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Date By Date By Date By D.w.v DRYWALL Type- Int.Brace Wall Date By W Date BY Date By FINAL INSPECTION 0 CD Water Line Fire Seperatiori NC Date By Date By Date f 2, ^ �k - © C" By p co to Pass or Request Inspect. c 0 Type of Insp. Fail Date Date Done By Comments 00 CD J01 A*X< ass / 0/3 crr ©�✓��i r�,o S a N :n 12-L,oy l L'y Tf?. J 0 M ■ii�/iiE/�������i���i����eiii■ ii ��i���'i�iiii�i�i�i��ii/li�l��ii�■ ■I�rl�irti���� ��i►��il�i�iiiiiiii�■ i�/�;��/�iiiii��a��,��i■1��i���ri��r�� ■��li.!�iiiii�ili�r-•----.fir■►'�iiii�� = i'!� mmmmummoms t^s, ■��'�iiliiiii�il���r���ii�►iii���E�� / ■■//MiiiiEENNINNOMMOM MiiCiiL_'R19f 11 ■04001:wdui�r UNINMEN NNE �i�i���i�1►1i�i `- �� ■rii���iii�i������Elii�iii�li►��i�3�iii`� mmMMMMMMwMMM1NmMMMMMMMM man NNE No ALL SETBACKS ARE MEASURED 1��ih�i�iii� '"�1��!�1i1��'�i��iiie��►���� m ROM THE FURTHEST PROJECTION OF Approval:fordftouse • .. r Date of . ��°���� �.� --•--� t"i A it iP} s � r �m v. � ooc OD r a � ;Ll , Ul n to -� -4 o \ x r n 30 1% \ N c a r� m N n 'i3Mon + '� —tArnt - -- -- Name 1 l Parcel# PP -"71 -•:5fb BLD# Mason County Department of Comm' unity Development Small Parcel Stormwater Management Application/Worksheet(page 1 of 2) Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is made for residential development,.or redevelopment',with more than 2,000 square feet of impervious surface'. 'Redgvelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development including construction,installation or expansion of a building or other structure,and/or replacement ofimpervious surface that is not part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment. 'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas, concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural.infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces. 7Buildirigs T Length X Width = Area All dimensions in feet X = X = Measurements for buildings are taken at the X = �� perimeter of the farthest projections(example: eaves/gutters) X = Driveways X = X = Length of drive begins at the right of way X Parking Areas X Any paved,gravel or packed area per definition above table Patios/Walks = X __ Any paved,gravel or packed area per definition above table X = Others X = X = X If the Total Impervious Surface is LESS N 2000 Square Fee se read,acknowledge and sign below. Based Upon the informatio you have provided a Stormwater Site Plan IS NOT require or this development activity. OwnerBuilder/Agent Acknowl that submission of inaccurate information may result in a stop ork order or permit revocation. Acknowledgement of such is by signatu w.I declare that I am the owner,owner's legal re ntative,or the contractor. further acknowledge that the information provided rs are granted access to the above- described pr perry for review and inspection as may be required.. X Owner/Agent/Contractor(circle one)Date: If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign the information provided on page 2 of 2. Page 1 of 2 FORM MUST BE COMPLETED IN INK MASON,COUNTY PERMIT NO. PLEASE PRESS HARD 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 '13 c 4 tz/"C,c f1H-2 C 4, A Company Name MailingAddress 1 331 CWLC '*­1r1X1c'^ AA-<1 Mailing Address City St te WIf Zip Code 13 r 3 7 city State Zip Code— Phone 346' "9/717 -/ Other Ph 360 775-171 - Phone Other Ph. .�P/vc. 2 Contractor Reg. Exp. Lien/Title Holder cl . E Mail Address E mail address 4 -140 C-�,et-1 Driver I s Lic.# Do";.:-/,1%/1/,J Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION -Con6ect to New Septic Existing Septic Connect to Water System - '--Name of Water Systom- 73 ce 44-/A.,r--c7 Well , Sewer System Name of Sewer System— PARCEL INFORMATION - 12 Digit Parcel No. • P,I- "T rl;� I i Fire District Legal Description..1 31A of smeve Y /3/;3!4 I*'-/S' 7 Site Address(Please include street name, street number and city) /0 7/ 1 0b, - -raczEd 1, 1.lil D' ct' nstosite *To 57 -j i/z FWP r-,IV t-c-7rT AK7ER 90f Will timber be cut and sold in parcel preparation?Yes/60) Pnnd Is property within 200'of Saltwater —Lake River/Creek Wetland Seasonal Runot—Strearn=......2opes or Bluffs 15% Is this permit submiGI the result of a Stop Work Notice,Correction Notice or ottterferrforceme6t action?Y o TYPE OF JOB- New Add—Alt Repair Other PRIMARY RESIDENCE W SEASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms X Square Footage-"Ist Floor JAW Floor 3rd Floor Basement Deck L t9vered Deck OtherSq. ft. Garage Attached Detach;T Carport Attached Detached MANUFACTURED HOME 1NfOR1*ATIOW-Mike7 -7 model Yearfd u Length-LLD—Width Serial No. No. of Bedrooms No. Bat rooms 3- Type of Heat &A 1: ; g j Purchase Price$ Replacement Unit.? Ye No InStaller.Name Certification No... kE.R/'BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. At merit of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further deda re 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.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS By MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. r X— Date: 041 COwner Powners Representative/ContrActor (indicate Which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by j Pm ig Date DEPARTMENTAL REVIEW APPRAWED DENIED NOTES 56 N.-Of Building Department Planning Department —------- Environmental Health Department Fire Marshal FEES t5-, Site Insp ction Buildin Permit Fee g gz 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 e-A)4 Pre-Paid at Submittal Valuation $ TOTAL FEES