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Date By Date By FINAL INSPECTION Water Line Date By 12 , Date By w. ., ,.,�.. _. Date By d � y N ►� w ,b o � � O 0 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 IN ORMATION, _ CONTRACTOR INFORMATI0 Owner y Contractor Name J-P `�ITV (_0✓1 ft, dzn, Mailing Address 0 I 14 Mailing Address 166to D r y 12C)a7`C 3 City L ;4 StateZip Code `� ' City (1 vt St te(&, Zip Code�2 Phone (3 ,U)27_G_16it�lh`e�r Ph. ( b0 ) '7/- j Phone ( �S~66 ther Ph. ( ) Lien/ - Contractor Reg. #,'f-5F=1�2 Email Address -by-o,61 p L.LJll`,-fe ymr-11kI;, le. �p 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 �Vl .Y- ,5 pv0 3 PARCEL INFORMATION - 12 digit Tax Parcel No. 12 / / L?Z? Fire District Legal Description 1.o # I (OjA'�v S P h d i!Ct`C. 3 r�D t fj� Site Address (Please include street name, street number and city) 2.2 Directions to site r-f r 'n 00,J +' Will timber b6 cut and sold in parcel preparation? (Yes/No) Is property located within 200' of saltwater IVO Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE ❑ SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt X Repair Other Use of Building ru Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?(Ye o) Describe Work % 1 0 ,,a,Vj No. of Bedrooms No. of Bathrooms QUARE FO TAGE - 1st Flo t -237 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage AW 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 REell&AND INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INF �j MAY RESULT IN A S ib WORK PRDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY S E W: OWNER AFFID IT-1 cartify that l am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify t9 am QQ��r11 reiCAN ment of the Contractor Rggistration Law RGW 18.27 and am aware terej as a contractor in the State of Washingtor tPYat t�Al of the ordinance requirements for w ich this permit'is issued'and� of ttie ordinate requirements regulating the rk for that all work will be done in conformance therewith. changes permit is issued and all work shall be done in co o,4ance there- shall be made without first obtaining approval. ' ' with. No` ges s all be mage without first o ing approval. X Dated li.e44 Date2 ,13 r FOR OFFICIAL USE BE OND THIS POINT Accepted �. . > :Planning Pd CSC# Date �r' — t `" -5 Bid Pd. l4eciept No. J i !' ) c_ dEFARTMENT L REY PftQY DEN © { IT1© COPES Building Department �.. t��i r %�;�`�" �',\ Occ GroupType Const. -r L Planning Department ; r Environmental Health Department 1NNPublic Works Department r. Fire Marshal Valuation$ FEES , Building Permit Fee Site Inspection Plan Review Fee EH Review Fee i 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 APPLICANT IN ORMATION CONTRACTOR INFORMATIOIy , Owner h 141 '` vs1�~ ? Contractor Name Mailing Address P2 'i� + 4-4 C-- Mailing Address City _- `�`, State ' Zip Code ` "> City �• i w v. St to�Zip Code'= Phone (�>(;J) '?5 4 ' Other Ph. (3tj ) �`7;�- �"j Phone ( )- 7�ther Ph. ( ) Lien/Title Holder Contractor Reg. #U'C-S F`2-T*2_,5i 4L_ 7 /-r) / Email Ad ;br 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 _ 4 , ; . it,1,:, -,5 PARCEL INFORMATION - 12 digit Tax Parcel No. i Z Fire District Legal Description L ) ,:� 3 ,-� +r..:.r 7 S i2PC -� LID r Site Address (Please include street name, street number and city) 42 id447 g- -5 t� Directions to site �a ,a.. Will timber be cut and sold in parcel preparation? (Yes/No) A.Li Is property located within 200' of saltwater IVJ Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE ❑ SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt k Repair Other Use of Building r'v f Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?(Ye o) Describe Work ALI e V ,2/' i G — - No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE- 1 st Floo f 2 3_z.2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage WAttached 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 8r VOID IF WORK OR CONSTR4CTJON AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUC-PION 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 STRUCTURE REVIEW AND INSPECTION OF. THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURA RMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH yC11IG I BELOW: OWNER AFFIDAVIT'- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT if curly regis- 4k ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State f W on andA@ am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regg the for Which this that all work will be done in conformance therewith. No changes permit is issued.and all work shall be don$h conformance there- shall be made without first obtaining approval. with.No spall be made witFirst obtaining approval. X Date X r-- Ct Date // FOR OFFICIAL USE BE OND THIS POINT Accepted Planning Pd Date f Bid Pd. Reciept No. dEPARTMENTAL REY I W „APPROVED DENIEDQ Ibl71t W dbtt ' Building Department , r Occ Group Type Constr`--" �. Planning Department UG vocw Environmental Health Department Public Works Department Fire Marshal Valuation$ FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee r 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 PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton,WA 98584 Shelton(360)427-9670 Belfair(360)�75-4467 Elma(360)482-5269 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name _ Mailin A dress ��� �t2k I Mailing Address City - Stater¢ Zlp Code City AU4" State jl . Zip Code Phone( they Ph.( they Ph.( Lien/Title_Holder Contractor Reg. #-J" � L� n Address - ' r`'r Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic..>(__Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 digit Tax Parcel No. 12 ��_! / 00r-)! Fire District Legal Description Site Address(Please include street name,Street number and c7itA 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 Toilets Type of Unit No.of Units Fees - Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs � — Dryer Vent 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-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 conformance therewith. No changes shall be made without approval. first obtainin pproval X Date X Date FO I Fl IrPC U E BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. AEPARTNEEidTAE R£iFIEtiY RPFROYfED f3ENIEf3:> G.... IOfJ CLIFTE5 Building Department Occ Group Type Constr. Planning Department Other Other .. ............................................................ Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee f Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal Violation Fee TOTAL FEES PERMIT NO.: MASON COUNTY PLUMBING/MECRANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton,WA 98584 Shelton(360)427-9670 Belfair(3601�2754467 Elma(360)482-5269 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner °�- Contractor Name;Pc ;�-( e t2- Mailing A dress Pb f371 x 4 Mailing Address City iApl-C, StaWAJ. Zip Code!�j,-,F City 1'4 L^ State LL24, Zip Code;" Phone( 715 ther Ph.(� -T�.�� Ph.(� -.` they Ph.(� Lien/Title Holder Contractor Reg. # Jsa _r_T-22� :') Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic_y Connect to Sewer System Name of Sewer System T� PARCEL INFORMATION- 12 digit Tax Parcel No. � 2 3'�/ / U�� _Fire District Legal Description h Site Address(Please include street name,street number and ci Directions to site + </ c J ` t 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_)LRepair 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 Toilets T Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps u Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood _ Hosebibs Dryer Vent 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-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 conformance therewith. No changes shall be made without approval. first obtainin approval )( Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. AEPIIRTHEF I7AE tFi1"Ilt RFFFtC]Ve DENIEID. GONDITIQfV E0[J>~S Building Department ` Occ Group Type Constr. Planning Department Other Other ...... .:. .:... Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES LICENSE DETAIL INFORMATION Form Page 1 of 2 STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES Specialty Compliance Services Division P. O. Box 44000 Olympia,WA 98504-4000 THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS: LICENSE DETAIL INFORMATION Current Filter: None Registration#or License JESFII*228D0 Name JESFIELD CONSTRUCTION INC Address PO BOX 1590 Address City ALLYN State WA Zip 985241590 Phone Number 3602756684 Effective Date 3/20/1978 Expiration Date 11/24/2003 Registration Status ACTIVE Type CONSTRUCTION CONTRACTOR Entity CORPORATION Specialty Code GENERAL Other Specialties UNUSED UBI Number 600293059 * * *VIEW CROSS REFERENCE FILE FOR THIS LICENSE* *_* * * *VIEW PRINCIPAL OWNERS) FOR_THIS LICENSE* * * *VIEW CONTRACTOR BOND/SAVINGS INFORMATION *_*_C_HECK _INQUIRY_FOR_SUMMON_S_AND__COM_PLAINTS*_----- * * * VIEW CONTRACTOR INSURANCE INFORMATION_* *_* New inquiry by CITY , NAM...E , PRINCIPAL_OWNER NAME , LICENSE , UBI NUMBER, check the L&I Contractor Industrial Insurance Premium Status or return to the L&I Construction https://wws2.wa.gov/lni/bbip/TF2Fonn.asp?License=JESFII*228DO 8/1/2003 THIS PARCEL INCLUDES PLANS, BLUEPRINTS OR OVERSIZ E IMAGES LARGE FORMAT IMAGES HAVE BEEN. STORED IN FILE CABINETS) UNDER PR-CAEL NUMBER PARCEL # CAS E # ZM�003 Gdl � l S � TF Pc MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Planning Mason County Bldg.1 411 N.5th P.O.Box 279 Shelton,WA 98584 (360) 427-9670 Belfair(360) 275-4467 Elma (360) 482-5269 Seattle (206) 464-6968 "QUEST FOR BUILDING PERMIT EXPEDITION NAME: u;-y MAILING ADDRESS: PARCEL NUMBER: i d 3 3E LEGAL DESCRIPTION: SITE ADDRESS: REQUEST DUE TO: MEDICALLY NECESSARY FIRE DAMAGE EXPLANATION OF HARDSHIP: 4 fol-6 21 nL4 ����A� /" �n /UQ e 7G� Ffc� diA cz J•+' _ q! 1 ea �hC' (►r0y%d�� kJif� /IuDe I10 elac—p 7V 41-e -ic4d MUST INCLUDE SUPPORTING DOCUMENTSff THIS MAY BE A LETTER FROM A DOCTOR, INSURANCE CLAIM REPORT, OR REPORT OF FIRE DAMAGE FROM APPROPRIATE FIRE REPRESENTATIVE . I (WE) UNDERSTAND THE INTENTION OF THIS FORM IS TO DETERMINE AND DOCUMENT JUSTIFICATION FOR EXPEDITION OF A BUILDING PERMIT TO ALTER OR RECONSTRUCT A RESIDENCE O THE ABOVE NAMED ROPERTY. SIGNATURE OWNER/AGENT OFFICIAL USE ONLY RE T DENIED F R FOLLOWING REASONS) : J:ta &lotAOAEk' REQUEST APPROVED. DATE: �y � SIGNATU: , _ 14*1/\, lf-I OF COL ITY DEVELOPMENT