HomeMy WebLinkAboutBLD2004-00032 Bulkhead - BLD Permit / Conditions - 5/10/2004 W
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FORM MUST BE COMPLETED IN INK PERMIT NO.: BLD
PLEASE PRESS HARD MASON COUNTY
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
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner O t Contractor Name /3 �ht` r�IvifXTd�N
Mailin Address -m Mang Address o0
City State� Zip Code City Q d State l _ ip Coe ?Prf
Phon 2 Other Ph.(Jbo »7S 90?? Ph.(A Yrkther Ph.(2S3
Lien/Title Holder Contractor Rea. #
Address . Expiration P /_Z/ O
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic X Connect to Sewer
System Name of Sewer System Wel)e--Water System Name of
Water System
PARCEL INFORMATION-12 di it Tax Parcel No. /1_Z3Z / /0 / OZO / Fire District
Legal Description c T _ S.So C/Co
Site Address(Please include street name, street number and city) S'Sv
Directions to site o w /n
c n
ill timber be cut and sold in parcel preparation? (Yes o)
Is your property within 200' of the following: Body of Water(Name)_, 4 �e Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB New Add Alt Repair Other Use of Building i
Describe Work / ZO D &ihq ykcy !Zo
No. of Bedrooms No. of BathroonW SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other A-pI !A_ 600 sq. ft.
Garage Attached Detached Carport Attached ached
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-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. firs Jing royal. hh �—
t=
X Date X ��/ _ Date�0�
FOR OFFICIAL U E BEYOND THIS POINT
Accepted by Date ubmittal Amount Due Receipt No." IoW
OEPP1RTMENTAI,: VI�V11 �XPPROV�f� pE.IVIEU;< QQN>QITII+�N GUQES
_. .Building Department
Occ GroupType Constr. — / --Q
Planning Department
Environmental Health Department RECEIVED
r
Public Works Department
I
Fire Marshal 426 W. CEDAR .
Valuation $
FEES
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
i
PERMIT NO.: BLD —
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 1 Shelton,WA 98584
0 27-9670 Belfair 360 2f5 Elma 360 2-5269 Seattle 206 4-6968
,APPLICANT INFORZATION CONTRACTOR INF RMATION -
Owner of t . Contractor Name 1f4Y 1-41gt,1 ,r� , ,r,•,�
Mailin Address Mailing AddressF " "i
City 6 "/, State� Zip Code .. City_/ State� Coe J
Phon t Other Ph.('?-4o )-">,7 "d7 Ph.( 7!b 0" ) - A/0ther'P,h. ". ? r�Y - lit 2
Lien/Title`Holder Contractor Reg. #
,Address Expiration/ Z 7 / c
`SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic-,y Connect to Sewer
System Name of Sewer System Wely_Water System Name of
Water System
PARCEL INFORMATION-12 di it Tax Parcel No. Jzz ?z / /a / OZ 0 f Fire District
Legal Description . 7 rAX � ct rt� 1 i
Site Address(Please include street name, street number and city) T70 C
Directions to site rg,* -4.1 rjxL •jt s ��. �f �31"1zt ,-
,
Will timber be cut and sold in parcel preparation? (Yes o)
Is your property within 200' of the following: Body of Water(Name) 4 Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe Work s-� 'led Itoc0 AV,M /art`
No. of Bedrooms No. of BathroonW SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other *A- 600 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. firs ing prOval.
X Date X / • , r Date '+ •
FOR OFFICIAL U E BEYOND THIS POINT
Accepted py a ct_ Dat '' Submittal Amount Due - 1 Receipt401_
........... . .............. ......:.:. ..... ...........<»::::»>::::>::::>::::>::::::.............................................:.,.:.;;:.;: <:.;,;.;:. ...:..:............:...::...,.:..:...:.........X....
RfiMtwtTAl»:: : . »::>::>: I:.;;::.;:.........:...................................__.................... ... N..�D.:::>::»> ::<:::>:<:::»;<:>:>::;:_:<: :I"��D�TI1t�N..�+DaE�:::.::..:...:..::.::.:..........:..:
...............................................................................................:.....:.:.::::::::::::::::.::::::::::::::
Building Department
Occ Group '- Type Constr.'v., J
Planning Department
Environmental Health Department t �� w
u Public Work ;,Department44
Fire Marshal z r416 W. CEDAR ST.
Valuation $
k' xl F
i�'.:yy
Ky
„w.>. .faux.,.A...<.i �. ..........::::::......
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee "" Planning Review Fee
Mechanical&Base Fee Other
J
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ( )
:s, Ems• �.,?ty ....gym �:�.aru
PERMIT NO.: BLD
_n4
MASON COUNTY
..BUILDIN PE�i NIT APPL t i�►►"!'ION
426.W.;C t/P.O.Box-1 Shettor WA 9W
Shelton 60 427467D 8606lt 360 2i6.440 EIM4, S 206 4-6968
APPLICANT INIF T10N CONTRACTOII FNEO'RMATION
Owner Contractor NameArtnc s, t
Mai
Address' Mailing Address 21 V���� t _
City State Zip Code City _State Ip Coe Elsa 6
Phon Other Ph.(160 )� " ",>� Ph.( � therPh.(2S1
Lien/Titti Holder. Contractor R
Address ExpirationT !
PTIC/WATER BYBTEM FNFORMATION-Connect to New Septic Ezlsting Septic Connect to Sewer
System Name of Sewer System Wel —Water System Name of
Water System
PARCEL INFORM `TFON-t2 di it Tax Parcel No. ' / t! / 0 Fire District
Legal Description 'r
Site Address(Please iriclude street name, street number and city) +�
Directions to Site 4 u�>'n
a e "-° 1
ill timber be cut and Sold in parcel preparation? (Yes o ^`~
Is,your property within 200' of the following. Body of Water(Name) - A! Saltwater
Lake . Fiver/Creek. Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT.; DF:I OE ly7 SEASONAL RESIDENCE El
TYPE OF JQ$NeW Add Alt Repair, Other Use of Building
Describe'Work e A M
No. of Bedrooms No. of Bathroo SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basements Deck Other +r.+( A012 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)
lnstaller Name Certification No.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORKIS SUSPENDED OR ABANDONED FORM\PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTWUhiTION OF WORK IS BY MEANS OF A PROORES.S 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-]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: ing a rova �
r'a X Date )( / _ Date+AP41193
>» . FOR OFFICIAL U E'BEYOND THIS POINT<
Accepted by Dat ubmittal Amount Due r ! Receipt o.
,t ;
::.._ill.:. I» > ,... V # i# NI»f ... . .. :.. ..: : Q1f .....
Building Department
Oce Group ,� Type Constr' f
Planning Department �'}�s-�f•�- t< p �
R
Environmental Health Department
'JA
Public Works*flepartment � - � ;, - - ••
CEDAR
Fire Marshal
Valuation$
�.
Building,Permit Fee Site Inspection
4
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 ( )
a <:, TOTAL FEES
ti
PERMIT NO.: BLD
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box, She",WA 9$584
Shelton 360 427-9670 Beltair 360 275 She",
482.66269 Seattle(206)464.6969
APPLICANT INfOR.WTION CONTRACTOR INFORMATION
Owner & t 'Contractor Name
MailingAddress Mailing Address a
City mate zip Code City State _ ip to de fps4 6
PhOn t Other Ph.( 6a �'2_1i ►9d7? Ph.( ,� ) 31�ther Ph.- S3 � jT joZL
Lien/Titie Holder Contractor Re . #
Address Expiration / 4:7 / 4
`SEPTIC/WATER SYSTEM INFORMATION_-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Weil)Water System Name of
Water System
PARCEL INFORMATION-12 di it Tax Parcel No, Z. l_U / at. 4 / Fire District
Legal Description �- p
Site Address(Please include street name, street number and city) 3,70
Directions to site a g A41F, C01111,11(&
t t c �+%ill timber be cut and sold in parcel preparation? (Yes o) S E,7
Ie�
Is your property within 200' of the following: Body of Water(Name) ` Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE El SEASONAL RESIDENCE 0
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe Work o 0 lei 2�C
No. of Bedrooms No. of BathronnW SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other 1[6 , r&AD sq. ft.
Gara92 Attached Detached Carport 'Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length Width Serial No. No. of Bedrooms No.of Bathrooms
Type of Heat Purchase Price$ 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-1 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 ail work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. firs ing r val. ��. + ..
X Date, X R � / _ Date/ /-03
%. FOR OFFICIAL U E BEYOND THIS POINT
Accepted by Dat ubmittal Amount Due Receipt IQoaCU
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Building Department I -
Occ Group Type Const NO CASCS / -Q
Planning Department ; Dc
CEIVEn
Environmental Health Department r C
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Public Works`Department
4$6 .W
Fire Marshal
Va.luation $
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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
Mason County Permit Assistance Center
Planning Intake Checklist
Owners Name: yo_
v Date: /— /4 0-V
Project: " Reviewed By: 4�6.
Commercial evelopment: YES O
Planner: GBM ---RAA4 PBC Comments:
Site Play :. _-__-------------
_;North Arrow
Property Dimensions: r,.;15_X
,,a Streets and Driveways Shown. Road name: gl
,ef' All Existing Structures shown with setbacks
,,a "Well Location, Septic and Drain-field Shown with setbacks
,a' Identify all surface water(streams, ponds, shoreline, wetlands etc.)
Topography(slopes) � �' �1���
,p- Proposed Structure Setbacks (Direction/Setback):
F: W /&QqR: E— S1: M Q S2:
w Utility and Drainage Easements: Yes (if yes enter condition#5022) 42(, 5
❑ Other Easements
Shoreline and Planning Info I
I
Setbacks: Shoreline: Slope:
Shoreline Designation: Comprehensive Plan Rural Zoninj
❑ Not Applicable Designation: �R 2.5 10 20
Urban ❑ Agricultural ❑ RMF
❑ Rural ❑ Inholding ❑ RC 1 2 3
❑ Conservancy ❑ LTCFL ❑ RI
❑ Natural id'Rural ❑ RNR
❑ Unknown ❑ RAC ❑ RT
❑ RCC-Hamlet ❑ MPR
❑ Urban Growth Area ❑ Unknown
❑ Unknown
Water Body(type of water if unnamed): s�--
SEPA: Yes ' No Unknown
Flood Plain: ES ."NO Unknown Map #
Aquifer Recharge: YES NO Un _*n Map #
Tags/Cases: y ,
RLC/SPI Case: IKP 6-Year Dev. Moratorium: YES
Eagle Nest Tag: YES 1 - ` Other YES Addressing: Check Check box if needed Reviewed by:
❑ County Access Permit Needed (add condition#0010)
❑ State Access Permit Needed(add condition#0020)
Standard Conditions to be added to all Building permits that planning reviews:
#0046,#4999, and# 5019
Revised:04/11/02