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(p_ d' By Exterior-Date B nl Set-up r Point Load/isolated Footings INSULATION Date By BG 1 SLAB INSULATION ----.-------- Date By Data By FIRE DEPARTMENT Foundation Wails Floors Date By Date By Data By DECKS FRAMING Wails Date By Date By Data By PROPANE TANKS PLUMBING vault Date By Date By OTHER Groundwork Attic Date By Date By Type Date By D.W.v DRYWALL Type- Date Brace Wall Date By 100 Date BY Date By FINAL INSPECTION 0 v Water Line Fire Separation _ ON Date By Date By Date �� -�-� By T�� O m to Pass or Request Inspect. c Type of Insp. Fail Date Date Done By Comments 44. CD co v 8 a 0 CA 0 s sn 0 0 u 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 - APPLICANT INFORM TION CONTRACTOR INFORMATION Owner Company Name w Mailing A dress Mailing Address +� City! State �.(J/� Zip Code City State Zip Code Phone O her Ph. (o Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address r+ E Mail Address I Drivers Lic.#4 ,Y DOB 016 // 0 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic i Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No - -00 Z 1 Fire District Legal Description TY^Q c.�' � I Ore N 6. 5 uJ LoT b S hor Site Address (Please include street name, street number and city) I 1 I Hanglik r-T A I kin,jU 7:�-) +o n raWA- Aj1, jQ .Ijpn c Ej Directions to site ad I i Will tim r be cut and sold i arcel preparation?Yes'/ o IJ I Is property within 200'of Saltwater Lake River/Creek Pond i Wetland Seasonal Runoff Stream Slopes or Bluffs >/o I Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No " TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ i , i Use of Building _Describe Work No. of Bedrooms o. of Bathrooms Square Footage- 1 st loor 2nd Floor 3rd Floor Basement Deck--- Covered Deck Other Sq. ft. Garage -1Attached . > —Detached Carport Attached Detached j MANUFACTURED HOME INFORMATION - Make 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. E OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare 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 i 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 informaticn 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 OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X "' _ Date: (0/'+)O q (PXn3eY Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date LO Irk U DEPARTMENTAL REVIEW APPROVE ENIED NOTES Building Department G9 Planning Department Environmental Health Department Fire Marshal , FEES Building Permit Fee 0 Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee `�- Planninq Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State Fee • SV Violation Fee 'C'4I Pre-Paid at Submittal Valuation $ TOTAL FEES 40 ........................................................................................:...... ... ................... ... .... ... ... .... .... ...... ...:.. / .. .... ,...:..:::.: 4 : > x ................<.........: .......................... ... .... .... ...................... .... .... ... .... ... .... ... ... .... ... ................ ... ... ............................... .. :........:................ .......:.......................... <... .............. <. ...... .......;.......<........................ .... ... .... ....... <... ... :.........,...... :........ .................:.........;........:........:;........:.........:...... 3.... .... .. . 3... . ... ... ... ... ... ... ... .... ... ... ... ... .................:........ .......::................:.........:........:.........:........:. :. :................ ........' .. ... ... .. ... ... ........................... .................. .. ... H'�, ........ .......:>.................. ....>.. . .... ............. ......:........... ........... .......<.............. ..../�..:.�...r' . . ..n.. ..(.;;................>.. .......... ..... ...........:........ 1 .............. .. >...... .. ,�.. :........>............... ..1.. 1. ... . . . !.v!........:..................;...... ..... ................ ........ ....... .........I . . ................. ....... ....... ..................................................................... ....................................... ............................ i.................................. ........................... ........................... .......................................... . ... .... .... ............................. . .......................... ......................................... .... .... .... .... ... .... .... .......................................... ................... ......>.. ..::.. ..:. .........>................ ...................:.............................................:........ .. .` ..... ............... ... .... .... ... ... ........<....... ........>......................... ... .... .... ... .... .... .... ... ... ... ..... : . . . .: : . : e ................. .........:.......:................ ......:... ...:.. ..:...... .. .........:.. ...:............................ 16A �. A :. :. .. :.. :: ::::.�: : : :: ..:::::::: ::: : .: :. :. :: :: �. ... ; jj t MASON G�� P�A�.li�t J. ............................................:............................... OIL SITE.....,,.. ..... ..... . SITE PLA:;! i J BE .................CHANGES... r ...T.( ..,�'P- OVAL..................................;. :...,....>.......................... : II ' :...... .v.. .111.0. ...... ........................::.......::........:............................ ........�............... ........:....... ..... ..................>...................... TOP GRA HY PROFILE: g en�-I Q Ape pe Direction: Scale: �! �Z Approval: for ofte use Building Permit number: Building: Owner/Applicant: �T�CJ(Ii'1 -- Date of Planning: application: Env. Health: Parcel Number raa-q3�9- ©a Vim I Name Vle Parcel# �aa a oo a BLD# Mason County Department of Community 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 2. 'Redevelopment 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 of impervious surface that is not part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment. 2Common 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. Surface Type Length X Width = Area "All dimensions in feet Buildings X Q 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 X = Any paved, gravel or packed area per definition above table X = i Patios/Walks X X = Any paved, gravel or packed area per definition above table X = Others X = X = X = If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below. Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- described property for review and inspection as may be required. X �L/` tLV�---- Owner gent/Contractor(circle one)Date: " Q 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