HomeMy WebLinkAboutCOM2001-00096 Final Reinforce Structure L3 - COM Permit / Conditions - 5/21/2003 0
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FORM MUST BE COMPLETED IN INK `d✓ PERMIT NO.: BLD
PLEASE-PRESS HARD -
MASON COUNTY Lbw
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275-446T.Elma 360 482- 269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
OwnerCNutLu op aS6 G149-le of I,QI:Igiz, 10&�SA,ul.; Contractor Name WriCtz
Mailing Address 0 o iDor c;2'1 Mailing Address
CitylZof,iaesYae State wA. Zip Code Jer2l_'i City State Zip Code
Phone(,%bo )7,13-aL1 D Other Ph.(3)514.566 Ph.(_ Other Ph.(�
Lien/Title Holder Wool; Contractor Reg. #
Address Expiration
'SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Well Water System Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. 12214 /5/ (00000 Fire District S
Legal Description Potzf,%tew of HV4IIh I Are— IgT ZZ,N) 121 w I W,A&.
Site Address(Please include street name, street number and city) kAGt 230 G-0*4 ftlys 6,autH
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No)
Is your property within 200' of the following: Body of Water(Name) COON LANs Saltwater NO
Lake__�LL River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB New Add Alt Repair Other Use of Buil ing ALmrINc�J;qr-Griees — l�3
Describe Work 12eIN xl N e -- o
k No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor NONF-
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
BILE HOME INFORMATION-Make Model Model Year
Leng Width Serial No. No. of Bedrooms No. of Bathrooms
Type of at Purchase Price $ Replacement Unit ?(Yes/No)
Installer Na a7 Certification No.
NOTICE: THIS PERMIT BECOMES NULL E.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 AFFIDAVIT4 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 t erewit . o chi nges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
appro first obtaining approval.
X Date OQ 1206 1 X Date
i_ ARLcct! CJ.ru` iD"FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
................ ............::.: .I!�...:a�.,.:R�V���4F::::::.:.,:.:::::::.::. ::,:..............:. ::A�.AI �N>�Yl'I�. .. .
Building Department Keel, \
Occ Grou - . T e Constr. —11 6i`AA
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
Valuation $
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 ( )
v ,.,. _< . .,, TOTAL FEES •
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD _ '' PERMIT NO.: BLD
MASON COUNTY
BUILDING PERMIT APPLICATION �dmz� ��
426 W.Cedar/P.O.Box 186,Shelton,WA 98684
Shelton 360 427-9670 Belfair 360 275.4467.Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
OwnerC41irizz OF .k416 GNpIST BEST 46iuI5 Contractor Name 0WrkL-z
Mailing Address ho15oT S7_1 Mailing Address
CitY9e6Aes1ttz State w^. Zip Code Gt2�A City State Zip Code
Phone(,%tio 2,13-t»'10 Other Ph.( )r cep Ph.( ) Other Ph.(_ )
Lien/Title Holder- 14nN6 Contractor Reg. #
Address Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Well Water System Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. 1221q / Z�/ &0000 Fire District 5
Legal Description P02fiId>J I2F NW 114, I �, IA T 22 N 1Z t W t \AJ �
Site Address(Please include street name, street number and city)� � 'LSD GaoLI �ILw /��/�.►�
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No)�_
Is your property within 200' of the following: Body of Water(Name) i✓DON LAVs Saltwater NO
Lake_River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
1TYPE OF JOB New Add Alt Repair Other Use of Buil ing!'res�lwc� 4H r*es , L 3
Describe Work luum xl N V � _ v
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor NONE
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
BILE HOME INFORMATION-Make Model Model Year
W
Leng idth Serial No. No. of Bedrooms No. of Bathrooms
Type of at Purchase Price $
Replacement Unit ?(Yes/No)
Installer Na a Certification No.
i
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 AFFIDAVIT4 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 t erewit . o ch nges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approv first obtaining approval.
X Date G,p 12W 1 X Date
i -4RLOV W, e,,_2/3i3O&AF70R OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
Building Department
Occ GroupType Constr.
Planning Department
Environmental Health Department
Public Works Department k
Fire Marshal
Valuation $
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee a S r
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 li..
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD PERMIT NO.: BLD
MASON COUNTY
BUILDING PERMIT APPLICATION Low z� l-a?1b9�
426 W.Cedar/P.O.Box 186,Shelton,WA 98684 -" 3
Shelton 360 427-9670 Belfair 360 275�467.Elma 360 48Z-5269 Seattle 206 464-6965
OwnerAPPLI ANT INFORMATION CONTRACTOR INFORMATION
Owner ANT
OP.l!5,16 CAW T 0155TJ�:��i6� Contractor Name �Wt�tctz I
Mailing Address_h o 8or c -1 Mailing Address
City_1zvr Aesr*w State 1%0�.. Zip Code_JW211 8 City State Zip Code
Phone(%,&p )7,13-0771 o Other Ph.(3&2 )53d.Si!;S Ph.(_ Other Ph.F
Lien/Title Holder_wiiu6 Contractor Reg. #
Address Expiration
`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
ARCEL INFORMATION-12 digit Tax Parcel No. 4CJ�
' Fire District S
Legal Description P�tzfilON of NWild. [,r�� tq, i'""
Site Address(Please include street name, street,number and city)
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No)��_
Is your property within 200' of the following: Body of Water(Name) GOON 1,A V a Saltwater No
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 Buil ing j L_3
Describe Work VLEtrl xl N e
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor NoN1:
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
BILE HOME INFORMATION-Make Model Model Year
Leng. Width Serial No.
No. of Bedrooms No. of Bathrooms
Type of at Purchase Price $ Replacement Unit ?(Yes/No) j
Installer Na a Certification No.
NOTICE: THIS PERMIT BECOMES NULL d.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: I
OWNER AFFIDAVIT4 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 I�conformance t erewit . o ch nges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without !
appro first obtaining approval. 9
s
p s
X Date 6 1206 1 X
Date
1. AAuty 0 LA-R,86vaaItFOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
..............................
Building Department
Occ GroupType Coristr.
Planning Department A
M
Environmental Health Department
Public Works Department
Fire Marshal
Valuation $
INARM
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 ( )
`