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Ro 7 O g ' ° 01 O a .. 3 ar 0) 0) n N N p 01 < gay < C- ma o �; rp CONCRETE MECHMICAL V4 XtFACTURED HOME Deft Faaftp t cs dies 8y RNabons o interior Date By interior-Dab By Dab, By iA mDow Exterior By Exterior-Dube B �-rrp 0 Paint toad t 1"Wed FoadW By W sG I SLAB Vdit"s�,l Date By Dam By FIRE DEPARTMENTm Faundatlon Wals Floors Dabs By X Date By Dote By DECKS FRAMM Daft By Data By deft By PROF AiNE TANKS P..UMING _ Vault Date By 04e By OTHER Groundwork Mile Date Do" By By - — Dene By D V DRYWALL Type: I t Brsoe UhN trebo By W Dab By awe By FINAL�1sFEcnt�N N Mbrfe Line Fine 8+eperadon By Deice By Date By 0 m Pa3s.UP R� ! DO#1B B C01�111'IRI W Type Of hasp. Fail Y yr m t� gB' 3. N 8 o , 0 J FORM MUST BE COMPLETED IN INK n PLEASE PRESS HARD r�PERMIT NO? 'D"(`)35 Q MASON COUNTY DEMOLITION PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORM TIOJ4 CONTRACTOR INFORMATION Owner—Ro IS 1� ' Contractor Name I II C 1*=L= K) Mailin Addre 9 ,t -r14 Mailing Address Cityci E 91 Sta a Zip Code i - O City WI fC9.S11Y State Zip Code Phone ZS - f0 Other Ph.( Ph.QW )301-:8ftg- Other Ph.(Zo )�( 4jeA/Title Holder SA N16 Contractor Reg.# Address Expiration_9 / Z-5 / 0 PARCEL INFORMATION-12 digit Tax Parcel No. / 3 / O / Qa Fire District 3 Legal Description o L 2 -rAX 3 — L W MC DECREE A R� 3616 Site Address(include street name nd city 550 CICON1001S 5.2 Directions to site: FRoM Si4erToN. Wy 0 No '— Ifs L 0 v Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs /f 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? What is the use of the building being demolished? 5UM MEi3 RL=S i DirIN EF� 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 orc nance requirements regulating the work for which this permit is issued will be done i n o ance th with. No changes shall be made without ani all work shall be done in conformance therewith. No changes shall first obtai ' g app a nade without flA obtaining approval. Date al� X Date Provide a plot plan indicating location of improvements and structure to be demolished. 4 vf, v(Awir�l) -R)i FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Grp Type of Const. Planning Department Fire Marshal FEES Building Permit Fee Q Other Violation Fee Other Site Inspection Pre-Paid at Submittal ( ) TOTAL FEES ^ PERMIT NO.: IN'ASON;COUNTY DEM0LJTI0N,P9RMIT APPLICATION 4 426 W.Ced4r/P.O.Box 186;Shelton,WA.9964 M Shelton 60 27.9670 Betfair 60 2 -4467 Ima 880 Seattle 1206MG44M8 APPLICANT INFO IO � CONTRACTOR iNFORMATit)N` n r Owner I Contractor.Narne f -' Mailin AddressTW Maiing/�d .eSS City i a Zip.Code City State Zip Cody Phone Other Ph.( Ph.( � Other Pi /Title'Holder Contractor R # AddrA+ss Expiration/ / PAR EL INFORMATION-"12 dig' Tax Parcel,�10- / Fire District Legalbescription o L iG T - C 6 Site.Address(include street name nd city Diriions to site: tlr NOro oP { U 1© I Is your'property within 200'of the following: Body of Water(Name I -- Saltwater Lake River/Creek Pond Wetiand 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 ►•((xlsting socture could affect future building locations. How Will the debris be disposed of? What is the'use of the building being demolished? SUM MIER I eIy C Ir } NOTICE: THIS PERMIT BECOMES NULL A 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 PR40RESS INSPECTION. The owner or 'agent on owner's behaH,represents that the . information provided is accurate and grants employees of Mason County access to the above described property and structu for review and Inspection of this project. Acknowledgment of such is by signature below: I h, OWNER AFFIDAVIT-I cxr�Hfythat I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-1 certify I am'Am tly•registered as a the Contractor Registration Lady ROW 18.27 and am aware of the contractor'In the State of Washington and 1 am aware of the ohlinance requirements for which this permit is issued and that all work �s regulating the work for which this permit is Issued -: will be done' ncegpes shah be made without wor(I sI�be done in conformance therewith. No changes shall first obtain' appr witlwut approval. "itAx Date X `bme�j .. t OF /717 Provide-a plot plan indicating location of improvements and structure to be dennolished. z aF , a � t FOR ; USE SEYfu W TH-Du IS�POINT .;: ! r"`�•° .._'At . RIty" CQDLS 4 f ' hVD � I"Marshal r' ;. FEES B J"V Penn it F Other Violation Fee Other Site Irelvetiar Pre-Paid at SubtnBtat ( ) } TOTAi.:FEES s FOR MUST BE COMPLETED IN INK i PLIASi=PRESS HARD e PERMIT NO MASON COUNTY DEMOLITION PERMITAPPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 Shelton 360 27-9870 Belfair 360 27"67 Elms 360 2-5269 Seattle 1206IM4.6968 APPLICANT INFORM TION CONTRACTOR INFORMATION Owner Contractor Name Mail Addre Mailing Address —C Iva Cit Sta a Zip Cod City State Zip Code Phone t ) WiDther Ph.( Ph:Q, .rpift Other Ph.( itle Holders He Contractor Re .# T Address Expiration PARCEL INFORMATION-12 digit Tax Parcel No 0,2 4 4 1 Fire District 3 Legal Description 2 T*AX CIIBJ-A GwaprNW. MC IWCREG Site Address(include street name and city Dit'octions to site: Is your property within 200'of the following: Body of Water(Name) — Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluff t,_If your project is located adjacent to or.within an area that is listed above, it is advisable to contact the IJept. of Community Development regarding future development prior to demolition;since removal of gl`existing structure could affect future building locations. H bw will the debris be disposed of? What is the use of the building being demolished? NCB 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 Upon County access to the above described property and structur's for review and Inspection of this project. Acknowledgment of such Is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-1 certify that I am dLrrently registered as a the Contractor Registration Law RAW 18.27 and am aware of the contractor in the State of Washington and1hat I am aware of the ordinance requirements for which this permit is issued and that all work or 'nance requirements regulating the work for which this permit is issued will be done i ance the es shall be made without an all work shall be done in conformance therewith. No changes shall , first obtat ' app "` ade without fi obtaining approval. Date X Date ^� 1 Provide"a pjot plan indicating location of improvements and structure to be demolished. "FOR OFFICIAL USE-BEYOND THIS POINT .. ,.:.- ,0Ec d.by $ .{ { ... � abmitt"AmbtMt Du . - _ Receipt l+fo. - - t— DART ENTAL REVIEW AhPROVED DENIED. CONDITION CODES Bt Iding Department Ooc Grp, TvDe of Const. Planning Department 7 Fire Marshal FEES Building Perl7ft-Olf Other „ Violation Fee Other Site Inspection Pre-Paid at Submittal ( ) r TOTAL FEES 'I