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FRAMI G Walls date by date 16 <— by/' 7( date by OTHER PLUMBING Attic Groundwork date by date bv WALLBOARD NAILING D.W.V. date by date by FINAL INSPECTION dateWat by Line by date /C by f �� date by fib =� I - �� . r^ 7 V _ 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 APPLICANT INFORMATION CONTRACTOR INFORMATION 0 w n e r h, r Of it SL el k" Contractor Name Mailing Address t? avrj 4 ` Mailing Address City � � Sta e„ _ Zip Code City State Zip Code Phone . `,'a � KOther Ph.( ) Ph.( ) Other Ph.( ) Lien/Title Holder ' We,OWe, Contractor Reg. # c 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 i PARCEL INFORMATION-12 digit Tax Parcel No. / / $ Fire District G Legal Description Lif ". Site Address(Please include street name, street number and city)q, ML-IP :a n `a , �` eµ ` may : r Directions to site 6A7' a oF ' RT7i apr- Adl,3 "Wie. Ize ` Will timber be cut and sold in parcel preparation? (Yes N_o) Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland : Seasonal Runoff V Stream Slopes or I Bluffs I i f TYPE OF JOB New Add A Alt Repair Other Use of Building Describe Work "k -��� No. of Bedrooms No. of Bathrooms SQUARE FOOTAG 4,st Floor'�57& 2nd Floor 3rd Floor Loft Basement Deck Other - o ' sq. ft. I Garage Attached Detached Carport Attached Detached I 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 i inspection of this project. Acknowledgment of such is by signature below: i OWNER AFFIDAVIT-[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 approv,.al. first obtaining approval. f � r Date * 121 r,:l tt X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted 4 Date r < Submittal Amount Due° tf�ic�Receipf� , ;i __g' ___ IPAFZTM. N7 AI» RVIW APRQvI*D ?pNtED CON©ITaON CODESi __ Building Department c Occ Group Type Constr. Planning Department i I Environmental Health Department t Public Works Department f I Fire Marshal i Valuation $ E _._........................................ .........._ ....................._............._......................................::.::::.::.:..:.::._.::::.::::::::::::::::::...::::::.:::::::::::::.:::.::::.:....:.:. rMS i .. .. Building Permit Fee �a �5 Site Inspection s � ,, 61 j Plan Review Feer pq UFC Plan Review Fee i l Plumbing & Base Fee ._ Public Works Review Fee �w Mechanical & Base Fee Other 5� Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES ES 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 APPLICANT INFORMATION , r CONTRACTOR INFORMATION Owner s Vj y It � �p'�° Contractor Name Mailing Address 90 4"vd e7-404 Mailing Address city Be lr St e Zip Code City State Zip Code Phone Other Ph.( Ph.( ) Other Ph.( Lien/Title Holder *reWe, Contractor Reg.# 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 PAR EL INFORM/ TION 12 dig' Tax Parcel No. 3 9 / 7, / 0 '7 Fire District dk:Directions I Description 4 - UrV a -re— O I Address Please include street name, stfeet number and cit 'a �J1. 14 ( Y) to site - 4- t� /,. e Sao ' k 1 0, e'�, timber be cut and sold in parcel preparation? (Yes No Is your property,within 200' of the following:Body of Wa er (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add X Alt_ Repair Other Use of Building 0, , Describe Work : `� . a: i. r` a5e�--01-D C1 (p0 No. of Bedrooms No. of Bathrooms SQUAKE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft - Basement Deck Other 0 R..A&e— sq. ft. r^' 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. 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 obtaining approval. X �9 'i Date a'�,r air' _:t X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted D Da e Submittal Amount Dui.� " Receipt#No.. pEF'ARTMENTAI. f V UV APPRQVED pINIEI� Cc3NpIT1JN ODES Building Department Occ Group- Type Constr. Planning Department - f �: Environmental Health Department Public Works Department I' Fire Marshal Valuation $ . F1~BS Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Othe39 Wood/Gas/Pellet Stove FeeOther Violation Fee Pre-Paid at Submittal ( ) r.. TO TAL F EES PERMIT NO.: BLD1� 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 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner, Contractor Name Mailing Address �y � ,,<<�s� j �� � Mailing Addressr City sz .6 .J; St ate Zip Code &y City State Zip Code Phone - t Other Ph.( ) Ph.( Other Lien/Title Holder /" ,y',,,t- Contractor Reg. # 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 i PARCEL INFORMATION-12 digit Tax Parcel No. / / C,, 4V3 Fire District Legal Description Site Address(Please include street name, street number and city) 2 yJ—L t Directions to site k '� ° 4� Will timber be cut and sold in parcel preparation? (YestNo),, Is your property within 200' of the following: Body of Wbfer(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add e Alt Repair Other Use of Building „ : Describe Work ," s " 0 No. of Bedrooms No. ofBathrooms SQUARE FOOT GI="1st Floor'" 2nd Floor 3rd Floor Loft Basement Deck Other 5 f: fiI e-- sq. ft. `;7 :. Garage Attached Detached Carport Attached Detached r MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No.iof 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-]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 obtaining approval. X Date ' X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted b ­5; Dat;ef , , Submittal Amount Due Receipt No.. ; e L7EPARTNlENTAI">RFUItIV Af'PRE1VEp INIEU" CONPITI�JN ecQ Building Department Occ Group Type Constr. Planning Department Environmental Health Department LV C CD �3i1ZV Public Works Department I Fire Marshal Valuation $ Flw..S Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee ZSTt r "4 Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) ::::<>: a:r> :s:# s:;? Wit; ?v :::.::ssr`•%r > '>3<zt :>E?�{�ii'' :4A.. x4 . TO TAL L FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION �r Case No. p �y Name AR Cil-. � I J�- � PARCEL NUMBER/�3,?9 7.�70G7-3 Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line- I , <-adjacent property line 0A1 Se-p ,-&,fre- 61-ie-�ldOp I le-5 P 04">KS I old �Rr`(�.j���L 13rrE I�r yt 6,�a it �� � Fi/mod f 9 I , I I I ' I I I � I I I , I , I , I , I I I I I I I , I 1 I , I , I , I , adjacent property lined I E-adjacent property line SAMPLE SITE PLAN adja�nt property lined I a 3io' 30. �Q«RVE _ Fadjacent property line I SEACG�!AL. I• ti 71� ,� _�f�TSL—_,`J C1 �K c I MOM 6 \�I I tw •Gas.Eu I j PrioPaseD s¢pt:c —�� I 1 ' R I VAGKJT MAc s Rose T IfA—"—=LL8L0h\'t—RAL 3j 50 IIiIIII, , //0i0 j"n I L—e-LL I I 1 I /00' I L.��GLL adjacent property line- , , A'. \ In, � ; Fad'acent properfy 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.) '1'V^S A" ejr SAMPLE TOPOGRAPHY PROFILE SI•"L / 0 (���eW distanea to dib't'ar+GG to ► Slop¢ {o¢ � dista��a. +e t ev,rr -res� �a l 04�4 -/ �/- Si ture Date