The URL can be used to link to this page

Home My WebLink AboutBLD99-0450 - BLD Application - 5/25/1999 PERMIT NO.: BLD V,OC150 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 APPLICAW_1 O M f TION -CONTRACTOR INFORMATION Owner "� ' $ :,` - ,.,.� Contractor Name - Mailing Address ^ a;c 7 `o!t Mailing Address City 4/,,, i State«f` Zip Code ' City State Zip Code Phone( Other Ph.L___) Ph.L____) Other Ph.( 4ien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic ' Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION 12 digit Tax Parcel No. " ''/ < .`,/ `' s< `' ` 'g� � �� r4 �� Fire District Legal Description i- .a. V_L.Ic,-),-)r; ,,� I �.... Site Add ress(Please,inclwde street name, ,stretyt number a�lty) 3 b'R I f ' v`� Dire ctigns)o site r,� :' >, r , -fr n y r �(�_ r it!. I✓; cRic za, c/ 3 6<.. �..,y Will timber be cut and sold in parcel preparation? (Yes/No) 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 Describe Work f ` x e l'rr r � :. ; :� ) i:' ve No. of Bedrooms No. of Bathrooms 9QUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement 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 8"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. p!�,r;_,/ r first obtaining approval. X Date J/t 9 f �� X Date FOR OFFICIAL USE BEYOND THIS POINT �.," � ' )Submittal Amount Due �': � Accepted by + - ti Date 3 Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION COQE$ ». Building Department Occ Group Type Constr. Planning Department I j Environmental Health Department j Public Works Department i Fire Marshal Valuation $ F> Es Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee 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 [ [ y" O 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 APPLICANT INfOSR,MATION CONTRACTOR INFORMATION Owner r� t^? �'' '` ? Contractor Name Mailing Address f`'' ,sY .7 Mailing Address City f`�t. State,0 Zip Code '71" City State Zip Code Phone( Other Ph.L___) P In,L____) Other Ph.( I,ien/Title Holder Contractor Reg. # Address Expiration SEPTICIWATER SYSTEM INFORMATION-Connect to New Septic Existing Septic a - Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION 12 digit Tax Parcel No. "� Fire District Legal Description i• -i .9 y' i .'� ! I r.` Site Address(Please include street name, treet number anti city) .3IF-1�f I ;�.v-tL f,�vc�JD Directigns o site A?" � h �.a.� � 1� �; �, w , _ '4 A' !p' 'c _ ew, Frr v,r '';1,.� .e'r' /':. te" U,c+/ / ✓ ery r.r-rt ,.. Will timber be cut and sold in parcel preparation? (Yes/No) [your property within 200' of the following: Body of Water (Name) Saltwater Bluffs- TYPEake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or �a' OF JOB New Add Alt Repair Other Use of Building '''..�'" I %le— Describe Work f.r, ,' O�c. :,4 s !^r � eCV 1 '� J No. of Bedrooms No. of Bathrooms tQUARE FOOTA6E-1st Floor 2nd Floor 3rd Floor Loft Basement 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. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 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. r' first obtaining approval. X -Date ��,0 �,' I< X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by 11` Date ? Submittal Amount Due Receipt No. >� DEPARTMENTAL REVIEW APPROVED, DENIED> CONDITION CODES Building Department Occ Group Type Constr. Planning Department S ,71 ��1 VYi Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) ...........:..:.................. .:..r:•...:.�:•:.,:::•:::::,..::::::::•::+::::::•:::::..:.:..............:.....:.:::::.�::::::::. TOTAL FEES 10 J Y Yt � k s { N d 0 C 0 D Z (� C � 1 k � � o a 'I f t � I e � LA1 s � o ^ D � a 8 � r � \r O V A i 4" FIN 1 - � i U� U f