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Date il;�,� ^I( Date By FINAL INSPECTION Water Line Date ,' �� B y x Date C By j. � � ���; Date By nr mac-_ 4 m m , s G�� - C h10-23-02- F1'?& r"Com/Ato; -691Z.FaL , Ifn)g//V i CZ rile �� fLP L)v Alef fomDZ91WrrD JAISU ik Aa A6 Ll [) 1,,t.1,14 /l4 6 I t+--- ��5� r.�r� t� / q� O - CD 0 00o R° 0 I� 0 PERMIT NO.: LDOOa�MO MASON COUNTY BUILDING PERMIT APPLICATION C�1 426 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 CONTRACTOR INFO, MATION Owner ecv-we J. ue i,V, Contractor Name w s Mailing Address ?(, v,,x 6315 Mailing Address i /o -1 ud sad City >Itie 1 4w w State_� Zip Code 'ibr53 y City_ i' State [��'t Zi' Code Phone 3( « 1/1.7-761.2 Other Ph.( ) 786-5-21 Ph.( Other Ph. Lien/Title Holder Contractor Re # Address Expiration / C :,_/ 63 t r. 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. 2 0-0 / / / 7701 Fhre District Legal Description . ro Site Address(Please include street name, street number and city) � a 1 r Directions to site C `i 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_ PERMANENT RESIDENCE 0 SEASONAL RESIDENCE❑ 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 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&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 E'ware 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 cpnformance therewith. No change shall be made without approval. first obtaining ap val. X Date X ,,.r Date F+ (c oz- FOR OFFICIAL USE BEYOND T IS POINT Accepted by� Date Submittal Amount Due], t- -Recei t oy� DEPARTMENTAL-REVIEW APPROVED::. R N1ED! CONOITl+JN CU Building Departm.e t 0-7G ;Z Occ Group (4ype Constr. C Planning Department Environmental Health Department Public Works Department I, Fire Marshal 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 CONTRACTOR I1\11�Rf 1ATION Owner Contractor Name Mailing Address Mailing Address 'f City State Zip Code City State Zip Code Phone( Other Ph.( Ph. Other Other Ph. Lien/Title Holder Contractor Ri g. # Address Expiration I SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 digit Tax Parcel No. :/ / / Fire District Legal Description Aa. Lrf Site Address(Please include street name,street number and city) Directions to site S 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 Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage C Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No.of Fixtures Fees LPG Natural Gas Heat pump Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other 4.,5' 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 b made without approval. first obtaining approval 'e K,lef )( Date' Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. fpEPAiRTMENTA fiEil[E1N 11PPf;C7V W [SENIEf3: . GOltiflt7lON: €i S Buildinq Department .--,- 17A' , ,I 31 04/ a L M Sr CT:,II , "A 98!�-8 l 340- '1 7012. v� T��. 1 `l.2oQa 1`! 7vo3U N [� Q DAY-TOM `TP iLS " so i f—..: NAME � Z4 �AtQLt n1 e- A-To►.J NORTH VlC1NITY MAP SITE ADDRESS CITE S ,. ZIP MAILING ADDRESS Q X/ 83Y - CITY ZIP SdS 8 PARCEL NUMBER 5co3o PHONE NUMBER H y.17- 701 Z W S5-/I 5 MILES FROM HILINE HOMES sa Wb 1� t4rn�•v j i 1 1 i r- i i s r i t i I . i i a c 77 K \ ' TIZA I i yid .Aw: .n