HomeMy WebLinkAboutBLD2002-01581 Final Carport/Storage - BLD Permit / Conditions - 12/12/2002 O F7 m (D L
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FORM MUST BE COMPLETED IN INK J� PERMIT NO. Bu,PW-016S
PLEASE PRESS HARD MASON COUNTY
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
On the Web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Se c r X e kiSS Contractor Name
Mailin Address 3 3D 4 �t:� `i 1� #=3 Mailing Address
City 'r State Zip Code �dr.2g City State Zip Code
Phone L166)37a-o22Od Other Ph. Phone L ) Other Ph. L J
Lien/Title Holder CA Contractor Reg.# Exp.
E-mail Address :S,Z' s'p GZOL E-mail Address
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic fisting Septic Connect to Sewer
System_Name of Sewer System Well Water System
Name of Water System
PARCEL INFORMATION- 12 digit Tax Parcel No..1 2 30 7,5 / ,6 Fire District
Legal Description 0za1,,,e^ /y6 ( -5*z 6 9 Se�
Site Address(Please include street name,street number and city) 7$� e�it/cK ��`!lam- Dr D�/�k i/
Directions to site g wy 3 To rae xe lr' Al
Will timber be cut and sold in parcel preparation? (Yes/No) A149
Lake River/Creek Pond Wetland Seasonal Runoff x Stream
Slopes or Bluffs
PERMANENT RESIDENCM SEASONAL RESIDENCE❑
TYPE OF JOB-New Add Aft Repair_Other Use of Building C&AO6 r45 rO s
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(Yes/No) <.`5
Describe Work re_ t^ C.C�✓ O �S
No.of Bedrooms—rV No.of Bathrooms 2k SQUARE FOOTAGE- oor
3rd Floor Loft Basement Oth tft
Garage Attached Detached Ca $ ch De hedS'
lMOBILE HOME INFORMATION-Make=14 Model Model Year
Length il,l Width _70 Serial No. No.of Bedrooms No.of Bathrooms —F-
Type of Heat /�G%rr`C Purchase Price$ c. epp ace entUnit? No) D ,
installerName dAjejg<e-Z0jJ_57%4 Certification No. j/ L
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.Owner/Builder acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgment
of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
the Contractor Registration Law RCW 18.27 and am aware of the ordi- contractor In the State of Washington and that I am aware of the ordinance
nance requirements for which this permit is issued and that all work will be requirements regulating the work for which this permit is Issued and all
done in conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No changes shall be made
obtaining approval. without first obtaining approval.
X / Date I1 �2 X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date ubmittal Amount Due Receipt No.
Building Department
Occ Group TvDe Constr.
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 I Pre-Paid at Submittal ( )
TOTAL FEES
PERMIT NO. BLD
,. MASOK COUNTY
BUILDING PERMIT APPLICATION OW-Cbl l
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
On the Web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner c Contractor Name
Mailin Address.Addresi_7,.EW 03 Mailing Address
City . ` State Zip Code City State Zip Code
Phone(3(�Q),.37e1-oZ]Of, Other Ph. C� Phone L_) Other Ph. ( ) R i
Lien/Tdle Holder C d Contractor Reg.# Exp._J___/ ` {
E-mail Address G E-mailgddress
r.
13EPMC/WATER SYSTEM INFORMATION-Connect to New Septic fEAsting Septi-C.1 Connect to Sewer
jSystem_Name of Sewer System a Water System I
Name of Water System +
i
PARCEL INFORMATION- 12 digit Tax Parcel No. 2 / 15 / 601 '7 1 Fire District
Legal Description 0 x 4!� K
Site Address(Please include street name,street number and city) 7 & ^A1e r je `/! Of- l�w_lF'a
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No)AIQ
Lake River/Creek Pond Wetland Seasonal Runoff-Stream
i
Slopes or Bluffs
PERMANENT RESIDENC SEASONAL RESIDENCE❑
TYPE OF JOB-New Add Aft Repair_ Other Use of Building C z T S
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? (Yes/No) e
Describe Work
No.of Bedrooms No.of Bathrooms SQUARE FO TAGE- o it
3rd Floor Loft Basement De Other' ft.
Garage Attached Detached Carpo ch _-_�� e�
MOBILE HOME INFORMATION-Make Model � Model Year q
Length Widths Serial No. No.of Bedrooms;No.of Bathrooms �. -"
Type of Heat rice �` e-_ Purchase Price$ k e acement Unit? es/No) +] It. ice;
Installer Name Certification No. 3 �<
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 ANYTIME AFTER{HE 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
j of this project.Owner/Builder acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgment
of such is by signature below:
I" OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
fthe Contractor Registration Law RCW 18.27 and am aware of the ordi- contractor in the State of Washington and that I am aware of the ordinance
nance requirements for which this permit is issued and that all work will be requirements regulating the work for which this permit is Issued and all
done in conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No changes shall be made
obtaining approval. without first obtaining approval.
` X Data X Date
FOR OFFICIAL USE BEYOND THIS POINT
f Accepted by i' F Date/ ubmittal Amount Due Receipt No, a
f
Building Department N9 10•oa '
Occ Group -1 Type Constr. \1-)L) EAF a4w/M,2 irL 4 6
Planning Department 4
Environmental Health Department
Public Works Department
F »
IMarshal Q
`..f. :a✓' 4
iF
Valuation$ A
r
Building Permit Fee �lb Site Inspection
Plan Review Fee L. ,u EH Review Fee
Plumbing&Base Fee N. Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee L v0
Violation Fee CA ic') Pre-Paid at Submittal ( c? )
TOTAL FEES
I ;
TImo- PERMIT NO. BL[D k)bg—o 15 3
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W.Cedar/RO.Box 186,Shelton,WA98584
Shelton(360)427-9670 Belfair(360)275-4467 Elma(360)482-5269 Seattle(206)464-6968
On the Web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner M m l A4 V 3t RvSa' a r,4 , +k/ r " Contractor Name AJA#
Mailin Address 3 Q d (Oe j J5 f'. ' � 3 Mailing Address •
City State Zip Code 4J&50 )1T City State Zip Code
f Phone(3W� 1 - C1br Other Ph. ( _J Phone(_) Other Ph. L_ '
i Lien/Tdle Holder C{�(�� Contractor Reg.# Exp.
I E-mail Address ,:r E-mail Address
w
E
/WATER SYSTEM INFORMATION-Connect to New Septic 'stin Septic Connect to Sewerem_Name of Sewer System a Water System
e of Water System
04
PARCEL INFORMATION- 12 digit tax Parcel No. lgo Fire District
Legal Description t 4l ' ° - r c'/ *
Site Address(Please include street name,street number and city)
Directions to site _I a..— r - . 7 �
off
! .
Will timber be cut and sold in parcel preparation? (Yes/No)
Lake River/Creek Pond Wetland Seasonal Runoff '�_Stream
Slopes or Bluffs
PERMANENT RESIDENCE SEASONAL RESIDENCE❑
TYPE OF JOB-New Add Aft Repair Other Use of Building G C.An t 7 -1 T fz.- "
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? (Yes/No)
Describe Work r4eiO4.1e C-a or e,-
No.of Bedrooms No.of Bathrooms SQUARE FOOTAGE,,-�'W, Floor .2rM Floor
3rd Floor Loft Basement Declt `' Oth ft.
Garage Attached Detached Carportch to e4
MOBILE HOME INFORMATION-Make W2Model r �_Model Year
Length �Width '70 Serial No."N_ � No.ofBedrooms_ No.of Bathrooms ;•L
"t-
Type of HeatAe"/ct a" L Purchase Price$ a . lace Unit? )
Installer Name . / Certification a10
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.Owner/Builder acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgment
of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
the Contractor Registration Law RCW 18.27 and am aware of the ordi- contractor in the State of Washington and that I am aware of the ordinance
nance requirements for which this permit is issued and that all work will be requirements regulating the work for which this permit Is Issued and all
done in conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No changes shall be made
obtaining approval. without first obtaining approval.
X Date .? X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date/ tubmittal Amount Due Receipt No.
Building Department
Occ Group Type Constr. CA �az,_Vj/Ma
Planning Department r^r- 1
Environmental Health Department
Public Works Department
Fi ",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
MASON COUNTY PERMIT NO. BLD
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton(360)427-9670 Betfair(360)275-4467 Elms,(360)482-5269 Seattle(206)464-6968
On the Web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner -?- ,�Contractor Name ,r_ �f
G¢lc � r r" .j4SIG 3� Mailing Address
Mailing Address a5-
City. / '. , r State_WAZip Code!JJ Z City State Zip Code
Phone G'tOther Ph. (_J Phone(___) Other Ph. C
Lien/Title Holder e,Gl' 4- � Contractor Reg.# Exp.
E-mail Address . 11i E-mail Address
[Name
TIC/WATER SYSTEM INFORMATION-Connect to New Septic sting ep c Connect to Sewer
m_Name of Sewer System Water System t
of Water System
A* r' ,. Fire District
M
PARCEL INFORMATION-12 di it Tax Parcel No. �'
Legal Description
9
Site Address(Please include street name,street number and city) 42,4e-_ pf "-
Directions to site 1J4 3 1 1,; 1 " A" l
Will timber be cut and sold in parcel preparation? (Yes/No)
Lake River/Creek Pond Wetland Seasonal Runoff—_X_Stream
Slopes or Bluffs
PERMANENT RESIDENCE SEASONAL RESIDENCE❑
TYPE OF JOB-New Add Aft Repair Other Use of Building 7 „�T". .
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(Yes/No) f%��-;
_
Describe Work
No.of Bedrooms No.of Bathroo s SQUARE FOC)TAGE-1st Floor 2nd Floor~, r
3rd Floor Loft Basement Deck r _ « Other
Garage Attached Detached Carport AtJached .I !J ►�- eta W ed "
MOBILE HOME INFORMATION-Make Model 3 Model Year 3,� 4 X
Length Width / .
• " o-o edrooms o.of N Bathrooms
. { "< Serial N t
Type of Heat se Price$f 3 e T` s ,, °' W`�cement Unit?(Yes/No)
Installer Name Certification o.
NOTICE:THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
{ PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection
of this project.Owner/Builder adcnowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgment
of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
' the Contractor Registration Law RCW 18.27 and am aware of the ordi- contractor in the State of Washington and that I am aware of the ordinance
Hance requirements for which this permit is issued and that all work will be requirements regulating the work for which this permit is Issued and all
done in conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No changes shall be made
obtaining approval. without first obtaining approval.
X f Y x ¢� Date , X Date
FOR OFFICIAL USE BEYOND THIS POINT
'f
' f
Accepted by Date '} Submittal Amount Due ' Receipt No.
om
Building Department
Occ Group Type Constr. / r
Planning Department tt
Environmental Health Department i 3U
Public Works Department
Fir Marshal
Valuation$
NINE
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee 3��
Plumbing&Base Fee K. Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ( )
OEM
TOTAL FEES