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HomeMy WebLinkAboutCOM2003-00066 Sign - COM Application - 3/20/2003 FORM MUST BE COM PLETED IN INK PERMITNO. BID.Cpinw��i— PLEASE PRESS HARD MASON COUNTY BUILDING PERMIT APPLICATION , 4M W.CedarlP.O.Box IBM shdton.M$W84 Shelton PM 427.9670 Wick(960)275-4467 MMa(960)set-aM Seaftlu(206)484-esee f On the web www co.masonma us APPLI NFORMATION CONTRACTOR IN RWIATION owner S.4 =�/�•n-c, 1 '' Contractor Name 5.� maaing�AQddress cV3t G/ .c/E _ . " 3 Mai1ng Address /1(ex I City !ICfe 9 i .StateA&4Zip Code 985:79 City N Stat&2±21p Code 2 dl, Phone G3 W .27S-Of?2 or Ph.(___) Phone y�77-�.�?S Omer Ph.�) Liot Title Holder Contractor Reg.# �'e-JZS E // eBT Exp.,?J£_)t E-mall Address E-mail Address ENVATEA SYSTEIIA INFORfl1ATiON•Connect to New Septic E�asting Septic Conned to Sewer Name of Sewer System W6ll Water Systemf Water System PARCEL INFORMATION-12 digit Tax Parcel No. Fire l)(strict Legal Description Site Address(Please include strvot name,sireat number and eiM R b ! A r- �• av7�e rr(y Directions to Site Wla timber be ctA and sold In parcel preparation?(Yes/No) Lake River/Creek Pond Weiland Seasonal Runoff Stream S12M or Bluffs PERMANENT RESIDENCE O SEASONAL RESIDENCE❑ TYPE OF JOB-New Add Al Repair Other Use of Building Is this permit:submittal the result of a Stop Work Notice,Correction Notice or other eniareement aoffon?(Yeaft) -Describe Work :r^- - // (/ Dom- Sj /< r*-4-e-L 4. Al! .S/G"I 242" 77/e n, No.of Bedrooms No.of Battmms SQUARE FOOTAGE-list floor 2nd Floor 3rd Floor Lott Basement Deck, Other sq.R. Garage Aft shed Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit?(Yes/No) Installer Name Certification No. NOTIGE:THIS PEIWIT BE00ME6 NULL&VOID IF WORK OR CONMUCTION AuTHop=5 is NOT MAMM TrrHN 190 DAYS OR IF CONSTRUCTION WORK IS SUSMDED OR AIslV'1DONED FOR A PERIOD OF 160 DAYS AT ANY TIME AFTER THE WORK 16 OOMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.The owner or agent on p tagf{lfmt the information provided is actuate and grams omployeas of Mason County amass to the above descrtbed property and I of this project.OwneriBuilder ackrowiodges submission of irw=r att ate Information may result in a stop w onset or permit revocation.Acimowledgment of such in by Signature below: MAR 2 0 2003 ObVNER AFFIDAVIT-1 certify that I am exempt from 1ho requiremGnte of CONTRACTORS AFFIDAVIT•1 certify that 1 am currently registered as It the Contractor Regiafratlon law RCW 19.27 and am two of the*di- oontr *W in the State of Waahington' pbrttiiC tti irtanca nance requirement!:for which this permit is issued and that all Work will be feWlremente regulating the work for tad ad done In conformance therswith.No changes shall bo made without first worts shell be done In conformance ttwewlth.No changa3 shalt be made obtahing approval. without first obtakrkrg approval. I X Date Dadov�-o7 •v FOR.OFFICIAL USE BEYOND T POINT . o Accepted by Submittal Mrount(due Receipt No.t ljz� 13uliding Department occGroup M Type Constr., -N3 Planning Department Environmental Health DaparIF7 - 1 - nent Pubic Works Departrrwnt n mirihal V"tion$ w.w�.�wiwiunw.��rwwvrn�.;.�.�•- 02%14%201,3 13:1U tAl J);A 4Y; , :JO uAau.r c,u r.:.nnAi yin �` FORM MUST BE COMPLETED IN INK PERMrr NO. BLD PLEASE PRESS HARD MASON COUNTY BUILDING PERMIT APPLICATION , 426 W.OedariP.O.Boot 1 a Shelton.WA 9WU Shelton(sec)4227.9670 a ttalr 060)275-4467 EJma(M)489-aM seanto(2W)4a4-10ee On the woo www.ommason.wa us APPLICANT INFORMATION f, CONTRACTOR IN RMATION Owner �i4i=�LrJ �cfi/r► ��it.".�.�, Contractor Nam i' ^/ — M mating Address c0 9r,/ Wt- ` __ _ 3 Haling Address -OX City ge , SWoAa Zip Code 985-?fr' City N _S Wj L4- 1p Code� Phone&& v27r-09.72 or Mi.(_--_j Ph01'*LfM IF..77-32S Other Ph.(_) L ien/Tift Holder Contractor Reg.a Aeys FTC//OBT Exp._j jg E-mail Address E-mail Address =L,,�,IWAER SYSTEM INFORMATION-Connect to New Septic 6deting Septic Conrwct to$ewer ame of Sewer System Well Water Systemer System PARCEL INFORMATION-12 digit Tax Parcel No. Fire Dlstric:t legal Description WSite Address(Please include strvot nalrw,strM number and city) o??� / A r 0v f c 3 / Art Directions to$b a kli 1+ Wlil timber be cut and sold In parcel preparation? (Yes/No) lake River/Creek Pond Wetland Seasonal Runoff Stream S12m or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB-New Add AN Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(Yeaft) Deec ibe Work Y/LS i/I / 0�11Z- No.of Bedrooms No,of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq.ft. Gage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Wit? (Yes/Ne) v► Installer Name Certification No. NOTICE:THIS PERMIT BECOMES U &VOID IF WORKORC UCT10N AUTHOF=D IS N 1 YS OR IF CONSTRUCTION WORK 13 SUSMDED OR Ass DONED FOR A PERIOD OF 1 W DAYS AT ANY TIME Ai`TER THE WORK 16 OOMMENCED. PROOF OF CONTINUATION OF WORK IS D er Y MUNS OF A PROGRESS INSPECTION.The own or agent on t_h-eythYe Information provided Is eccvrate and grants employees of Mason County acetu to the above described property and ' of this project Owner1Euilder m W&Modg"submission of heccumis Information may result in a stop work order or perms revocatbn.AcotoMedgment of such is by signahae below. MAR 2 0 2003 OWNER AFFIDAVIT-I owilly that I am exempt front the requiremento of CQNTRACTQR'$AFFIDAVIT-I cer*#W I am ourrently registered"a the Contractor Igegistradw Law ROW 1 t1.27 and am aware of the ordi- writrador In the Stone of washk4anBI it l;m tapgrppf�t)>4oQd ntAna nonce requirements for which this permit is imued and that all work will be feWirernente regulating the work for ffb pbtfiM�i`�d tnd ell done In conformance therewith.No changes shall be made without fx9t wok shall be done in eanfarmance therewlth.No changes shell be mode obtayyng approval. without first obtaining approval. x Date `�g•y3 FOR OFFICIAL USE BEYOND T POINT - 1 Submittal Amount Dus Roorsi No. Accepted by ��Jc l 'D� 3 Ix Building Department 2�'V Occ Grou T e Constr. Planni Oe ent Sal rtg Perim -I Aas rip C Environmental Health Department Pubic Works Depattrrient Fire M&ihal Vduafort$ BUILDING cli cli 4- — Q E to cm U � U — c cts c%> Q cis a ao % • _ � a ♦o - N Q M F=V u Q T Q. ���g�mn W z • (n o N co o z o D =m o c ''S'o a — z uJu ¢ N O - u�7 c\l^r_ 0) CCC 3 r Q U C d. g W 0 Z lol O p - Z O Z 3 it U C a — W 0 o d c o �J 0 © W J 3 ' m Q — 0 Lu o °� 1 ZU W LL • m W Q Z m O Lu o GO x w 0 w ? D W LLJ < l p H J W Q W J U cn Lu z coZ N m m 2 LL O r� W cl) - 0 x N J v Z W x co 0 0 z 10-052. ? a RECEIVED MAR 2 0 2003 Y AK J! j 1 �1S I1 a L _ O M uj to D p _ �- w N cn U r < � � ri y O 0 �H <cr) - � m U 'L^ N V C7 W Z to W O AL M U W N ^V/ cn W _ gym; i.r 4f .e RECEIVED MAR 2 0 2003 426 W. CEDAR SI Site#: GROC-1571 Elevation-Cabinet& Letter Sets Western Grocery Stores Project Mgr: Danny Goldberg SAFEWAY Surveyor: John Fitchett 23961 N.E. STATE ROUTE MC Sin Computer: Gary Anderson BELFAIR,WA 98528 Reviewer: Corporate -' t---------------------------- --------235'---------------------------------------. 35' ' 23' 23' ; i 31 Safeway Logo 6' x 6' E2 Safeway 5' x 45' E3 Food & Drug 2' x 33' 5" RECEIVED MAR 2 0 2003 426 W. CEDAR SF Site#: — tM�J - 5 Cabinet & Letter Sets Western Grocery Stores Project Mgr: Danny Goldber SAFEWAY Surveyor: John Fitchett 23961 N.E. STATE ROUTE 3 MC Sin Computer: Gary n erson BELFAIR,WA 98528 Reviewer: Corporate RECEI QED MAR 2 0 2% 426 W. CEDAR ST. Vestibulel 1' 7'/2" x 1' 8" Vestibule2 1' 7'/2" x 1' 8" Site#: GROC-1571 Sight Photos Western Grocery Stores Project Mgr: Danny Goldberg SAFEWAY Surveyor: John Fitchett 23961 N.E. STATE ROUTE MC Sin Computer: -Gary Anderson BELFAIR, WA 98528 Reviewer: Corporate 6 a P RECEIVED MAR 2 0 ?003 426 W, CEDAp ST __. r ► IJ, - 3 r... Site#: GROC-1571 Sight Photos Western Grocery Stores Project Mgr: Danny Goldberg SAFEWAY Surveyor: John Fitchett 23961 N.E. STATE ROUTE MC Sian Computer: Gary Anderson BELFAIR,WA 98528 Reviewer: Corporate MEN a ti m RECEIVED MAR 2 0 2003 426 W. CEDAa ST, Site#: TF Sight Photos Western Grocery Stores Project Mgr: Danny Goldberg SAFEWAY Surveyor: John Fitchett 23961 N.E. STATE ROUTE MC Sin Computer: Gary Anderson BELFAIR,WA 98528 Reviewer: Corporate RECEIVED MAR 2 0 2003 426 W. CEDAR ST