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Z e+ ...........g,....7.:, = 1 I I 1 1 CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping date by Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING FIRE DEPT. Walls date by date by date by PLUMBING OTHER Groundwork Attic date by date by I D.W.V. WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by 1 I I 1 _. z PERMIT NO.: BLD 60,01 146 MASON COUNTY 1 0' ),9�, 3 BUILD! G PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton(360)427-9670 Bielfair(360)275-4467 Elma(360)482-5269 Seattle(206)464-6968 AFPLICANLT.. INFORMATION CONTRACTOR INFORMATION Owner Jo IN s,tr�"'�'ta,er 1 A,t c_ Contractor Name ,54A ✓ at,/iiF,�cS Mailing Address irCpa p•/c•G�' CT: So Mailing Address ,pOo S la KISF.y G"r" 56./ City ieG a..Ki-c,r'� State _.,A Zip Code 94-5gt City `. State * /Lip Code ?kc> 7 Phone(cj a,✓De41-I-Sl1r7-. Other Ph.(q `5)(4 ►`1-g."-.75-; Ph.( ,gcd 53 yt Other Ph.( ) Lien/Title Holder Contractor Reg. # Address Expiration '' / r / F 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 PARCEL INFORMATION-12 digit Tax Parcel No. a. ""` ,r) / .j 0/ 0 0 c 95x- ' Fire District ,� Legal Description Pare-may TG,•,0 6c.i 95 �j Site Address(Please include street name, street^n�u,mber and city) 4?Z 0)0 ,i/ /0/ ✓ 7 47`C6� Directions to site 1/ /U/ Al i /17`LAA'4 )j2t,U ,,,4, 04 ,' ,R/F,� S - Will timber be cut and sold in parcel preparaton? (Yes/No) t �, Is your property within 200' of the following: Body of Water (Name) / )'- / CG--+--7�..-_A Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New • Add Alt Repair Other Use of Building Describe Work No. of Bedrooms No. of Bathrooms SQUOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement C Dec 3S/ Other sq. ft. 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 Pr•ce $ 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 recuirements 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 / 2 FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due '� °"f`''. / Receipt No. // DEPARTMENTAL REVIEW A.'PROVED DENIED CONDITION CORES Building Department q-,cam Occ Group, U/ Type Constr. SA/ Planning Department Environmental Health Department I Public Works Department I Fire Marshal Valuation $ FEES. .>: Building Permit Fee y)-7 . 25'• Site Inspection Plan Review Fee k, UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other 5; 2, - � 71 Violation Fee Pre-Paid at Sub I al ( -�v ) :::;. ;:•••;i?;s:::,rt iiii:::'•::3:: `iimiii....iiim..:. TOT FEES l / � � REGISTERED AS PROVIDED BY LAW AS CONST CONT GENERAL REGIST. # EXP. DATE CC01 SALISB*011JG 09/05/1999 EFFECTIVE DATE 04/07/1999 SALISHAN BUILDERS 20025 JOWSEY CT SW ROCHESTER WA 98579 Signature Issued by EPARTMEN OF LABOR AND INDUSTRIES 03/16/99 MON 10:33 FAX 360427779El MASON COUNTY BLD 3 "" ' F5RM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION d��00 4. r/O/ J)o.IL Case No. Name . pf h N,v SP6/c"R ld 1 PARCEL NUMBER,d2D3 60 0001.6 Date 3 /i .99 SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E. W in relation to the site plan w Lot Dimensions Fences Existing Structures [Iriveways)< Structure Setbacks X Shorelines A Water Lines X Topography ,, (, Well Location (including adjacent))(' Drainage Plan Names of Streets Easements Natrley of Fro Ung 8trocts X 8 ptia 8ystortl x i' DRAW SITE PLAN BELOW(include adji rflp,updrtieS itu,r sliUleline or within 100 feel of ddjaeenl p,uperty line.) adjacent property 11ne--> l I A ; -adjacent property line - I 1 iII-,. 1 ,Jrt\c------ -5 ` I 1 Juk.u1 a adjacent property line 51,.-JLt. i -adjacent property line w /0y' TOPOGRAPHY PROFILE(Show a stria vita 4f property. Show sinpe.. cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dt sta.+ca - �—018 ---�°• sr.uyt r� /..\\. i.... drs�ta►,cc t•o ? 5fapct Yo¢ 40p c- . � —�41& /6-9s Sig lure / • Date — 1 5(-7,V1'7 {.7 Ak j _ �° . Llq s 1 L-r5 N 5 o r Foo 1 L bC-C k. 0- sr‘e 1)14k,A7 l`' •°l axe A-sr C� 0 - r • to. 0 buil 3a ell a 1 \IYf° A -3S A !% \ '�' S.Ah 5fp� 'I) __ T r ......_ Erj (t) k 3s-a 37:--L . . N L 1 (;1-, - 4' P.A 0.-k ic J` cl X `T-4-£4 7T ,Z Z4 vvc L r ✓� 1 C aZ.°912 >c 5/ Zack"1 3(0 w w ............_, 1 -'' -16.3,.-5.t.._ X• Y5,-( { {--. fix-k,nJc 'AooiL i %,' u 43 ce /( .2.,,4,.- ,s-T , ( - .' . ' . 7 26 c (.....21..42 Ack Lt,t,z_ ‘ `" ( Ir j s` . L. l FROM : SALISHAN EUILUERSR FAX NO. : 368-273-3418 Oct. 18 1999 89:26AM P2 r r.. 306 ,D-„an'I„' 31M ES—Ta d Q 1 d° ?1 CO S+- T,a „a'1` Z V w �0/3' E, .001.93A 311L11 9141IF•w t0 . i`6, 4 di-I u ii\ Zn:1 -'1'4k----- .....---=------- e ; i> , 2.: - N 11 _\ _ ;' i) ,— -.1..r . *. r5. 2, 1 •=a4 ks. ! 4., P) ' CUN) • .,-,‘'iz,- )-.1 faN 1 i r .... 3 1,. r, , �' k c i 'vy t _ - --, , IIM: ..., ' 5 tn. c12, ! k. _, Q 91 tore � 6 • . i ,-.,rri �rI.';1 ' ..11 I 4 N' i '1 • • ii"g1 16. N 14" . [ 1 - 8 S i . 'fr.? • — m . 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