HomeMy WebLinkAboutBLD2007-01109 Final ATF Bulkhead - BLD Permit / Conditions - 3/3/2009 C%j CV
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Date By Data By DECKS
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Date By Data By PROPANE TANKS
PLUMBING Vault Date By
Date By OTHER
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FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD MASON COUNTY PERMIT NO. �(-
-rT I BUILDING PERMIT APPLICATION
T�)L" 426 W. Cedar• P.O. Box 186, Shelton, WA 98584
� elton (360) 427-9670 • Belfair(360) 275-4467 - Elma (360) 482-5269
On the web www.co.mason.wa.us
1APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner MICA eAg MLWWAM Company Name * � 11LgL-ire
Mailing Address 315M Mailing Address —�
CitA9!f#_Xa*grJ _Qt.t.AA Zip Code. 31 City State Zip Code
Phone 3— Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # Ex
E mail address E Mail Address p
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
nnect to Water System Name of Water System
Wel Sewer Systeru__ Name of Sewer System
PARCEL INFOR ATI N - 12 Diglt Parcel No.
Legal Description UL Fire District
Site Address(Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparatio .
Is property within 200'of Saltwater Lake River/Creek and
Wetland Seasonal Runoff Stream Slopes or BluffsT15%
Is this permit subiqittal the result of a Stop W Notice,Correction Notice or other enforcement actin ?Y No
F3d
E OF JOB - Add Alt Repal Other PRIMARY RESID E SEASONAL
of Building nescribe Work
f Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd F
loor Basement Deck Covered Deck Other ft. N
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width S ' No. No. of Zr No. of Bathrooms
Type of Heat Purchase Price ment Unit? Yes/No /
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on ow s behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described rty and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is
not comm nc d within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
MEANS RESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 1 D WILL INVALIDATE THE APPLICATION.
X Date:
ner e/Contractor (indicate which one)
FOR O FI IAL USE BEYOND THIS POINT Accepted by: 4 Date
DEPARTMENTAL REVIEW 1APPROVED DENIED NOTES
Building Department
Planning Department— N
Environmental Health Department
Fire Marshal
FEES
IR
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
Valuation $ TOTAL FEES
i )
Ml�SOI' COUNTY PERMIT NO.
r _ 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 101Q%5EL.► ' fte 1 F mqgau Company Name CWtX*'2j��111.bC''t. -
Mailing Address Mailing Address
City State VA Zip Code City State - Zip Code
Phone .7- Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to'New Septic Existing Septic
Connect to Water System Name of Water System
Well'"V Sewer System Name of Sewer System
PARCEL INFOR A. TI_QN - 12 Digit Parcel No. Fire District
Legal Description b1 UL
Site Address (Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparatiL�ake
Y o
Is property within 200'of Saltwater River/Creek and
Wetland Seasonal Runoff am Slopes or Bluffs 15%
Is this permit sub ittal the result of a Stop Wor*Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - Add Alt Repal Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building Describe Work ,[11
No. of Bedrooms No. of Bathrooms Square Footage- 1st Floor 2nd F r
3rd Floor Basement Deck Covered Deck Other ft.
14
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make odel �--'" -Year-
IV,
Length Width S I No. No. of Bedroox�°rS'�J No. of Bathrooms
Type of Heat Purchase Price Reptacement Unit? Yes/ No
Installer Name Certification No.
I
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare i
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work j
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on ow s behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described o rty and structure for review and inspection. This permit/application becomes null &void if work or authorized construction is
not Comm nc d within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY
MEANS RESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF laO DAIYSWILL INVALIDATE THEAPPLICATION.
X Date:
her s Rex /Contractor (indicate which one)
FOR O FI IAL USE BEYOND THIS POINT Accepted by: ; Date 1
DEPART ENTAL REVIEW APPROVED DENIED NOTES
Building Department t
Planning Department I ;S-0� "' (-= •,,y -
Environmental Health Department
Fire Marshal
FEES
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
Valuation $ TOTAL FEES
MASON COUNTY PERMIT NO.
:. BUILDING PERMIT APPLICATION /�\\
.� 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 V `
Shelton (360) 427-9670 - Belfair(360) 275-4467 - Elma (360)� -5269
1 On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner M1U .. 4r IY1D¢a6 m Company Name �► .�
Mailing Address Mailing Address
State VA Zip Code 31 City State Zip Code
Phone-21W ,343-07420 Other Ph. Phone Other Ph.
Lien/Title Holde e & - .2 Contractor Reg. # Exp.
E mail address 3`a. E Mail Address
Drivers Lic.# DOB r. Drivers Lip..# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect t"-ew Septic Existing Septic
nnect to Water System Name of Water System
Wel Sewer System Name of Sewer System
PARCEL INFOR ATIQN - 12 Digit Parcel No 9M Fire District
Legal Description AA5j Ly, 'TIZ
Site Address(Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparatio o
Is property within 200'of Saltwater Lake River/Creek� and
Wetland Seasonal Runoff Stream Slopes or Bluffs 15%
Is this permit sub ittal the result of a Stop W Notice,Correction Notice or other enforcement actin (?Y s/No
TYPE OF JOB - Add Alt R e p aDtA Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building describe Work�Ai �* ( I p R1 t l L h-f 1 (
No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd F
3rd Floor Basement Deck Covered Deck Ott + ft.
Garage Attached Detached Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model —Year—
Length
Width—_S'I No. No. of Bedro No. of Bathrooms
Type of Heat Purchase Price cement Unit? Yes/No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare
that I am entitled to receive this permit and to do the work as proposed in the application. I declare that I have obtained the permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on ow s behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described o rty and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is
not comm nc d within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
MEANS RESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 1 D SWILL INVALIDATE THE APPLICATION.
X Date:
her /Coritractor (i rcate which one)
FOR O FI IAL USE BEYOND THIS POOT' Accepted by: Date
I
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department I
Fire Marshal -
FEES
Building Permit Fee _ ,'L.S'� 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 a Pre-Paid at Submittal
Valuation $ TOTAL FEES