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'01 z ..� m a - o 3 o in o m OMZ 0 �n ` n � z o ar � � Vim -° m � C CD r. o ca o• n O CD CR a a cl = = o � o (n � coG) m o o0 D ai aria CODCL ID< @ � � � (n o v z = o o '< CD CL Z 0 j mo v v 000 DOTD 3c G) � m Cn > > 3 CD m mo (nZ :nv G m0 3 CD o D < � `� ° � CO ° c v ZD = o o- a 3 -0 CD � ymm 0 0 > :3 � z � ° otomn �� mX U) 0 N Q � " m = co vm � m o K _ X � mCD oo, x CD O< 0 Z ' (n m Z o � ,� CD m u;� 'a p = pm > � _ m cn m _ o aN Z o C -1 a ao m � CD c MCL O (� v 0 0 D Om co ��, 0) o m m 3 ozoo (D -1 C — w m a Z D > O o y =; o o`< OmZZ O CL or o a, � -- � co w o Z > > v o W ca .00.. � m o nN m n0 CD > C = 0 0 0 -� a o -+ � mr- D o v � c(D C. SD CD o X o � v — cc (n z 0 r. CD G) CONCRETE MECHANICAL MOBILE HOME Footings-3etiiack date by Ribbons da. "& "4K-l>d by Gas Piping date b _ Found-, W ;s date b Set Up date 1S by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING ) 11 FIRE DEPT. Walls date Z - L �� by ^iC date Z -Z 4 by �� date by PLUMBING OTHER Groundwork Attic date b date by D.W.V. WALLBOARD NAILING date -Z by date o'✓— v ' by `J Water Line FINAL INSPECTION date by date G) /� o� b date by �'' c �S%%t✓ iy c-c- 94,IJZ SIC cjIle- 4. ��� n/G 6 C7 �✓ �d /'ems 1 I — i l l //ff / -0 PERMIT NO.: BLD/� 15 MASON COUNTY BUILDING PERMIT APPLICATION 5� 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 APPLIC NT INFORMATION e CONTRACTOR INFORMATION Own C— Z- Z..L�1 Contractor Name �J in MailiW Address Mailing Address City+ 1 Sta .F,- Zip Cod 15Z� City State Zip Code Phone _-) - yU Other Ph.( ) Ph.( Other Ph.(� Lien/Title Holder 1O Contractor Reg. # Address Expiration SEPTICIWATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Wel1,�_Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. -3 /�_/ Fire District Legal Description Site Address(Pleasp include stye t name, street number and city) 1-1 Directions to site t ) t-G MILr, f 0, >a r Will timber be cut and sold in parcel preparation? (Y Is your property within 200' of the following: Body of Wa er(Name) Saltwater Lake River/Creek Pond Wetland asonal Runo Stream Slopes or Bluffs PERMANENT RESIDENCE❑, SEASONAL RESIDENCE❑ f TYPE OF JOB New Add Alt Repair Other Use of Building Describe Work No. of Bedroom No. of Bathrooms SQUARE FOOTAGE-1st FlopZ-Q31v 2nd Floor I 3rd Floor Loft Basement Deck] 4,Z> Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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-[certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance 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 will be done in requirements regulating the work for which this permit is issued and all work conforr9d9ce therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without prov I first obtaining approval. ti i DaZ X Date IU FOR O fICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. EFCRTMENTPri..RVl1(V 4PPRQVED DI»MEDCENUIT13Ai CC)p . Building Department Occ Group Type constr. Planning Department Environmental Health Department Public Works Department 1 Fire Marshal Valuation $ 1 4a. Li a ;� ✓ °;>> ................................................................................................................... Building Permit Fee 9 T) a Site Inspection Plan Review Fee t�`�! �q k UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee ` Mechanical & Base Fee l Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal •:?:,,..fi::.. ':or;.r:..7:,}.raxv; •: •:r<rS:.�r.%i'i%it�r�i7::tr:ti�' :`•' �r: r::% ><:�>�:< r>:�'>•':�W.t4 `«' .:ems:»x::,`::� .< ,�::},v�::,>.>.� ::t}:: TOTAL FEES •.•{:.,r:.,..::d::.:•,•;a.:::t..�r.},•� ,�'v>rx'o• Y:7L;.:.w:°y�:�' ••:'s�.�,•�.h::a •.,.,.sr.•crf•:x.•'.::,:•r:: •'••::••.::?.: '':`i:.e.:'+.:�•::•>f:'+.'+.r<:y.`::.:�r::e::.ee'tet.:a:£a`�i:%?,..Us•:s}••:{(•,edii:� .FE<>::•.t}...a`.'•x•::�:'2w%e•':;Cx:•: :}as:::::�s.::.::• 1 PERMIT NO.: MASON COUNTY' PLUMBING/MECHANICAL 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 ` I APO ICANT INF RMATION CONTRACTOR INFORMATION Own4r Contractor Name Mailin' A res Mailing Address City,(1Jjl Stated 4_ Zip ode City State Zip Code Phoneed,a —�?V4 Other Ph.( Ph.( Other Ph.( Lien/Title Holder Contractor Reg.# Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic_3e!L_Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No.,(, 3j //l / �bD Fire Districts Legal Description Site Address(Please include street name, street number and city) -, Directions 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 Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric_ Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump.,.,G Toilets Type of Unit No. of Units Fees Bath Basins _ Furnace Bath Tubs _ Heatpumps Showers Vent Fans Water Heater i�L — Propane Tank Laundry Wsher 1 Gas Outlets Sinks _ Wood/Gas/Pellet Stove I — Dishwasher Direct Vent? Other Other Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 the CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a i Contractor Registration Law RCW 18.27 and am aware of the ordinance 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 will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X Date X Date k FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. l raW:>::>:<:<:<:::>:.;:.;:.;:.;;:.;>:.:.;:. :.;�t�7ttlD.;:.::::.DEN1�3 Building Department Occ Groupeonst, ! Planning Department f Other . (� l Pe it Fee Site Inspection Plan ew ee' n Review Fee PI u bi 8 B e!ee Other M ica &Base Fee = tL_ _ l G t-_ Wo as/Pellet Stove Fee Subrh.50 ) Violation Fee TOTAL FEES �tt 1 , FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name ��� PARCEL NUMBER f 2,23/ 11 ffV&( Date3 SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences L uctures Driveways etbacks Shorelines s Topography on (including adjacent) Drainage Plan treets Easements ronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent prQperties if on shoreline or within 100 feet of adjacent property line. adjacent property line- I I E-adjacent property line ICMIC, a Pc+ 2 60° 1:3 �� I � GeaP too too Pro 55 I 1 UACAW- I I WELL_ }Ii 0 L4.Sr 'm I I� I IL I Ir I 5PO 1 I I I I � I I I I I adjacent property lined I E-adjacent property line SAMPLE SITE PLAN 111� 3adEjAa�xcn tl property perty line -adjacent property lineE D 36. FRZsdRv6_ w d _ "1 L CREEK i \ � I Honer I \ ,Cs46.EA1 I HCusf� I j PriOPox0 60' I � VACANT I 1 GAMAG6 II 31 G0.oPosCD R\ I / TAdA=LLLT&JXAL 50'—� 40 1 � I I , 1 � I i0o' I I � t.._.eLL I I 1 I 1 00' .I I I• r LG.. I adjacent property line4 f-adjacent properij line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dtst�r.cm to �/ rreLtL�Yc diS't'.1r.CL t0 S�opm tn¢ dis+a�Im I t o t. 5fl ' �W 3 ignature Dat l i L� p n a t7 s AAA" r • ?�f (1 'O its M � � I v � i 1 ,' • � ...�__'-Tom.____'. ..�___._ o � L I en � 0 1 , I it C A L. ' N ire az.l C+wAJ•"' �.---- C,1-t v5 "Ails.:: Office File No.: Q-102300-SM DBSQtZPTZON: The South 315 feet of the following described Tract,of land: A tract of land in the Northeast quarter of thq' Northeast quarter of Section 31 , Township 22 North, Range 1 West, W.M., in Mason County, Washington, described as follows: BEGINNING at the Southeast corner of the Northeast quarter of the Northeast quarter of Section 31 , Township 22 North, Range 1 West, W-M., in Mason County, ce North feet% eofWest the6Northeast quarter South theONortheast thence quartertand the POINT 660 .feet to tOF said Southeast corner heast . BEGINNING; EXCEPTING all that portion lying Westerly of State Route 3, and EXCEPTING THEREFROM road rights of way for State Route 3. T with that certain 19K Mobile hale, being 6M in size. hated an said premises- 09�' pWVO ND :120 1100050 - -. Physical Address: E. 16460 Hwy. 3, Allyn Wa 98584 xx xx TOTAL P.02