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Date By Date By FINAL INSPECTION Water Line Date I0 B y Date By Date By 09 f- 0 �(�/���Ll� ��9�'fc,f`C'9 ', ��"G'^Ln.�.0 �k �t-t ( ��•`" L�iJ7r+.— /uC:c:/i°�� .!�'�/iG�i Vtr' 1 L' �...� CD o a Cn 0 5 ccn N O CD O � W b N \p W � 0 PERMIT NO. BLD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA98584 Shelton(360)427-9670 Belfair(360)275-4467 Elma(360)482-5269 Seattle(206)464-6968 ` On the Web www.co.mason.wa.us APPLIC,ANTJNFORM!ATION_ CONTRACTOR INFORI,IATION. Owner f l i e t,, �... y f ; i Contractor Name }� 1 ram✓ ' 1., ' " i` > a Ma Address % ✓ ailing Address • "' ' s ' City ' '9 " State j Zp Code Phone �,? '4 lOtfi Pft } . .w^-'� 1 ;� /Phone �r.:' Y �... er Ph. U a —r P Lien 'I Holder - Contractor Reg.# "�''� _': Exp. E-mail Address ? E-mail Address,,�- SEPTIC/WATER SYS, FORMATION-Connect,10 N w214' eptic Existing Septao Connect to Sewer System_Name of Sewer System " ' '' " ra. '' Well Water System Name o�-1N1 ter System ✓ PARCEL INFORMATION- 12 digit Tax Parcel No. ' _/ 777 / 477777' !/ Fir6 Distract, Legal Description Site Address(Please ic�clude street d6e,street number and city) Directions to site-�' "�fiA 94 1 1� Will timber be cut and sold in parcel preparation? (Ye o) Lake River/Creek Pond Wetland Seasonal Runoff Stream,Slopes or Bluffs _) PERMANENT RESIDENCE❑ SEASONAL RESIDENCE IA' TYPE OF JOB-NewT_Add Aft Repair Other Use of Building _ Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action ,. (Yes/ o -,/ Describe Work No.of Bedrooms No.of Bathrooms SQUARE FOOTAGE- list Floor 2nd Floor 3rd Floor Loft Basement beck Other sq.ft. " A�ttatredPT DDetached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length=" idth er I No. ° � No,of B f t"ms Type of Heat_ ti '' i {�' s ,, ' •°° ent Installer Name ' ,r`��• r r P , 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.Owner/Builder acknowledges submission of inaccurate information may result in a stop work order or permit revocation.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 ordi- contractor in the State of Washington and that I am aware of the ordinance nance requirements for which this permit is issued and that all work will be requirements regulating the work for which this permit is issued and all done in co ormance therew chan�igos shv e.made without first work shall be done in conformance therewith.No changes shall be made obtaini prov a �.1 -6,1' "I without first obtaining approval. Date X Date FOR OFFICIAL USE BEYOND THIS P9t-W ' i l � r Accepted by Date !I ii �' Submittal Amount Due Receipt No. '4 ,• x w14* ,s Building Department , Occ Grou Type Constr-\1 t4 \3'6 -03 , Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation$ MMM v d0/• (p Building Permit Fee p 7• 6ZS Site Inspection Plan Review Fee d'�9 70 EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( f ) W. TOTAL FEES h' �'.:. 7i Ask for: Water Ade MASON COUNTY PERMIT ASSSTANCE CENTER Septic Perri� - PLAN SUBMITTAL CHECKLIST Owner's name: lr)aAtl1 Date: B —1? 3 Project: Reviewed by: Document Accurate site pl a tached to each set of Tans (road setback /sideyards <10?/Q) ' Topography attached to each set of plans r y Building permit application completed LUkJ,�,(ig+ o 0 of Contractor's registration no. W () C�� "✓a C�J Planning intake checklist completed nine'; y r Gde "*U atlon form- - orced air/electric etc. g Application— W R FUE TYPE—forced air/electric etc. Is en ed? (2 sets of calculations) Construction P ns: 3 COMPLETE sets submitted Plans legible ✓ Recognized scale Elevation views � �� J �� u/a.`I � l �~ Cross-section u w .� n_ Foundation plan Floor framing plan— all floor levels represented Roof framing plan—using pre-manufactured trusses? C oich i pan— re decks? ✓'0O Plan Details: Engineer's design criteria- lb. snow load, exposure , seismic zone 3 Wall framing—does bearing wall exceed 10 `? (engineering may be required) Concrete walls—does concrete wall height exceed 8'? (engineering is required) Non-conventional framing— steel, form core, logs, etc.? Yes/No (engineering is required) Heated by furnace—location of furnace shown on plans? Fireplace/stove information shown—fuel type Window sizes marked on plans Braced wall panels (shear walls) marked on plans or lateral engineering? (Plans may not be approved if not provided.) cmh\word\checkl ist.ver2 Mason County Permit Assistance Center Planning Intake Checklist Owners Name: Marf l n Date: 3 7r"d Project: 10tJrAAe Reviewed By: Commerci evelo ent: YES NO Comments: Planner: SAL GBM RAM Site Plan: North Arrow �� p�Property Dimensions: X e-- treets and Driveways Shown. Road name: eAll Existing Structures shown with setbacks Vi 11 T nratin13 SP13tic and Tlra;n a"Identify all surface water(streams,ponds, shoreline, wetlands,-etc.) 5fVrM CL t(A�_ ga--Topography(slopes) a-lPro osed Stru e Se a ks Dire tion/ etback : p F: / R: 2 S 1:)W/70 S2: JE_: l )q Q u-'Utility and Drainage Easements: Yes No (if yes enter condition#5022) tether Easements ROCUL Shoreline and Planning Info Setbacks: Shoreline: _ Sl e: Shoreline Designation: Compre ensive Plan: Rural Zoning: ❑ Not Applicable ❑ Agricultural ❑ RR 2.5 5 10 20 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy ❑ Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area ❑ MPR ❑ Unknown ❑ Unknown Water Body (ty e of water if unnamed): o�Q__, SEPA: Yes n Unknown Flood Plain: YES ;�iU Map# Aquifer Recharge: YES N Unknown # Tags/Cases: RLC/SPI Case: nmu 6-Year Dev. Moratorium: YES Eagle Nest Tag: YES NO Other YES NO Addressing: Check box if needed Reviewed by: n l i 3- 6 ❑ County Access Permit Needed(add condition#0010) ❑ State Access Permit Needed(add condition#0020) 6 Nam/ k_f5 On UE — Standard Conditions to be added to all Building permits that plann ni g ie s: 4 # 0046,#4999, and # 5019 � —� Revised:10/15/02 o III ° ilil' III 1 � i O IIII! II IL i' IIIII ''I Il • •J II Z IIIIIII IIS IIIIIII II z 0-9 ,i o o - I I O x IIII _ A 1 1 I I III I I I I 11 zWs; I 110 ,�o Z Iililill Z --o > ' it `l z II`O IIIIIl11 tl c7 - IIIIIII IIS� I I I 1 II }' W < I I I II�� Illlil'i II J '� z CI ,iillll i'lll'Il II W it W - I ! I � J IiIIIiII II W 11'I'll , W Illiilll II it N �� ffi I dl li�l�i� i� I- III' I'll Ili ; II �J .. !e�.�� � i t I I' I I I II I i I II �: I1111111 II , �. y i, IIIIIII ,I IL' 411. 1111 I I I W I I I I CC 7 ? iall #? W 2 _ �_ i 1�7i1� I- 0 i1i 11 0 1�OOY, r G •131-: gf! 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