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Home My WebLink AboutBLD2001-00463 - BLD Application - 5/15/2001 I_�Zq 3 i'l. PEWIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 1, Shelton 360 427-9670 Belfair 360 275.4467 Elma 360 482-5269 Seattle 206 464-6968 + APPLICA,IILT INFORMATION CONTRACTOR INFORMATION Owned' atSs' w '� J° `-'�°e�4 rc? w� Contractor Name � ` Mailing,Address �w r , ' c Jl. �' Mailing Address rim f :"a"r! State L�L p City State Zip Code City Zip Code , " Ph. Other Ph.( Phone . "',';. Other Ph.�—� (--� Lien/Title Holder Contractor Reg. # . Address Expiration SEPTICMfA'1'ER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System''°' Name of Sewer System Well Water System Name of ulfat�System ARCEL INFORMATION-12 digit Tax Parcel No , // -' /!�� Fire District L gal Description ... � , a�rJ eL „ t ;'�� 4` s! ,j ite Address(Please Include street name, street number and clty�, `V2.( < yy��'" o'°>A Iirections to sit 4,y 4, ��'i'.i trk "y'd 1:,� e� J"�'� 1 �,,J ['"► . Will timber be cut and sold in parcel preparation? (Yes o Is your property within 200' of the following: Body of Water (Name)!tF =� -, 1 ,, Saltwater Lake a"d River/Creek Pond Wetland Seasonal Runoff Stream Slopes or —a - Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB ew Add>,L Alt Repair Other Use of Buildings°, " Describe Work)", «. �i a~ l �' r �£ � �w :: „"fit No. of Bedrooms o,ftNo. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor . Loft Basement Deck Other sq. ft. Garage,-'"" Attached Detached Carport Attached Detached i MOBILE HOME IN„ pfCMATION-Make Model Model Year LengthClVidth Serial No. No. of Bedrooms No. of Bathrooms Type o w.Hf3at Purchase Price $ Replacement Unit ?(Yes/No) Ins er 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 t at 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 v{hi this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformzinic4 therewith o changes shall be made without apprpV1 / first obtaining approval. r. I ate .,,� X Date FOR OFFICIAL USE BEYOND THIS POINT f Date ,� �'> Submittal Amount Due r r Receipt No. Accepted by i ��,` s-- r r QEPARTMNTAL;R VlE1N. APPROVED DENIED CfJ;NDITI [ CpES j Building Department Occ Group Type Constr. Planning Department I Environmental Health Department Public Works Department I i Fire Marshal i Valuation $ FEES Building Permit Fee Site Inspection I Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee i Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) j TOTAL FEES PE,R T NO.: BLD MASON COUNTY ` s�5 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 4;/1_t ' - APPLICA11 INFORMATION CONTRACTOR INFORMATION Owner'"17,. l,f 4 6 /�'Y�� t e�1 �'^a ' ;.LL a Contractor Name Mailing Address " " � �� ra`C ."' a - ° Mailing Address City//1, , ` ''7�e State kA Zip Code City State Zip Code Phoned3,�4 )?.. = '75 3 ebther Ph.( ) Ph.(_ Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration SEPTICAYAt'fER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer • Systell" Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. . ��1' w +� /af� ! e Fire District �. ! rjt! �� ) s 'tea 1 Legal Description", �. � � � - � 1 Site Address(Ple Se include street n me, street number and city Directions to it � 6 12 4) AJO #!da".ram f ax .4�� '' Ai Z:S' 7P" Will timber be cut and sold in parcel preparation? (YeVNo Is your property within 200' of the following: Body of Water (Name) Saltwater LL 1 .+�� r Saltwater Lake_River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB rVw Add Alt Repair Other Use of Building 1e Describe Work q�;" ' `` c!��ra'a � c ��: �' id.Pa' �-1,0e,,&6 �,L'.-,-,zr:,je No. of Bedrooms ,"+lo. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Lott Basement Deck Other sq. ft. Gar age ^' Attached Detached Carport Attached Detached MOBILE HOME IN,.GKMATION-Make Model Model Year Length 1. -°' idth Serial No. No. of Bedrooms No. of Bathrooms Type o kitat Purchase Price $ Replacement Unit ?(Yes/No) Ins er 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 thg, Qrl1 for�v^�$hiphis permit is issued and all work conforrpance therewith. No changes shall be made without first obtaining shall be done in conform rya�d Hwith.4a o changes shall be made without approval first obtaining approval. r" v ate X Date FOR OFFICIAL U5E BEYOND THIS POINT, Accepted by ,�� ?/ :� Date r �, ! s`� Submittal Amount Due Receipt No.�;' DEPARTMNTAI: wl!»IN APPRC�VIwD DN1D CDNDITIN CC1f7�5 Building Department6- Occ Group Type Constr. Planning Department Environmental Health Department r Public Works Department I Fire Marshal Valuation $ FEES [Plan uilding Permit Fee Site Inspection 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 I -- BUILDING PERMIT # L. -� (.O DATE S - 2 Z _ Q t GNU e� Planner Area Parcel # 2 3 30 S 0 " y d 1 CHECKLIST FOR PROPOSED CONSTRUCTION Comp Plan Designation UGA RAC RCC RA For IH Yes No [/f [ ] Within 200 FT of SMP designated shoreline, wetlands, etc. Where? [✓j [ ] Located near possible Critical Area, What Kind? (Wetlands, Streams, ake , kjopeS [ ] [ uj RLC already done? [ ] [ ] Proposed construction within floodplain [ ] [�, Eagle nest nit C) [ ] [V Six year moratorium [ ] [ 0/" Multi-Setbacks ( ] [ State road access needed [ ] [Commercial Development (parking standards, sign ordinance, public works review, other applicable [ L'r�gencies) mobile Home or RV Park Al.