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O o`<< = CL O = O O 0 O p N (n O Q_ 0 7 o0 CD (D (D "` � = w ai o (D Cm �. � C c < (D « u) (D 0 m CD CD80 o cn D 3 o � O O' �; O zr D o � in- co o CONCRETE MECHANICAL MAN'UFACT'UREO HOMEc o ____mm Date D Footings d Setbacks � Ribbons � Gas Piping C) Intenor Date By Interior-Date By Date By D Exter x Date K5 r°,�r 0-7 By LrJI Exterior-Gate B _ Setup130 Point Load r Isolated Footing INSULATI(7N Date By m BG 1 SLAB INSULATION Date By Date By FIDE DEPARTMENT � Foundation Watts Floors Date By m Date By Data By DECKS m FRAMING Walls Date By C1 to By )L� Data By PROPANE TANKS PLUMBING Vault Date: By Date By OTHER Groundwork Attie Type- Data By Date gy Dates By DRYWALL type: Date Int Brace Wall Date �y W �` Date ey FINAL INSPECTI m Water Lime Fire Separation CD Date By Date By Date IZ N(n By Lzc_ V CD Pass Or Request Inspect, � 3 Type of Insp. Fail Date Date Dane By Commept; o c- o <� a _ ✓1vAZ r2 +� ���e.^ �`rc.( s 0 8 o iz Ni1 Z li,, ncn 0 s a 0 MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Sheltor, WA98584 UCIA Shelton 360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 �� On the web www.co.mason.4.us rn APPLICANT INFORMATION CONTRACT R INFORMATION Owner try At?I'I O'Civ Company Ne me r/rf OKA LAN 47-16 S Mailing Address ! 0 Ly2<k-1X4,t117 DR. Mailing Addr s P0 0 City 5W-04To u State Zip Code ° 919 N City TENt State tc.r1 ip Code 99489 Phone360- 1/27- /Yo2 Other Ph. Phone 0- O-S"Y Vd Other Ph. Lien/Title Holder L. Contractor R g. #T/MBIEG L 9S7LZ xp.19' 9 — cs? E mail address �r'T.' fRo . �o E Mail Addre s w �.�+ reitcery c.fn Drivers Lic.#Lu A DOB 41-- V — L Drivers Lic.4 D B SEPTIC /WATER SYSTEM M FORMATION - Connect to New Septic o Existing Septic Connect to Water System A10 Name of Water System Well Sewer Systero Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include stre t name, street number and city) / wE w 2 ocl 1#1,vP DR S004 Div Wd Directions to site © O L Will timber be cut and sold in parcel preparation?Yes o Is property within 200'of Saltwater _ /o Lake River/Creek Pond__L_�j Wetland Na Seasonal Runoff rvc Stream Ale Slopes or BI s 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE Q-§EASONAL ❑ Use of Building Describe Work No. of Bedrooms No. of Bathrooms D Square Footage- 1 st F Ioor 6 7.2_ 2nd Floor 3rd Floor �; Basement Deck Covered Deck Other q. ft. Garage V'' Attached Detached "'" Carport Attached etached MANUFACTURED HOME INFORMATION - Make Model —Year— Length—Width Serial No. No. of E edrooms No. of Bathrooms Type of Heat Purchase Price $ Repl acement Unit? Yes/ No Installer Name Ce ification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in 3 stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or the contractor. I further declare that I am entitled to receive this permit and to do the work as proposed in the applicatio . I declare that I have obtained the permission from all the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained permission from them to apply for this perrr it and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becc mes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 80 DAYS WILL INVALIDATE HEAPPLICATION. X r Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accep d byL Date DEPARTMENTAL REVIEW ARPRO DENIED NOTES Building Department r— '% 2c O Planning Department Environmental Health Department Fire Marshal I f1'1 FEES Building Permit Fee 3 Site Inspection Plan Review Fee W-91 b1 EH Review Fee Plumbing & Base Fee Planninq R view Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid a :Submittal Q �� Valuation $ �7k70`7 TOTAL FE S Request To Revise An Approved Plan Permit Number: BLD200 Name S a.r Parcel Number Phone Nu ber daytime (_3t0D ) 2-7 I y d a Project Address Mailing A dress d L&nA C I I 1� Please provide a complete, detailed description of the proposed revisions to the approved plans: Are two sets of the revise plans or addendum indicating the chan 2es included? ❑ Yes ❑ No Are the approved site plans included? ❑ Yes ❑ No Are the revisions clearly and accurately identified on the plans or dendum? ❑ Yes ❑ No Does the plan contain an engineer's or architect's lateral or vertic 1 analysis? ❑ Yes ❑ No If Yes, Has the engineer or architect approved this revisio ? ❑ Yes ElNo Is a stamped and signed approval included with this reques ❑ Yes ❑ No Note:No structural changes to a"designed"plan will be a roved without the writ en consent of the engineer and/o architect of record. Does the proposed revisio modify the footprint or location of the tructure? Yes ❑ No If Yes, Is a revise site plan, with all new setback dimensions included with this rec uest? Yes ❑ No Additional Information: Applicant's signature Date: i Office Use Only Received by: Date Sent Assigned To Approved By Date Original Valuation: $ ❑ B. Additional Valuation $ ❑ P. D t� Sq.Ft. x$ $ Sq.Ft. x$ $ Total New Valuati $ Addition i Fees: ❑ P'W' Add t'onal Planning Dept. $ Add t onal Plan Review $ Additional Conditions /Comments: Add t onal Building Permit_ Add tonal Plumbing t Add 4onal Mechanical $ Addi 4onal E.H. Dept. $ Othe $ Total A ount Due: $ l/ `� Amount Be Paid Up-Front$ i r k f s. f i. 4 ate`$ 6,apt} .: P a � t i PPROVED I MASON C 'iUNTY DCD PLANNING k _,.�.... .,. SITE PLAN REgUIRED TO BE ON SITE CHANGESUBJECT TO APPROVAL: By — Date ="A PRO MASON CO, IT 'j LANNING SITE "t.r^ '` , To E ON SITE CHAN,,. 8 u U TO PROV'AL t f / 1 PLA PLOT REVISI DATE PLANNING FING z � ��r=� �� Al"? f PLANNING: � � ; °iE f, �,! ,� ALL SETBACKS REMEASURED HE M` FROM TH4 FURTHEST PROJECTION OF THE BUILDING