HomeMy WebLinkAboutBLD2006-01251 Cancelled Remodel - BLD Permit / Conditions - 7/17/2006 co
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� E E
MASON COUNTY PER NO.
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
APPLICt'NT lhll�tIMATION CONTRACTOR INFORMATION
Owner 0"Q 0QU4.MAAJi<epS4A1? Company Name
MailinAAddress k. 1,-P,Kt= t-A M b R- Mailing Address
CityIluki 15.7-cf City —State — Zip Code-
-State ILI &Zip Code 5A,
Phone 30 A "LIS- qZIZ_ Other Ph. Phone Other Ph.
Lien/Title HolderIVI �Wrill i -SAJ Dwvr�pt Contractor Reg. # Exp.
E mail address 14- C61616 E Mail Address
Drivers Lic. #G Fla 9 k,n SS_LALq_ DOB I&SIff c/L- Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic— Existing Septic
Connect to Water System L Name of Water System L&KELOND
Well Sewer System y. Name of Sewer System AlItitj 'S�-WO�u
PARCEL INFORMATION - 12 Digit Parcel No. 12. 2 Q-S'7 Q 6 0 27— Fire District 014'
Legal Description LAMLANJ) Villact? Q �,orl-1 'd
Site Address (Please include street name, street number and city) 7S�)- - k 4 x I-La,,u a 1)A all YAJ, &A fej 2
Directions to site y lu W�E�1 0 0 kA 1,((-:(-A IL A\ 1)k 6 o jo U-AA1 - hC� ACArnz- 0^j jlli
N A 1AA V 0 tk) VV,,a� L 10 0 y
Will timber be cut and sold in parcel preparation?Yes hjV �
Is property within 200'of Saltwater —Lake W1 River/Creek Pond
Wetland SeasonalRunoff Stream Slopes or Bluffs > 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?YesINA- 1
TYPE OF JOB - New Add_Alt_ Repair—Other PRIMARY RESIDENCE r,-' SEASONAL ❑
Use of Building Rkl 100p rr1L Describe Work Gik:kk% rMit"fulN Ldd�L-j%�nff
No. of Bedrooms No. of Bathrooms3 Square Footage- 1st FIooLj 6 3 0 14 2nd Floor
3rd Floor Basement %TO'b Deck—Covered Deck Other. Sq. ft.
Garage— Attached -Cfoe'tache —5-LE Carport— Attached — Detached
-MANUFACTURED HOME INFORMATION Make Model Year
Length—Width—Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Price $ A Replacement Unit? Yes/ No
Installer Name VV Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate infp rya i;;n may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I 6m 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 owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is
not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY
MEA.NSOFAPROG S R TION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
C'S;41 I
S
I . Z . wo
X LT/L Date: TAI,
Owner/Owners Represen ative/Contractor (indicate which one)FOR OFFICIAL USE BEYOND THIS POINT Acce9p e by: Date
DEPARTMENTAL REVIEW APP5PVED DENIED NOTES
Building Department 0 A)E-
Planning Department
Environmental Health Department
Fire Marshal
FEES Site Inspectlion
Building Permit Fee
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 Al(.) 4EAA0Z- Pre-Paid at Submittal
Valuation $ TOTAL FEES