 1Rcf` T a °•v r�i" '�j 'QP •c ` Occ GrpT e of Con Planning Department Fire Marshal FEES Building Permit Fee Other Violation Fee Other Site Inspection Pre-Paid at Submittal ( ) I j TOTALFEES i , a� .. PERMIT NO.: MASON COUNTY DEMOLITION PERMIT APPLICATION (a/-7 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton„360 427-9670 Belfair 360 275-4467 Elma 360 82-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Norbert van Dam Contractor Name. Mailin Address box Mailing Address City geattle State Zip Code City State Zip Code Phone( — 4770ther Ph.( ) Ph.( Other Ph.( Lien/Title Holder . Contractor Reg. # Address / `' K' 1 Expiration *PARF, EL INFORMATION-12 digit Tax Parcel No. 12229 / 41 / 00020 Fire Distri 3 I Description The N 1/2 of the south 1/2 of government lot 4, 'section 29Address(include street name and city w WA 4 ti ns to sike: i .tJFS1Situr property within 20(Y of the following Body of Water(Name) Case Inlet Saltwate x Lake River/Creek Pond Wetland Seasonal Runoff Stream_ Slopes or Bluffs Ifyour project is located adjacent to or within an area that is listed above, it is advisable to contact the Dept: of Community Development regarding future development prior to demolition;since removal of an existing structure could affect future building locations. How will the debris be disposed of? it _ What is the use of the building being demolished? Single Family Residence 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 CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the 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 4 ordinance requirements regulating the work for which this permit is issued will be done in conformance there i o changes shaft be made without .'and,all work shall be done in conformance t4rewith: k r changes shall -` first obtaining approval r" ~ be made without first obtaining approval. a X Date i q X Date AU d&aI4 Provide a plot plan indicati of im r vements and molished L.. rt, y f FOR OFFICIAL USE BEYOND THIS P61NT ' Accepted by Date L4 u�mittal Amount Due Receipt`qo. DEPARTM AL REVIPY APPROVED DENIED CONDITION CODES Building Departure /t/ /;� .7 C1G7 i ''i � Occ GrpT e of Cons. Planning Department Fire Marshal FEES Building Permit Fee Other �- Violation Fee Other Site Inspection Pre-Paid at Submittal ( ) TOTAL FEES