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HomeMy WebLinkAboutBLD2004-01072 SFR, Garage Room - BLD Permit / Conditions - 6/30/2004 FORM MUST BE COMPLETED IN INK PERMIT NO. BLD PLEASE PRESS HARD MASON COUNTY ��� BUILDING PERMIT APPLICATION 0 W�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.waus APPLICANT INFORMATION CONTRACTOR INFORMATION Owns A a Contractor Name Mailing Address Maili ress City State Zip Code City�ll�-----State Zip Code Phone Other Ph.( ) — Phone a� — Other Ph. Lien/Title Holder 1.)0 Contractor Reg.#7,RPe'Qi"C LO 19 M 7 Exp.9J2Vj — E-mail Address E-mail Address mmmmmma SEPTIC/WATER SYSTEM INFORMATION-Connect to New Se 'c Existing Septic Connect to Sewer System Name of Sewer System �A. Well Water System_ Name o Water System F RMATION-12 digit Tax Parcel No. j j / J Fire District ion 'Please include street name,street number and city)ite 00 Will timber be cut ad sold in parcel preparation? (Yes ) Lake_O _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 Is this permit submittal the esult of a Stop Work Notice,Correction Notice or other enforcement action?(Ye I(�o Describe Work b No.of Bedrooms__No.of Bathrooms_SQUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor N C) Loft (1© Basement &Q Deck Other sq.ft. 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. 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. Date X ct14 1! a&wlDat FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. Building Department ) C Occ Group T Constr. 0 Planning Department Environmental Health Department Public Works Department Fire Marshal 3� Cib Valuation$ 7�ildn, 71 ermit Fee Site Inspection w Fee EH Review Fee &Base Fee Planning Review Fee l&Base Fee Other k- wvj Q/Peilet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO. BLD MASON COUNTY BUILDING PERMIT APPLICATION �'� -�` �,� --'� 10- 1 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton(360)427-9670 Belfair(360)275-4467 Eima(360)482-5269 Seattle(206)464-6968 On the Web www.co.mason.waus APPLICANT INFORMATION ` CONTRACTOR INFORMATION je Owner L a Contractor Name Mailing Address Mailin d re+s+s City State Zip Code City� i &,--State Zip Code Phone �, �;'� _Other Ph. ( �'Q) - Phone Other Ph.( jz�/-I�Q9 L ienVTitle Holder L)b 0E Contractor Reg.#'Qo, t tD f2 M-7 EXP.fLJ.1L/!F E-mail Address 1 E-mail Address h I SEPTIC/WATER SYSTEM INFORMATION Connect to New Se is Existing Septic_ Connect to Sewer System Name of Sewer System IV Well Water System Name o Water System PARCEL INFORMATION-12 digit Tax Parcel No. f / J Fire District k Legal Description Site Address(Please include street name,street number and city) f Directions to site I Will timber be cut a(d sold in parcel preparation? (Yes),A) ' ILaker )_b River/Creek_Pond_ur Wetland Seasonal Runoffs Stream UQ Slopes or Bluffs PERMANENT RESIDENCE 0 SEASONAL RESIDENCE❑ TYPE OF JOB-NewVAdd Alt Repair Other Use of Building .I Is this permit submittal the esult of a Stop Work Notice,Correction Notice or other enforcement action?(Yes(N o Describe Work kAo ;-- No.of Bedrooms_No.of Bathrooms_SQUARE FOOTAGE- 1 st Floor 2nd Floor 401M 3rd Floor A.)d Loft it1 Q Basement ( Q Deck Other sq.ft. j Garage Attached Detached Carport �Attached Detached i i MOBILE HOME INFORMATION-Make Model Model Year No.of Bedrooms No.of Bathrooms Length Width Serial No. Type of Heat Purchase Price$ Replacement Unit? (Yes/No) Installer Name Certification No. NOTICE:THIS PERMIT BECOMES &VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPEND ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK I EANS OF A PROGRESS INSPECTION.The owner or agent on owner's behalf,represerns that the information provided is accurate and grants a loyees of Mason County access to the above described property and structures for review and inspection j of this project.Owner/Builder acknowledges su mission 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 r. 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 . ! Dat FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. ' Building Department , Occ Group Type Constr. Planning Department i Environmental Health Department Public Works Department Fire Marshal Valuation$ 140L 4 1 a 7Wood/Gas/Pellet ermit Fee3�� Site Inspection77 ew Fee +�(o�n �, EH Review Fee &Base Fee f ?�, t _ Planning Review Fee al&Base Fee l p GPD o�3�Stove Fee State Fee Violation Fee Submittal TOTALFEES i PERMIT NO. BID MASON COUNTY BUILDING PERMIT APPLICATION :...y>'✓' _"j 'j u y 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 t t 0 Contractor Name Mailin Addr ss Maili dress + * City µ State Lk Zip Code City State_4k Zip Code Phone( t' Other Ph. - Phone 45�_� Other Ph.LT&jb _/Sfy Lien/Title Holder 06 kX Contractor Reg.#V.RA T 10 9 M7 Exp.j_J2/tAL E-mail Address E-mail Address SEPTIC/WATER SYSTEM INFORMATION-Connect to New Se tic Existing Septic Connect to Sewer System Name of Sewer System �t?1A.1 Well Water System_ Name of Water System PARCEL INFORMATION- 12 digit Tax Parcel No. 1:a . / / _ / Fire District Legal Description [ �, PW` 4s ./ e, Site Address(Please include street name,street number and city) 1 hv��`�t Directions to site C, a J? 7 .N§si f"t� a�- f a'"'�.e•: ,F /.e!w. t"..:' ",'f f,:✓e - Will timber be cut and sold in parcel preparation? (Yes Lake_River/Creek_(1 _Pond_Wetland_Seasonal Runoff Stream_ Slopes or Bluffs PERMANENT RESIDENCE a SEASONAL RESIDENCE❑ TYPE OF JOB-New_ Add Alt Repair Other Use of Building Is this permit submittal the esult of a Stop Work Notice,Correction Notice or other enforcement action? (Yes{@) Describe Work a No.of Bedrooms_ No.of Bathrooms SQUARE FOOTAGE- 1st Floor 2nd Floor -tom 3rd Floor A) Loft_ _p a Basement Q. Deck Other sq.ft. Garage Attached Detached Carport kjo 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. NOTICE:THIS PERMIT BECOMES &VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPEND ,, ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BXWEANS OF A PROGRESS INSPECTION.The owner or agent on owner's behalf,represents that the information provided is accurate and grants e4loyees 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 1 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 DatesX""'A/ X ; f y .E 'cd •y°� ,' pat -fC'• 7 FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. Building Department Occ GroupType Constr. Planning Department r77= Environmental Health Department Public Works Department Fire Marshal C.� ( C j Valuation$ Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee . } µ. ° f%tWing Review Fee Mechanical&Base Fee Ogler Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES -- irrnsrwr++w.wrwu PERMIT NO. BLD 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 r Contractor Name Ljj LMk. w j Mailing Address '� Mailin%Address� le City, State Zip Code � City,'eir)' erN1 State_"Zip Code Phone(� j o/t_� Other Ph. /°lt Phone a j)���p�_Other Ph. ( Lien/Tdle Holder 1�;G Contractor Reg.# 'F*-, .l� s i o;i. Ml'7 Exp•_fLj .d E-mail Address E-mail Address 6 SEPTIC/WATER SYSTEM INFORMATION-Connect to New Se tic Existing Septic ',�tom"_ '_ Connect to Sewer System Name of Sewer System Gt% -�� Well Water System_ Name of Water System PARCEL INFORMATION- 12 digit Tax Parcel No. Fire District Legal Description /-f Site Address(Please include street name,street number and city) Directions to site Will timber be cut and sold in parcel preparation? (Yes Lake _River/Creek ] Pond d Wetlan Seasonal Runoffs Stream ice.l ,Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB-New__)(_Add Alt Repair Other Use of Building Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? (Yes/No) Describe Work Vic'► 1F- L '� i No.of Bedrooms ; SQUARE FOOTAGE- 1st Floor 2nd Floor No.of Bathrooms , -r--r-- 3rd Floor JV C Loft__)( Basement t30. Deck z C Other sq.ft. Garage ' : Attached Detached Carport Attached Detached r MOBILE HOME INFORMATION-Make Model Model Year I Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ Replacement Unit? (Yes/No) M Installer Name Certification No. NOTICE:THIS PERMIT BECOMES NVUL &VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF r 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 1 am currently registered as a r contractor in the State of Washington and that I am aware of the ordinance the Contractor Registration Law RCW 18.27 and am aware of the ordi- 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 'Ff X Date FOR OFFICIAL USE BEYOND THIS POINT a Accepted by Date Submittal Amount Due Receipt No. rPlanning Department ou T Constr.Department ' Environmental Health Department C� Public Works Department i 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 ( ) TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT NO.: PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL 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 APPLIC NT INFORMATION CONTRACTOR INFQRMAT ON Owner Contractor Name f +� Mailing Address Mailing Address City / 0'A14. Stat , Zip Code City StateAV4a Zip Code Phone �1- KO/ Other Ph. iQ>7.3/—/,3V Ph.(3Gv 3/;�122 Other Ph.QW )Sl2s-aN�f / Lien/Tit a Holder I Contractor Reg. # PA 11A 13.Z Address I Expiration SEPTIC INFORMATI N-Co nett to New Septic Existing Septic Connect to Sewer System Name of Sewer System ale PARCEL INFORMATION- 12 digit Tax Parcel No. 42 A / / m Fire District Legal Description L7/`U 4g= RAirg- ! As Pr 3G Site Address(Please include street name,street nu er and city) Directions to site >` Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Qgg-ldg%A ub Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric T_vne of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs � Heatpumps Showers / Spot Vent Fan Water Heater � Propane Tank l Clothes Washer 9 Gas Out is Kitchen Sinks / Woo tea 'Pellet Stove Dishwasher �_ Kitchen Exhaust Hood / Hosebibs Dryer Vent Other _ Other ,aye' Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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-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 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 DateJ2 9411► Dat FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DO :::> <:::>:: .:::>:::::::::APP�tt�VlwD.;:.;:.: CJENI�A:::::::::::::::::::.::......... Building Department Occ Grou T e Constr. Planning Department Other Other sa .:::::::::::::::::::::::.......................................... Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ) Violation Fee TOTAL FEES PERMIT NO.: r MASON COUNTY 5 PLUMBING/MECHANICAL 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 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 1tx!4 4., L5a^ Contractor Name � Mailing A ress �_ ,�,> f �= a i Mailing Address ✓, ,', �r 2.2ii City i 1'�r •: State Zip Code T� ra � City�� /1�.v. .c Statei/, Zip Code c-` PhoneAlz Other Ph. -< �1 f her Ph.( YT_ Lien/Title Hol er Contractor Reg.# Address Expiration lid SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System__,�'-Name of Sewer System Alz *? g2 IC PARCEL INFORMATION-12 digit Tax Parcel No. Fire District Legal Description J,A� Z;—,4W4 r:- 1 Site Address(Please include street name,street number and city) Directions to site ,r. . ° 9, Q44, 1 Is your property within 200'of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New._.IL..Add Alt Repair Other Use of Building x .: �' F Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage v, Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Tvice of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump Toilets woe.of Unit No.of Units Fees Bathroom Sink< Furnace Bath Tubs Heatpumps Showers / Spot Vent Fan Water Heater Propane Tank 4 Clothes Washer d Gas Outlets Kitchen Sinks E Wood(U- Pellet Stove t Dishwasher T- Kitchen"Bxhaust Hood 4 Hosebibs Dryer Vent I Other Other 4. Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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-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 ' ! > ,r.%" Date f X �" r Date t FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. C> NI1 I`A..It�EW.... Building Department Occ Group Type Constr. Planning Department Other Other Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES Look Up a Contractor,Electrician or Plumber License Detail Page 1 of 3 Topic Index I Contact Info Labor So" ilr is rarr c to *tmpp Trrad"a i i"nsire Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber General/Specialty Contractor A business registered as a construction contractor with L£tl to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment I of account and carry general liability insurance. License Information License PARADBI108M7 Licensee Name PARADISE BUILDERS INC Licensee Type CONSTRUCTION CONTRACTOR UBI 601245202 Verify Contractor Premium Status Ind. Ins. Account Id Business Type CORPORATION Address 1 PO BOX 1228 Address 2 City BELFAIR County MASON State WA Zip 98528 Phone 3602752401 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 7/27/1990 Expiration Date 8/21/2004 Suspend Date i Separation Date a Parent Company Previous License NELCOC1641-9 i Next License Associated License Business owner Information Name Role Effective Date https:Hfortress.wa.gov/lni/bbip/detail.aspx?License=PARADBI108M7 7/29/2004 Look Up a Contractor,Electrician or Plumber License Detail Page 2 of 3 LSON, LYLE C PRESIDENT 07/27/1990 Bond Information Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received Bond Name Number Date Date Date Date Amount Date #3 CBIC SA3903 07/24/2001 $12,000.00 07/26/2001 #2 CBIC SA3903 07/24/1996 07/24/2001 $6,000.00 STATE FARM FIRE Ft #1 CASUALTY CO 980363022 07/24/1990 07/24/1996 $6,000.00 Savings Information No Matching Information Insurance Information Company Policy Effective Expiration Cancel Impaired Received In Name Number Date Date Date Date Amount Date #11 CBIC INSSA3903 07/24/2004 07/24/2005 $300,000.00 07/28/2004 #10 CBIC INSSA3903 07/24/2003 07/24/2004 $1,500,000.00 06/30/2003 FARMERS INS _ #9 EXCHANGE INSSA3903 07/24/2002 07/24/2003 08/19/2002 #8 CBIC INSSA3903 07/24/2001 07/24/2002 08/21/2001 #7 CBIC INSSA3903 07/24/2000 07/24/2001 #6 CBIC INSSA3903 07/24/1999 07/24/2000 #5 CBIC INSSA3903 07/24/1996 07/24/1999 STATE FARM FIRE #4 at CAS CO 98BS26936 07/24/1995 07/24/1996 STATE #3 FARM FIRE 98BK41014 07/24/1994 07/24/1995 STATE #2 FARM FIRE 980799229 07/24/1993 07/24/1994 STATE FARM FIRE a CASUALTY #1 CO 98033581 07/24/1990 Unsatisfied Summons/Complaints Information No Matching Information x Start a New.Search https:Hfortress.wa.gov/lni/bbip/detail.aspx?License=PARADBI108M7 7/29/2004 Lock Up a Contractor, Electrician or Plumber License Detail Page 1 of 3 Topic Index I Contact Info Labor and Industri --! 1E 11�0 � i J M%d" Lieansing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber General/Specialty Contractor _ M A business registered as a construction contractor with I-Ed to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment —rclJ of account and carry general liability insurance. f :� n License Information License PARAD61108M7 .— 1 0 1 V)5u0AVr;z Licensee Name PARADISE BUILDERS INC 1 Licensee Type CONSTRUCTION CONTRACTOR ,3 UBI 601245202 Verify Contractor Premium Status Ind. Ins. Account Id Business Type CORPORATION Address 1 PO BOX 1228 Address 2 City BELFAIR County MASON State WA Zip 98528 Phone 3602752401 Status SUSPENDED Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 7/27/1990 Expiration Date 8/21/2004 Suspend Date 7/24/2004 j Separation Date Parent Company a Previous License NEL_C..00*1641-9 Next License i Associated License Business Owner Information Name Role Effective Date https:Hfortress.wa.gov/lni/bbip/detail.aspx?License=PARADBI108M7 7/28/2004 h o Si J - e l 0 n O� O � Z � � a Mason County Permit Assistance Center Planning Intake Checklist Owners Name: ��^�1L ' Date: '3 0 - Project: (1tq 'In /-)p Reviewed By: Commercial Develo a YE O Comments: Planner: GBM TSC JLW Side Plan: orth Arrow Property Dimensions: J� X ar"Streets and Driveways Shown.Road name: ,(a; ❑ ctures shown with setbacks tal pr',- .) Y10 Topography(slopes) (slopes) Proposed Structur Set ptaacc (Dir tion/S tback): ' F: / d� R: l 61 S 1: �J S2: 9/,"Utility and Drainage Easements: �e)s No (if yes enter condition#5022) ❑,� rPcenry Ar�nn,f�a es ( ❑ 6 YR TIP ❑ nnld you like to be present for site inspection? YES/ NO Shoreline and Planning Info Setbacks: Shoreline: WA Slope: Shoreline Designation: Comprehensive Plan: Rural Zoning: ' of Applicable ❑ Agricultural ❑ RR 2.5 5 10 20 ❑ Urban ❑ In-holding ❑ R E ❑ Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy ❑ Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR ❑ Unknown -Hamlet ❑ RT 54Jrban Growth Area ❑ MPR ❑ Unknown ❑ Unknown Water Body(type of water if unnamed): rA(1�. SEPA: Yes (9 Unknown Flood Plain: YES NO nkno Map# Aquifer Recharge: YES NO nkno Map# Tags/Cases: ,, n RLC/SPI Case: N 6-Year Dev. Moratorium: VAN Eagle Nest Tag: YES Other S O t7 < � Addressing: Check box if needed Reviewed by: ❑ County Access Permit Needed(add condition#0010) ❑ State Access Permit Needed(add condition#0020) Standard Conditions to be added to all Building permits that planning reviews:#5019 and#0700 6-u.o i MASON COUNTY DEPARTMENT OF HEALTH SERVICES Personal Health Environmental Health PO BOX 1666 SHELTON,WA 98584 LOCAL(360)427-9670 BELFAIR(360)275-4467&4468 Application for Determination of Adequacy ins tructions ;:.;:.;:.;::.:::::<.:.;:..:............; .... :;<.;:. .:..::................. .....::......:.. . unt;1::I�art::I::as:.fi :::...:...:. 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PART 1: Applicant/Parcel Identification / Name of APP licant O Date Mailing Address P ��0� ��Py 13�-zC w Telephone 3E0-0 7s Assessor's Parcel Number �Te Water S stem Check One : Reason gA lication Check One : c/Community Water System(2 or more Building permit connections) ❑ Land use application,if so.. ❑ Individual water source(one connection),if so.. ❑ Division of land ❑ Well #of Parcels? ❑ spring/surface water SPH9 - ❑ �(exr�j ��� ❑ Boundary line adjustment ❑ Other(explain) PART 2: Water System Information Complete the section appropriate for the type of water system being evaluated for adequacy: Public Water S stem Name of Water System Ai � Water Facility Inventory(WFI)Number: ❑ The water purveyor has filed a letter granting blanket hookups to this water system. ❑ I am the manager of this water system. The water system has been approved for services. There are presently connections in use. This will be the connection. water system is able and water to this(these)connections w willing to prov'Te i out exceeding the limits of the water system or any limits set by state and local regulation. Signature of Water System Manager Date K•IWDATAWRCHIVEIWATERAD3.WP Update:March 22,1999 W - 7 LaQk Up a Contractor,Electrician or Plumber License Detail Page 2 of 3 NELSON, LYLE C PRESIDENT 07/27/1990 ---------------- Bond Information Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received Bond Name Number Date Date Date Date Amount Date #3 CBIC SA3903 07/24/2001 $12,000.00 07/26/2001 #2 1 CBIC SA3903 07/24/1996 07/24/2001 $6,000•00 STATE FARM FIRE Et #1 CASUALTY CO 980363022 07/24/1990 07/24/1996 $6,�•� Savings Information No Matching Information S E 7 Insurance Information Company Policy Effective Expiration Cancel Impaired Received Insurance Name Number Date Date Date Date Amount Date #10 CBIC INSSA3903 07/24/2003 07/24/2004 $1,500,000.00 06/30/2003 FARMERS INS 08/19/2002 � #9 EXCHANGE INSSA3903 07/24/2002 07/24/2003 #8 CBIC INSSA3903 07/24/2001 07/24/2002 08/21/2001 #7 CBIC INSSA3903 07/24/2000 07/24/2001 #6 CBIC INSSA3903 07/24/1999 07/24/2000 1#5 CBIC INSSA3903 07/24/1996 07/24/1999 STATE FARM FIRE #4 Et CAS CO 98BS26936 07/24/1995 07/24/1996 STATE #3 FARM FIRE 98BK41014 07/24/1994 07/24/1995 STATE #2 FARM FIRE 980799229 07/24/1993 07/24/1994 STATE FARM FIRE Et CASUALTY #1 CO 98033581 07/24/1990 Unsatisfied Summons/Complaints Information No Matching Information Start a New Search https:Hfortress.wa.gov/lni/bbip/detail.aspx?License=PARADBI108M7 7/28/2004 W cn V oC� pp � � fnrrT. 20 (D n 0) co O O o � N N S < C n O N (D N (D 'm� a -I CD m 3 (D CD O d M S CD d < CD `� o n r o m .-I � m o a m c C c� o c� 3 -I m s w c 2 0 c r -* c o m D 'v o� w Oy < H N N N 3 N (CD .�. 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