HomeMy WebLinkAboutCOM2001-00098 Final Reinforce Structure L5 - COM Permit / Conditions - 6/7/2005 n
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CONCRETE MECHANICAL MANUFACTURED HOME
N
o Footings/Setbacks Date By Ribbons
b Date IQ -a By Gas Piping Date By
C) Foundation Walls Date B y Set-up
00 Date By INSULATION Date By
B G / Slab Insulation Floors Final
Date By Date By Date By
FRAMING Walls FIRE DEPT
Date By Date By Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLBOARD NAILING
D.W.V. Date By
Date By FINAL INSPECTION
Water Line I Date ? B y ' j
Date By Date By
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FORM MUST BE COMPLETED IN INK
. PERMIT NO.: BLD
PLEASE PRESS HARD
MASON COUNTY Coln 26DI Q11D9S
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275-4467.Elma(360)482.6269 Seattle 206 464-6968 y
APPLICANT INFORMATION CONTRACTOR INFORMATION "
OwnercAvezt; ot:ells C14ZIS4 ,oF IATTtae Dam Contractor Name (7JWr-Aetz
Mailing Address h D 8o;% 1;7, Mailing Address
CitAzCLP 6T&z State wp,_ Zip Code !&Z01 City State Zip Code
Phone(,ugn )2,13-M a Other Ph.(7 )933A-5156 Ph.(_, Other Ph.(
Lien/Title Holder WomG Contractor Reg. #
Address Expiration
'SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Welt Water System Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. 12Ztq /3/ (o0Ooo Fire District 5
Legal Description POfafitOw of tt4WIIb -40e, t!61 TZ'Z.N, 1Z1w 1 WPM•
Site Address(Please include street name, street number and city)t,r 230 Goons Detva GBH
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No) 14a
Is your property within 200' of the following: Body of Water(Name) COON LA1Gs 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 Building
Describe Work ILFAr4r-ow XISTING 5tZI&XVIrs< <96f- (� 15+r-L)e_T- -1 Fe7
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Flo r 46& 2nd Floor NoNs
3rd Floor Loft Basement Deck' Other sq. ft.
Garage Attached Detached Carport Attached Detached
t BILE HOME INFORMATION-Make Model Model Year
Len g Width Serial No. No. of Bedrooms No. of Bathrooms
Type of at Purchase Price $ Replacement Unit?(Yes/No)
Installer Na a 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 t erewit o ch nges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
appro . Q first obtaining approval.
X Date O 2� X Date
f. AALccv W FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
:. APRE :.::.:D.B.Ntlwt?.:............................:..,:,.:,: QN. :.T1.:.::.. .:................. . ........... .
Building Department
Occ Group f Type Co Qa�
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
1
i
Valuation $
t ..:..... :....... ............. ...:........ ............
Building Permit Fee Ske Inspection
i
Plan Review Fee EH Review Fee
{ Plumbing&Base Fee Planning Review Fee
l
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
r
TOTAL FEES
FORM MUST BE COMPLETED IN INK 0 .
J
PERMIT NO.: BLD
PLEASE-PRESS HARD
MASON COUNTY WM 2a/- 8
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
OwnercA ezu of . SUS 6Ne154 ,ac IAXvw_ D&y S IL is Contractor Name L21N m
Mailing Address h 0 8or c I -e Mailing Address
City1Zof,ides,1r,z State wp,. Zip Code M56101, City State Zip Code
Phone(-%&p )2,15-0110 Other Ph.(3 )SSA-StG5 Ph.(_ Other Ph.(
Lien/Title Holder o_N6 Contractor Reg. #
Address Expiration
'SEPTICIWATER 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 / / (00000 Fire District S
Legal Description POILtIdN of V~14, ere, 1!6 Tr Z2N; 1Z 1w. W& -
Site Address(Please include street name, street number and city)_AG* 230 Goow Derma 6,0LItH
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No) RD
Is your property within 200' of the following: Body of Water(Name) COON Lxl,6 Saltwater NO
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE(3
TYPE OF JOB New Add Alt Repair - Other Use of Building
Describe Work IZZ rl e) 2
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Flo r 437" 2nd Floor Nowt:
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 a 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 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.
X Date g Z0 1 X Date
I ARtcty w FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
WOW
Building Department
Occ Group Type Constr.
Planning Department
Environmental Health Department 7 1 U
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 ( )
TOTAL FEES
FORM MUST BE COMPLETED IN INK 0
. PERMIT NO.: BLD
PLEASE PRESS HARD
MASON COUNTY G0.kn2dv/, 9�
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 I
APPLICANT INFORMATION CONTRACTOR INFORMATION
OwnerCg mll olr%J%g5 614Pj154 eF I,�Ti� Day j e,u* Contractor Name � mmz-
Mailing Address ho5or G2,'1 --� Mailing Address
City 20r,Aes-yb2 State W_& Zip Code J r2 '11 City State Zip Code
Phone(-,hyD )Zrt3-am o Other Ph.(2jzQ )qsd-9;t45 Ph.( Other Ph.(
Lien/Title Holder wi & 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
P RCEL INFORMATION-12 digit Tax Parcel No Irlt'1' A " / ' 1 ; prO�" Fire District S
-regal Description PD2t►tnyt of NW4111& . 4p:e lig, T7,ZN IVV . W.AA-
Site Address(Please include street name, street number and city)
Directions to site
f*A Pam
Will timber be cut and sold in parcel preparation? (Yes/No) go
Is your property within 200' of the following: Body of Water(Name) GooN LAv s Saltwater NO
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE 0 SEASONAL RESIDENCE❑
i TYPE OF JOB New Add Alt Repair Other Us of Puldtg
Describe Work 1'LEtri xls tN b G
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Flo r 43772nd Floor NoNa
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
11 BILE HOME INFORMATION-Make Model Model Year
en Width Serial No. No. of Bedrooms No. of Bathrooms
Type of at Purchase Price $ Replacement Unit ?(Yes/No)
Installer Na a 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.
I PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
t 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
s 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
appro first obtaining approval.
X Date g Z06 1 X Date
f_ .4 R77ty to cz213c "FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
'I ................................................................................................:......: ..:.........:....:.......::::::.:....:.:.........:::.:.::::::::::::::::::::::::::.:::::::::...:...:.:....:......:...;.:..;::..:...:..........:;:;.; ;.;:<:.::.:::.;:::.::.............::::
:»:::>::»::::>:::: >:::>:al'PRS .. I ...... 1 ::>>:'><><:<::>«:>::<::<:>::: t~3NR1't' f .. ... .. ...................... ..........
.::::...:.....:.................::..:::::...::D .N:f~D.::::.::::.:::::::.:,::.:,,.::.::::,::::.::. :..
Building Department
Occ Group Type Constr.
Planning Department
i
j 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 ( )
' TOTAL FEES