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CD ] CD / (D cr � _ \ \ % \ § (D2 ) -k2 © m 2 § Ea = - j § 0- cn m k s g \ / 2 $ mcn \ (a � \ / J § E & ¢ §' = e } < mc ° & (n § i \ j / 222 (De � 00 \ § f \ j 2 ] )/ kk . moo . 22 % § o �' e CD 2 / /\ -9 G0 3 / . - CD 57 = = En@ # m & ® \\ t / A -0 ° - \ ° S / / � R / \ » o $ CD ¥. \ ] 1 2 \ ` CD ) CD CD7 ® e' / / \ 2 / /% \ CD 00 k �w \ C � / k. � _0 _ CD 2 = m = & / CD C = m =0 Pm _ k CD k . CD q \ $ 33E k (D ] S - 5k fk \ o /§ - _ - -� o \ \ \ CD CD \ D0 cn 0 a a co: � \ / \ E / / s _ \ 7 \ E m § m * R2 / 2\ f 2 \ -. < -. / E \ \ j R E k n. \ . / / } / m 7 E $ / ± ee co _ :3 cn / ƒ ) CD 7 0 = o « % a CD \ kf Cd / ƒ \ \ D 0 x CDe C) 0 _ o \ } a a w \ _ \ 7f \ \ a CD ). o % n0 / / E; — MASON COUNTY PERMIT No. BUILDING PERMIT APPLICATION 486 W. Cedar•P.O.Box 186, Shelton,WA 88584 N C�#�.,'BSI#�l� ��� n a web www.co.mason.wa.usr AFFL!<P.TINFQRMATI.4 N, EQI TRA,CCTQRIJKFQEtI!tEATtQt�. Owner h rq �= r l"ter- Company Name. , ivldNir� tti if`d -7 Ma11i, 'AA, City r4,c,r -dy State Lila Zip Code City State �p Zip Code .F hUftul it�G--1? �L�-4trfdr lift Rhon@ t�th9r Ph. Lien/Tiitle Holder Contractor Reg.# Eyp, E ril, l5 , E Mail Address Drivers Lie.# DOB Drivers Lic.#ZMALE"j � DOg ..+.r...»� rr r...+...r r.'...r..r�r ♦r-.f.r.1�� ..ter,r<�r 49AT-IC•�VIfAM I"VrT- fffW ORMATION -Connect to New Septic Existing Septic.& Connect to Water System Name of Water System V1/e.11 Water System T Name of•Water System PARCEL INFORMATION- 12 Digit Parcel No Fire District Legal Description Site Address(Please include street name,street number and city - 'Directions to site Will timber be eut•and•s©ld-in parcel-preparation 'Yes/•No Is property within 200'of Saltwater Lake River/Creek Pond SIiI'drl#,-�fiddtll fiill3##: StYFikRI SIiS {`E3111ff > 15:°ta is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y TYPE'OF-JOB; ew Add AIt Repajr2L Other PR1MAAY F3F..S1bEN0E 0' SEASONAL [� Use of Building c✓►� Ot Describe Work - No.of Bedrooms No.of Bathrooms Square Footage-1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached Detached Carport Attached,�Detached MAN111=AGQM 1QMAT1t<?N'- (Ike i :4Oe1 Ysar Length Width Serial No. No.of Bedrooms No. of Bathrooms Type of HeO pwohtee Frl�ce S F(QR gM!eRJ VR,lt.? Yes'/No Installer Name Certification No. 4ViJ.BlJiL{?l #Iit7 ;:� tiI11 tf Irfsrtd idfsifiridtlti' y:tJittJh ;tp. drdr.#r# IriirCtrudd,,�'?rieldstrtterit Jyf such is by signature below.I dReclare that 1 am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this re red rof tm any cease t hald� any otherpft l�a y4n lnteres atilOat 1 this i1W th@ PQ(M.iSiQR frQM W1#1Q 0QQQ -r)(pwti�:1f RQmli�iQQ is rmred f from them to ►g application ar the work sed-in the application I-haVe obtained .­ I apply for this permit and conduct the work proposed. The owner or agent on one behalf,represents that the information ROOF OAowCONTINUATION F WORK IS BY MEd S O,c Wow A PROGRESS INSPECTION. p 440,4tutum 'r ieyr at�dlrlspaetiptt:, Owner/Owners Representative/Contractor indicate which one #09 O`i=FtWAL U-SE 9EYONE THIS•POINT Accepted by: fate DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department PJ;3�i111t�;R.QI�rIKt1.9'tit. Environmental Health Department Public Works Department Firs~Marshal FEES Diilisifri POMIt F &. Sits lfi; dtltfri Plan Review Fee EH Review Fee Plumbing&Base Fee 'Plannin Review-Fee Mch;3nical$�laq$q fee th r Wood/Gas/Pellet Stove Fee State Fee olation• ee. Ire-P1 id.at 3ubmittaf Valuation$ TOTAL FEES