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Ek / CD k E & % a CD 8. oa $ k ¢� ca . - a A J / A . % � m . § ; � E { W r o CONCRETE MECHANICAL MANUFACTURED HOME 0 G' Footings/Setbacks Date B y Ribbons o Date " 03 By LDV— Gas Piping Date By w Foun a on Walls Date B y Set-up Date ld/3d/43 B INSULATION Date By B G f Slab Insulation Floors Final Date By Date B y Date B y FRAMING Walls FIRE DEPT Date By Date By Date By PLUMBING Attic OTHER Groundwork Date By Date By WA�LLLBOO DNA JNG D.W.V. Date By Date By FINAL INSPECTION Water Line Date ' 3�' 0� B yl�` Date By Date By b 3 Io 03 �Qs -C*f6� eyescp '�'�1 �GQ fo'et0q 4 i, ri f, kl -n sPf b:e-4 Lail D -Pc 0 8 _ CASS a - o *IN FRAME- rg CA bot, ` s N 1 O l M1 N N W W 0 tit FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION 1�> b - � 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 APPLICA,bq INFORMATION CONTRACTOR INFORMATION Owner W Contractor Name Maili AddK O - Z.D Mailing Address City�� StateW Zip ode Icfb City State Zip Code Phone �"j _) -{ Other Ph. ( )Z7) -q3,% Phone ( ) Other Ph. ( ) Lien/Title Holder ikkLLS r-? 4O Contractor Reg. # Exp. Email Address Email Address 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 di it Tax P,�rcel No. 2 3Z / & 9M Fire Dis rict7 4 _ Legal Description S — Site Address (Please include street name, street n tuber and city) " M S7— Directions to site SA"-6- Will timber be cut and sold in parcel preparation? (Yes/No) �4- �N Is property located within 200' of saltwater VV Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB- New Add Alt Repair Other Use of Building Is this permit submitta the result of a Stop Work Notice,Correction Notice or other enforcement action? es/No) Describe Work e2 No. of Bedrooms No. of Bathroo s (TUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT-I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT- I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be made without first obtaining approval. with. No changes shall be made without first obtaining approval. X I.� 1 r+J �*h�''L� Date l)-03 X Date FOR OFFICIAL USE BEYONQTHIS POINT Accepted y Planning Pd A62i20 3-_0_"" qCk# Date Bld Pd. �57 Reclept N Building Department O Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation$ Building Permit Fee Site Inspection Plan Review Fee EH Review Fee 426 W. CEDAR ST! Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal TOTAL FEES 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 APPLICW INFORMATION CONTRACTOR INFORMATION Owner N W Contractor Name Mailirla Address n p 1 — 2-gcb Mailing Address City 'V(5 StateUVA Zip ode 17011cfb City State Zip Code PhoneZS-1 )52.21-(M Other Ph. ( +!j)Z�-9?� Phone ( ) Other Ph. ( ) Lien/Title Holder (AX1L5 %:OiZ40 Contractor Reg. # Exp. Email Address Email Address 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 Arcel No. Z. / / D Fire Dis rict _ Legal Description -- _ I Site Address (Please include street name, street n mber and city)_ Z.SS K ST y Directions to site Will timber be cut and sold in parcel preparation? (Yes/No) Al 0 � Is property located within 200' of saltwater VV Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB - New�Add Alt Repair Other Use of Building r�� Is this permit submitta the result of a Sxop Work Notice, Correction Notice or other enforcement action? es/No) Describe Work Q rCx - No. of Bedrooms No. of Bathroofylls QUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. GarageLy�Attached Detached Carport Attached Detached MANUFACTURED 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be made aa without first obtaining approval. with. No changes shall be made without first obtaining approval. X tW ��' < Datel)—05 X Date 42LI) FOR OFFICIAL USE BEYOtj THIS POINT Accepted �. Planning Pd �'�c.6 3•01a(4"C4 DateBld Pd. Reciept IN — z� Building Dep ent _ Occ GroupT e Constr. C�a/ TX �- Planning Department r ^� Environmental Health Department Public Works Department Fire Marshal Valuation$ /a yffl - IF Building Permit Fee �. Site Inspection Plan Review Fee / EH Review Fee9 V 426 w. CEDAR Plumbing&Base Fee t Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee t® �1?► Pre-Paid at Submittal '�! TOTAL FEES MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION ` _f 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 APPLICW INFORMATION CONTRACTOR INFORMATION Owner Vj Arlin so Contractor Name Maili Address Z.v`�j Mailing Address City �6 frlar>:!�- Stat Zip Code_1?01 cf 5 City State Zip Code Phone15_1 ) -i Other Ph. (31OU )2_- J 3216 Phone ( ) Other Ph. ( ) Lien/Title Holder U.14eA L S C1,&(z c,p Contractor Reg. # Exp. Email Address Email Address 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 P rcel No. 'Z / l f�'I Fire Dis rict i Legal Description v Site Address (Please include street name, street n imber and city) Z.13 (74 ft ST y Directions to site '5Ah,%O- Will timber be cut and sold in parcel preparati ? (Yes/No) E �✓ Is property located within 200' of saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs j PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB-New_ Add Alt Repair Other Use of Building 1 0, c Is this permit submittaA the result of a Stop Work Notice, Correction Notice or other enforcement action?-(Yes/No) Describe Work 4� V (/ / r 6, No. of Bedrooms No. of Bathroom's SOUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED 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 j INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT-I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be made without first obtaining approval. with. No changes shall be made without first obtaining approval. ^� a X� to L. Datel I-05 X Date FOR OFFICIAL USE BEYOfNRJHIS POINT t / Accepted by / Planning Pd 01444 C`C3•, �W-Ck# Date Bld Pd. Reciept N Building Department Occ Group Type Constr. 1 '� 1 !} 1 — � , Planning Department Environmental Health Department Public Works Department Fire Marshal , Valuation$ Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee a Violation Fee Pre-Paid at Submittal "� TOTAL FEES MASON COUNTY PERMIT NO. -- BUILDING PERMIT APPLICATION-r, 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Ahelton (360)427-9670 • Belfair(360) 275-4467 • Elma (360)482-5269 On the Web www.co.mason.wa.us APPLICW INFORMATION CONTRACTOR INFORMATION Owner K 1 L k t tL N �Mr� ram, Contractor Name Mailin�Addr7 s 1 10( — 50, 2.-"Z5 Mailing Address City 1�/�'S t t,. '. StateWA Zip ode City State Zip Code Phone'5 )5'2 -t 933 Other Ph. (3;0U) Phone ( ) Other Ph. ( ) Lien/Title Holder Chl At.. 5 t-."�-o- ca o Contractor Reg. # Exp. Email Address Email Address 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 P.ircel No. ITZ = l ty l- C)f. Fire Dis rict Legal Description f.' f Site Address (Please include street name, street number and city)_ c.` Directions to site Will timber be cut and sold in parcel preparatgn? (Yes/No) CA, � .T + Is property located within 200' of saltwater VV Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB- New Add Alt Repair Other Use of Building f' Is this permit submittal the t�ult of a Stop Work Notice,Correction Notice or other enforcement action?(Yes/No) Describe Work V - 1 I l No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this { that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shalLbe made without first obtaining approval. with. No changes shall be made without first obtaining approval. f � X L... Date R ` X Date i FOR OFFICIAL USE BEYOND THIS POINT Accepted by I- ,..X,6 c Planning Pd ' t�,t p t 7 - Date 4 r�`� Bld Pd. f C3, Reciept Na,� Al /Z 141 Building Department Occ Group Type Constr. � Planning Department Environmental Health Department Public Works Department Fire Marshal i Valuation$ i Building Permit Fee Site Inspection Plan Review Fee 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 77 TOTAL FEES FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. BLD ®? PLEASE PRESS HARD �.0 n BUILDING PERMIT APPLICATION V vS 14 426 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 On the Web www.co.mason.waus APPLICANT INFORMATION CONTRACTOR INFORMATION Owner_RAC) Ai b 4S W A►1 So 14 Contractor Name Mailing Addre �� `�0 i - (PS Pi. '4D. #w lips Mailing Address City O It`I�e5 StatewZip Code City. State Zip Code Phone(ItZ 5A1 -t M Other Ph. ed& 0$ Phone(_� Other Ph. L_J Lien/T1419 Holder -W ELLA !FAh&_© Contractor Reg.# Exp. E-mail Address E-mail Address 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. Fire District Legal Description T..SA S S #$ )(g41 , Q D V T L-01. A 312- Z 2 I Site Address(Please include street name,street number and city) 'L 8 b C1�0 a Qd15 i , A LL eo VJ A Directions to site -(JjtQ QFf Cvf;de EVifw LIP R b Olin CILW OWSj_ Q2 APpaaX Yb rnit a rdaw B icauj v!km CeI2A"L_R0, go 3y GOV OF iRD. WiALa c m PZ& k Q-.t , Will timber be cut and sold in parcel preparation? (Yes/No) IuD Lake River/Creek Pond Wetland Seasonal Runoff Stream Slo or Bluffs -S W P F b lo SDU WN PERMANENT RESIDENCE SEASONAL RESIDENCE❑ TYPE OF JOB-New Add _Alt_ Repair Other Use of Building P..." L', Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(Yes/No) QID Describe Work B D "MD No.of Bedrooms-No.of Bathrooms SQUARE FOOTAGE- 1st Floor r?tn#49F6or 3rd Floor 0 6 Basement Deck 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.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 conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No changes shall be made obtaining approval. without first obtaining approval. X �`�- Datel X Date FOR OFFICIAL USE BEYOND THIS POINTkQ Accepted by Date QZ&ZSubmittal Amount Due . Receipt No 7�? Building ent , / Ocx Grou T Constr.V d 7)CI EW Cia/� Planning Department Environmental Health Department Public Works Department Fire Marshal RE d Valuation$ .3 9 Building Permit Fee Site Inspec7Fee 77 7- tOAR S Plan Review Fee EH Review Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES MASON BOUNTY PERMIT NO. BLD . BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton(360)427-9670 Belfair(360)275-4467 Elmo(360)482-5269 Seattle(206)464-6968 On the Web www.co.masomwa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ' ►C Hpa n S IN Ak o sD IJ Contractor Name Mailing Address 161 l) I • iv— P1. S©, tt'gDIB Mailing Address City. f• t 1fl l t3ta'S StateWA Zip Code City State Zip Code Phone C1,4a 6M• Z6!, Other Ph. LOV& Phone L_J Other Ph. Imo) Lien/Title Holder W LIv.S F,"D Contractor Reg.# Exp.�_f E-mail Address P S►>q t l ID0 S VY A ate,M•S W. GO Nt. E-mail Address 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. 1'Ile Z 2., / do an inn Fire District Legal Description I:& AS 15 J$ It.41 TEk Vj L.J!l I sT_5 - 2 2, — 1 Site Address(Please include street name,street number and city) C P.b 4213le l � A LL hJ VJ,&_ Directions to site !' 40 GAID F Will timber be cut and sold in parcel preparation? (Yes/No) IL%-n Lake River/Creek Pond Wetland Seasonal Runoff Stream — ,Slopes es or Bluffs • 5 P F- SoJ r.11a PERMANENT RESIDENCE EASONAL RESIDENCE❑ TYPE OF JOB-New_lt Add__)�_Aft__)L_Repair Other Use of Building P.." Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(Yes/No) Wn Describe Work No.of Bedrooms_No.of Bathrooms_SQUARE FOOTAGE- 1 st Floor ,u f f or 3rd Floor Basement Basement Deck Other sq.ft. Garage) ' Attached Detached Carport Attached DetachedJL _ 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 ISQOMMENCED. 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 conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No changes shall be made obtaining approval. without first obtaining approval. X —C, Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted bydi; Date Submittal Amount Due �} Receipt No, J63 Building D ment io Occ I rr Type Constr. JNA.�) � )U �P F Cl., D� 1 Planning Department Environmental Health Department Public Works Department Fire Marshal R E r Valuation$ �a O Building Permit Fee 73 016 Site Inspection " EDgR s Plan Review Fee fi $ �7, EH Review Fee Plumbing&Base Fee S ID? Planning Review Fee Mechanical&Base Fe Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ( rim TOTAL FEES r � � rJAN 14 100t Request To Revise An Approved P w °AF -AR STI PP Plan Permit Number: BLD200p3L-aLZL! Name_ `:;,�, a� Parcel Number iz2 3 2- L _ n p oop Phone Number daytime ( 3av ) 7 —9�0 8 Project Address Z8� ice►^4.kSrC' Mailing Address � — Please provide a complete,detailed description of the proposed revisions to the approved plans: C uvK -i 7Z2 &--A f S Alf—IL ell Are two sets of the revised plans or addendum indicating the changes included? L'TYes ❑ No Are the approved site plans included? eYes ❑ No Are the revisions clearly and accurately identified on the plans or addendum? of Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis? ❑ Yes 13-No If Yes,Has the engineer or architect approved this revision? ❑ Yes ❑ No Is a stamped and signed approval included with this request? ❑ Yes ❑ No (Note:No structural chances to a"desi¢ned"elan will be sonroved without the written consent of the enlrtnrer and/or arclutect of record) Does the proposed revision modify the footprintB�No or location of the structure? ❑ Yes If Yes,Is a revised site plan,_with all new setback dimensions included with this request? ❑ Yes ❑ No Additional Information: Applicant's signatuwre Date:_ j--/ Q -O Office use Only Received by: ate Sent Assigned To Approved By Date $ Original Valuation: $ Additional Valuation: $ P. Sq.Ft. x$ $ Sq.Ft. x$ $ E.H. Total New Valuation $ P.W. Additional Fees: Additional Planning Dept. $ New Setbacks: Front / Additional Plan Review $ r / Additional Building Permit $ Sidel. Sid / Additional Plumbing $ Additional Conditions/Comments: Additional Mechanical $ Additional E.H.Dept. $ Other $ o-0 u Total Amount Due: $ �-- Amount To Be Paid Up-Front$ TOM k1ftW k' O � a �L — IPA LU C _ Z ~ Q -i Z O I � y � Q � •� Op p In lw W CM, z L t (ji w m f { f j r. e"�p'14 ti \ NEW ------------ APPROVED MASON COUNTY :)CJ PLANNING SITE PLAN REQUIRE TO BE ON SITE CHANGES SUBJEC► TO APPROVAL By M'�r�-� Q, 1-/0 '03 01003-61al'3 iV ew IIIIH�III IIH�IINHIIInIgN��IlH! 1/7903928 SWANSON DECL 10.00 Risen Ce, WA Return To: , � P £. P6Ltx I�f"1 — sue F4l_t.1A], W 1k DECLARATION OF COVENANT FOR ON VITESERAGE.SYSTEM I(We)the undersigned,grantors hereby declare this covenant and place same on record. I(we)the grantor(s)herein,am(are)the owner(s)in fee sunple of(an interest in)the following described real estate situated in Mason County,State of Washington,to wit owev uea iyai aew pv orpaanr o.seygr.r> 't t,2.A gDVT t-07 1, ,B P#IJ041 and having the Tax Parcel Number of: on which the grantor(s)owns and operates an portions of an on-site sewage disposal system and drain field repair area that serves a structure located on the following described real estate situated in Mason County,State of Washington:to wit: . . -tR to QDV*T LDT 3 * ► Q shi TR A D r Is P-*- 14041 and having the Tax Parcel Number of. I VLSI - 40 - 9 100 an grantor(S)is(are)required to maintain the on-site sewage disposal system in such a manner to facilitate treatment and disposal of the effluent. It is the purpose of these grants and covenants to allow easements for placement and access and to prevent certain practices which may have significant adverse impacts to the function of the septic system. NOW,THEREFORE,the grantor(s)agrec(s)and covenant(s)that said grantor(s),his(her)(their)heirs, successors and assigtts will allow an utility easement for the use and purpose of conveying sewage from one parcel to the other,to allow an easement for the purpose of maintaining or repairing the on-site septic system and appurtenances thereto within 10 feet of any portion of the septic system and to prevent practices not consistent with state and local regulations in this area. These covenants shall run with the land and shall be binding to all parties having or acquiring any right,title,or interest in the land described herein or ally part thereof,and shall intro to the benefits of each owner thereof. WITNESS hand this day ot_J dS�,i"42:W3 Signature � �• �� WQ/L!Q..h'l/1 i �to • 'Ci1cS.. G _ Ci-n2di ) State of Washin ton County of Mason j i��p,� I e undersigned,s N,,pp�tary,Public in and for the above naiwppd n�oun an St p do to c that on this day of ";9 Mpersonally appeared before meKIC ` own to be the individual described in an who executed the within instrument,and acknowledge that he(she)they)signed and sealed the same as free and voluntary act jand deed.for the uses and purposes mentioned. GIVEN under my hand and official seal the day and y ar st v writte i N61ary Public in and for the Sta Was ' to ,residing at ICI As I Mk- My Crnnmission Expires- Mason County Dept. of Community Development Mason County Bldg. 3 426 W. Cedar P.O. Box 186 (360)427-9670 Local (360)482-5269 Elma i Shelton,WA 98584 (360)275-4467 Belfair Notice to Obtain Final Inspection December 27, 2007 RICHARD SWANSON PO BOX 1617 ALLYN WA 98524-1617 Case No.: BLD2003-01213 Parcel No.: 122324090100 Proiect Description: GARAGE The Mason County Department of Community Development is currently reviewing all permits that are expired and have not been approved for occupancy and use. Pursuant to Mason County Code, Title 14 Building and Construction, a permit and final inspection for this type of activity is required under the 2006 International Building Code or the code your permit was issued and your property is currently in violation status of occupancy and use. Please contact our office to make the necessary arrangements 21 days from the date of this letter. Failure to contact our office to make the necessary scheduled inspections will result in enforcement actions. To bring your site into compliance, you must schedule an inspection. One (1) $64.00 site investigation fee will need to be paid prior to inspection along with any outstanding fees currently due on your building permit. For every inspection required after that, you will be charged $64.00 again, per inspection until final inspection and conditions are met. To schedule an inspection, please call (360) 427-9670 ext. 262. If you should have any questions regarding this notification, please contact me at (360) 427-9670'ext 359. Sincerely, Terry Ryarf Mason County Dep rtment of Community Development Cc: Property File December 27, 2007 BLD2003-01213 3'�