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Date B B G / Slab Insulation Floors Final Date - By Date By Date B FRAMING Wlls y a FIRE DEPT Date By Date B y Date By PLUMBIIYG .'—A,,k OTHER Groundwork Date - By , . Date By WALLBOARD NAILING D.W.V. Date . By Date By FINAL INSPECTION Water Dine Date B - -o y Date - - -gy .�_YR 3N bate By 6ict�Sl �l _ By s Act d ' o �� cis � �'1S <l . x ll � ce N Ltci� J_k6j 8 L' _ Z � _ 7 �.,..�.s / Jam. o jo I "V.�Ka TM \VV/ r CQ /3 p6 S OC e- GfL- -A / t j , -� lisle, i i 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 Owner l: eelj i j hl'-I oer Company Name c Mailing Address 2-'e 1)t"^ce 4 Ak NA Mailing Address City !�,Uel d..e:r State)_Zi Code 9 i- l P i City :,e S S P Y -State Zip Code 9 a':,; Phone-360 - 699- 417.3 Other Ph. Phone Other Ph._ ,(,,) Lien/Title Holder Contractor Reg.# Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic existing Septic � � �► Connect to Water System X Name of Water System--lia~I Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. .2 :X 17' e: Fire District 5- Legal Description_ J_n 1 A7 A A)A ,k.�. ij,0 �j �, f� $ �;4 ,9,� Site Address (Please include street name, street number and city) Directions to site '�3 4.a Will timber be cut and sold in parcel preparation?Yes/ 0o Is property within 200'of Saltwater 4 o Lake ,f-j a River/Creek Aj o Pond Wetland 1V s Seasonal Runoff �, Stream /-j s Slopes or Bluffs > 15% i­w Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New 1C Add Alt Repair Other PRIMARY RESIDENCE [2 SEASONAL ❑ Use of Building_°A k*1.4 Describe Work � A 4 �fi� m _ +:. ��r.� r•� No.of Bedrooms No.of Bathrooms Square Footage- 1st Floor_ -''7'g o 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make _ L, b.-r `r Model _ Lj -?c/o Year �= ' Length_,* Width 4 Serial No. Flo.of Bedrooms ? No.of Bathrooms =Z Type of Heat a, Purchase Price$ i . v+ t'�°� �<z���+ lv�<� ���_�'�� -r Replacement Unit? Yes k1V6 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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X °�.,. _� .�� Date: .+ , Owner/Own a resentative/Contractor indicate which one) �'— FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department �� A-r�� Planning Department Environmental Health Departmen Public Works Department 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 04� - Pre-Paid at Submittal Valuation $ t 1- U c� c� TOTAL FEES MASON COUNTY DEPARTMENT OF HEALTH SERVICES 0 January 06, 2005 PO BOX 1666 SHELTON, WA 98584 SHELTON (360) 427-9670 FAX (360) 427-7798 ELMA (360) 482-5269 KEVIN HOLDORF BELFAIR (360) 275-4467 8725 DICKEY PL NW SEATTLE (206) 464-6968 SILVERDALE WA 98383 Case No.: BLD2004-01953 Parcel No.: 122297890052 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Application for Water Adequacy Please call me at (360)427-9670, ext. 353 if you have any questions. Sincerely, Cindy Waite Environmental Health Mason County Health Services Comments: 1/6/2005 1 of 1 BLD2004-01953 Future Homes 520 Kitsap Way '�erton, RYA 98312 860-479.4663 ti` r l� A. & M. Development -. P.O. Box 34 00 Allyn, WA 98524 SO 0j ' a�r.•�i VA o �V-i �` �d :s " ,�, � ►t � ' ' Ram A� M1gN1 -2 7 '8 -� (L M -w MAN v �L M t1 LLLLI 1 11 1 LLL LLL A LLL """'" LL I„.I-LLLLLLLL frawAM&Y LLLLL4.6.L1- L-h -� « ttw.7F17 .. I W � ♦d L'_L LLL OINN6 LLL I L 'LL LLI.LLL LLLL Gc.© LLL L LLLui 6"4 _L L prp L I,L LU ww LL ICCROOM LL LL- tMrtaw ! ur.,af 1.. _ LL LL 2420 SQ FT. 314,2W6 FAA+U ROOM,MASTER SURE KL427010 ova py r MM �w ~ F 4 � E, .. � `'•'tom?�.� �� p f V _ SUBMIT 'PROVAL vORK !—,��y,,"7 r• 4..... 4:�� e�. r .gag f,'�r� g€ qw�:� Future Hornes 6620 xitsap Way Bremerton, WA 99812 ' f A• dr<Me Development 360-479-4663 Box 34 Allyn, WA 9M4 �. 12-06-2004 11:52 A M DEVELOPMENT 13602770488 PAGE:4 Jan 18 05 11 : 56a Spain Realty 360-830-5186 p. 2 01/18/2005 11:45 2538512764 BLACKHAWK RE PAGE 03/04 81/10/2085 10:02 2538572900 QJTTORMSEN PAGE 03 81/18/2085 69:10 2SM2764 B.A094AWC RE POM "aim MASON GVuN I Y DEPARTMENT OF HEALTH SERVICES IIo paX 1 w)7RM L0M4wM i3�.ri►n�(3M rs�t� s Application for I)CM rmination of Adequacy rtioias PARW 2: ,A,f lWastRUred LMeMMfitntfon Now 4APpliesot� TelepholDe As�e�emt'�paaodNusgbcr '� ��� . ter krn "*0"S: PIt6lialtamexttldryMWM s"at p ar ams auat Lend I=aypt ,irw.. 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