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O- O o 3 S 3 CD CD �. = cn= A CD N CD C° m 3 - m CD O CD g CD CD - CD 0 CD MASON COUNTY PERMIT NO. — BUILDING PERMIT APPLICATION C0538 426 W. Cedar • P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair(360) 275-4467 • Elma (360) 482-5269 On the Web www.co.mason.v a.us APPLICANT INFORM =07-,yy'V, I CONTR CTOR INFORMATION Owner � � X'. WAL.S'"r 9 Contrac or Name [7 w Mailing Address r/`f/7R V ST. MailingA dress CitysN,eirVAI State OR Zip Code 9PJW City State Zip Code Phone ( )43,7-,%/9'Other Ph. ( ) Phone ( ) Other Ph. ( ) Lien/Title Holder T ",n t, ,,, ji",: Contrac r Reg. # Exp. Email Address_ 91'4: �:flVa nw, t Email Address SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic *Existing Septic Connect to Sewer System Name of Sewer System P mKrjT# 003 "ply/S-7 Well Water System Name of Water System LII R fvB4DLAAI D PARCEL INFORMATION - I�digit Tax Parcel No.YZ0/Z /XL 000/!4 Fire District Legal Description ',J Q A N b M#AtVR rR i Site Address (Please include street name, street number and city) Directions to site /NC A i 6" rtlTR T Q o Will timber be cut and sold in parcel preparation? (Yes/No) /V Is property located within 200' of saltwater Lake River Creek Pond Wetland Seasonal Runoff Stream Slopes orl,Bluffs PERMANENT RESIDENCE ❑ SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt Repair Other Use of Building Is this permit submittal the result ol a St p Work Notice, Correction Notice or other enforcement action? (Yes/Noy AE Describe Work -) No. of Bedrooms No. of Bathrooms SQUARE FOOTA E - 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make A => " Model 1zr Model Year i Length Width Serial No. /O No. o Bedrooms No. of Bathrooms Type of Heat .,JA%rchase Price$ Z2 147 7,00 Replacement Unit? (Yes/No) Installer Name ►c - " ► 0 19%E L, Certfication No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCI ION 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 Y MEANS OF A PROGRESS INSPECTION. THE OWNER OR AGENT ON OWNER'S BEHALF, REPRESENTS THAT THE INFO MATION PROVIDED IS ACCURATE AND GRANTS EMPLOYEES OF Mason COUNTY ACCESS TO THE ABOVE DESCRIBED P OPERTY AND STRUCTURES FOR REVIEW AND INSPECTION OF THIS PROJECT. OWNER/BUILDER ACKNOWLEDGES SU MISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLE GEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is iSSL ed and all work shall be done in conformance there- shall be made without first obtaining approval. with. No changes shall be made without first obtaining approval. Aj X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Planning Pd 'Ck# Date Bld Pd. Reciept No. DEPARTMENTAL REVIEW APP,MQYE© DENIED' Ct4NITIC?"N"CC►IC?E Building D ent Occ Grou e Constr. JG —1 Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee EH Revie Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid a Submittal ( ) TOTAL FEES 2O_IN --.-_---I-tf•Xi.i--I_----•�-!!-_L;IT.i�--Q CH SLB �I L_-�PJECTTO it 4-1 1 L i ri - Ld' I I-I I I _j�-�JI-I�•f-t!-:�, -- III I i _ I , r CD o CONCRETE MECHANICAL MANUFACTURED HOME wo Footings / Setbacks Date B y Ribbons 0 M Date By Gas Piping Date ` J2 03 B w co Foundation Walls Date B y Set-up Date By INSULATION Date t �` g f y B G I Slab Insulation Floors Final D ate B y Date B y Date B y FRAMING Walls FIRE DEPT Date By Date By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILI G D.W.V. Date By Date By FINAL INSPE Water Line Date W1743 g 31 Date By � Date By zr a / CD F e Qa � CD v Er 8 Q o Cn 0 d r CD o y o � w � o w � 0 0 o o • CD O c N N CD ...■ o. ONECL NINE O CD T. �lJ111 ca 3 \\■l N , CL � I CD N O _ 0 I■■■�� o \ ./��i■■■l�� 0 _ ■■■■■■■■r- o Ir��7 I■■■■■ ■■ 1■■■■■ ■■ I w Lq � '�iiiiili■■��" 1 - o, x o d. CD • ( ' - O .o CD Uk CL fD X .� C O _ CD 9 CL o co