HomeMy WebLinkAboutCOM2004-00122 Sign - COM Application - 5/28/2004 Y i
MASON COUNTY PERMIT NO.( �OM
pp UILDING PERMIT APPLICATION
/�esort426 W. Cedar - P.O. Box 186, Shelton, WA 98584 W °`
08� ��dt✓bro°Kelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269
I! On the web www.co.mason.wa.us
AFJ9,LICANT INFORMATION CONTRACTOR INFORMATION
Owne-r .14A Fok -04 14L LC Company Name
Mail in Address es:s 6 S " ,,c, t4, 1/d Mailing Address
City iA State LC/4Zip Code goal City State Zip Code
Phona Other Ph(/;-0�9o- SaoS- Phone Other Ph.
Lien/Title Holder o,_14 ,44 o a✓�,�_ L�L- Contractor Reg.# Exp.
E mail address A"' ash H s'Te'h,w4A7 kl&/0111>1„ E Mail Address
Drivers Lic.# o DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION - 12 Digit Parcel No. Fire District
Legal Description
Site Address (Please include street name, street number and city) ou
Directions to site s 9
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs 1 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - New Add Alt Repair 4her PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building Describe Work
No.of Bedrooms No. of Bathrooms Square F&tage - 1 st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make 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.
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 permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica-
tion or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed.
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X-4• �- - Z.,,, psi fir,7 f Date: ��!�8
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 P RO ED DENIED NOTES
Building Department G
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Ins ection
Plan Review Fee EH Review Fee
Plumbina & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ TOTAL FEES
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Existing P 1D Electrical Panel with pod.Propos W a
sign cover located at 5'-0"from R.O.W. n Z
SR-106
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SECONDARY ENTRY SIGN
D O T Y 1/2"= 10'-0"
SIGN TYPE M
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1/4"thick wateW aluminum letters
with clear anodized finish.
Stud mounted to panels with studs,
1/4"spacers and nutted from behind. \j;
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V-0"
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II II o D o , I I 9-1/2„
4'-3" II II EST �'� � � � I I 2„
PUD Panel
MA I EVRANCE �>
Door is7" I I I I i' I Base plate with locking
above grade I I i I galvanized gate lock.
— — — — — — — — — — — — — — — — — - - - - � I PUD will attach lockout
C. II _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ tabs for removability
48"x 72"concrete pad for PUD electrical panel
Secondary Entry Sign. -n N 7
Fabricated aluminum face assembly with face
ELEMENTS: i SIGN TYPE M left and right edges, and top.
a Internal 3" x 3" galvanized post with internal post
Cut Out anodized Aluminum Letters ; for hinging. el to
continous bass chae channel.To be bolted to
Sign painted to match Rust Texture 'g = existing slab with 5 ea. 1/2"x 3-1/2"Hilt( kwik bolts.
OO N Cover to be welded aluminum.
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nW SECONDARY ENTRY SIGN
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Z m Cn SIGN TYPE M
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