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CD 0 v � 0 O a R- R 0. N CT c CD -con O CD CD O- CS (D C_ Cl Q. O O ((DD _ ooff. cr a O O O w a � 7 O �- (1 PL Cn l� v O Cv CD Cv O O un, fl m , r CONCRETE MECHANICAL MANUFACTURED HOME N rr o Footings / Setbacks Date 6 By ;2 � Ribbons 0 w Date By Gas Piping Date By (o Foundation Walls Date B y Set-up Date By INSULATION Date By B G / Slab Insulation Floors Final Date By Date JW3 BX,Z/� Date By FRAMING Walls FIRE DEPT Date B jM Date t OL`03 B j Q/V Date By PLUMBING Attic OTHER Groundwork Date Y Date By WALLBOA D NAILING D.W.V. Date Date -51/1103 B g/ FINAL INSPECTION Water Line Date B y - D ate tj 11 ((? _ Date y _.. m 00 KIP 94- rA i f, A � ;nit;( N'- aYJ n S 7 a3 � co Lj d3 5 s.lA - i h cisr.�r./ )(C �� t / !£ �E-Fr A L 1�5 E SAC 7 r Z b'� 7 L Ll oCn d r - oN CD o � o tJ _ o y w C ao for 6Q 1 e 'a L� 0000 \ � CA, ® = test V)o� 0 _ �ho I �� I ®A-3 Id � I � r � '� QroQGSect y � c. \ r t O �3 uC i` PERMIT NO.: BLD 2�I 1 J�/ MASON COUNTY BUILDING PERMIT APPLICATION r 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 0 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner I Contractor Name L tck /dC' 0 Mailing Address Mailing Address { _k e'P-rP-04 Dl- City State 4k Zip C deqlBISS City n State °J A Zip Code 8 F Phone( ) Other Ph. 3G y0- 08 Ph.( Other Ph.(� 0 Lien/Title Holder Contractor Reg. # irc e'l w-- t 03SDr- Address Expiration / 01P / 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. /' Q Fire District Legal Description Site Address(Pleas include sjrept name treet number and city) c4.V r-tori Directions to site-A.4jA V 161 N 4 Sry r {--- i t Will timber be cut and sold in parcel prep ration? (Yes/No) Is your property within 200' of the following: Body of Water (Name) 4 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 t>v P% Describe Work No. of Bedrooms No. of Bathrooms t SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck 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 Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL 8.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 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 con forma nce_therewitIn. No changes shall be made without approval. first obt�irti g approval. f4��t X Date X Y _Date��/Q < F —� FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date/—/ - i' Submittal Amount Due Receipt No.F D PARTMENTAI» R VI W AP'I'RQVED -ENIEIJ CONDITIc N CQ17 8 Building De ment 51,V11, reY���'S 4 i� 2x�, ,tJ 77 cV e� Occ Grou U/ Type Constr. V[�- G2LLU Planning Department G,C Environmental Health Department a301 Public Works Department Fire Marshal Valuation $ V� �� ��� ✓I—� FEES Building Permit Fee Site Inspection Plan Review Fee ® EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee 0; - S Other Wood/Gas/Pellet Stove Fee � nle State Fee Violation Fee Pre-Paid at Submittal ( E�9 ) TOTAL FEES PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL 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 206 464-6968 APPLICANT INFORMATION s CONTF ACTOR INFORMATION rn / r,.,����-7 WeOwner - Contra or Name i f MailingAdd ss t` MailingAddress City ,,1 . State Zip Code City /'` State t Zip Code Phone( ) 113 Other Ph.( Ph. 4 OtWr Ph�C Lien/Title Holder Contractor Reg. # WC I Address H Expiration / / 01A%_ SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit TaX Parcel No. c.. . Fire District Legal Description /__L- Site Address(Please include street name, street number and city) ��V 0 Directions to site I I U f g: �©j i Qu � A! M Is your property within 200' of the following: Body of Water(Name) A 0 Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No. of Units Fees Bath Basins Furnace u>• Bath Tubs Heatpumps Showers Vent Fans IN rp Water Heater Propane Tank Laundry Wsher Gas ZG4/ ellet s Sinks Wo Stove Dishwasher Direct Vent? es-N14-t-6 S OtherL4itA.6';nK _ Oth r EXti• ! z Other 13r �_ Oth r .k er► ewo­ A_ Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 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. fiX obtaining approvalW � X Date61 Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. . ...:.::. ..:.:. ..... .... . DEPi#RTMEIdT/ i1^VtEyv:.. .. ::°'.:i1PPRf7VED pEPflEt3. GO...... :4TA1 CORI S :>:::: Building Department Occ Group Type Constr. Planning Department Other Other :.::.::.......;:.;:.;:.;:.;:.;:.::.::. Permit Fee Site Inspection Plan Review Fee LIFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES