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( i _ 1 mlean 131 Is a Isis in IV ..•.' p a a x Mn D - S i M .. ate+ « i ! a- s i a Q ! i i t N •a maw ! M 1 over as 1 r or t ew 1 CONCRETE MECHANICAL M"NOTE Foolk -Set" dale by Rbbons dole Y— 21—P cis pow dde by Fmnddbn Waft date by set Lip dole by WMKILATION by Ineul.don PimaFay by by by maby rs DWI I dab by Aft dde by data by D.W.V. wALLBOArrD NAILM �► date water tine FlNAL tv dote by L by -fao r. S L-J y—/6 - f 7 i tIa a w �a Cl) ca ' sd xao 3 V xv'I Irm 0 ova 4Cd v x 00 co — —C-1 aP—v-saarc'I"7sa"I 3aE as"stz Val —0a *<0"I--Zr+'IaoasaZ0 "IA as coo Oza vz--ow< oc Cs air. a =s ar cn 0 r+ta 17 o—0 0+='7 r+— —C 31"Y Q#o to � o z o o m -�as cam tTd• ti a►o'C1,•!J c ao o '*C*<r+r+ 006 •+c— ft _6 51M -► o 0"I 0 06 "4-4 O—0% aE V O O '? 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(> ..1 st Isq olive =--Z--< r+ w> 00 v o M?-"Z(DM D ► o -aw Zoo— c w - ers .+ -a-c a �C c<o mix Ctr> 7 n o ce ar as W r+-s "s sr cam>r mlu Z a C?t" M r+o "f a i — -1 V !S <:rc --r+ c ca c•. > >A0 Q i M30C 0? 00 "#2 2m Ztn317Dzo OD Q C rF 0 MITI Q a--ry —tttZnlr"C7' Z -+ "Q a z 0 178 a ZO)(AZM 4 ZO a - z cZm WITIM-40Z C C: a > — v 4 4 -�Oc W r A z — o zr — a Z—""M v In cc 0+040.6 a zz Z o = A , o"1a MOWD Oe . ` IC►A 0 [l r f � I I l f W m tft c 1 i I I i oQ � I g ; I I � o � 1 1 moo C) 1 h QN z I ; 0 m ly 00 Q 1 I _ 01 -� 1 I I I I I I � 1 � � 1 I: l I: 1 I l [ i I I CNf ( PERMIT NO.: BLD MASON COUNTY 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 Seattle 206 464-6968 i APPLICANT INFORMATION CONTRACTOR INF RMATION Owner M ai k :t LeS 1 ; e A-)Lkrt oA et to Contractor Name 're tie" A k"S D _C Mailing Address P.Mailing Address O o City All 4 /V State� ip Code 5'L City Re 4A ,iR State A Zip Coded SZ Phonef�3 60 )Z:7S Z.Cue Other Ph.L__ )? Ph.(3&0 ) 7:7 Other Ph. Lien/Title Holder Contractor Reg. # 'te I q Lw Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water,System PARCEL INFORMATION-12 digit Tax Parcel No. ( Z Z3 Z / 44 4D / c) 11 Fire District Legal Description—rJR I 6ouLF• Ln: _:j Site Address(Please include street name, street number and cl y-- // 4F C r0 h t Q Directions to site -714 rn ,Qt .� e Ad o ;ul � u' fe o Cow p Will timber be cut and gold in parcel preparation? (Yes/No) NU I Is your property within 200' of the following: Body of Water(Name) /I/D Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or I Bluffs TYPE/OF JOB New Add Alt Repair Other Use of Building ✓'+� Describe Work H No. of Bedrooms [5 No. of Bathrooms SQ RE FOOTAG st Floor 2nd Floor 3rd FI©'or Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make M del 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-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 conformance therewith. No changes shall be made without first obtaining shall be done in confo therewith. No changes shall be made without { approval. gist o ppr al. ;III{ X Date X Date zjzd+ �_ FOR OF�FIIC AL USE BEYOND THIS INT�� Accepted by Date'G Submittal Amount Due F Receipt No.1 » ... : Y PEREVE APPR.0VEfpENIEU O . . f Building Department (ordP , Occ Group -1 Type Constr. 230 I-z 7-9 Planning Department Environmental Health Department Public Works Department Fire Marshal f Valuation $ 3 nil 3 2 q ::;:: >:. aw EES........ ....... ...:.:..::...........::.::.........::: . i Building Permit Fee 44 •Z 1 Site Inspection ` Plan Review Fee �� v UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other ST • Fe e y•s"o I Violation Fee Pre-Paid at Submittal <:�?_� :::»:•;�:L>,{. �:.<:•>,.s .,:�;�<<Y,.... .,. . s.�:;- •.fi:<. ..Yh;! TOTAL FEES II :::•: ..taeac9.•xu.::aswri:.rro:.•:ataa::+..;a:.v<a.:as:•'•,x•+u•: ab, FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name k /Vu -IMR� PARCEL NUMBER lZ2-32-— ef0-O//BCDate SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions 1 co' x 330' Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography U, Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW I u e a 'a a nmnprtia if on shoreline or within 100 feet of adjacent property line. adjacent property line-> �, 66. ' , E-adjacent property line X ,N 24� 3b Sl8 ' -7' 2.6' f o' �e� X ZO �j Cx►`ar:w� el `` I � I "Tn3� oy 1 I � I I 16' O 3bi M ' � Ex►sr'ha, I RIr e,si�e•+ce F 'I J ' I I adjacent property line- I I <-adjacent property line fool SAMPLE SITE PLAN 411 adja t property line-> 3ic� _ _ f-adjacent property line saa I D 30' rRiv 'SEAso w!AL I L _ Pc7L__,� I- � 1W I Gos.Ew CREEK I I i�c,ws4 I j 1 1 1 VACM,T 3 j PAnPoSCI] �\ T A&Rz.G"r".1XAL 50, 1 40'-31 \ �. I I I I � I /oo' I I L--aLL I I I 1 � /00' I I L4 'e I \ adjacent property line-> E-adjacent properiV 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 dt3tar.cm to I'[LL�'LLNL &sta r,C-r- t o 51opm �-o¢ dls+a�c� +e A. {80 3 2-A,8 Al e Date