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BLD � ✓" `^���� BUILDING 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 On the Web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ° Contractor Name Mailing Address Mailing Address City State- Zip Code City State Zip Code Phone (_� Other Ph. Yv Phone L_J Other Ph. L_J Lien/Title Holder a[-/f�� _ 177`Z C Contractor Reg.# Exp. E-mail Address -Q. rz- E-mail Address 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. / / Fire District Legal Description i .I W 4F ,. e`r JA&AIP 2 Site Address (Please include street name,street number and city) �l W#CAOt C_7% 5r- tug+ S Directions to site i — I�- t© 4 '° '!7Q 4, f o Cam. 01 Jw(A dr IZ014P Will timber be cut and sold in parcel preparation? (Yes/No) Lake River/Creek Pond Wetland Seasonal Runoff AIG Stream ------ Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB-New Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? (Yes/No) 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.Owner/Builder acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am cxur ntly registered as a the Contractor Registration Law RCW 18.27 and am aware of the ordi- contractor in the State of Washington and that I ari* a ordinance nance requirements for which this permit is issued and that all work will be requirements regulating the work for which this perm' issued and all done in conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No Changes shall be made obtaining approval. without first obtaining approval. 42 �t 92003 X Date '- X ?6 4fat FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. Pill', Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation$ Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES to r 0 o CONCRETE MECHANICAL MANUFACTURED HOME 1' Footings / Setbacks Date B y Ribbons 0 Date �G�fa3 By( Gas Piping Date By V Foundation Walls Date H y Set-up Date By INSULATION Date By B G 1 Slab Insulation Floors Final Date By Date By Date By FRAMING Walls FIRE DEPT Date Z � By Date By Date By PLUMBING Attic OTHER Groundwork Date By Date By WALLBOARD NAILING D.W.V. Date By Date By FINAL INSPECTION Water Line Date 9 Zz/03; By :2 Date B �''� Date H � y ��:.z� = y ch (D O 8 a o 7 fa S d y C O W 0 O � y 0 SITE FLAN AND T0F0(5F,,AFHY tl) cr, _Tj 70 m m 5COTT KEITH n 51 W. CF,055WYN D CT, :7t m 5HELTON, WA, 9,55,54 te, Cog wo-9 ��a p .,.... _ .. #.:_ I. .., 20 EQUESTRIAN AND,.WAL),IN6 PATH ... 517240 559.w. .. AF# �AF�52] n4 H �.In�k.r�w " !x.`�«sy"�.. `bn, N. °R X µ `' «i: ' n b•.``,'«, a A:°M 9 I.. S a. ls� J 30'OEVELOPEMENT DUFFER x « « I } PER PRIVATE CONENANT5y „ d ro s F.......... ... ..... 'ya N ZN N tN ., j f < NiN Zs .y +x 2.55 Ck ' ` `�� .... €1 9W 1111 a k Pt64 >T�y n'3 4 I « ' i ....... SEPTIC µ � SYSTEM ° APPROVED . ON COUNTY DCD PLANNING k µ tTE PLAN REQUIRED TO BE ON SITE � ,� « HANGES SUBJECT TO APPROVAL ° L ..... _ Date (( n ... .`w,."o- na ` .°"«'`.: •"a. x° �' as2"e ^r, y." .a.� .. ........w. ,g .. a, a I �. « o �^• <ya«r. x3: « k; r'a•.. s ., °'�',��,p, a I NN ..... ... ... . ...... M s An t s I I I 1 08, I rAR' OF 60' RIJ'TE A5 ME T __. :._, WATE(Z.,S t'1?.L ED`Y C.OMMU�ITY WATER 5�5TEM._...... 4 ; .... I I. .:" ORINGRESr ERE�v^5 �_....: 1 i I I DRAINA(5E AND TILItIE5� b ... #:5 jjj ...........! I... " ; M 0 f A 724 A��#5 55 ! I , TYPOGRAPHY PROFILE;TOTAL CONTOUR OF PROPERTY< 4' '� BUILDING PERMIT NUMBER: DIRECTION: SCALE: APPROVAL:for office use HIGHWAY 102 WEST 1"=40' TO DAYTON TRAILS. BUILDING: TL ONTO DAYTON OWNER/APPLICANT:5COTT AND ALAUKA KEITH TRAILS DRIVE.TR ON TO DATE OF CLOVERDALE.TL ONTO APPLICATION: PLANNING: CR055WYND.END OF PARCEL NUMBER:_42008�8 90112 ROAD ON LEFT. Z )1 _ j ENV. HEALTH: