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N C CCD I W p O CD o S° rD m < r► o p oo � �7p � 0 o � .Zv3 � � o co a v CD � o Z m0 my w0CCDD ' X•v r, O < Cn � � •o3 - mcDo =r CD r C) a �, CCDD -. 3 0 10 m 0 � � 3 0 (DNoD < o a mCD 0o y o ZZ - o o v m� � cl a CL X � mn BCD m CCD Ov K o o m �-0 m (n -o m S° a (n -0 CD zm -1r D -. n n0 CD- D � K mo �' � `< < CD po < m Q < D 3 a� p o m CD v -.w C1 Zp moo m CD o ti '-i �O v O a - ? CD mw vZ QaN m O n o 06 oa 3 � a o CD o m CD CD CD �, o 0a -' CD CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by - J1 Ribbons date �''/c` by j Gas piping date b I Foundation Walls date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date /2,—/y_Z(X-0 by , �' date `L t/21-)cV by,,WAF--- date by PLUMBING Attic OTHER Groundwork date b date by D.W.V. WALLBOARD NAILIN date f Z I y`�� (� by dater t by Water Line FINAL INSPECTION date -/41 Zr�L�(,) by date _�GJ_2C 1 by date by I /6-/0- Zwvo fico; f R55 19, ` a o2bbl17ME. 9,*S . M . 2 Ok F02 qo ©ay -F.LM t?DRARV CPU QAAICV 12 PERMIT NO.: BLD l "J \ \✓1 - i MASON COUNTY (, BUILDING PERMIT APPLICATION 019-7 426 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 INFORMATION Owner + iy �'� Contractor Name Mailing Address } .)+ Mailing Address City State Zip Code City State Zip Code Phone( ) Other Ph.( ) Ph.( Other Ph.( Lien/Title Holder Z Contractor Reg. # Address Expiration 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 i PARCEL INFORMATION-12 digit Tax Parcel No. -" / YY /Qu i Fire District Legal Description t Z> Wit)& lAt 2 Site Address(Plea e include street name, street number and city) '. Directions to site fi 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 y 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-1 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 approval. X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No., DEPARTMENTAV RRVIEV APPROVED DENIED CONDITION C DRS Building Department Occ Group Q3 Type Constr. p Planning Department Environmental Health Department 1 Public Works Department j Fire Marshal Valuation $ ota 3= log FI*S Building Permit Fee (3 y+ ?S Site Inspection Plan Review Fee r5��'3 `�9 UFC Plan Review Fee Plumbing & Base Fee C��c oQ Public Works Review Fee Mechanical & Base Fee +Q� Other 5-- Wood/Gas/Pellet Stove Fee Other i ) _ VMrionFde � Pre-Paid at Submittal ( S 3-)_p 3 ) 'isi> :>i:# <>::??3i'• ��>>::<:% >:s:...................... ;:::;::<:::::;t�:::>:<:::>:>::>:<:s::::>::»>:::>::;::i::;r::>:>:::: TOTA F L EES 1 15 `�n t Q PERMIT NO.: MASON COUNTY / PLUMBING/MECHANICAL PERMIT APPLICATIONf ? 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 INFORMATION Owner Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone( ) Other Ph.( Ph.( ) Other Ph.( Lien/Title Holder Contractor Reg.# Address Expiration / / 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 t Site Address(Please include street name, street number and city) i Directions to site T 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 Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No. of Units Fees Bath Basins Furnace Bath Tubs Heatpumps Showers vo Vent Fans tGI,SD Water Heater — Propane Tank Laundry Wsher_ Gas Outlets Sinks r Wood/Gas/Pellet Stove Dishwasher Direct Vent? Other 14oe 3,0.,, 1 Other. Other ^t 5_ Other Base Fee l.( Base Fee s-0 TOTAL PLUMBING 00 TOTAL MECHANICAL ►,oc1 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 be made without approval. first obtaining approval. X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. .............._... ............................----................--------------- _........... .........................-...................---------....._........-........_..-------._..............................._...._.. .... APIPI+Ft3-:;;-;: _ Ntl =::_>;_»_»» >:_<:>:«__:_: <::<:>::;;::; :<:;::. .:.I #fQ#= f »»> »»> _>:>:>;:_>:< >: :::<:_< Building Department Occ Group Type Constr. Planning Department Other Other - _.-....... - ............ ------------ Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES F:?;4M MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name DUZ:' "T 1_l n ��n � PARCEL NUMBER LA EMCQ I'�— Date (0-- � SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW L11^^I �^ ^�"^^^^' ^�^��-� - ��-��I ^� nr g--4 adjacent property line.33' adjacent property line4 I id EASE Inc NT 1 <—adjacent property line I I I I I I ii 1 1 I I I I I 1 .iz ri. I 1 I 1 I I 4 I '4 169, I � ` adjacent property line- I PM'vti WICK -- l <-adjacent property line 33i SAMPLE SITE PLAN adjac t property line iII � fi H3Oa Mot E-adjacent property line D 30' E�E . 0rA1_ L '_ . Grlaen, I > I pROPO1GD 1 SI -- 1 I I I \ �F. �\ � AbRZLLLLfu.ILAL SO I IV"1 I 1 •I I � I /00" i \ I 1 I I 1 I adjacent property linedadjacent property line I TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fiiis. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dls+ar.G2 to C�i�'I,ar.CG �o dis+anc2 t o !_ Signature Date