HomeMy WebLinkAboutCOM2001-00099 Final Reinforce Structure L6 - COM Permit / Conditions - 6/17/2005 p m r
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0 CONCRETE L-C MECHANICAL MANUFACTURED HOME
Footings/Setbacks, Date B y Ribbons
D ate gyp' By Jam_ Gas Piping
o Date B Y
0 Foun ation Walls Date B y Set-up
C° 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 Date J'j B Y Z-OX
D ate B y Date B Y
02 17 - 02 1� Ot1 ss. 'CL
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FORM MUST BE COMPLETED IN INK �wJ
PLEASE PRESS HARD - PERMIT NO.: BLD
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98684
Shelton 360 427-9670 Belfair 360 275.4467.Elma(360)482.6269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner .0 H of.kSfiS Glap�>�I: I.i r SAID Contractor Name (7Wl�lefz
Mailing Address_h0ti3or S Mailing Address
City_lZ Ao6,-me State WA Zip Code 4561 A _ City State Zip Code
Phone(-,h&o )'Lrt - � Other Ph.(3W )S�� cL� Ph.(_ Other Pht-
Lien/Title Holder_wowG 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 (oo00O Fire District S
Legal Description Pazttnu of NWIIb t eip:e I! _ T2'LN 1Z tw W,,ti
Site Address(Please include street name, street number and city) �1►;G, TS0, C Dow lylk
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 Lxles 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 Buildin AL&5eli-c4 �11{gt rem,:; o
Describe Work Me4r4 _ -x1 N 0
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor Nons
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
f
BILE HOME INFORMATION-Make Model Model Year f
Leng Width Serial No.
No. of Bedrooms No. of Bathrooms j
Type of at Purchase Price $ Replacement Unit ?(Yes/No)
Installer Na a Certification No.
i
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:
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 all work
conformance t erewit . o changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
ap first obtaining approval.
pro
X Date a,p 2a,3 I X Date
-4ALI" lJ. (A-Zfli"mFOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
Building Department
Occ GroupType Con r. — 6
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
TOTAL FEES ..
S
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD PERMIT NO.: BLD
MASON COUNTY
BUILDING PERMIT APPLICATION LOrn 2M -6M9q
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 27"67.Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner 4il¢4u OF SkW26 61491% ,17F La.Tkly- 17&!�4e,wr5 Contractor Name owr-Aem
Mailing Address h08oA q,7:-I Mailing Address
CitytZot,PP,6-rar_ State wA. Zip Code City State Zip Code
Phone(,%y0 )2,13-(n,'10 Other Ph.(3)5SA.566 Ph.( Other Ph.(
Lien/Title Holder. Wtju6 Contractor Reg. #
Address Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Water System Well Water System Name of
PARCEL INFORMATION-12 digit Tax Parcel No. _ i2Ztq / &0000 Fire District 5
Legal Description P02ttdN OE NW I!b t t,�_ to T ZZ N, 1Z t w t \A/,AA
Site Address(Please include street name, street number and city) �A{t Z30 Goow Deiva �nT�
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No) Ro
Is your property within 200' of the following: Body of Water(Name) GOON ! AV b Saltwater NO
Bluffs River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
1TYPE OF JOB New Add Alt Repair Other Use of Buildin gu�5?ttrc4Et.t,Errs L&
Describe Work 264r4 _ F-xlSTwae Co D
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 406t 2nd Floor Honk:
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport Attached Detached
MO-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 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 j
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 r
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 changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without !!!
app oV2r first obtaining approval.
X Date 0 2061 X
Date
ARL"V 10. L'"'to"FOR OFFICIAL USE BEYOND THIS POINT I
i
Accepted by Date Submittal Amount Due Receipt No.
APP.RQVE .. ... . .. ::;.:.;:.;
.....................
Building Department
Occ Group- Type Constr.
Planning Department
Environmental Health Department
Gv
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 ( )
Hill,]
...,_>. ... .. ,...:... ,.:,..., TOTAL FEES
FORM MUST BE COMPLETED IN INK J
PLEASE PRESS HARD PERMIT NO.: BLD
MASON COUNTY
BUILDING PERMIT APPLICATION ' `Dm �
426 W.CedartP.O.Box 186,Shelton,WA 98584 Btu le
Shelton 360 427-9670 Belfair 360 275-0467.Elma 360 482-6269 Seattle 206 464-6968 it
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner .0 124H of JtSn 141ZIST BE IA1��4eY,5 Contractor Name 0Lr4c_=
Mailing Address ho15or 1;7,-1 Mailing Address
CitytZor,rl�stse State wpk Zip Code �&6*1q City State Zip Code
Phone(,%en )L'13•(n,'10 OtherPh.('? )cakrt!c„_ Ph.(+ Other Ph.(
Lien/Title Holder LInu6 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. 1?r2t� / /� Fire District 5
al Description Patatt e>N of NW t 1 b ee_ Ig r 22 N 1Z t w
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) COON l.Alas Saltwater NO
Lake_River/Creek Pond Wetland Seasonal Runoff Stream Slopes or j
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB New Add Alt Repair Other Use of Buildin w
Describe Work VMvq _ xI N O �
tJ
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor Pot 2nd Floor Noss
13rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached Carport —____,Attached—Detached hed
BILE HOME INFORMATION-Make Model Model Year
Leng gWidth 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-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 1 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 2 9 X
Date
i RLcctt LJ, u Rl3io"FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
RQVE.
::.::. . :.::.:;:.:;:;;:::::::::;:<.;
Building Department
Occ Group Type Constr.
Planning Department AM
Environmental Health Department
Public Works Department
Fire Marshal
i
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 ( )