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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date by
Foundation Walls date by 'Set Up
dat@ by INSULATION date �� 3 '/r/ by,,- W�
BG/SLAB Insulation Floors Final tdate ]�
FRAMING by date by date by
Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic j
date date by
D.W.V. by WALLBOARD NAILING l i
date by date by N
Water Line FINAL INSPECTION
date by ;i date by date by
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CONCRETE MECHANICAL MOBILE HOME
Footings,-Setback date by Ribbons
date by Gas Piping date by
Foundation.Walis date by Set Up
date by INSULATION date by
Bu/SLAB Insulation Floors Final
date FRAMING by date by date by
Walls FIRE DEPT.
date by date by
date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
i date by date by
Water Line FINAL INSPECTION
'date by date by date by
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MASON COUNTY
BUILDING 111 426 W. CEDAR,
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION NOTICE
Job Location (
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: ItTs Listed below must be corrected to gain code compliance
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You are hereby notified that the above correctior s shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
F Call for re-inspection when corrections are made before continuing
❑ Make corrections, items will be checked on next inspection
❑ OK to
❑ This is not a complete inspection Department �3
Date —0c) Inspector
DO NOT REMOVE T IS TAG
Building Permit # �l�l —•- -� MASON COUNTY
BUILDING 111 426 W. CEDAR
SHELTON, WASHINGTON 98584
(360) 427-9670
CORRECTION N P TICE
Job Location
This structure has been inspected by Mason County Building Department
and the following VIOLATION of County Laws and Ordinances has been
found: Items Listed below must be corrected to gain code compliance
7 ton -tell
You are hereby notified that the above correctior s shall be made
BEFORE PROCEEDING WITH ANY FURTHER WORK
Call for re-inspection when corrections are made before continuing l
❑ Make corrections, items will be checked on next inspection
❑ OK to
❑ This is not a complete inspection Department
Date /0—/ 2- " `/�� Inspector �-
DO NOT REMOVE T IS TAG
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CONCRETE MECHANICAL MANUFACTURED HOME
o Footings 1 Setbacks Date By Ribbon
N Date By Gas Piping Date By
Foundation Walls Date B y Set-up
Date By INSULATION Date By
B G f Slab Insulation Floors Final Date By Date By Date Z 23 B/ y
FRAMING galls FIRE EPT
Date By Date By Date By
PLUMBING= Attic OTHE R
Groundwork Date By
Date By WALLBOARD NAILING
D.W.V. Date By
Date By FINAL INSPECTION
Water Line Date By
Date By r. i Date By
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PERMIT NO.: BLD
MASON COUNTY -I
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 Seattle 206 64-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner V•evA,r%svJ^J Contractor Name b(/ i ti
Mailing Address q') /Va.4 h J e s p I ac 4, Mailing Address kS 4Aovv L . .SK
City 1-Jcacaij spa 6.t State Wol Zip Code City 4/r %f'a St to cUp, Zip Code 95513
Phone(36o) $?'�•639UOther Ph.( j Ph.( �bt� )�f91—�y 7 O her Ph.L �rO� S/{�79
Lien/Title Holder Contractor Reg. # 5"J I By 6Aq
Address Expiration
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 II
PARCEL INFORMATION-12 digit Tax Parcel No. y 74 900 / 7 Fire District
Legal Description
Site Address(Please include s reet namd, street number an ci y)
Directions to site *+•
Will timber be cut and sold in parcel preparation? (Yes &0
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 Add Alt Repair Other Use of Building
Describe Work
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detach
MOBILE HOME INFORMATION-MakeCelpfri t4ejr Model DK S184G I r= od I Year 2.oazi
Length Width�_Serial No. w -1 7 p(o No. of Bedrooms No. of Bathrooms
Type of Heat_F Purchase PriceLE30ertification
°= Replacemen Uni ?(Yes/No) o%lo
Installer Name No. s i
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-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 ail work will be done in requirements regulating the work foi 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
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by -� l Date Submittal Amount Due Receipt No. .,:
I7 PARTMIENTAI» F�E+VI'EW A VED:: ENI IJ' CD DITJON CC1
Building Department ;t' :✓ / 0`! _ /
Occ Group Type Constr. ° l
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
......................................................
.......... .............. ..... .._ .. _ ........... ............ .. .... .... ..... ............ ...... ......- .........
FEES > . ;::
.. _. ..
Building Permit Fee
i ✓
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 ( / b )
.....................
.....:;...... TOTAL FEES
...,r•...::..::.:.........:.:......::,.
MASON COUNTY PROJECT SITE INFORMATION,
Case No.
Name PARCEL NUMBER Date
SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicati ng IN, S, E, W in relation to the
site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography
Well Location (including adjacent) Drainage Plan
Names of Streets Easements
Names of Fronting Streets Septic System
DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line.
adjacent property line- I I <-adjacent property line
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adjacent property line-> 1 I E-adjacent property line
SAMPLE SITE PLAN
adja�nt property lined 3to� _ _ _ _ E-adjacent property line
I D 30' rR-`-S_RvE 3 1
SEACO_Al_ I a _�PTZG._._,�
CRCF K I HOM t I
1 � � .Gnaen.i
1 F �. I HcusE
1 � � PrioPasEn s¢pt:c I
( 1 �
VACANT i 1 C A'rt AGE
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adjacent property line-� E-adjacent ro ert�line
TOPOGRAPHY PROFILE(Show aside view of property. Show slopes, cuts and fills. If possible include height and the
degree of slopes. See sample topography profile.)
SAMPLE TOPOGRAPH PROFILE
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Signature Date
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Home b : 1c s morulwobi IN .
671E Martin Way E Sum C*Laoey,Wa98516
phone( 491-5467 Fax(360)491-2670
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