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WALLBOARD NAILING date by date by Water Line FINAL INSPECTION date by date by date by rrysp�'e770 47TWehfo d ew Jl 91 r rExterior NCRETE MECHANICAL MANUFACTURED HOME W o bite B � o ings d Setbacks C#�ts Piping Ribbons C o or Date By interior-Date Bar Date By Fn w Date By Exterior-Rate By ra tip M Point Load r Isolated Footings INSULATION late sy BG!SLAB INSULATION Crate By Date By FIRE DEPARTMENT in Foundation Walls Floors Date By Crate By, bate By DECKS F RAWI Nd Wars Date B Date By bate By PROPANE TANKS Vault Dutc E3y PLUMBING Data By OTHER Groundwork Attie Bete By Type. Date By Date By D..w.rr DRYWALL Type: Int Brace Mali pate By W Date By Date By FINAL INSPECTION 0 (D Water Line Firs Sepe ration C Data by Date By Date � is /b By L.n07 p o ` Pass or Request Inspect. c 3 Type of Inset. Pail Date Date Dune By _ Comments 0 00 0 O0 ! l n W 0 PERMIT NO.: BLDV%_any ) MASON COUNTY 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 206 464-6968 APPLICANT INFORMATION I CONTRACTOR INFORMATION Owner A ,6 Bou V1 e r Contractor Name dli .e •�r+ce NW Mailing Address .,306 P+.v%- eo-e3 Wgt Mailing Address 8705 #,aw 6y, Ljr V& City ',rJ7Ae/to.0 State,GUa Zip Code City Cfiy� lea State fiJC Zip Code s r Phone(3&) 8Wo-(PTffOtherPh.( ) Ph.(b) S/9� i5-1%7 OtherPh.0 Lien/Title Holder Contractor Reg. # HOrwti ES 7( / O YO PY Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic X Existing Septic Connect to Sewer System Name of Sewer System WeII__)(__Water System Name of Water System -1 —L" PARCEL INFORMATION-12 digit Tax Parcel No. -7$" / QT Fire District Legal Description Site Address(Please include street name, street number and city) . e ♦,es KJ: Directions to site �.� ;> ; a m - �� o. ?� o-� -t p 5".t" 4 Will timber be cut and sold in parcel preparation? (Yes/No) 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 Detached MOBILE HOME INFORMATION-Make 6o/ rdt,0te(.T Model C*WGO'L.F Model Year 1999 Length�Width 2-7 Serial No. wO�E+73�✓ GZI No. of Bedrooms %7 No. of Bathrooms 2. Type of Heat Purchase Price $ ys980�- Replacement,Unit ?(Ye Al' Installer Name ,f e S+✓vr a�e Al� Imc Certification No. WA wS 1($3'e��"-0 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. first obtaining a royal. X Date X Date /A FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. D .ARTMENTAI" RaV p'�Ni�t2 Cf3NpIT1fJRi CC?pE Building Department /'16". t 1S a Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department i Fire Marshal Valuation $ Building Permit Fee UC, Site Inspection 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 ( ) 'f.::.':. . TOTAL FEES �L i yN >� A �ZN m2 K N1 ' O < N �O D o 0 < < L � Oor wnaa Q LOGa�iOn I WA.)b I F �U p at Cu m - F• O I CD 'I mow) I ° o D ; Ci) Itj acmxsr °'*-' '----- c W So ---Emere^fnxoen( S I C ter m o — �j mCD y� ter . m o > > OD r tD` rj i Z ------------�- Z o f. z3. < 0 y Q OD Co O i - m �- T Co F m Co --a--i. 0 OW—A— Opp WA.7a WA-IS C�^\ Locatoo. Location `\V J OD �(+ C � O I t j N ° p C:) A i ? Dc, D m 0 T N Fr c� +' z Z," TTI {� I m -n I Nft- .;:�JIL m � N aA-) 3 rv � �� mJ> Ill in ��) o d I _- UT o O DOU \ n z r m > 0 _-- > D p Z Ul z � rn y M � o rnx1 � D �� � o Q rn 2 -r- a + vo N r r T- z F Z -� � — U) ^ Q r z rvul - r-- p O -iDzr rD-mr L z p p � I �A �,� rn Mason county o z r APPROVED O Xr T -( M X -Z-I Y r, su - �,, f%v e� ' / `� to in' ' L 0 q O > -�I i -1 r o os N Q C' m !tom— —T--, Ln o UJ f11 3 )J to N V n I D �-- - 3 Z a � j QN D � Oz z � , 3 y a U' F r r o00 0 to n (5\ �n o Iv _ X `� �iG .rn Return Document To: Mason County Department of Community Development/Building Division Attn: Debbera Coker PO Box 186, Shelton,WA 98584 Addendum to Certificate of Non-Conforming Development Taxpayer: VANDERBUILT MORTGAGE AND FINANCE Owner at time of violation: ELLIs B BOUVIER Site Address: 306 W Pine Acres Way, Shelton Legal Description: TR 6-C of Survey 13/188 TR 3 of SP#2244 Parcel No.: 42002-75-90063 The recording of this document amends and releases AF#1933907 regarding the lack of a final occupancy inspection of the manufactured home and required landings located on the parcel identified above. A final occupancy inspection was performed and approved by the Mason County Building Department on July 8, 2010. The manufactured home is approved for occupancy as intended. ;eraiCoker ths 13th day of July 2010. Building Inspector/Code Enforcement I certify that I know or have satisfactory evidence that Debbera Coker is the person who appeared before me, and said person acknowledged that she signed this instrument and acknowledged it to be her free and voluntary act for the uses and purposes therein mentioned in this instrument. Given under my hand and official seal this 13th day of July 2010 NOTARY PUBLIC State of Washington KATHL.EEN SOINE Commisslon Expires AUGUST 22,2010 NO-UBLIC m and foie State of Washington, residing at Shelton . My term expires ��; f�