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Home My WebLink AboutBLD99-00103 - BLD Application - 2/19/1999 PERMIT NO.: BLD MASON COUNTY E ,- go, /3i BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 �3 Shelton(360)427-9670 Belfair(360)275.4467 Elora(360)482-5269 Seattle(206)464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner C. L ;!'/ H O W A S d Contractor Name nr Mailing Address i2- 1 2. / S 5 s ' Z«-`1 - Mailing Address City S 6 State L,Lt Zip Code 9 A 1 `t City State Zip Code Ph.( ) Other Ph.(______ Lien/Title Holder mac A Contractor Reg. # Address Expiration / _/ S PTIC/WATE - I I~ R SYSTEM INFORMATION-Connect to New Septic Existing Septic _Connect to Sewer System Name of Sewer System ' Well Water'System_b- 1'Jame of Water System $I-A__ f�ss PAF CEL`INF0RIV� ►TI t 3 fC"fast l noel f i. • / Fire District j Legal Description Ls�7 4, �s d*e S s c. L iT Ile, c.. + / )' r% .� = 'te Address(Please include street name,' treet number and city) �'" llcSr✓K?G. 6:A- N/r Directions to site -,_ s44 . -+ Con,! r'w t1 L° .,#— — .. 5► Will timber be cut and sold in parcel preparation? (Yes/No) Nc3 Is your property within 200' of the following: Body of Water(Name) Saltwater_L�/� Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs OF JOB New Adder Alt _ ,. Repair Other Use of Building scribe Work No. of Bedrooms No. of Bathrooms Si�UAE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement �dltOther sq. ft._VI Garage 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 Unit ?(Yes/No) Installer Name Certification No. L_.- NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180`DAYS OR IF RLIF ftON- IS1(SPEA1DI=t#AR.A$�tINDODLEQ�4R�,g P�tCp OF,,.14!DAYS AT ANY TIME AFTER THE WORK IS COMMENçP. PROOF OF CQN1iNl1ATION OF WORK IS>#Y MEANS OF A PROGRESS NSPEt PION: The owner or agent on owner's behalf,lepfeslfht that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and • inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval, first obtaining approval. X 6 -» Date . "f " X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. Building Department Occ Grou Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal, Valuation$ IF lw ......::::. lw Building Permit.Fee Site Inspection Plan Review Fee UFC Plan Review ee Plumbing & Base Fee Public Works Review Fee Mechanical &Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO.: BLD I. MASON COUNTY ` • BUILDINGPERMIT APPLICATION ?/ 426W.Cedar/P.O.Box 186.Shelton,WA 98584 Shelton(360)4274670 elfair(360)275-4467 Elma;' 69' Seattle(206)464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner C.Li / 1 0 W A S Ci Contractor Name 4-,00 N e Mailing Address__I Z 1$ o , Z21 Mailing Address City _ 5 E A State to Al Zip Code I B i 9 8 City State Zip Code Phone Zt m )�► Sr��4f ` QMier Ph.( — Ph. Other Ph.( ) , Lien/Title:Holder ,1✓o n Contractor Reg. Address — Expiration / / SEPTIC/WATER.$`ir+S INFORMATIOW'Connect to New Septic *` :ti,Existing Septic Connect to Sewer System -;Name of Sewer System Well ` Water System 1- Name of Water System ____7 ' 4s t/ f ' Art PARCEL'IN ORMA lON-12 ti irTax Parcel''N . / ti. T4 5 / .0 Q a Fire District Ap Legal Description LD7 44b -,rk4A5 Ae Z's LZ,t7' d. i:l L .s�:"�g �. ✓/'e ac! Site Address(Please ' elude street rra t}, reet'n tuber and city) ".7:S €K�4S v io 1.A- DireQtio s to site 4A -:G�'i+l�'"d �i Will timber be cut and sold in parcel preparation? (Yes/No) n Is your property within 200' of the following: Body of Water(Name) Saltwater_ / Lake River/Creek Pond Wetland Seasonal Runoff_ Stream Slopes!r, Bluffs SFr TYPE OF JOB New Add. Alt Repair Other Use of Building Describe Work No.of Bedrooms No. of Bathrooms_,SQUARE FOOT/ GE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck ✓✓ Other sq.'if.' 8 6 Garage - 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 Unit?(Yes/No) Installer Nlttne Certification No. NOTICE: THIS PERMIT BCOMES NULL d,VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS ORIF. CONSTRUCTION:WORK 46 SUSPENDED.ORANDONEQ FAR PEIi;WD ØF 189 JAS AT ANY TIME AFTER THE WORK IS COMM ED. PROOF OF CON`TINUA.ION OF WORK IS BY MEANS OF A PRO($ItEBS..NSPE4 ff he owner or agent on oVimet"s behalf,tepresMtl'iatthe. { information provided is accurate and•grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: rt OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 10.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance III requirements-1r which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work • conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without • approval. • first obtaining approval X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. Building Department //- • Occ Group Type Constr. Planning Department • Environmental.Health Department Public Works Department Fire Marshal •. . • s • Valuation$ r?.?:i.,C:-:e.C:::.vv::{>::r}i:'+'fi::f:?.,....hf lrz`fJf f {..+'ff:9}ft f :-F-•{:::. fr:�i:. _.{r?:? S::#3.aY'.:H}:ft".}rrfif %t%f'-r-=: f f r' ::f.. ::. .u::ff•:fS.rr:.:�.:,u?f- rr: .c:• Spfii ;;.?Ss :::�::. :........... , .' ..:}:-:}. r.:#'Pf• ?-ff:- :/..fi'• .rr. .fry'.u:. -{ : :.S::.a:: .,r.✓.?ri,.r.kl^ lF ............:v;:.'u:. .......... - v ._..rc,:::.:r...::....-... •:r .... :... FEES ....x:::w.:.v:::.::::.,v.•:+r:.::+::::f^:'?+ir>}i:{:}`f�+:.....: ......• rr l /r}?•,. :/::.}y:::::::::.....n.:y n.n,..,. {:. -. -{-.r:::........r/.:.....................:..f - ....................}....F....-...hn+. .:f. f •. f 1 v fair v.J.-�,..vwvs,::?:..::.:...:.....:.:.:::.:r:::.:x:?y.:f::,..f.f <r.:f+f?:-,,....:r... ,.r:.:...:..........}. ......r:f.:....•:.�:::...f:r !-} :x f"'.?.,:cr 2......... ..r...r ::... Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing &Base Fee Public Works Review Fee Mechanical &Base Fee ether, Wood/Gas/Pellet Stove Fee Other ' Violation Fee • Pre-Paid:at Submittal ( ) TOTAL FEES