HomeMy WebLinkAboutCOM2006-00021 Cancelled Install Parapet Extension - COM Permit / Conditions - 5/9/2006 o
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Foundation Wails Floors Date By X
Date By Data By DECKS O
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Date By Date By FINAL INSPEGTION N
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Type of Insp. Fail Date Date Deane By Comments
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Mason County Dept. of Community Development
Mason County Bldg. 3
426 W. Cedar
P.O. Box 186 (360)427-9670 Local (360)482-5269 Elma
Shelton, WA 98584 (360) 275-4467 Belfair
Notice to Obtain Final Inspection
j December 05, 2007
/ z 1,31
MCDONALD'S CORPORATION
10220 NE POINTS DRIVE #300
KIRKLAND WA 98033
Case No.: COM2006-00021
Parcel No.: 123282390002
Proiect Description: Install parapet extension - Sign remodel, Arched frame and
channel letter "M" and "McDonalds"
The Mason County Department of Community Development is currently reviewing all
permits that are expired and have not been approved for occupancy and use.
Pursuant to Mason County Code, Title 14 Building and Construction, a permit and
final inspection for this type of activity is required under the 2006 International
Building Code or the code your permit was issued and your property is currently in
violation status of occupancy and use.
Please contact our office to make the necessary arrangements 21 days from
the date of this letter. Failure to contact our office to make the necessary scheduled
inspections will result in enforcement actions.
To bring your site into compliance, you must schedule an inspection. One (1) $64.00
site investigation fee will need to be paid prior to inspection along with any
outstanding fees currently due on your building permit. For every inspection required
after that, you will be charged $64.00 again, per inspection until final inspection and
conditions are met.
To schedule an inspection, please call (360) 427-9670 ext. 262.
If you should have any questions regarding this notification, please contact me at
(360) 427-9670 ext 359.
Sincerely,
Terry Ry�
Mason County Department of Community Development
Cc: Property File
December 05, 2007 COM2006-00021
r'
1pMason County Dept. of Community Development
Mason County Bldg. 3
426 W. Cedar
P.O. Box 186 (360) 427-9670 Local (360)482-5269 Elma
Shelton, WA 98584 (360) 275-4467 Belfair
r 14 Notice to Obtain Final Inspection
December 18, 2007
MCDONALD'S
12131 113TH AVE NE
STE 103
KIRKLAND WA 98034-5944
Case No.: COM2006-00021
Parcel No.: 123282390002
Proiect Description: Install parapet extension - Sign remodel, Arched frame and
channel letter "M" and "McDonalds"
The Mason County Department of Community Development is currently reviewing all
permits that are expired and have not been approved for occupancy and use.
Pursuant to Mason County Code, Title 14 Building and Construction, a permit and
final inspection for this type of activity is required under the 2006 International
Building Code or the code your permit was issued and your property is currently in
violation status of occupancy and use.
Please contact our office to make the necessary arrangements 21 days from
the date of this letter. Failure to contact our office to make the necessary scheduled
inspections will result in enforcement actions.
To bring your site into compliance, you must schedule an inspection. One (1) $64.00
site investigation fee will need to be paid prior to inspection along with any
outstanding fees currently due on your building permit. For every inspection required
after that, you will be charged $64.00 again, per inspection until final inspection and
conditions are met.
To schedule an inspection, please call (360) 427-9670 ext. 262.
If you should have any questions regarding this notification, please contact me at
(360) 427-9670 ext 359.
Sincerely,—�
Terry Rye'n �
Mason County Department of Community Development
Cc: Property File
December 18, 2007 COM2006-00021
MASON COUNTY DEPT. OF CeOMMUIVI TY UE`✓ELOP VIENT Inspection Line(360)127-7262
Mason County Bldg. 3 426 W. Cedar P.O. Box 186 Phone: (360)427-9670,ext.352
Shelton,WA 98584
P10
00MMERCIAL BUILDING PER IT COM2006-00021
OWNER: MCDONALD'S CORPORATION RECEIVED: 3/3/2006
CONTRACTOR: 1-5 DESIGN AND MANUFACTURE 800-459-2967 LICENSE: IFIVEST15103 EXP: 10/1/2006 ISSUED: 5/9/2006
SITE ADDRESS: 24200 NE STATE ROUTE 3 BELFAIR EXPIRES: 11/9/2006
PARCEL NUMBER: 123282390002
LEGAL DESCRIPTION: SW NW, E OF R/W TR B OF SP #2487
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
Install parapet extension - Sign remodel, Arched frame and McDonald's
channel letter"M" and "McDonalds"
G
General Information Construction &Occupancy Information
Type of Use: Insp.Area: No. of Units: Type of Constr.:
Type of Work: Fire Dist.: 2 F40.of Bathrooms: Occ. Group:
Valuation: $ 103,000.00 No. of Stories: Occ. Load:
uilding Height:
Pre-Manufactured Unit Information Square Footage Information
Make: Length: Lot Size:
Model: Width: Building:
Year: Serial No.: Basement: Parking Spaces:
Setback Information
Shoreline&Planning Information
Front: Ft. Shoreline: Ft.
Rear: Ft. Slope: Ft. Water Body: Shoreline Desig.: Not Applicable
Side 1: Ft. SEPA?:No Comp. Plan Desig.: Urban Growth Area
Side 2: Ft.
Fire Protection System Information
Auto Fire Alarm System?: Emergency <ey Box?: Standpipe?:
Auto Fire Sprinkler System?: Acces Road?: Fire Extinguishers?:
Fixed Fire Suppression System?: Fire H -drants?: Fire Lanes?:
COM2006-00021 Please refer to the following pages for conditions c f this permit. 1 of 4
May, 9.
.......2006..,,Fi..4; 51 PM MeahAntcal Fixtures mr.No. 0439 P. 1
Type city. Type city, Type By p to Amaunt P=vlN
Plan Chock Feo KKK um7nnoz saRri RR V77MRnn
Planning Ravipw Re KKK v.'ir7nnq Com nn C97nnRnn
Building State Foe ni n .vnnnnR ra cn sp
euildina Remit Fee rvr. AJivnnna a1nanRs QymaRmaQnn
rwd ;1,928.91
'-CASE NOTES FOR
-7 COM2000.00021
CONDITIONS FOR
COM2WO-00021
1) ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND THE INTERNATIONAL CODE REQUIREMENTS AND
OCCUPANCY IS LIMITED TO THE PERMITTED AND APPROVED CLASSIFICATION. ANY CHANGE OF U E OCCUP Y WOULD
RESULT IN PERMIT REVOCATION. CHANGE OF USE MUST$I-APPROVED PRIOR TO CHANGE.x
2) Changes to approved bulking plans that affect compliance to the current Wachington Scale Energy Code(WSEC),ve Ilatlan and Indoor Air
Quollt/yCy dd e(VIAQ B idinglPlumbinglMeohanlcal Codes andlor Mason County Regulations shall be approved prior to construction.
Xj/ o"
3) CONSTRU ION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE
ADOPTED BUILDING COOS.
The construction of the permitted project Is subject to Inspections by the Mason County Building Department. All construction must be in
conformance with the Intematlonat codes as amended and adopted by Masan County, Any correcllons,changes or alteratlons requited by a
MasonCQu�ty Build pector shall be made prior to requesting additional inspections,
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P 4) All building 4rmlM shall have a feat Inspection performed and approved by the Mason County Bullding Department prior to permit expiration.The
failure to request a final Inspection or to obtain approval will be documented in the legal property records on Me with Masan County as boing
nol)] iiant with aE County orOtnances and building regulations.
X
6) Provisions fall surface/subsurface drainage control must be Implemented with new construction or development on site and MUST NOT adversely
Impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance,either private ditches and drains will meet requirements
of the slormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose.
a For further informatioh regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the instal Iationlconstructlon of it
m driveway or access oonnecting from a Mason County Road,Contact the Mason County Pubflc Works Department prior to Construction at Ext450.
For any construction which is proposed to be located within 2$'of a Masan County road rlghi of way,It Is suggested to ooritact that office to review
b future planned K Ich may your project.
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COM2006-00021 2 of d
May. 9. 2006 4; 51 PM No, 0439 P. 2
6) All approved plans are required to be on-site for Inspection purposes. if Inspection Is called for and plans are not on site.Approval vdtLL Nv r ue
granted. In addition,a ralaspectlon fee,based on the current fee sellodule,minimum one-h our wl a charged and lacted by the Mason County
Building Department prior to any further Inspections being performed or approvals granted, 0
7) PURSUANT TO INTERNATIONAL CODE, ALL SITES MUST HAVE APPROVED NUMBERS OR ADDRESSES PROVIDED IN SUCH A
POSITION AS TO 6E PLAINLY VISIBLE AND LEGIBLE FROM THE 5T'REF7 OR ROAD FRONTING THE PROPERTY,MASON COUNTY
BUILDING DI=PARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECTIONS, A REINSPECTION
FEE,BASED ON RATES AS ADOPTED BY THE JURISDICTION AND THE INTERNATIONAL CODE WILL BE ASSESSHD IF
OW NqR/' N`TRACT R FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS,
•--
6) Contractor re istration laws are governed under RCW 18.27 and enforced by the WA state Dept of labor and Industries,Cohtrae(ar Compliance
Division.There are potential risks and monetary Ilabilitiea to the homeowner for using an unregistered contractor.Furthers information can be
obtained at 1-800-647-0 6 The Go Ign41g this condition Is either the homeowner,agent for the owner or a registered contractor according to
WA state law. X r,11
8) Contractor registration Iaws a governad under RCW 18.27 and enforced by the WA State Dept of Labor and Industries,Contractor Compliance
Divialon.There are potential riake and monetary liabilities to the homeowner for using an unregistered contractor.Further Information can be
obtained at 1.800.647-0 2.The ning this condltbn is either the homeowner,agent for the owner or a rsglstered contractor according to
WA state law, x & ,el
Y
� 10) Appro ed perdi tensions an aetbecksan submitted site plan.Setbacks are measured from the furthest projection aithe structure.
11) Any change In construction Shall he reviewed by engineer of recofd and submlHed In writing to the Mason County Building Department prlor to
construction, All englneering documents are a part of the approved set of plans and must remain attached thereto. If engineering documents are
3 removed,approval will not be granted. In addltlen,a relnspeotion fee,based on the currant fee schedule,minimum one•hourwlll be charged and
colleped y the Mas unty Building Department prior W any furtflef Inspections being performed or approvals granted.
X
This permil bewmas null snd void lrwcrkorconstrudian autha t cl is not mmrnarted winin 180 days,or If contraction or work is suape^drrd for a period of 1813 deya st any ame after work is
commenced, EvidenceofwnnnuetIonofworklsaprogrwainspaa6onwithln the 160 day period. rinal Inispealon nisi be approved beforia building can bacccUpled.Prodolconlillitiallon Of
work Is by mwa its of a progress Inspection.The owner or the agent on tiro owners bebprf,m Preemie thst the In ramatlon provided Is accurate and grants employmes of Masen County scoem to
the above desoribc d prWortt)y and'structure forr review and Ina peotIon,
a OWNER aR AGENT= 7CL1A/1/L(.f u WGt/ DATE;
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COM2006-00021 3 of d
Mar 21 06 04: 03p I - 5 Signs, Inc. 36045GO415 p. 1
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STORE DECOR • SIGNAGE•AWNINGS • IDENTITY CREATION
FACSIMILE TRANSMITTAL SHEET
FROM:
TO:
Debbera Coker Kathryn Cobb,Permit Coordinator
DATE:
COMPANY: March 20,2006
Mason County
FAX NUMBER:
360.427.7798
TarAL NO.or'r.1GE5 INCLUDING C01'EA
PI-IONS NUMBER: 3
360.427.9670 x 510
RE:
McD-Belfair COM2006-00021
N OTF S/COMMENTS:
Debbera,
Here is a copy of the initialed conditions which you requested,the check and the engineering
went out to you via Fed-ex on Friday. Please let me know when the permit can be mailed to
US.
Thank you,
Kathryn Cobb
I-5 LllESIGN & MANUFACTURE
8751 COMMERCE PLACE DR. NE, LACEY, WASHINGTOGO`9 5G.0415 6
80o.459.296 360.459.3200 fax: 800-459,3494
www.i5dcsign.com info@i5design.com
Mar 21 06 04: 03p I - 5 Signs, Inc. 3604560415 p. 2
Information for permit: COM2006-00021
t
Planning Review Fee $255.00 $255.00
Building State Fee $ 4.50 $ 0.00
Total Fees: $ 1,926.91
Amount Outstanding: $ 1,015.05
Conditions
SITE PLAN
Approved per dimensions and setbacks on submitted site plan. Setbacks are measured from the fi:
projection of the structure. X_KL,
RCW 18.27
Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept
Industries.Contractor Compliance Division. There are potential risks and monetary liabilities to t
homeowner for using an unregistered contractor. Further information can be obtained at 1-800-64
person signing this condition is either the homeowner, agent for the owner or a registered contrac
to WA state law. X KC,
RCW 18.27
Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept
Industries,Contractor Compliance Division. There are potential risks and monetary Liabilities to t
homeowner for using an unregistered contractor. Further information can be obtained at 1-800-64
person sinning this condition is either the homeowner,agent for the owner or a registered contrac
to WA state law. XC_
PLANS REQUIRED ON SITE
All approved plans are required to be on-site for inspection purposes. If inspection is called for at
not on site, Approval WILL NOT be granted.In addition,a reinspection fee, based on the current
nninimum one-hour will be charged and collected by the Mason County Building Department pri(
further inspections being performed or approvals granted. X (,
POST ADDRESS
PURSUANT TO INTERNATIONAL CODE. ALL SITES MUST HAVE APPROVED NUMBE
ADDRESSES PROVIDED IN SUCH A POSITION AS TO BE PLAINLY VISIBLE AND LEG
THE STREET OR ROAD FRONTING THE PROPERTY. MASON COUNTY BUILDING DEI
REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOR ANY SITE INSPECT)
REIN SPECTION FEE,BASED ON RATES AS ADOPTED BY THE JURISDICTION AND T1
INTERNATIONAL CODE WILL BE ASSESSED IF OWNER/CONTRACTOR FAILS TO PO`
ADDRESS ON SITE PRIOR TO REQUESTING INSPECTIONS.
x ytG
ENGINEERING
Any changes in construction shall be reviewed by engineer of record and submitted in writing to
County Building Department prior to construction. All engineering documents are a part of the at
plans and must remain attached thereto.If engineering documents are removed,approval will not
In addition,a reinspection fee, based on the current fee schedule, minimum one-hour will be char
collected by the Mason County Building Department prior to any further inspections being perfoi
approvals granted. X
ALL CONSTRUCTION
ALL CONSTRUCTION MUST MEET OR EXCEED ALL LOCAL CODES AND THE INTER
CODE REQUIREMENTS AND OCCUPANCY IS LIMITED TO THE PERMITTED AND API
CLASSIFICATION. ANY CHANGE OF USE OR OCCUPANCY WOULD RESULT IN PERIv
REVOCATION. CHANGE OF USE MUST BE APPROVED PRIOR TO CHANGE.
k�'
MCPW Development Requirements
Provisions for surface/subsurface drainage control must be implemented with new construction o.
http://www.co.mason.wa.us/permits/main.php?caseno=COM2006-00021&case_type=COM 3/20/2006
Mar 21 06 04: 03p I - 5 Signs, Inc. 3604560415 p. 3
Information for permit: COM2006-00021 • "b" "' "
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development on site and MUST NOT adversely impact adjacent parcels. Cinder the requirements
County Stormwater Ordinance.either private ditches and drains will meet requirements of the sto
ordinance or prior approval will be granted to use an existing utility and drainage easement dedic,
specific purpose. For further information regarding this ordinance and the REQUIREMENT to of
ACCESS PERMIT for the instal lation!constructioil of a driveway or access connecting from a M;
Road.Contact the Mason County Public Works Department prior to construction at Ext 350. For
construction which is proposed to be located within 25'of a Mason County road right of way. it i!
contact that office to review future planned work which may affect your project.
x i c,
Changes to Approved Plans
Changes to approved building plans that affect compliance to the current Washington State Energ
(WSEC),ventilation.and Indoor Air Quality Code(V1AQ),Building/Plumbing/Mechanical Code
Mason County Regulations shall be approved prior to construction.
X
FIELD CORRECT
CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON CC
BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The constriction of tilt
project its subject to inspections by the Mason County Building Department. All construction nets
conformance with the international codes as amended and adopted by Mason County. Any correc
changes or alterations required by a Mason County Building Inspector shall be made prior to regt
additional inspections. X
FINAL INSPECTION REQUIRED
Ali building permits shall have a final inspection performed and approved by the Mason County I
Department prior to permit expiration.The failure to request a final inspection or to obtain appro,
documented in the legal property records on file with Mason County as being non-compliant witl-
County ordinances and building regulations.X JJ""?"
This information was last updated: 03/20/2006 at 9:06 am
Information may be inaccurate and outdated.
Please refer to the Permit Center to verify any information
l3uildin�, Plannin- Liwironi»eMa( nisclaimer Search our Site
(lrnne Dome Health HomeDisclalincr
http://www.co.mason.wa.us/permits/main.php?caseno=COM2006-00021&case_type=COM 3/20/2006
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION �� M
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 INFORMATION CONTRACTOR INFORMATION
Owner c. S Company Name I'S esiyn YYlcw>UfaCtOrC-
Mailinggdg9ss_NFr ;tLQW o-iuf2 3 Mailing Address jj l t ryi_o _yc e_ I. r-)V
City k tr State leL Zip Code_ �1� City--L-ac&:�4 State WW Zip Code 'IMI
Phone_ b G) Other Ph. Phone Other Ph.
UeN Title Holder Contractor Reg.# s=t a3 Exp. (�9.�r3— j
E mail address E Mail Address Kcobb r �da�igvi cow, f
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Sept'_ 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) Sble P,"aza eamc
Directions to site
Will timber be cut and sold in parcel preparation?Yes/ o
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y
TYPE OF JOB -New Add Aft Repair_
Other PRIMARY RESIDENCE ❑ SEASONAL
_f� ❑
Use of Building s�-uvra^a Describe Work 10 1� r ru.�� CXL-EA
No.of Bedrooms No.of Bathrooms Square Footage- 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 P $ .103 rDOO Replacement Unit? Yes/No
Installer Name� =Z h r Certification No.
OVOM/BULDER Admaxledges stb7asion of inacctuale I forrnatiort may result in a stop work order or permit revocation.Admowledgernm of
suds is by signattus below I declare that I am the owner,owners legal reps esenfa8ue,or the contractor.I kuther declare ttmt I am saw to receive this
perrnit and to do the work as proposed in the application:!.declare that I have cbtaited the permission from all the is
required from any easement holder or any outer party in 11' rest necessary Peres'ff Pew
permission from them to apply for this perNt and condrx,t the work or the work proposed in I have obtained
provided is aocurate and gramempbyees of Mason G1auMy accesss to t aaboae deeatbed or agent on owners
PROOF OF CONTINUA MW V IS BY MEANS OF A PROGRESS C110N. and structure
X Date: a a7t�(o iMIAR 01 Zoos
Owner owners Representative/Contractor mcicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department — , l 5
Public Works Department
Fire Marshal
FEES
Buildina 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
Valuation$ TOTAL FEES
MASON COUNTY PERMIT NO. �a Q-609
BUILDING PERMIT APPLICATION M ��
426 W. Cedar• P.O. Box 186, Shelton, WA 98584 cc
Shelton (360)427-9670• Beifair(360)275-4467• Elma(360)482-5269
On the web www.co.mason.wa.us
APPLIC&NjINFORMA7MXN CONTRACTOR INFO i�MATION
Owner S Company Name 1=�� -- 1Mctvx)(c'ctU�
Mailinct q_ r@ss_N� aq " a Mailing Address t-G k Cemn�rcc 1. r)vf
City—k_.�..i ,r State-Udr-Zip Code City l.A 9& State w W Zip Code 17 m l
Phone... g•�q 4 L 1 Other Ph. Phone Ear-) ,(4r 9.agL7 Other Ph.
LieNTitie Holder Contractor Reg.# srt 63 Exp. 1_T(, _
E mail address E Mail Address_ c o1�b i design c�w, j
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION-Connect to New SWftVj'A- Eg g
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)
Directions to site
Will timber be Cut and sold in parcel preparation?Yes/ o
IS Property within 200'of _-____Lake —River/Creek_Pond_
_Seasonal Runoff Stream__ $ or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Native or other enforcement action?Y
TYPE OF JOB-New Add Aft Repair r PRIMARY RESIDENCE SEASONAL
Use of BuildingCe s�l-uvra w4- ❑ ❑
- Describe WOrk��. � nro�.pC-a �c�-catcl n"
No.of Bedrooms No.of Bathrooms Square Footage-1 st Floor_2nd Floor
3rd;Floor____.__Basement Deck—Covered Deck Other Sq.ft.
Gars _ 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 P $ 10S,0_ Replacement Unit? Yes/No
Installer Name i h r- PL aeldlf
b aCertification No.
CIA NER/BL DER Ads wAwgw subrrrission d kuwA ale iiomnalort may rat in a stop work order or pert revocation.Admowled wwl of
such is by cD dD#e bekwk t pq)o gd in pp owner:owners legal rep* er *e,Ortrecocrf<arctoo I A dtterdad=that I am erddedto receive this permit and to do the work as proposed h the appGc;ad=I dedare that I have 6bWkjed the pmy*Wm from d the
mq A ed from anyas eerneo holder or any other party in Merest regarr k this or the work in necessary j have o
bWnad
pemrrission flan them to apply for this pennt and oorAo the work proposed. The owner or agent on owrxn
provkled b aocumle and employees of Mason Courtly aoo w 10 the above desated property and shuctune
PROOF OF OONi11W1A X0yRK 15 BY MEANS OF A PROGRESS IMMOTICK
X Date: a a7zy MAR 01 2006
Owner Owners reeent0ve/CoWactor nkate,whkh one
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date
V
PARTMENTAL REVIEW APPROVED DENIED NOTES
ding Departmentnning Department 3
Environmental Health Department :—
Public Works Department f
Fire Marshal
FEES
Bu�di Permit Fee Sffe In
speadon
Plan Review Fee EH Review Fee
Plumbi &Base Fee Plannina Review Fee
Mechanical&Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION C M
426 W. Cedar* P.O. Box 186, Shelton, WA 98584
Shelton (360)427-9670* Belfalr(360)275-4467• Elma (360)482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFO NATION
Owner S Company Name I__5 si
Mailinq,�1d�r@ss_Nk 2L1AW dress 3 _ Mailing Ad M Comme�rc c I. r)v�
Cit+,/__k l ir State r"rl9-Zip Code City LAQ_ -e , State w W Zip Code I M 1
Phone Yr10b A- i Other Ph. Phone_ a?L-7 Other Ph.
Lien/Title Holder Contractor Reg.# SEIS10,3. Exp.- 10 t o(= _
E mail address E Mail Address_Kcolab 6Digs igvn.entn
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 Dlgit Parcel No Fire District
Legal Description
Site Address(Please include street name,street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes/ o
Is property within 200'of Saltwater_._Lake River/Creek Pond
Wetland__,___Seasonal Runoff Stream,Slopes or Bluffs ) 15%
Is this permit submittal the result of a Stop Work Notice,CorrwOon Notice or other enforcement action?Y
TYPE OF JOB-New Add Alt Repair Oth r - PRIMARY RESIDENCE ❑ SEASONAL C
Use of Building_fZsavrar-1 De�dbe Work►` me k esc"sl e)"
No.of Bedrooms No.of Bathrooms Square Footage- 1st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq.n,
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 Pr S 103,tom Replacement Unit? Yes/No
Installer Name h t- NL Certification No.
OWN:R/BUL.DER AdmaMedges submission of Irmm ste kftmaton may=tit Ina stop work ceder or permit revocal A knouAekigarrtent c
such Is by signaUv below:I declare that I am the owners WW mp v=t*A,or the coritactor.I tatter dedare that I am er*ted to mode this
peank and to do the work as proposed in the appilaftn.I declare that I have d*kwd the permission from as the necessary parties.If perrrfsion is
required Iran any easement holder or any other party in kttenest regar&V this appkatbn or tte work proposed In ,I have obtained
perrti Wm from them to appy for ft permit and c ndM#w work Wgxna The owner or agent on ownerY3
prodded is aw ate and �of Mason county aooess to the above desaWd properly and stricture
PROOF OF OONTINUA IS BY MEANS OP A PROGRESS=PEcm0N.
X MA
Date: a 17LVo p za0�
Owner Owners R resentative/Contractor a which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date. UN VY
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department ��� Z- , r_.7.
Planning Department
Environmental Health Department
Public Works Department r
Fire Marshal
FEES
Buldina Permit Fee s Site Ins ectfon
Plan Review Fee
� EH Review Fee
Plumbing&Base Fee Plannina Review Fee
Mechanical 8 Base tt0o=veFe9j_
Other
Wood/Gas/Pellet
State Fee
Violation Fee Pre-Paid at Submittal , &
Valuation$ TOTAL FEES