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N CD a 7 w N a -a or ?cl CD _0 7 .. o a (n �. 5• � O O `< O CD _ v O CA) N -n O CD CO O W O = O CD = 0 CD -. -„ 0) O v CD ar O 0 0) a) ---ICl 0 a (n Ca N :3 CD y 0 m te a,CD = 3 0 0 � a CD a �- °- .� CD a m a j CONCRETE MECHANICAL Footings-Setback MOBILE HOME date by date b Ribbons Foundation Walls Gas Piping date date date by Set UP B&SLAB Insulation INSULATION date b date by Floors Final y FRAMING date by date b date by Walls FIRE DEPT. y PLUMBING date by date by Groundwork Attic OTHER date b date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by , date by V l DIGS PERMIT NO.: BLD MASON COUNTY Tuec BUILDING PERMIT APPLICATION gl�� 426 W.Cedar/P.O.$ox 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275 4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFO MATION Owner 41, r; Is, i ' 1� `� Contractor Named :_ . Mailing Address is rjX C, cJ Mailing Address City T 11 fPl.f',rt Statet�. Zip Code `f S` f City State Zip Code Phone�3 72--1 60 Other Ph.( Ph. Other Ph.(_, Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/V1 tER SYSTEMINFORMATION-Connect to,44 Septic Istin Septic nnect to pv Sr Systerrrt, Name of Sewer System 'Y ri ';'Well Water ystem _Nalafe of �. Water STstem PARCEL INFORMATION-12 digit Tax Parcel No. -?Z 2-0, 7 / o /G c 1-/ %. Fire District} Legal Description C t- y,MPz C 6FfiCR 7/ 12 R- X 1 7.29 :' /Z6�',y A- ��2 ,#/ rf Site Address(Please include street name, street number and city) /V� 2 C 5F/! /VLVI TH -`_}/ �d 97 1/� +../ Directions to site " '% . 1 .' t rC rti ; , c e r S cr t ?t1 f°e.< <-14, Will timber be cut and sold in parcel preparation? (Yes/No) &6 __. Is your property within 200' of the following: Body of Water(Name) ir`/ Saltwater Lake River/Creek r Pond Wetland , Seasonal Runoff -- Stream — Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building 4 Ct/11 F gC S Toa'<pe f 41 Describe Work fD r'NF-"! 6"- lam r C.r fn tr '/ 1`"2 r � 1! S c No. of Bedrooms-- No. of Bathrooms -- SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft - Basement '- " Deck " Garage - " Carport Other <= 7-r z q F j'`c t E 1'�,thk,Tl sq ft. c7�y LL,f/`i� P A " MO�IL�E HQME INFORMATION-Make Model _ . Mod ear of Be rooms N f Bathr sLenth Width \Perial No.P e $ oTypeof'HeatLhase Y Installer Name -U r ification 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-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-[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. j` �,fj } -7 r C n first obtaining appro I. P X .�� e-r1� `'cam- Date X Date FOR OFFICIAL USE BEYOND THIS P9INT Accepted by 4. Data; c` Submittal Amount Due a Receipt No. _ 0EP#4RTNtEN 'A ...if >:t E-N10 Building Department 3 Armes r►e r Occ Grou Fype Constr.Vt✓ �G"' Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ Building.......................... Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) :.;: TOTAL FEES FORM MUST BE COMPLETED IN INK Q PLEASE PRESS HARD PERMIT NO.: BLD O (� MASON COUNTY BUILDING PERMIT APPLICATION ��3�/ 426 W.Cedar/P.O.Eox 186,Shefto A 98684 Shelton 360 427-9670 Belfair 360 276-446. ma !6269 Seattle 206 464-6968 APPLICANT INFORMATION ►CTOR INFORMATION i?Owner 1`°>d" P T r � Con ractor Name � Mailing Addresses 6 X 1 Mailing Address Gity .7. �l Fig/ `rp State(V f4, Zip Code t) ,f < 's City State Zip Code Phonq('�+"r' ( 3 1 2 "? �_(:("Other Ph.( Ph.( Other Ph.(_� Lien/1' £ 'Holder Contractor Reg. # Address Expiration SEPTIC/WA-t R SYSTEM INFORMATION,-Connect to,Ne Septic EX stin Septic nnect to S Name of Sew r System �.� ..,Well Water ystern NaR e of Water System PARCEL INFORMATION-12 digit Tax Parcel No. 7;2 2-�; 7 C / 6 3 Fire Distric `J Legal Description (7- IP7- C ( H 7L 13 1 6 C'A✓ X r _ , / f , 1•t / '» Site Addres*Please include street name, street number and city) tip,_ i C ' / �V tN •. '-� T. , •' Directions to site o r - /V Will timber be cut and sold in parcel preparation? (Yes/No) 1 t Is yourproperty within 200' of the following: Body of Water (Name) / ,'L Saltwater Lake River/Creek �.- Pond f. . Wetland Seasonal Runoff - Stream Slopes or Bluffs TYPE OF JOB Newly; Add Alt Repair Other Use of Building A 7e ,C-4f% Describe Work k. ,Gv No. of Bedrooms— No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd FloorR 3rd Floor Loft - Basement " " Deck Garage _ Carport Other 1-, 6 ' 44, f�_ "r sq�� MOPILE HO�IIE INFORMAT Make Model Mod ear Length Width rial No. N . of Be rooms No. f Bathro s Type€of Heat Ptbr,-Qhas� e $ Rep em nit ?(Yes o 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-[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 64J c;' ! L'r ti first obtaining app ov I. X = ' Date h X ✓ f Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by .�1 Dater Submittal Amount Due Receipt No. .......................................................................................................................................................................................................................................................................................... APPRQUED:: :;: I EPARTIUfEN .1I�. IEt�#.............. REN..IxI...... ..... .. CC(�QIT1.....I ..Q I . .. ....... . ........................................................................ ..... . Building Department / Occ Group Type Constr. Planning Departmenty �d Environmental Health Department ' Public Works Department Fire Marshal Valuation $ ...................................................................................................................................... .............................................. ... .... .................... .... Building Permit Fee Site Inspection Plan Review Fee UFC Plan RevievWFee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) .: TOTAL FEES P } `s• <' FORM MUST BE COMPLETED IN INK p U G PLEASE PRESS HARD PERMIT NO.: BLD L p ' O MASON COUNTY �rc� F��S BUILDING PERMIT APPLICATION �j3 ' 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-6269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner a + Contractor Name Mailing Address_ Mailing Address City 7 State Zip Code � � City State Zip Code Phone( '� ) _s i -Other Ph.(� Ph.�� Other Ph.(� Lien/Title Holder Contractor Reg. # Address Expiration SEPTICIWATER SYSTEM INFORMATION-Connect to New Septic Existing Septic C(rnect to Sewer System Name of Sewer System Well Water System Narn' of Water System PARCEL INFORMATION-12 digit Tax Parcel No. - ;� / 4 / ! l " Fire District Legal Description rr r ,:,[ / / r x ? Site Address(Please include street name, street number and city)-�' ;r Directions to site Will timber be cut and sold in parcel preparation? (Yes/No) A'L 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 X Add Alt Repair Other Use of Building e = ' Describe Work _ t : No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor _-- Loft Basement Deck -` Garage Carport Other _,� :,. sq. ft. MOBILE HOME INFORMATION-Make ,LTModel f Modej'Year Length `, Width �erial No. g No-:`of Bekooms r No. \f Bathro s Type PT Head. Ptlxr�hase Price $ '.��f' RepPaem nit ?(YesYtyo Installer Name C-e-�ification 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-1 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 r �. first obtaining approv 1. X '"� r� f Date t r X : Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. - APt'.Rt?lflwt :' ' >} IMPARTIDENTAL..IIM1f.... . . .................................U .( IEt3::....:......::.:.:.::::::.::..::::::.:::.. tNI:TtN:::QE ;:::: .......................................................................................................................................................................................................................................................................................... Building Department Occ Group _ Type Constr. Planning Department Environmental Health Department (3©ace Public Works Department Fire Marshal Valuation $ t .::::..:..................................................................................................................................................................................................................................... ................................ ... .. Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other � � Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) i �, ,< ��: k. :., TOTAL FEES V- _- P4 r N / L R 209 6-ra P ,4r2 ,f,/ so / L. y A Ca C Tom , SE Q F ( 3 ) /t 0D-7- T-T�cYV09L 6 'XXK TGz �� r� dos T o L T,67 40 o/v IV S .Z d ��, X 6 �� 5��,�/✓Y�i�' CY ,�v�2 y /o ' �i9lY,D ,rams (,u T H /z T// / QV- �a a F S yS T o /-] p , X-T-- S 7 --777/V C.2 Z C1 /VC,- 1,200a S 2 l Z Q� rc h r 1l S a o F or�c P is ao s ram. x l U� � K6x�a t, Z 2, O ©gyp ,, C r-,4 l a a i v /C x/V TO AHDE „ �G l � 0o y 13 c� C��I�A�- ZZG7 �SO 3 �Rc � �- ` SP 1766 OtO A Con/STdLcic7"�D W� - � v€R c-rA , ST DE ui T/// /`X/a '� E OR2 s D.=N6- 1�2 11 p!L=MER 6ofl�e0, C2,> o co z S, >V 0 T42 (-fSs /LQcF SYL7-E/'1 W1 ovEA /3uxL7- 31/z 11 X l9 " GLur L, m-S 2- 2- 1 i - �� .� �� .. _�� _-� .�� _ - � !a �� ~