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FRAMING waits Date By Date C-, -q-11( Bye_,) Date PROPANE TANKS PLUMBING vauft Date By Date H By OTHER Ground%wrk Attic Date By Date By Type. Date Fay aw.v DRYWALL Type- Int Brace Wall Date U3 -0 Date By I Date By r- (D FINAL INSPECTION w (D Cn Water Line Fire Seperation Q Date By Date By Date By (D (D 6 Pass or Request Inspect. 5 Type of Insp. Fail Date Date Done By Comments CD 6 14,_ AA (D in Y e.ss '7 i 5--/3 7-14 -/J i 0 0 ... (n 0 01 e_ Fill 0-- r 401-1 tj e-, 3m,(Yx Wvr, to 4J. S t Cav lie I L6—1A N pi--55 sv (D 0 C. MASON COUNTY PERMIT NO�JICI'20i3-C�`�IZ BUILDING PERMIT APPLICATION B 0 �- 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 i2tCa Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 n ;� On the web www.co.mason.wa.us APPLICANT INF§ORM TION II ss CONTRACTOR INFORMATION Owner T L-1 l e �, ��tYl f`i't� , Company Name �D Mailin Address t'G Mailing Address City 'A T State Zip Code 1 City State A ZipviSode Phone ' -`9 5's Other Ph. Phone th h. I ° L Contractor Reg. # Exp. E-ffta,r addfess E Mail Address zwwef r# Dt7B Drivers Lic.# DOB SEPTIC M INFORMATION - Connect to New Septic - Septic rC ect to Water System e of Water System _ ell Water System Name o PARCEL INFORMATION- 12 Digi arcel No. 2-0!1 A - Fire District_ Legal Description i I , Site Address (Plea e include street name, street number and city) Imo` Q L `> �,l tc,n t rY wL Directions to site "it _ r G� � Will timber be cut and sold in parcel preparation? Yes i`)/� Is property within 200'of Saltwater Lake River/Creek Pond �1 Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result ofA Stop Work Notice,Correction Notice or other enforcement action?Yes TYPE OF JOB - New�-�Add Alt Repair Oth' r P IMARY RESIDENCE SEASONAL !> ❑ Use of Building Describe Work �T ' ' � -(ETA 't } 1 No. of Bedrooms No. of Bathrooms Square F ae st Floor ' ` 2nd Floor 3rd Floor Basement Deck Other Sq. ft. Garage Attached Detached Carport Attached Detached MANUF ME INFORMATION - Make Model ear Le Width I No. No. of Bedro No. of Bathrooms pe of Heat Purc Price $ Repl ent Unit? Yes/No Installer Name ertification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a 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 application. 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 permit 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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by a' '' 0 U Dated,-' ' I DEPARTMENTAL REVIEW APPROVED DENIED % NOTES Building Department -g- D/,j Dy. OY Planning Department Environmental Health Department f- _ Public Works Department Fire Marshal FEES Building Permit Fee 3 Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee a -7° 3 planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES /ys ti3.7 PERMIT NO.�I 1 2 13-may Z-1 MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 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.wa.us APPLICANT INFOR�ATiON CONTRACTOR INFORMATI N\ Owner I/ i cc' _j tyt 1 4_' Company Name Mailing Address Mailing Address City State Zip Code City St ? Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic. Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 Digit Parcel No Fire District I I Legal Description Site Address (Please include street name, street number and city) IS-An ��► ►' I� art Ylttc Directions to site Is property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1 st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNIT Type of Fixture No. of Fixtures Fees Fuel Type:Electric Z LPG_Natural Gas_Heat Pump_ Toilets Type of Unit No. of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER Acknowledges submission of inaccurate information may result in a 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 application.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 permit 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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES s4li 41AS01V Lq Alvlv'NG T � F ON sl i P L A TSAG��S ARE tt,^iEASUR:EI € �. I� ; . FRCl OJi1HEr r .I It � J FT�z� St�7-1 C Clf ET R PC,LE LIA J IL ou5e rr 20 LrF f 2-4 f s PR Pa,E- ta hG� A-ICai4'tC'YI � f I ( 2.00 A - A 4Zo[Zr I DPtyje /-;y EAST F.�" RO,