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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 PACIFIC COAST INVESTMENT COMPANY Company Name Mailing Address 700 FIFT — 6010 Mailing Address I City SEATTLE Stato WA Zip Code 92104 City State Zip Code Phone 78 800-562-62 Other Ph, Phone Other Ph. Lien/TitleH^Ider PACIFIC COAST TNVFSTMFNT COMPANY Contractor Reg.# Exp. E mail addressi E Mail Address Driver's Lic. DOB Drivers Lic_# DOB SEPTIC /AMATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Conned to Water System Name of Water System ,t^lell r System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. - ,mil Fire District Legal Description UNION BAY HOT TUB CABINS - 6730 EAST H I GHWAY 106 Site Address fi lease include street name, street number and city) ROOF REPAIR - 3 CABINS Directions to si)e Will timber be out and sold in parcel preparation?Yes / No Is property within 200'of Saltwater Lake River/ Creek Pond Wetland. i Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement act! p µa.r7 TYPE OF JPI3 - New Add Alt__._ Repairs.Other PRIMARY RESIDENCE [:] -SEASONAL © Y' Use of Building Describe Work ROOF PFPATPNo. of Bedrooms No. of Bathrooms Square Footage- 1st Floor _2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage_I— Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length ! Width Serial No. No.of Bedrooms No. of Bathrooms Type of Heat i — Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. UNNER/SUIL>J1ER Acknowledges submission of inaccurate information may result in a stop work order o r f A.;Imowledgement of such is by signature below.I declare that 1 am the owner,owners legal represerrta declare that I ark entitled to receive this permit and to do the work as proposed in the application.I deci I ve sion from all the'neces ary parties.If permission is required from any, easement holder or any other pa i re �Inng - tion nrthe f ferk ropo ed in the application, I have obtained permission from them to apply for this per con rrrplQ RAYMUNDO SALGAD0 Date_ 2/18/04 o X—�--- - ASS/,eTA �wn n 0 resentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by:_ Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW AefaOVED DENIED NOTES Building Department N 10 Q. Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Buildin Permit Fee -TI Site Inspection Plan Review Gee EH Review Fee Planning Review Fee Plumbingix Base Fee Mechanical :4I6ase fee Other Wood / Gas I;pellet Stove Fee State Fee 4IS0 ,Violation Fee Pre-Paid at Submittal