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BLD2008-00124 BLD2003-00683 BLD94-1335 BLD0088 #26 - BLD Permit / Conditions - 3/28/2008
FORM MUST BE COMPLETED IN INK �° ) l —Cl /� t� PLEASE PRESS HARD 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 INFOTNI TION CONTRACTOR INFORMATION Owner $ ITA" Company Name Mailin ddress r�Nuc�� I D�— Mailing Address City 7State UA Zip Code City State Zip Code Phone Ot er h. Phone Other Ph. Lien/Title Holde Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic. # DOB Drivers Lic. # DOB SEPTIC I WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer S ste PARCEL INFORMATION - 12 Digit Parcel No. — — Fire District Legal Description S Site Address (Pleas ye t lu st me, reet'jenumber d y Directions to site Will timber wi cut an old parcel preparation?Yes/ No Lek Pond Is property with 0' of Saltwater Wetland Seasonal Runoff Stream Slopes or BluffsT5% Is this permit submittal the r sult of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New_Add_Alt_ Repair_Other PRIMARY RESIDENCE ❑ SEASONAL Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage - 1st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck. Other Sq. ft. Garage Attached Detached Carport Attached Detached dglz MANUFACTURED HO E INFORMATION - Make Mod 1 Yea Length 5 dt Serial No.�W1D o. of Bedrooms o. of Bathrooms IQ Type of Heat Purchase Price $ +Q�•`� Replacement Unit? o Installer Name���I��� Certification Installer Certification N0 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 1 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 F A PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X��a`� Date n r/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Plannin Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ 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 INFORMATION N CONTRACTOR INFORMATION Owner LN''iZrt I ,� ii t k ) 'R 7 €' f x Company Name Mailing P.ddress- Nr / I H a f V j�;. Mailing Address City / , /= State L/J? Zip Code ' r City State Zip Code Phone - Other ph. Phone Other Ph. Lien/Title Holder I t?R-T ;.,<A;U I!"P t Jf? - Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic. # DOB Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. i , x YX j, Fire District - Legal Description Site Address (Please include street name,istreet number and Oty) + 'C Directions to site e / Will timber be cut and sold in parcel preparation?Yes/No Is property within200' of Saltwater .Lake River/'Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 15% Is this permit submittal the rasult of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - NewAddAlt_ Repair_Other PRIMARY RESIDENCE ❑ SEASONAL 0' Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION Make Ll " Mod Yeari " Length dt ' z Serial Nof1 I o. of Bedrooms Flo. of Bathrooms Type of Heat t t' = Purchase Price$ 1%>',O f =' Replacement Unit? l No f nstaller Name � PIJ �� �! t ,, li,� {' Certification No. r% t f i l.- i iMd e-1:4 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 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 permitlapplication 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 PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. „-q x ' Date: n r/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: ___ Date DEPARTMENTAL REVIEW APPROVEDDENIED NOTES Building Department }; Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee dd EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood /Gas / Pellet Stove Fee State Fee Violation Fee a a Pre-Paid at Submittal Valuation $ ITOTALFEES FORM MUST BE COMPLETED IN INK �1 c� PLEASE PRESS HARD MASON COUNTY PERMIT NOC900 - 00�a3 BUILDING PERMIT APPLICATION 2I 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 L I T-P Company Name Mailin ddress7StateVZ A Mailing Address City p Code City State Zip CodePhone hPhone Other Ph. Lien/TitleHolde Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer S ste PARCEL INFORMATION - 12 Digit Parcel No. I — Fire District Legal Description Site Address (Pleas i lui stre t me, r et number d y 5 Directions to site Will timber be cut an Id in parcel preparation?Yes/No Is property with 0'of Saltwater reek Pond Wetlan Seasonal Runoff,-:-' Stream Slopes or Bluffs Is this permit submittal the r sult of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New _Add_Alt_ Repair_Other PRIMARY RESIDENCE ❑ SEASONAL Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage - 1st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck. Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOPnE INFORMATION - Make Mod I Yea Length,5� dt l�l Serial No. 0 o. of Bedrooms o. of Bathrooms Type of Heat Purchase Price $ ���6W• Replacement Unit? o Installer Name - lA0$�f��SQUIn�� Certification No. 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 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 MES FAPROGRESSINSPECTION.INACTIVITYOFTHISPERMITAPPLICATIONOF180DAYSWILLINVALIDATETHEAPPLICATION. XAN Date- /-3/-2oo fS n r/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date 3� DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Departmen Fire Marshal FEES Buildinq Permit Fee Site Inspection Plan Review Fee EH Review Fee f Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal \/alnatinn 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 INFORMATION CONTRACTOR INFORMATION Owner 1' �'- " Y/ 11 N I I I -1`4t f" I-A k- Company Name MailinqAddress- I .,"t/,fit% / ,c / / t Mailing Address City IA7`l l L , State �'11 Zip Code '> � City State Zip Code Phone 7 - /-r Ot er Ph. Phone Other Ph. Lien/Title Holder tt�-'ti'v !';'17 7 1°711T t%fc Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. r Fire District Legal Description Site Address (Please include street name,:street number and City) Directions to site 1. Will timber be cut and sold in parcel preparation?Yes/ No Is property within 200'of Saltwater Lake River/ Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluff—s :�;715% 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 Use of Building Describe Work No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck, Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -. Make / ii Mod I Year�`is_ Length_ /n fu dth Serial No '- ' o. of Bedroom o. of Bathrooms Type of Heat r I f'% Purchase Price $ X I'. ( Replacement Unit? o Installer Name- 'ri t i/- I I ' % 1` + 'i( `� Certification No. 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 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 MEAN FA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X - ii vn,. z t-0 7 Date: r- wn€r/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES r BuildingDepartment PlanningDepartment 03 Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection 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 Pre-Paid at Submittal Valuation $ TOTAL FEES Model [� 3 bedrooms, 2 baths, great room, corner oval tub � 1 1 378 sq. ft. overall area, 52-0' x 26'-6' overall size OPTIONAL FRONT ELEVATION m 50 1P-1"x 104- L L _ MIL Br. i 6§ GrL DID. Br.2 18_2"x16' - - Din. 6"x 12'_7" 11'-1"x 12-7' CA> EGRALCEILING -. STPNDARO THRDUGHOIlr - -_ L , € '1 51 Jv eaC1,4a, �ool� c,6e Millennium NOMEY 1N�II fA n.f ..rrt. �rnry r . r c IN IN t e r /,arr.., n P Mr�Lor!.ar' r rTl.reTNl htunN� rr.rrr.f"wr -�'Tryu�rt .......... q..nNo garfT ( Name_ Parcel# - — BLDN Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page I 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. '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. '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. To Calculate Impervious"Surfaces Please'Ctimpfete This„Table Surface Type Len th X Width = Area * All dimensions in feet Buildings X X = Measurements for buildings are taken at the X = perimeter of the farthest projections (example: X _ eaves/gutters) 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 X = above table Patios/Walks X = X = Any paved, gravel or packed area per definition X = above table Others X Eevyuipul XIf the totall,imperviousa ea of the proposed siteX dlent is$gfe 3ter than 2000 square feet a Srriama ll Parcel stormwater Site Plantis}jec)uired Total Impervious surface Area (sum,of all areas). elr 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 or 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 I of 2 eoN CO U MASON COUNTY ryTA DEPARTMENT OF COMMUNITY DEVELOPMENT Mason County Bldg. III, 426 West Cedar Street PO Box 186, Shelton, WA 98584 www.co.masonma.us (360)427-9670 Belfair(360)275-4467 Elma(360)482-5269 lRSd January 11, 2008 Name Patrick Stone j L Address 20 NE Roessel Rd. Space 26 i Address Belfair Wa. 98528 �RE: Mason County Building Code Violations — PENDING ENFORCEMENT Building Permit — BLD2003-00683 — STATUS: CANCF_I LEI) 11�\C'j bite Address: 20 NE Roessel Rd Space 26 Belfa Legal Description: ��1(� Parcel No.:123325000050 � t To all interested parties: The Mason County Building Department has a pending enforcement c Sagainst the above described parcel of land situated within Mason County for non-permitted placement and occupancy of manufactured home. According to the Mason County Assessor records, you are the current Title Owner and Taxpayer of this parcel. Pursuant to Mason County Code, Title 14 Building and Construction, a permit and occupancy for the type of activity is required under the 2006 International Building Code and your property is currently in violation status. Original permit issued under BLD2003-00683, never received any inspections and was cancelled due to inactivity. A site visit was conducted on January 3, 2008 to confirm if manufactured home on site. Inspectors noted that the 24 x 56 manufactured home on site does not.match the original permit description. You are required to immediately apply for the appropriate building permits. Our records indicate that you have never received county approval or occupancy an the man'=f?ctured horny To hrinn vntir aitp into compliance and avoid enforcement actions, you must submit for a new building permit. Please contact me to the necessary arrangements prior to January 31, 2008 to resolve this issue. Failure to make the necessary arrangements by January 31, 2008 will result in additional enforcement action. If you feel you have received this notice in error, please contact me immediately at (360) 427-9670 ext. 359 to discuss your concerns. Sincerely, Terry Ryan Building Inspector Cc: Property File Golden Bell Mobile Home Park N.E. 20th Roessel Rd. Belfair, WA 98528 (360)275-4623 Mason County Building Department P.O. Box 186 Shelton, Wa. 98584 As required we are sending you notification of a new lease agreement with the following new tenant. Lease agrement will commence when their MOBILE HOME arrives on our pre-existing lot. The new tenant will be serviced by the Belfair Water District#1. If you have any questions please call during normal business hours. Legal Description Tract# 20 Sam B. Theler's Home Garden Tracts Vol. 4 page 20 Records of Mason County. Parcel # 12332-50-00050 NEW TENANT NAME --, AN 17 NEW TENANT LOT# Thank you Deede Schattenkerk Manager 4 f Q I q W � � w W O Ffa' W co � N N m a w 10 � o w i� Ln N Ll c co e <3T4r 71T R �\ ,N /U PLANNING = mom m z !7 �J 1 o o o � IC D a ro m r- O r oz a m c Z r1i V ECEI VE® y 2 81003 426 w- �fnGR S1 601 -T APPROVED MASON COUNTY DCD PLANNING SITE P AN EUI;iEO TO BE ON SITE C G SUBJECT TO APPROVAL BY - -- Dateo� `e E �vING . PLANNING SAREMEASUREDE FURTHESTOF T HE BUILDING -------- ------ --- --- ---- -- Lj -Wo� W o tf� - --- r o o 3 m - S m Z m _ O7 ' N Ln m W - - -- --- LD oat a`{ S,p !J°� r O'er THESE PLAN._ MUST BE ON THL .JOB bITE FOR INSI-LCTION. 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CD � m m D O ma 0 - M fD n - < a) 0 W 0CD hm N0 p m ° ond. 0 C (D a C. = .?. N a .00 a N d N o m N. � � mc. n_o �. � D � m ' � fm D - 0 0 0 m 0 x C m = m m u CD 3 6- O 0 �< FR o �< 0 m �< m 0 m < o o m 'o J 0« CD 3 CD J n. N m 0 D) Z O � � C a nm u 3 0 c � c D im � � (D S 3 "w CD = C. N 0 Z J o"'a C (D CDc m m o < � a, m N J (D p m a� m � m 0 0 CD o - ° -_ C) - m f 0 3 i ? ? O m J 0' J n m J 0 m n O O N 0 n O J y C D N TI O m m D 3 � 0 O p C ? C D) O _ 0 U� J J S "o - N J W O J 0 0 0 m m m mm S a) CD -� �c a' . 3 -u g s 0CS < m 3 m � J m w :E 3 30 �, � mJCD p � s m -o m o � m 0 0 IQ MANUFACTURED MECHANICAL MANUFACTURED HOME y 0 Footings I Setbacks Date By Ribbons 90 Gas Piping CD o Intenor Date By Interior-Date By m Data By a Exterior Date By Exterior-Date B Sst-� Point Load J Isolated Footings INSULATION Date By BG I SLAB INSULATION Date By Data By FIRE DEPARTMENT < Fmndatlon Walls Floors Date By Date By Data By DECKS FRAMING Walls Date By Dale By Data By PROPANE TANKS PLUMBING vautt Date By Date By OTHER Groundwork Attic Date By Date By Type. Date By D.VY.v DRYWALL Type. Int Brace Wall Date By W Date By Date By FINAL INSPECTION p m Water Line Fire Separation N �^ Date By Date By Date By O m O Pass or Request Inspect. c CD Type of Insp. Fail Date Date Done By Comments a m xo N O 8 i 0 s N 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 INFORMATION CONTRACTOR INFORMATION Owner f? L1 r S ,� -� �� Contractor Name G Mailing Address N Mailing Address City State v,#A Zip Code q <"'ZA City State Zip Code Phone 18 31-71 Other Ph. (_) Phone (_) Other Ph ( ) Lien /Title Holder �1--i?7-/z I c k. 5 ti = Contractor Reg. # Email Address Email Address SEPTIC /WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System'�C_ Name of Water System 9,C c F'R //Z- w // 7- 'F/2 D I ST/2 I CT PARCEL INFORMATION - 12 digit Tax Parcel pNo. ) _� 3 I —I L(1) Fire District Legal Description ^ C b ,; /.� L C_f Pr7 C' X_ ;Z. p Site Address (Please include street name, street number and city) -- Directions to site /(/o k' 7-,Al 1 Z?r)4 V 9 H kl Y 12//9N7- &, ST t, eFT 1+7- TC- If .L 97' V-r< o/u 7?/F L F- F7— Will timber be cut and sold in parcel preparation? (Yes/No) Is property located within 200' of saltwater Lake River/ Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE K SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action? (Yes/No) /V Describe Work fT W/' -¢ 'ge a P /L Of /A-' U / L_ 6- P /2 No. of Bedrooms No. of Bathrooms j SQUARE FOOTAGE - 1st Floor V yo 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Model Year /q90 Length 60 Width 141 Serial No. No of Bedrooms ;2-_ No. of Bathrooms / Type of Heat )t_�c 17 ,Q /L- Purchase Price $ SC>CJf, ' �io Replacement Unit? (Yes/No) Installer Name i7i//sP�S SE ' Gf lam'' Certification No. CX_ 5 $,;2 69 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment ofthe Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and th�t aware egula1jpg of the ordinance requirements for which this permit is issued and of the ordinance requirements r -tc�r�f� ich this that all work will be done in conformance therewith. No changes permit is issued and all work shall be rQU4 nfo'm a there- shatll�ade without first obtaining approval. with. No changes shall be made without fUsjpttiblWoval. X Gv� rX '^ Date 5 2 t 'd`'> X �D\\ateGG ST FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd Ck# Date Bid Pd. Reciept No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department OCo1�- OccG"u Type Constr. �/- ,1 Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee n o5 Site Inspection Plan Review Fee EH Review Fee Plumbing& Base Fee Planning Review Fee c Mechanical& Base Fee Other Wood/Gas/Pellet Stove Fee Slate Fee L @9 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 INFORMATION CONTRACTOR INFORMATION Owner ' Contractor Name '• j. _ Mailing Address R�,45 /,_1 r< + �14> Mailing Address City ",'c Birk State'v rs; Zip Code -? _:?f City State_Zip Code Phone " ' . 7 Other Ph. Phone Other Ph. (—�) 'T� P O O ( Lien/Title Holder _ c- tr' "7' Contractor Reg. # Exp, Email Address 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 /< e� r? ` t r { +' S 7 PARCEL INFORMATION - 12 digit Tax Parcel No. ! 1 Fire District Legal Description G i 4 p •' L zrob Site Address (Please include street name, street number and cit ) Directions to site .•�`�''-% '/V � ' / Zvi✓-� y 12/(/V7 Fij1r T rl)T4 riG I Will timber be cut and sold in parcel preparation? (Yes/No) Is property located within 200' of saltwater Lake River/ Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE K SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice_, Correction Notice or other enforcement action?(nYesi IL Describe Work $ �'T ,. < .y R/u 1"> t m .7 u;z 6 r r� /t j �f/ B !' */z Kc No. of Bedrooms �`- No. of Bathrooms I SQUARE FOOTAGE - 1st Floor .7?� %' 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - MakeZ'1 t� f L Model Model Year /,�gz; 11 Length 6-0 Width Serial No. No. Bedrooms ,— No. of Bathrooms Type of Heat /'c i( Purchase Price $ _ -' ' rr Replacement Unit? (Yes/No) Installer Name /tr i� 5' S F— — �'i P Certification No. C-� f f,�2 1?`? 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the StatQpfpsPto/yerthat I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements i t ��� for which this that all work will be done in conformance therewith. No changes permit is issued and all work s��` 1�Qfrr�i nformance there- shall bemade without first obtaining approval. with. No changes shall be mad9Wtl�oYitrfiF2t� Ing approval. X Date z X 426 W. CEDMST FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd Ck# Date Bid Pd. Reciept No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group rou Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee -- EH Review Fee _7 `' Plumbing&Base Fee Planning Review Fee .l 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 INFORMATION CONTRACTOR INFORMATION Owner Contractor Name Mailing Address ^C Mailing Address City State Zip Code City State Zip Code Phone ( ) ' '' �'' Other Ph. ( ) Phone (_) Other Ph. (_) Lien/Title Holder Contractor Reg. # Exp. Email Address Email Address SEPTIC I WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System ��Name of Water System " PARCEL INFORMATION - 12 digit Tax Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site Will timber be cut and sold in parcel preparation? (Yes/No) ' Is property located within 200' of saltwater Lake River/ Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE ® SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add—Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?(Yes/l ; Describe Work No. of Bedrooms No. of Bathrooms 1 SQUARE FOOTAGE - 1 st Floor -` 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Makef ' Model Model Year Length Width Serial No. No. of Bedrooms ` `_ No. of Bathrooms Type of Heat Purchase Price $ ell 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. OWNERIBUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - Itdr>#tilCAE1 I�aE Ghrently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of in ton and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements re nitla I*Or which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be made without first obtaining approval. with. No changes shall be mad42i6hW.fiC4 i6Tapproval. X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd Ck# Date Bld Pd. Reciept No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Group T e Constr Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ PEES Building Permit Fee Site Inspection 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 Pre-Paid at Submittal ( ) TOTAL FEES Mason County Permit Assistance Center Planning Intake Checklist Owners Name: Sbr12 Date: Project: In N . Reviewed By: � Commercial Development: YES Comments: Planner: SAL GBM DMJ Site Plan: 1cr North Arrow CD p�Property Dimensions: SSA (�,•( Streets and Driveways Shown. Road name: All Existing Structures shown with setbacks ,e- Well Location, Septic and Drain-field Shown with setbacks ,,a' Identify all surface water(streams,ponds, shoreline,wetlands, etc.) Topography(slopes) Proposed Structure Setbacks (Direction/Setback): F: N / PJ R: S 35 S1: C / 31a S2:W A— Utility and Drainage Easements: es No (if yes enter condition#5022) ❑ Other Easements ❑ Accessory Appurtenances ❑ 6 YR TIP o Would you like to be present for site inspection?_YES _NO Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: ,B Not Applicable ❑ Agricultural ❑ RR 2.5 5 10 20 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy ❑ Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT ,NC Urban Growth Area ❑ MPR RECEIVED ❑ Unknown ❑ Unknown / MAY 2 8 1003 Water Body(type of water if unnamed): / AR SFI SEPA: Yes Unknown Flood Plain: YES ;1�Unknown Map# Aquifer Recharge: YES NOP Unk mown Map# Tags/Cases: RLC/SPI Case: / 6-Year Dev. Moratorium: YES No--A Eagle Nest Tag: YES I�/ Other YES D16/ Addressing: Check box if needed Reviewed by: ❑ County Access Permit Needed(add condition#0010) ❑ State Access Permit Needed(add condition#0020) Standard Conditions to be added to all Building permits that planning reviews: #4999, #5019 and#0700. .. ,b.-0.3 § [ - (\ § co4 } _ j \\ \ \ \ \ / d cl k ) k k \ \ � \ � \ ° °LU m E ` { / ) \ 0 o [ k ) / $ LL � \\ { � = = § zz § / � 0 : a � tr | 7 ) ± Ci \ / - - © k 0 - 0z \ � � / ! ) ; ! ! ! - r )- !z m om LU IL k \ \ \ \ \ q R § , \{� z ) ƒa ) � ( / §§ w> m = w <± ( \ i = § j[ / § ) E/> 0z §:\ B [\ 0 0 E Z -1 } # � / § L 2 /� - - } § ] § § / ` m � § LL _ \ EE0 § \ kk / 0 } o � ® A zmLu ! ; § aco .. / L � COM0 IL N \ � } § o z / § \ Z - - e k \ / ( ) \ � } m moo / e S f ® 222m > a = % ` § > R2 < ; E0 \ ƒ a ) ± - k \ 2 ( 0 w / % § f § ( ® A \ [ § ) ( � \ { _ § 6 \ \ LL e < = o IL _ ! , z r 5U) ® G E ( r j ¥ § ! 00 $_ ° UX ee - 05 7 j \ 0 } \ f 4 r § mOD _ ) < 2 0 ` \ 00 Y ) a) a) C — O 7 N O N 7 L a) a) (D M c a) } a N a 4 n 3m u m 4) M .N LL c L 7 c E o C N D L O a N ' N N (na 0 O C O M '0mo n3 .o �_ O c7 y O T@ C O 7 0 `O O o) >, U N m U '4- C m — N OL K U a) n coC13Mw - L - '3N ? O oo. S@ c n m U M c O 3 «. m O y o o> _o C m U C CO M C N L LPL C O O O m '- N 0 .rn� 7 0I M 3 @ m n a m 'p m 0 n in m n 8 � C L � C O) co ZOm 3: U 'm ¢ ` 'O ` N O } Ld— LOo _Ca) g` N m p- m a) M O U 0 M W E CD O (M yO O co m O CcNp > U O doO p mN Lo N co coN'O y U y O "c m Co h 7 E C d N n M Y N m 'oC M n y oa d mU x �r N U C 7 N N LL >• N -O J O n¢ U n n met J � a)c E `m0E E U C a OC a t « � �) r c rn@ n F U - O a) -o o — > X N N L 7 N -C13O O �_ ` E N .Lm. L a) J O N > t O O m >. " w `p- U 1 .0 - O N O C C p V C_ O 5 a d 8 5 'O N Y y (n O ' N C "O 'C N D- N C O C W Q U T E N C O -p `l N N (6 3 > C p_ O a E T n c N FLLJ O X U c O M C a) F- N L O N C = U � M �• �_ 3 ° N � ¢ 0 c no O w m F m o o aw ID Cn o Z Ca�LM ( MCILa) U °p O � omZ atDm O CNNN o) M c m n � N � >` Vim „ U) cmi � n 3 m o M cb 7 4) c m 'p -o o p 'o 3 > ui o -o 0 m a) a) @w - CO m a) cr m 4) o a a o 7 p N L C 0. o X o) N = N co X O O Nco -p N U ... O m c a) N N m F N n � lC6 N � FK � � ua > > 7 Mm c E °) o c - z ouim M7m c '� 'oN O 7 n L ML c nc nc — c m a) c m O o E ENmo z o � � � ronrn E aoc O o0 0 'w s ._ d m a) w m (n m t� Y Q' p d p Q T m y 7 7 m LL _N Co a) h C m N c N W n N M Q c p N E 3 > ° y 9 U�U a N C ¢ C U C CL.. L C Y p E l0 N a) E N ry •- C - 1 m ¢ O -0 "o M 3 p U ,r O w X a) L .L.. CO T5 L w a1 7 > O m - O)L J C - C C Yj m v 3Qmo w nm � voim2 co `o o) Qao mo o gym_ o r m c m N N = _ � a-Oia Y o CC m c J o) E 7 o E � v _ c w Co .m y .CD co a _ _ — N " O c CO n > a - m c - mm U) oma`) m mr 10 f0 � `o UZ -o � c T y o ` er o 6 M E � c -2w < ( M a) E ¢ — ma o `m v o O m 0 U W (n � O '` N E E 'O `O m 0 a — (0 N C o 3 N0M F- Co Z -p � � � F N' L7 - W � MLm M yo pp a) a) } O � an= o _N � � �, N � wNc a 0 30 S jN Z m O¢ c o - c 0vm0 cnoaa)) o — Z ° X 7 � �c wU c M -o = 8 . EO � Q ? Y� > � � N mEaa)) X � Z 2 aa)) c o0 a n a U) oco le �° 76 (L)) � O � � ° cm a`) � o0 0 LU N E a > E9 w a n— w O U O n 0 O C c C J w C T o O 5 C7 m >.� v7i@ w dnQ:a (D Nn E � � M m � mmCo a a 8w ¢ co c c o c = W d c a c L L - 7 0 L O w L C a) — n n O o0 0 0 aE W N N C) N M 7 t0 aJ L 0 OJ Q) H U O J m f � gKqp � Permit No MASON COUNTY BUILDING PERMIT APPLICATION D ( (� 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-56 PLEASE PRINT #1 wn j 0 A� Phone# 1/ 7 3�;+, ,1�„ v it��a A// �(1 QC1 C )Q b J oZ�o Fire Distract t o�__ e Add St V1+ Zip R$S2& City (=A Nc)tir P� K Directions to Job Site ��C!f�Ci(/ 1{�! AGC G' Owner Mailing Address CQ ,cfQ St f* Zip 2na City E�tEF2 C/ Lien/Title Holder F P— O U114 EP iI A Cddre PC M St v C Zip q t-�U N fS Mf�/•1 U Fj`�,'7 X E. 00-1 67 Contractor Reg # ��lb/1�SSi #2 Contractor Name J f Address Pp IB/)( 7 T9 Expiration Date city [�� St W 4 zip 9$3-0 Phone# �1 ( 7K 7�/ #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well MC c/� - Connect to Sewer System? Name of System �'I t (If residential, proof of potable water is required) #4 arcel NO..j Q13 - -23(ATI . gal Description f�`ram' CIS #5 Building Square Footage: (existing/proposed) Loft / 1st FI 2nd F / 3rd FI / Basement Deck #bedrooms / #bathrooms /_ Garage Carport (Circle: Attached or Detached?) Other sq.ft. / `, � #6 Use of building �lG�-�-/yt-g' — Describe work #7 Type of Job: New Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION �e Model Year 94 Make /EETtuao odel_U6�Q 54A! P0iN7- Length Width I H Serial No. # Bedrooms —# Bathrooms Type of HeateL Purchase Price $ R c111;oo #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other FFShowhow following on t77planns tures Abacks V Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW � ? I 1 I\� J APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW 3 N Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, _Bath Basins Heatpump, Other _Bath Tubs No. Units Fees Showers Furn BTU _Hot Water Htr _ ',,Heatpumps _Launoy Washer Vlit Systems Sinks Spoi Vent Fans Floor Drains',. No. B it m r r _Laundry Basins\ _ HP _Dishwasher \ 1j� 7Air"H' Inlin i _Disposal V cfm# � _Urinals No. Fire Protection Syst m _Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR APERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. t-- X OWNER X BY DATE �� 0��� DATE FFFOR{OFFICIAL USE ONLY:Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: s 6fona S� mans Environmental Health: Building Plan Review e;�;h,` 'r/1r�� vw;ze',, ,btu Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee [� Other Other Building Valuation: TOTAL FEE y / 0o O O Z) V� .- - - - x o O O OD Q` CD W \ oP O CZ Q A z cn O, _ C - Q O ((D co Q oo Q Cn OD rn a r - p r _o < ° o w � m � x a 0 z x � 0 Q A z 3 N _ CU (Q O n =3 (D 10 Q U _ 00 A v OQ Wo o C,() " 0 0 00 0 z n ° 00 n N Z 00 :3 m oa OD 0 ° co CONCRETE MECHANICAL MOBILE HOME Footings-Setback date date by Ribbons b Foundation Walls Gas Piping date y b date date by Set Up by BG/SLAB Insulation INSULATION dateby Floors Final date b FRAMING y date by date by date by Walls FIRE DEPT. PLUMBING date by date by Groundwork Attic OTHER date by date by D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by y� date by BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATE ISSUED PERMIT NO. 71BUILDING , NAME (� MAI ADDRE //1) CITY�r TTATEp� G p ' lC�Q �IL.��L� . � IJI-LFA FEW&s{. PHONE GL '- _LQw 1 7 SEE ATTACHED SHEET) R NAME MAIL ADDRESS CITY$STATE LICENSE NO. PHONE LES� pLNC� Class of work: ANEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: /1 LF_ N,F_KJ Moll 17f OMB . (p Valuation of work: $ O PLAN CHECK FEE IT F E SPECIAL CONDITIONS: BEDROOMS__ _. IOECKS _ .CARPORT NOTICE BATHROOMS _. TOTAL SO. FT. _ GARAGE NO. OF STORIES BASEMENT ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. TOTAL SO. FL FIREPLACE - DETACHED : THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER I Certify that I am a currently registered contractor in WORK IS COMMENCED. the State of Washington and I am aware of the ordinance requirements regulating the work for which FOR OFFICE USE ONLY the permit is issued and all work done will be in conformance therewith. PERMANENT SHORELINES Firm SEASONAL . FLOODPLAIN E.D. NO. S.EP.A. By ------ Special Approvals IN OUT YES APPROVED NO Lic. No. _ _. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. PUBLIC WORKS I certify at I am exempt from the requirements of the FIRE MARSHAL contr t or registration law RCW 18,27, and am aware of a Mason County ordinance requirements for BUILDING DEPT. w ch this permit is issued and that all work done will ROAD ACCESS conformance Y��rgg rewlth. /„` MOTOR VEHICLE PERMIT O ne r Date /V D �' APPLICATION ACCEPTED BY PLANS ECK BV APPROVED F05 ISSUANCE Gr. y'cYl�! PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH