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HomeMy WebLinkAboutBLD2008-00095 - BLD Permit / Conditions - 1/24/2008 FORM MUST BE COMPLETED IN INK MASON CC*JNTY PERMIT NO. �I ' PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 ,� D Shelton (3 0) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 :: ► rV1 CL On the web www.co.mason.wa.us rAPPLICANTIO CONTRACTOR INFORMATION ner i e� . Company Name OGtJ'NE'� Mailing Address 6-72/ A4 oFXy0kA&QAc'44/ Mailing Address City Z4=40 State WA Zip Code 9'6'4Dl City State Zip Code - city ?G/-ZT'o0 Other Ph.2T-m -S'ZZ/ Phone Sit ME Other Ph. Lien/Title Holder a"1Es Contractor Reg.# Exp. E mail address 8 52VsrA1¢ srl�zf,�,Fs2E.C-'W E Mail Address Drivers Lic.#-W/TFf,N1B487B$- DOB 1-25'-SZ Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System_2X Name of Sewer System 6opt/A151- 77L S PARCEL INFORMATION - 12 Digit Parcel No. /22 2 I A 60020 Fire District Legal Description --SAE Site Address (Please include street name, street number and city) 42Z O d0r- SQL 302 ANN,r2fZ,6Z,1-444 Directions to site Alw)y3 ?a --3;e- 3421Z A0967. f O E9S7- To .�� AOST S,49' AO' <4;rV Will timber be cut and sold in parcel preparation?Yes/ Is property within 200' of Saltwater X Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - NewZC _Add Alt Repair_ Other PRIMARYSIDENCE R SJ=ASO(JAL ❑ �p Use of Building IPESl.D�iV�E' Describe Work Q."kj No. of Bedrooms_ —No. of Bathrooms— _Square Footage- 1st Floor_ 2nd Fl&o 3rzLELoor­ Basement: —De Covered Deck Other Sq. ft. Garage A49ehe Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width? Serial No. No.of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. 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 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 MEANS 0FAPP,0GRESS It4SPPCTION.1 CTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X Date: -Z`>t-�� caner/Own epresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date 1 -2-°1-68 DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department PlanningDepartment �- Environmental Health Department n 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 FORM MUST BE COMPLETED IN INK MASON Ce)UNTY PERMIT N0120 Aoo6 PLEASE PRESS HARD BUILDING-PoE RMITBox6APPoLI WATION - ;�-426 W. Cedar (� Shelton (3 0) 427-9670 - Belfair(360) 275-4467 • Elma (360) 482-5269 -�J I ry) On the web www.co.mason.wa.us FAPPLICANT INFOR AT CONTRACTOR INFORMATION /'��e�'�' �• ��'l`jft� Company Name aG-Oi✓E'R Mailing Address 672/ /V, IISCkc5/D_'ZA1 Mailing Address City ?� State _Zip Code City Stat Zip Code PhoneZS3-�6/-2S'6-0 Other Ph.ZS3-380-SZL/ Phone ;ME� Other Ph. Lien/Title Holder SA 146 Contractor Reg. # Exp. E mail address-8 5/y/TV 9. 5/4l C401J E Mail Address Drivers Lic. DOB l-25'-.SZ Drivers Lic.# DOB SEPTIC !WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System_>S,_ Name of Sewer System 6� A r n S PARCEL INFORMATION - 12 Digit Parcel No. /Z2 Z-1 43 60620 Fire District Legal Description -TA15E-4T"Gb� Site Address(Please include street name, street number and city) 422 0 Or- 4;q 30Z AWZ.,Ic, .40,AO.4 Directions to site lfwy3 7a �� 3p2-��T• CO ErT To �?/t��OST 3.S'. �2iGir�7 s//�'. IAI lGTD Will timber be cut and sold in parcel preparation?Yes/49 Is property within 200' of Saltwater X_Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New C Add Alt Repair_ Other PR S�jASQ1jAL ❑ Use of Building R'E'SlD�eVCE Describe Work a No. of Bedrooms- —No. of Bathrooms _Square Footage- 2nd FI r or Basement-, ___—De Covered Deck—, Other CGar r A0aelged Detached Carport Attached Detached MANUFACTURED HOME INFORMATION-- Make _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. 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 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 MEANS OFAP GRESS I�SCT�I �CIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WALL INVALIDATE THEAPPLICATION. X Date: 1-2.-4-007 caner/Own epresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by:qwu Date DEPARTMENTAL REVIEW APPR V D DENIED NOTES Building Department Planning Department G" Environmental Health Department A_ 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 /Vo E4#5 Pre-Paid at Submittal Valuation $ ( Flo- TOTAL FEES MASON COUNTY PERMIT NP`"� FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 FAPPLICVANT Shelton (3 0) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 _I I r1i1 On the web www.co.mason.wa.us FOR ATIO CONTRACTOR INFORMATION k'& ,f• c�%'l`jf� Company Name 0110A✓AV�X' Mailing Address 5074/ IV, ,#,4kQ5i0_41 Z-Al Mailing Address City 2Zra40 tate WA Zip Code 5W4-9 r City tat Zip Code Phone2f3-'?`1-�aa Other Ph.ZS3-3�0-SZL1 Phone E� Other Ph. Lien/Title Holder m-SAVIAE Contractor Reg. # Exp. E mail address 8 SM/ti12 S/K/Z'fr,Fi,2E'.C.�W E Mail Address Drivers Lic.#_V1 ry 7 DOB ,�-ZS'-.SZ Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System X Name of Sewer System 6MLAIr S PARCEL INFORMATION- 12 Digit Parcel No. /2Z 2-1 43 00620 Fire District Legal Description -54�E ATTA►4A6ZD Site Address(Please include street name, street number and city) 4Z20 0• �t,I�#eo IV.1 Directiop§to site A1W /GTO Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater X Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - NewLAdd Alt Repair_ Other PRIMARY WCL NCE R SFASOf�AL ❑ Use of Building IE'E"�l��NC� Describe Work. No. of Bedrooms_ _No. of Bathrooms_ _Square Footage- 1 st FlooL_ 2nd Flbbr or Basement: De Covered.Deck Other Sq. ft. Garage eked Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make 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. 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 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 hull &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 MEANS OFA P GRESS I SP CTION.I CTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. x Date: 1-Z-4—O[7 wner/Own epresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date -2-1-68 DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department 03 OJ L- Environmental Health Department RA- 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 i FORM MUST BE COMPLETED IN NK MASON COUNTY PERMIT N PLEASE PRESS HARD 13UILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 1 FAPPLICANT Shelton (3 0) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-52694 On the web www.co.mason.wa.us INFOR ATIO CONTRACTOR INFORMATION er /`?A, A- Af- � 17,_AV Company Name Mailing Address G7X/ �V, Mailing Address City 24CO A StateW—Zip Code ?AO!&I City Stat Zip Code Phone2s3"?d!-2S'oa Other Ph.ZS3-3W0-SZL/ Phone Other Ph. Lien/Title Holder _154/46E Contractor Reg. # Exp. Email address 8.5AIII'f/f9 S/lf C,Ll E Mail Address Drivers Lic.#_Vl 1 iaF 7 DOB /-ZS--T2 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer Systern—X_ Name of Sewer System 6WAA _ n S PARCEL INFORMATION - 12 Digit Parcel No. /ZZ a 1-4-3 606z0 Fire District Legal Description -%d!.E *7;*FGWAe F-AP Site Address (Please include street name, street number and city) 422 0 AF- $Q 302 Directions to site ,IWY3 723 Sroe- aO EST /6zo Will timber be cut and sold in parcel preparation?Yes/40 Is property within 200'of Saltwater X_Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - NewLAdd Alt Repair Other PRIMARY RESIDENCE R SRASOIJAL Use of Building Describe Work Q ki No. of Bedrooms_ —No. of Bathroom— _Square Footage- 1st Floor 2nd Flabr or Basement: —De Covered Deck Other Sq. ft. Garage d r Aoeehed Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No:of Bedrooms No. of.Bathrooms Type of Heat Purchase Price$ Replacement Unit? Yes/No Installer Name Certification No. 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 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 MEANS:E::;Z;g;Z:;;j CTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. x Date: caner/Own epresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date 1 -2--1 8 DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department It✓ Environmental Health Departmen ,C Fire Marshal FEES Building Permit Fee Site Inspection. Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State.Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES �iCt aac�8-- c�a0c1'� Mason County Permit Assistance Center Planning Intake Checklist Own e: Date: Project: Reviewed B Commer 1 Comments: Planner: GBM TSC KJM PBC RDH Svq� 11 -4 OWMAS hlxle Site Plan:North Arrow Arrow Property Dimensions: 100 X 1`�9 Streets and Driveways Shown. Road name: - EaC 1S+1 VI t re backs � e I Location, eptic nd Dra' -fiel hown with set ac I en surfac water eam , nds, shoreline, wetlands, et Topography(slopes) glop-¢-,S��y (�},A'�.,er Ct tks+D ❑ Proposed Structure Setbacks(Direction/ etback): I r F: a / C R: S� / S 1: (PTO / _S2: Utility and Drainage Easements: Yes No f yes enter condition#5022) ,a' Other Easements Accessory Appurtenances UnhA&4 Aelfl Arse ❑ County Access Permit Needed(add condition#001 ❑ State Access Permit Needed(add condition#0020) >Ex ls+lK Standard Conditions to be added to all Building per that planning dews:#5019 and#0700 Are there any impediments that may restrict access to your site? (dogs/gates) na Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zoni El Not Applicable ❑ Agricultural �RR 2.0 10 20 Urban ❑ In-holding ❑ RW ❑ Rural ❑ LTCFL 0 RC 1 2 3 ❑ ConservancyRural ❑ RI ❑ Natural ❑ RAC ❑ RNR 0 Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area 0 MPR 0 Unknown 0 Unknown Water Body(type of water if unnamed): A5, ' U -)Ll�i— a&jbA SEPA: Yes No own Flood Plain: YES NO o Map# Aquifer Recharge: YES NO nknown Map# Tags/Cases: RLC/SPI Case: l 1M'i f��o5 6-Year Dev. Moratorium: YES - Eagle Nest Tag: . 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CD CD S r. 3 ° 3 a Q � aN 0 CD < cn Nm a m CD flu mm co m cu (�cn m S �' � 3 � Onm o Nv �CD __ 0 o D cn w a O v?i m cmii n� ? � = o v m � N -0 CD � ? 3 c n c0 c m �i �► (D m 2v"Xi�• �� = m Vicc ao 0 p c� � (D o =r v-0 CD =r CC 0 - 0- rn 0 0 0 N co =. � 9' o CD - = 0) m � OmQ0 w = -1Cm m i58o cn cn C � v CLE*rr 03vma ocn mcn CD �t ,i fl v►' m �' X 3 toil 0 3 m X �, o w'� N o vu oco' m : Om m � � 0 < � � _ — Q (D (D N = _ = S " = m m m v m � _ < m tQn 7 C m �' cn 0 O V N n :3 8 m �' � cn m c 3 NoOawm 0a) °' co �-0 5. 8 �' 0 'mow Q __% co = = 0 0mm 0 p S' _ (D CD N Q cc O Cn = m CD (a0 CD _Q Q N - C 0 �_ �' 3 ��. �_ � CD X. v m 3.3 cnm 0Z0 0 Q_ _ _ � co (D c a (D CD 3 =_0 —I �' N o mo N A. ac < o r. v 0 - 3tn v 3 -0 o m cn m < cn00 of a CD 3cn B g o < o CDnd 0 �' = N CL 0 � m � o m : CD�`< a) CO ° 0.0 CD (a vcu 3CDm o:v3 . mm@ 03 CL o � �• � . mny o -0� 3m _� C0 o 0 °O CO)� m mo N . n < < - a w o 03a) Q cn = 3 < o �, `0 CD 3 cmg Q- a m `< QQo 5 * m 5 o o - p a m m O. s2 m °--• 3 m m-00 p 3 s8 o, Q < g to m >' m _" � 3 am v am y �' (D N (D CD ,< (n �"a O N O N. p� N N < _ ~! ,n�, CD (CD 0 = � N N � _ tr = g 0 n p' n �' ? 3 m O6 r. m 0 (7 O 7' Ncc C = m O = 3 aD m e ' O ?� 0) -h -a 0) � 3 to CD n v N D ? O " 0) C) n CD7 m Q n fl: m C ? N O CO) .y_+ 0-► (�A (3D �G 3 o N m = < c (�D fD 7 < m m O 9 .► S = �, m m m O N. 3 to FORM MUST BE COMPLETED IN INK MASOIN`COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 In U.�h�ItQn 427-9670 • Belfair (360) 275-4467 - Elma (360) 482-5269 -J i "V t�L�� On the web www.co.mason.wa.us APPLICANT IMORMATION CONTRACTOR INFORMATION Owner IIAA& •6. 5;417-1V Company Name QZO'A1E--le, Mailing Address 672.1 Al Rht1Zk-,�5/0-x--'Lam/ Mailing Address City 2ZC&,%/J State WA Zip Code g'�07 City State Zip Code Phone2 3-'76,!-ZS'oa Other Ph.2S03 -WQ-SZZ/ Phone S�MEQ Other Ph. Lien/Title Holder -54,o 9E Contractor Reg. # Exp. Email address B 5,01.rAl C2 S'Nl/�f/�i2E'• C W/ E Mail Address Drivers Lic.#S,� 774/?8467,_5 DOB l- S2 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System__X._ Name of Sewer SystemCot/N� r/LL? S PARCEL INFORMATION - 12 Digit Parcel No. /222/ 43 60620 Fire District Legal Description SEETTAC,�� Site Address(Please include street name, street number and city) 422 O AL -R 307- &EZ.,Gi0i..Z,G/1,g Directions to site AfWY3 7 3y2- ,S*6n Cy D ERvT TD /BOOST.�•S', iE'i�ilf7�lL ,At< <GZD Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater X Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - Newer CX Add—Alt—Repair— O PRIMARY RE.S)DENCE R SFASO(JAL ❑ Use of Building i E Describe Worka1 I n I�AI L No. of Bedrooms_ —No. of Bathrooms_ _Square Footage- 1st Floo 2nd Fl0r or Basement: ___.—De Covered Deck Other Sq. ft. Garage d r A#eel�ted Detached Carport A ac ed Detached MANUFACTURED HOME INFORMATION-- Make 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. 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.1 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 informaticn 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 MEANS 2Z;g;;2:;;;ECIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Date: I-2`-i-DF) caner/Own epresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date L M-68 DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department ! CG Environmental Health Department t1 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 TOTAL FEES Valuation $ FORM MUST BE COMPLETED IN INK MASOK COUNTY PERMIT NO 61j, �-Moqq PLEASE PRESS.NARD BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 n �_ C i1 ►►�► A � h�ItQn 427-9670 • Belfair (360) 275-4467 • Elma (360)482-5269 -4 i rat On the web www.co.mason.wa.us APPLICANT I ORMATION CONTRACTOR INFORMATION Owner_,/`')A,1e-e AS. Company Name QGc�tsyE� Mailing Address !ri272/ A4 ,P,04k-,5iD_A-�44/ Mailing Address City 2�f State WA Zip Code ?'84D7 City StateZip Code Phone2S3-74/-2S'aa Other Ph.ZS3-380-SZZ Phone E Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail address B S/lbrAl0 SAfI Ff2E. C414f E Mail Address Drivers Lic.LtRV7-A&B48WS DOB -ZS=.52 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System.._ Name of Sewer SystemCocrNr TjL T S PARCEL INFORMATION - 12 Digit Parcel No. /2ZZ/ 43 00020 Fire District Legal Description -'%E.E #f7;*9CA1,40 Site Address(Please include street name, street number and city)}22 O 302 Directions to site yW" 3 M S,e- 3yZ�'9vT. d EW67- T� Will timber be cut and sold in parcel preparation?Yes./ Is property within 200'of Saltwater _Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs _150% Is this permit submittal the result of a Stop Work Notice,Correctio ther enforcement action?Yes/No TYPE OF JOB - NewLAdd Alt Repair_ PPIMARR�1ES CIE SF-ASSJItIAL ❑ Use of Buildings E Describe WorkQ.L.N1 I rl No. of Bedrooms_ —No. of Bathrooms_ _Square Footage- 1s o 2nd�FlNbr or Basement. De Covered Deck Other Sq. ft. Garage A#9ehed Detached Carport A ac ed Detached MANUFACTURED HOME INFORMATION -Make 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. 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.]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 MEANS OFAP GRESS I SP CTION.I CTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X Date: caner/Own epresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by:cibw Date I -?N-68 DEPARTMENTAL REVIEW APPR DENIED NOTES Building Department Planning Department I G Environmental Health Department n / Fire Marshal FEES Building Permit Fee 2? Site Inspection Plan Review Fee EH Review Fee Plumbino & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/ Pellet Stove Fee State.Fee Violation Fee /vo &-vo. Pre-Paid at Submittal �I Valuation $ /0 / �`— TOTAL FEES I FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. Q L-b — Z0 o 8^e0o©gAfl PLEASE PRESSNARD BUILDING PERMIT APPLICATIONY 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 % l in CA Sh ltQn 427-9670 • Belfair (360) 275-4467 - Elma (360) 482-5269 -4 h►'Yt �1 L1� On the web www.co.mason.wa.us APPLICANT I ORMATION CONTRACTOR INFORMATION Owner 14110,,e_ Lam" AS. N5 441 7--IV Company Name OGtJe�/E'� Mailing Address 672164 Xy0&c5i0_A'--LA/ Mailing Address City ;�lff State WA Zip Code-610-Z City StateZip Code Phone2S3-?6I-2S'60 Other Ph.2S9--WO-SZL/ Phone � E Other Ph. Lien/Title Holder Contractor Reg. #� Exp. E mail address B 51fMAI0 TlfI ,f/,F,f ,C404'1 E Mail Address Drivers Lic.#_J/ThfMB487BS DOB /-ZS i Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer Systern__>�_ Name of Sewer System 0WAoi r,►� T S PARCEL INFORMATION - 12 Digit Parcel No. /ZZ Z-/ 43 QQQZQ Fire District Legal Description- Site Address (Please include street name, street number and city) 4220 A*�'. -!R 3402 AEK_ _eo U-1-4 Directions to site yw y3 7V 3O2-E.2967. d EA�6�- le M Will timber be cut and sold in parcel preparation?Yes](0311 Is property within 200'of Saltwater _X Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal h result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New C Add Alt Repair_ O PRIMARY RESIDENCE �I S�ASQt�AL ❑ .vl-a.�.� I r1 Use of Buildings nescribe Work �d.�A N of � Ba - 0 o Bedrooms- —N of thro m o. o s_ _Square Footage 1st Floo 2nd Flbbr or Basement: De Covered Deck Other Sq. ft. Gara e At�aehe�} Detached Carport A ac ed Detached 9 p MANUFACTURED HOME INFORMATION -Make 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. 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.)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 hull & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for period of 180 days.PROOF OF CONTINUATION OF WORK IS BY Y P P Y MEANS OFAP GRESS I SP CTION.I CTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X Date: wner/Own epresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date -2-`1-68 DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department PlanningDepart ent ® oS'r mn � Environmental Health Department e)A / Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbin2 & 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 FORM MUST BE COMPLETED IN INK MASOKi COUNTY PERMIT N PLEASE PRESS HARD BUILDING PERMIT APPLICATION -' 426 W. Cedar- P.O. Box 186, Shelton, WA98584 4 *' 4 Rt I Ir1 LU���I�n 427-9670 • Belfair(360) 275-4467 - Elm a (360) 482-5269 - try'; l.L� On the web www.co.mason.wa.us APPLICANT I ORMATION CONTRACTOR INFORMATION Owner_nAkk- AS. 5"417-,f1 Company Name Mailing Address 6721 ,III. ,44kQ5/D-0-L-c/ Mailing Address City ;� A State" Zip Code 96VA27 City St It Zip Code PhoneZS3-7_1/-2S'da Other Ph.ZS3-380-SZZ/ Phone !SAtIE� Other Ph. Lien/Title Holder— 5*M_dE Contractor Reg. # Exp. E mail address 8 S,V/Fi/¢ 5.Af/Z/1,I"f2E: C,cW E Mail Address Drivers Lic.#.WIT''W/'IB487BS DOB l-2-S=S2 Drivers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Sewer System LX_ Name of Sewer System G6c/N� nLET S PARCEL INFORMATION - 12 Digit Parcel No. /222/ 4 606 0 ► Fire District Legal Description-_ .E i9_rT,AGl4� Site Address(Please include street name, street number and city) 4220 0'- -' 3OZ A66!4,,50,,I/Z,U-44 Directions to site A/W)y3 723 --S;e— 34:12-eR*62! . CO _,-54�57- TO 16;r Will timber be cut and sold in parcel preparation?Yes./ Is property within 200'of Saltwater X Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - NewZC_Add Alt Repair_ O PRIMARY RED DENCE R SFASQIIAL ❑ Use of Buildings describe WorknFloo n LiA�No. of Bedrooms_ —No. of Bathrooms_ _Square Footage- 1s 2nd Floor or Basement: De Covered DeckOther Sq. ft. Garage Atteehecl Detached Carport A ac ed Detached MANUFACTURED HOME INFORMATION -Make _ 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. 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.]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 MEANS:FAP GRESS I SP CTION.1 CTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILLINVALIDATE THEAPPLICATION. X Date:116— caner/Own epresentative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date ( -2H-Q DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Departmenf-lal_2114A 1 jA / 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 Assistance Center •Planning Intake Checklist Owners Name: M 11 Date: 1 -• 2-1— n ER Project: Reviewed By• Commercia evelopme : t- Comments: Planner: GBM TSC PBC RDH Site Plan: North Arrow ❑ Property Dimensions: 100 X 1-79 ❑ Streets and Driveways Shown. Road name: a — t ❑ All Existing Structures shown with setbacks ❑ Well Location, Septic and Drain-field Shown with setbacks ❑ Identify all surface water(streams, ponds, shoreline, wetlands, etc.) ❑ Topography(slopes) ❑ Proposed Structure Setbacks(Direction/Setback): Cpn Pro L i l�u ❑ Utility and Drains a Easements: Yes�No if es enter condition#5022 g ( Y ) ❑ Other Easements ❑ County Access Permit Needed(add condition#0010) F—X t S-6 rl ❑ State Access Permit Needed(add condition#0020) Standard Conditions to be added to all Building permits that planning re :#5019 and#0700 Are there any impediments that may restrict access to your site? (dogs/gates) Shoreline and Planning Info Setbacks: Shoreline: Slope: Shoreline Designation: Comprehensive Plan: Rural Zonin : ❑ Not Applicable ❑ Agricultural RR 2.5 10 20 Urban ❑ In-holding / . ❑ RMF v 0 Rural ❑ LTCFL ❑ RC 1 2 3 ❑ Conservancy ,,V Rural ❑ RI ❑ Natural ❑ RAC ❑ RNR 0 Unknown ❑ RCC-Hamlet ❑ RT ❑ Urban Growth Area 0 MPR ❑ Unknown 0 Unknown Water Body(type of water if unnamed): - SEPA: Yes No llknown Flood Plain: YES rno Map# Aquifer Recharge: YES N_�!!!"ap# Tags/Cases: RLC/SPI Case: 0001 O 6-YearDev. Moratorium: YES Eagle Nest Tag: . YES NO Other YES NO op 'i Addressing: Check box if needed 0 V-�Wriewed-bp- yloe4k .W Revised:12-19-2007 I:IPLANNINWAMPLANNING INTAKE it MASON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Mason County Bldg. Ili,426 West Cedar Street PO Box 186, Shelton,WA 98584 www.co.mason.wa.us (360)427-9670 Belfair(360)275-4467 Elma(360)482-5269 UPLAND ROCKERY "rescriptive Design and Installation Standard Bladdop or impeMous soil for surface drainage. To. Maximum Rodceryfieight 8'0" grade. Washed granular drainage material 5 +r ts-mm. Undisturbed soil not fill) 4'0- I Min.12"layer of drainage material Specify rock sizes ranging from Vr•• coarse(1-1/2•)to fine(318"). Approved filter fabric ro^ � Mason County Dept.of Community Development may require that any rockery be designed by a licensed soil engineer, especially in soil sensitive areas. fro• . �� J (a1011rld r9Y0r -. Min.4"diameter perforated drain 1r the to an approved discharge. Permits Required A building permit is require for all uplansrockeries over four feet in height. Rockeries less than four feet in height do not require a per- mit unless: 1) Located on a site containing an Environmentally Critical Area(See Mason County Critical Area Ordinance. 2)There is a surcharge such as a driveway,building footing,etc,3)impoundment of Class I,II,or 111-A liquids(IBC 105.2) OR #4) Possible failure that could cause damage to adjoining properties or structures. Even when rockeries do not require a permit,rockery installers are advised to follow the rockery design principles outlined in this pub- lication. Permit applications-for rockeries must include a site plan showing the location of the rockery and a cross section of the rock- ery showing the proposed design details. Rockery designs must either be prepared by a Washington State licensed engineer or com- ply with the Prescriptive Rockery Installation Design. Rockeries over 6-feet in height must be designed by a Washington State licensed engineer or architect to ensure stability against overturning,sliding,excessive foundation pressure and water uplift. 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