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HomeMy WebLinkAboutCOM2003-00195 Repair Store Front, Final - COM Permit / Conditions - 12/11/2004 0 • _ K ,vCONCRETE MECHANICAL MANUFACTURED HOME o Footings/Setbacks Date B y Ribbons D ate C) By Gas Piping Date B y Foundation Walls Date B y Set-up Date By INSULATION Date By B G / Slab Insulation Floors Final Date By Date B y Date B y FRAMING Walls FIRE DEPT ate lL-2 —o.�! By L-zJ 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 Z J2--c�j B y Date By f" Date By /2--IL -o Y—/ — 0 y � a O O .. O O y y i 0 O O ' < o wo W oho �' fDCD CL `< -i D `m N .rT < BCD �° n CO -n ° c o -i r co m D °: 0 c D m G CL T o �o c m D CO) r- D W > b9 �1n m -- mn ��{ � r c o o 3 mQ 0 T� � rm mZ- N M. Zy m 3 a m m zM (((n � � j (n c' cn �, a 5 - 00 ° m 3 Cn ' Z � wonn D a Z 3 33 � w; �• � � m -1 (n � �DT� � CDz0 (no 3 za( c ; m `OO aC °o s s 5 = p cQ cD m m p � (Z —-n w Z ja _ -IpT N � zZ C � a ' < O � pZ � m :. 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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,{t (rji!' 1 Contractor Name ��ICSp �,Ov C Mailing Address 20 6 &, ?(.& Mailing Address . )c lurd City Altzh State W�4 Zip Code SZy City & SO�i(' State WA_Zip Code Z Phone (36a ) 27I- K9H Other Ph. ( ) Phone (3kD-) 2."15-5gMOther Ph. (tML) 17/0i Lien/Title Holder Contractor Re Email Address 9 ��KsG114�'MIExp._L_/zl / 2 - Email Address�a SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic C Connect to Sewer System Name of Sewer System Well Water System T Name of Water System au �C PARCEL INFORMATION - 12 digit Tax Parcel No. / Legal Description —�/ Fire District II S TR. oT g Site Address (Please include street name, street number and city) �. 0 1 Directions to site or N raw. 6,klaK 4y,BeliLfo a. wti "Or1. Will timber be cut and sold in parcel preparation? (Yes/No) Is property located within 200' of saltwater 40 Lake wia River/Creek Pond Wetland Seasonal Runoff .Jo Stream do Slopes or Bluffs ,oc 77 PERMANENT RESIDENCE ❑ SEASONAL RESIDENCE ❑ TYPE OF JOB - New Add Alt Re air p �p< Other Use of Building gp-16 cc„ 1 �1a-n Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(Yes/No) &1c, _ Describe Work QL�_t o clams-ne r� S1 t �teti.�do�c s.�; tfS No. of Bedrooms _0 No. of athrooms I SQUARE FOOTAGE- 1st Floor Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unit? (Yes/No) Installer Name 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT-I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT- I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- sh e e without first obtaining pproyal. wi o Chan es shall be made without first obtaining approval. X � s LO� �Dlate- // X Date FOR OFFICIAL USE BEYVND THIS POINT Accepted by Planning Pd " ,—/— Ck# Date / Bid Pd. ��. `t� Reciept No. d 'Y rBuilding Department Grou T e Constr.nning Department Environmental Health Department Public Works Department Fire Marshal Valuation$ a 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 j k TOTAL FEES MASON COUNTY PERMIT NO. �• `'`r� ,1^A 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 On the Web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Name � ��ti1V1�1Jv1 Cov►5'}. Mailing Address 2L is ��,j ti'iwcc Mailing Address 7 0• Ox likef City A llyv\ State y,)A Zip Code 1&5_2q City 04o,�C State Itilft Zip Code Z Phone S''15H Other Ph. ( ) Phone (360) 2 3-5'4COOther Ph. (_%0 731 -710 Lien /Title Holder Contractor Reg. #-�kA�K_ICI182,MExp. 7 /-7 1 / C` Email Address Email Address SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic x Connect to Sewer System Name of Sewer System Well Water System— Name of Water System t at QC11 ( PARCEL INFORMATION - 12 digit Tax Parcel No. 1 "Z 4 / 3 / 1 �`�d Fire District Legal Description P&0' ''V N&0 SW Vet o f Yy -1Z A o4 bf IS Z_ Site Address (Please include street namef street number and city) 7-j M A)t S Z 3 c u Directions to site nt.,rU, ,-,� }I,u� 3 do ��c�f�� t� ir(�,;c_. i��cl; SS ;s Nub �u � �afd� 5�occ f tCT— T_X-w CC 4LA'(j SE4F ova. Will timber be cut and sold in parcel preparation? (Yes/No) r40 Is property located within 200' of saltwater n10 Lake ND River/Creek No Pond A)o Wetland ua Seasonal Runoff 40 Stream A)o Slopes-6`r"Bluffs A3o PERMANENT RESIDENCE ❑ SEASONAL RESIDENCE ❑ !I TYPE OF JOB - New Add Alt Repair k Other Use of Building Cow c(c_;,j siotG Is this permit submittal the result of a,Stop Work Notice,Correction Notice or other enforcement action?(Yes/No) 40 _ Describe Work Rc ;c b� c�a 0. J Sloe 4ka,,+ 400<s ,,,�;Hc { �nJrt11S. No. of Bedrooms .© No. of 13athrooms I SQUARE FOOTAGE - 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unft? (Yes/No) Installer Name Certification No t1 NOTICE: THIS ERMIT COMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NCIT DOMME CED WITHIN 180 DAYS OR IF CON RUCTION WORK IS SUSPENDED OR ABANDONED FORA PER10D'OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMM ED. PROOF OF CONTINUATION GKWORK IS BY MEANS OF A OGRESS INSPECTION. THE OWNER OR AGENT ON O ER'S BEHALF,REPRESENTS THAT THE INFORMATION PRO [hCI_1S ACCURATE AND GRANTS EMPLOYEES OF Mason CO TY ACCESS TO THE ABOVE DESCRIBED PROPERTY AND STRUCTURES FOR REVIEW AND INSPECTION OF THIS PROJE T. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORD OR R OR PERMIT REVOCATION.ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certi et I am exempt from the require- CONTRACTOR'S AFFIDAVIT - I certify that I am currently regis- ment of the Contractor Re ' ration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requ' ents for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will b one in conformance therewith. No changes permit is issued and all work shall be done in conformance there- sh e hou st obtaining.applpV I wi . o chan s shall be made without first obtaining;apprc val. X Date �2 21 X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted b Planning Pd Date Bld Pd. ! • `�1 Reciept No. , k I Building Department Occ GroupType Constr. 1' U� 00 r G' Planning Department Environmental Health Department 7 iRECEIVED Public Works Department NOV 21 Fire Marshal i Valuation$ 426 W. CEDAR ST., '� 'M # i( Building Permit Fee /�57 �� Site Irys e rl,„V 3 00 21/- 10 • Q Plan Review Fee (�� EH Review Fee 5v v(� (J Plumbing&Base Fee 11 Planning Review Fee i Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( f TOTAL FEES