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Home My WebLink AboutCOM2005-00100 Water Tank - COM Permit / Conditions - 10/19/2005 O � o N Cn Cn CD a � 1 C- C) m m 0 o N � m m m C) m :3 < CD -o ;u 0 cn iy 5 - M o CD -•I r o X cnzm � °: z 0 m -0 C) W D CD D rj CD Mmmz cn m 0 i4 C-n 00 CD NC) � Z n c 0 m C 000o to O O o 0000 0 o CCD m � .Z�ln `� = m c aom - z CD cn D) a � Dy o zX � zX 0 O cn X C COa, c o � w < CO00 Z cny CD 3 cn PI) CD D n 3 .-o3 � m �• r 0vm � � Cps o c �, p -n cn 2 2 00 co o C � oz a co o r" , r- cn OD � mm0G) CL •f.— Z m m 3 0 0 w O n N D n n m rn m 0 D o cn c v y ad N %inn � m coov �+ N OND mmm CD m r Z 0 � n o D 0 0 v '� 0 �! m r O `D 0 o m m 000 w cn n o _ 9 CD 0 o L N I `° m m 00 Z y U v z � � T C o � CD Wzo Q o r 0 co 0 ayCL CD v �7 D 4�i N 7 N cD O 0 C CD cn CA CD �. 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MANUFACTURED HOME oFootings 1 Setbacks Ribbons 0 Date By Gas piping Dante By O Foundation Wails Data By Spat-cep O _ _ Dante By INSULATION mate By BG I Stab Insulation Floors FINAL INSPECTM Date By [date By Date By FRAMING Walls FIRE DEPARTMENT Lute By gate By gate By PLUMBING Attie OTHER Groundwork gate By Date By WALLBOARD NAILING Date By D.W V Date By k_, v Wator Line FINAL,INSPECTION Date By I Cate/ //�� Date By T.,rlr- of Irisp. }' )Ce F ii Request Date insect. Date Done By Comments � j s I 0 z O O N X c 2 o mCD o n o D n m CD ........... W FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.CO PLEASE PRESS HARD BUILDING PERMIT APPLICATION 60 L. on 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 INFORM TION CONTRACTOR INFORR SON r L Owner k ul vi C ' Company Name Mail' g Address 0• Mailing Address 33 ,73 City v f tate Zip Code City U 1 State Zip Code Phone Y7 Other Ph-2S3-VDT-6 6 2AO Phone — Other Ph. 3, Lien/Title Holder Contractor Reg. Exp. E mail address E Mail Address Drivers Lic.# 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 P rcel 7N . 2 — — Fire District Legal Description 4 £. D G , TlV 2 W ftlaqN G. Wa- Site Address (Plea a include stree name, str et number and cit ) 0 G 20 i!X LAJAli Dir2f2 ons t site �w •w R Will timber be cut and&16 in parcel preparation?Yes/ Is property within 200'of Saltwater Lake A-10 River/Creek AJ 0 Pond 0 Wetland_,—_Seasonal Runoff__,4ZQ_Stream__ALV Slopes or Bluffs > 15% evQ Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yeamo TYPE OF JOB - Newer_Add Alt Repair Other __ P MARY RE ID NCE ❑ SEASONAL ❑ Use of Building I,1j4+r-i- 1—h-AuK Descri a Work � R dz lobo (.-+PLC No.of Bedrooms No.of Bathroom Square Footage- 1s Floo 2nd Floor MIX 3rd Floor Basement — Dec Covered De Other;�r�Sq. . Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INF RMATI N - Make Model Year Length*/i _Widt Serial No. No.of Bedrooms ,No.of Bathrooms _ Type of Hea Purchase &ce$ Replacement Unit? Yes/No Installer Name 4d Certification No. Wig 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 recenee this s 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 accu a an g is employees of Mason County access to the above described property and structure for review and inspection. 's PROOF OF C OF W I ANS OF A PROGRESS INSPECTION. X Date; w er Owners Re re At tive/Contractor indicate which one FO OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department ✓I.4 T-,� Planning Department — A/F-7' Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical& Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal j! Valuation$ TOTAL FEES ` MASON COUNTY PERMIT NO.001'n tR00 ) I BUILDING PERMIT APPLICATION 60 1 00 426 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 1 AM T N CONTRACTOR I OR TI N Owner G ' Company Name Mailin Add ss • Mail' g Add, s g3072 City tat Zip Code' City State + Zip Code Phone '" Other Ph ` " Phone Other Ph Lien/Title Holder Contractor Pa # IcGd Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB j SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Allif Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFOR TION- 12 Di it P rcel N "" Fire District Legal Description S to ' Site Address(Pleg§e include streel name, str et number and city) q3Q 1-04 1(11441 W RyL' Dire c 'ons t site: * ' Will timber be cut andfola in parcel preparation?Yes/ Is property within 209'of Saltwater Aofb Lake River/Creek AJa Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 1 15% *OV12 Is this pmA*ybmIttaI the result of a Stop Work Notice,Correction Notice or other enfor t-aeti m?Yets1No TYPE OF JOB New Add Alt Repair ther P MARY RE iD CE SEASO L Use of Building I�fFrt. r&+AJK. Descri a Work No.of Bedrooms No.of Bathroom Square Footage- 1 s Floo 2nd Floor _ 3rd Floor 'Basement Deck Covered De Other Sq. . JAL— Garage Attached Detached Carport Attached Aj Detached MANUFACTURED HOME INF RMATI N - Make —.Model Year Length 4414—WidtI Serial No. No.of Bedrooms 4ft Krn-of Bathrooms Type of Hea Purchase rice$ Replacement Unit? Yes/No Installer Name IF All A Certification No. a104EA/BULDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Aelanowledgement 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 permif and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.ti perrr"on 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 inflomtation provided is accu an grmts employees of ason County access to the above described property and structure for review and inspection. PROOF OF OF W I EANS OF A PROGRESS INSPECTION. Date- ' r Owners Re re ent tive/Contractor indicate which one FO OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department I *- G 1-4 Planning Department Environmental Health Departmen Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Plannin Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES PERMIT NO.CO MASON COUNTY BUILDING PERMIT APPLICATION (50 i Cad 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.conason.wa.us APPLICANT I O TION CONTRACTOR INFOR TION Owner C • Company Name a- �6 Mail' g A dre SMailin Address 3Ci State Zi Code C tate Zip Code tY P Other Ph ""i ate! Phone — Other Ph. Lien/Title Holder - Contractor Reg. Exp. E mail address E Mail Address t Drivers Lic.# 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 P rcel N Fire District Legal Description ISM-R&E lid Site Address (Plea a include stree name, street number and ci ) got I(� Direct'ons t site • • Will timber be cut andiold in parcel preparation?Y!2' Is property within 200'of Saltwater D Lake River/Creek- Q Pond _ Wetland Seasonal Runoff 0Uj2 `.Stream Afo Slopes or Bluffs a 15% /Vin Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?. TYPE OF JOB--New_.Add Alt Repair Other PR MARY RE ID CE SEASON L 0 Use of Building {>cR. 1-,+QC Descri a Work • No.of Bedrooms No.of Bathroom Square Footage- 1 s Flo o 2nd Floor 3rd Floor Basement Dec Covered DecOther—Sq. —. Gara a Attached Detached Carport Attached Detached MANUFACTURED HOME INF RMATI N -Make Model Year Length ._Width Sedal No. AIJA No.of Bedrooms 46E Wo.of Bathrooms Type of Hea PurchaselArice$ Replacement Unit? Yes/No Installer Name Certification No. 0VMER/BUILDER Ack&Wedges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that l am the owner,owners legal representative,or the contractor.I further declare that I am entitled to 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 perfrik on 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 accuutfe anO g is employees of anon County access to the above described property and structure for review and inspection. PROOF OF C OF W 1 EANS OF A PROGRESS INSPECTION. X A114 Date: r Owners Re re ent ive/Contractor indicate which one FO OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department PIG ' Planning Department k 4 /' Environmental Health Departmen Public Works Department Fire Marshal FEES Buildina Permit Fee Site Inspection I Plan Review Fee EH Review Fee Plumbing&Base Fee Planninq Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee f Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES #' MASON COUNTY PERMIT NOrw i* •' t pujkk ING PERMIT APPLICATION 426 .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.mesbn.wa.us APPLICANT 1 )RMSTIQN CONTRACTOR IN Flu Tin Owner 5A e- ' Company Name �' W cs# f - Maif Add r ss Mail' g Address City tat Zip Code City State ' Zip Code Phone '" Other' '�7" ' �► Phone Other Ph Lien/Title Holder Contractor Reg. Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Fxisting Septic AIM Connect to Water System Name of Water System— Well—Water System Name of Water System PARCEL INFORM ATION- 12 Di itFarcel N - — Fire District Legal Descriptio�� Af It 151&jV049tT#VTWPz3N • Site Address (Ple a include streWk e name, str et number and c. ) D A ix � Dire,'ons t site hr ' AN !"I Will timber be cut and folb in parcel preparation?Yes/ Is property within 200'of Saltwater ` Lake River/Creek _Pond 4 Wetland ,A r Seasonal Runoff Stream Slopes or Bluffs 1 15% �� Is this permit submittal the resuR of a Stop Work Notice,Condon Notice or other enforcemeird ecliomFVbalNo TYPE OF JOB- New Add Alt Repair Other P MA RY R ID CE SEA L ❑ Use of Building t&9Aftt- Tit K nescri a Work No.of Bedrooms No.of Bathroo Square Footage- 1 s Floo 2nd Floor 3rd Floor,Ai I X Basement Deck _Covered De Other Sq. . Gara a Attached Detachedli it Carport Attached Detached MANUFACTURED HOME INF RMATI N -Make _phi Model Year Length dAl .Widt Serial No. No.of Bedrooms W No.of Bathrooms A ram Type of He Purchase rice$ Replacement Unit? Yes/N Installer Name Certification No. 0V*4ER/BLX DER Acknowledges subr asion of wwwrate inforrrration may result in a stop work order or permmrt revocation.Ado owledgerrrent of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that 1 am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the pemission from at the necessary parties.If pemr don 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 pemut and conducrt the work proposed. The owner or agent on owners behalf,represents that the infonrrabon provided is acc u fe employees of County access to the above described property and structure for review and inspection. PROOF OF OF W MEANS OF A PROGRESS INSPECTION X Date: er Owners R r n tive/Contractor indicate which one FO OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department ,f. Environmental Health Departmen Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee H Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base fee Other L /Gas/Pellet Stove Fee State Fee on Fee Pre-Paid at Submittal on$ TOTAL FEES Mason County Permit Assistance Center Planning Intake Checklist Owners Name: All ✓ C- Sf4 t Date: cr C �— Project: t_./ 4,— Reviewed By: Commercial Development: S- Comments: Planner: GBM TSC M M SNG BJR Site Plan: North Arrow Property Dimensions: X Streets and Driveways Shown.Road name: (6 ❑ All Existing Structures shown with setbacks ❑ Well Location, Septic and Drain-field Shown with setbacks ❑ Identify all surface water(streams,ponds,shoreline,wetlands,etc.) ❑ Topography(slopes) ❑ Proposed Struc a Setbacks(Direction/Setback): F: /�'R:�/�S 1: ✓V /1�S2•—S l ❑ Utility and Drainage Easements: Yes No (if yes enter condition#5022) ❑ Other Easements ❑ Accessory Appurtenances ❑ 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: #5019 and#0700 Are there any impediments that may restrict access to your site? (dogs/gates) Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: � t Applicable ❑ Agricultural ❑ RR 2.5 5 10 20 ❑ Urban ❑ In-holding ❑ RMF ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy ❑ Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown ❑ RCC-Hamlet ❑ RT LJrban Growth Area ❑ MPR ❑ Unknown ❑ Unknown Water Bod (type of water if unnamed): SEP : Yes Unknown Flood Plain: YES NO Unknown Map# Aquifer Recharge: YES NO Unknown Map# Tags/Cases: RLC/SPI Case: 6-Year Dev.Moratorium: YES NO Eagle Nest Tag: YES NO Other YES NO Addressing: Check box if needed ❑ Reviewed by: Revised:07-12-2005 MPLANNINOCHARELL&RENEE\PLANNING INTAKE