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CT 00 0 (n XQ N v n m 07 a Q 0 O o g m m v v m, o v = w m < m o CQ o D O O m O —1 zr m C: m ° C (n v ('p O cn o n O 2 CONCRETE MECHANICAL MANUFACTURED HOME D N Z Footings f Setbacks Gas Piping C) DateBy Ribbons — - O oInterior Date By interior-Date By Date By Z w PO Exterior Date By Exterior- Date By Set-up D INSULATION Point load I Isolated Footings Date By X BG I SLAB INSULATION < Date By Daw By FIRE DEPARTMENT Foundation Walls Floors Date By Date By Date By DECKS FRAMING wails Date By Date By Data By PROPANE TANKS PLUMBING vault Date 13y Date By OTHER Groundwork Attic Date By Date By Type.- Date By o_wv DRYWALL Type_ O lot.Brace wan Date By Dale B Date By 9 y FINAL INSPECTION c Water Line Fire Seperation p Date By Daw By Date !�k dV G Pass or Request I nspect. o Type of Insp. Fail Date Date jDoney Commentsr A #'b 513I0o Sk�v6 0 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD 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 APPLICA T INFORMATION 771TV 19 . f I IVW CONTRACTOR INFORMATION c� Owner A nS0 r1 Company Name `') Mailin_g Address Mailing Address City to State L A Zip Code 5 2 _ City State Zip Code v Phone 3 Other Ph.3lod- 4M-()DSO Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address P tC. • (` E Mail Address Drivers Lic.# kkA CCeEqVDQ DOB /1 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System r Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. SO Fire District �Z Legal Description f2uioVA4 cl h P 01_ � y-R bt—A JL 0AA- Site Address (Please include street name, street number and city) t 1" e. ' 10LO Directions to site r e.r 04 j0 (o1 L 0 Will timber be cut and sold in parcel preparation?Yes/ o Is property within 200' of Saltwater �_Lake River/ Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal the result of a Stop YVork Notice,Correction Notice or other enforcement action?Yes o TYPE OF JOB - New Add Alt Repair Other PRIMARY RESI.pENCE SEAS JAL Use of Building +�`��' Describe Worker atit ''� Y l ilu� � �nf- I�'0P M6 72 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 HOME INFORMATION - Make Model Year Length Width Serial No. IMP No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit? Yes/ No Installer Name 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 MEA- A PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. x a i/alC al 6'1.<J ut- Date: 313 /0(o Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES d 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 Planning Review Fee Mechanical & Base fee Other Wood / Gas / Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES 7-7 - A - MASON COUNTY PERMIT NO.CAM avv ��n r BUILDING PERMIT APPLICATION Qnc� ' V 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 9 APPLICANT INFORMATIONi-fit`i� . �it}tS�/t CONTRACTOR INFORMATION o Owner «'�_o rA Company Name Mailing Address `� �_^ Mailing Address City n tateW Zip Code G` City State Zip Code o Phone � V Other Ph.-3(g g 'OaSU Phone Other Ph. ('5' Lien/Title Holder ,i Contractor Reg. # Exp. E mail address ' P o - fl o M E Mail Address r Drivers Lic. # DOB T /1C. 5� Drivers Lic. # DOB .r SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic 'e.- Connect to Water System Name of Water System Well Sewer System Name of Sewer System li� PARCEL INFORMATION - 12 Digit Parcel No. ' Q VQQQ= Fire District ' Legal Description r, Site Address (Please include street name, street number and city) 0 AIII&Q l � S. I 'rr f. v f Directions to site " Q l\ DAL '-X'A ' Will timber be cut and sold in parcel preparation?Yes/ o Is property within 200' of Saltwater Lake River/ Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 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 t��u , �� ` `� Describe Work4'r' `0 YiDly +3 ' i r, 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 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. 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 permiUapplication 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 OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X �1�. ,y; f/.?7 1,✓I aG lc t.(,k, Date: :5 L3/0(a Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED INOTES Building Department 31slac �l� 12 Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee �� Site Inspection Plan Review Fee -`1 EH Review Fee Plumbinq & Base Fee Planning Review Fee Mechanical & Base fee Other Wood /Gas / Pellet Stove Fee State Fee S" Violation Fee Pre-Paid at Submittal Valuation S -) TOTAL FEES MASON COUNTY PERMIT NO.0 v r V ' L�l) ��n r BUILDING PERMIT APPLICATION + V 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 cJ APPLICANT INFORMATION a4.5/l CONTRACTOR INFORMATION Owner L 11 • 'k A Company Name Mailing Andress 'J :�O k t r Mailing Address ` City '+ State Zip Code 4N5 � —_ City State Zip Code o Phone szc) Other Ph. RqK-Oin').50 Phone Other Ph. Lien/Title Holder + Contractor Reg. # Exp. .r Email address :y - (L. I- n E Mail Address Drivers Lic. # +L7 4Wr! 'O DOB J 15 2 Drivers Lic. # DOB SEPTIC / WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System !1 Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit 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/UO Is property within 200' of Saltwater Lake River/ Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluff�/o Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alter Repair Other '1, PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe WorkM y 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 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. 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 MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: ._> 10 Le Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department �t t = Planning Department r3 Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection 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 IFIF1`1 r1111111FIRlIll - MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION I 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 Company Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone Other Ph. Phone Other Ph, Lien/Title Holder 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. 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 within 200'of Saltwater Lake River/ Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% 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 - 1st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq. ft. Garage - Attached Detached Carport Attached Detached 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. 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 MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X Date: Owner/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 Planning Review Fee Mechanical & Base fee Other Wood /Gas / Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation TOTAL FEES k de {1/=//jll��• H i � j th t `IL . 11 13 ON . ..��w T tee!J _/� I f g •, �y e i _ t `:ram - .� '.t�..1 s •yt}' ,.-• �:.- � s .;t s I { ,e 'may.y�'`, �,,,1h ..t �.A►r _-, • "t.'�1.1.`J .�- _sue. sid ido 41 r. r � Sc7 to MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT n ion WSEC/ VIAQ Compliance Application � � Owner: P Telep one: U Parcel#: �a3 —o OD Type of project ( ) New Residence ( )Addition ( ) Remodel Total Sq. Ft. 1 s Floor : 2" floor: Heated Basement: of heated area:: Heating System Type: O Electric wall heater O Electric Central Furnace aLPG Furnace O Heat Pump with electric furnace O Heat pump with gas furnace O Boiler, specify fuel type: O Other: Specify Glazing Compliance O Prescriptive Option see reverse side circle one: 1 II IV Percentage: pliance Method O Component Performance , Chapter 5— Calculation worksheets required Check one.-.- O Systems analysis, Chapter 4 O Whole House Ventilation system O Whole House Ventilation using a Heat Ventilation using exhaust fans&window or wall fresh air S stem vents (VIAQ 303.4.1) Y Recovery Ventilation System (VIAQ 303-4.4) Check one O Whole House Ventilation Integrated O Whole House Ventilation using an inline with a Forced Air System (VIAQ 303.4.2) supply fan. VIAQ 303.4.3) Window & Door Schedule (if needed, attach an additional sheet) Manufacturer Room/location U-Factor Size QuantityTotal Windows: Square Feet Windows: Total Sq. ft. Doors: Doors: Total Sq. Ft Total window and door area Total window &door area /(divided by) total sq. ft of heated area = %of glazing Cam. o w QA N ffs�ll� r� K ctir eo.