HomeMy WebLinkAboutBLD2004-00535 Final Dock - BLD Permit / Conditions - 8/9/2004 o X pCD CL
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FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO.
PLEASE PRESS HARD 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_ 1AAK f LAcc,err j;;vlea-M 4S&v Company Name
Mailin Address 7 0 G I X 7 *"" PL S- F_ . Mailing Address
City FtijOiy State &/q Zip Code g?ps'` City State Zip Code
Phone ` 2-T -Z7I -55'01 ether Ph.AS3-771-9 y 9 9 Phone Other Ph.
Lien/Title Holder, 48N A1490 /"PitrCAGF_ GNwo tAo'L Contractor Reg.# Exp.
E mail address -Paec., r",- ves- a A H A A Q c�,k. co E Mail Address
Drivers Lic.# Rvmr=i 6 Z- DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic L�ls'T Pyr��F/J
Connect to Water System Name of Water System
Well X Water System Name of Water System
PARCEL INFORMATION - 12 Digit Parcel No. a2.330 -.S0 - 00 138' Fire District
Legal Description X-or Ar.'4 "at /38
Site Address (Please include street name, street number and city) 140 NF Leahy PL TQyrJhn , '-A 9f588'
Directions to site SEA
Will timber be cut and sold in parcel preparation?Yes/ o
Is property within 200'of Saltwater Lake K 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 a ion?Yes/No
TYPE OF JOB - New Add X Alt Repair Other PRIMARY RESIDENCE SEASONAL 0
Use of Building Describe Work Bvr" 'Y N'Vo'
No.of Bedrooms No.of Bathroo-- square Footage - 1,
t Fi^^r 2nd Floor
3rd Floor Basement ueCK Govered Beck-- ether OccK Sq.ft.
Garage Attached 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 permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this applica-
tion or the work proposed in the application,I have obtained permission from them to apply for this permit and conduct the work proposed.
r�
X cf► Date: el 116'/0')4
Ownerj Owners Representative/Contractor (indicate which one)
to
' ��:Jam-- OFF �� USE BEY I P. INT
Accepted b . Planning Pd �Ck# Date Bld Pd Receipt No
DEPARTME L REVIEW APPROVED DENIED NOTES
Building Department _ —
Planning Department
Environmental Health Department RECEIVED
Public Works Department
Fire Marshal �2-0—OV 426 W. CEDAR T:
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
TOTAL FEES
Valuation $
'',i
MASON COUNTY PERMIT NO.
BUILDING PERMIT APPLICATION
426 W. Cedar • PO. 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 I'l A rL-. I c'_ A �A- 2 T r I`v r;r t. ,y c-- Company Name
Mailing Address 7V O 6 /?- 7 + ' nL -5. / Mailing Address
City L f_ '"` °`W State ;;,/A Zip Code `% F'056 City State Zip Code
Phone `f z 2 7/ -.5-`- 0 1 Other Ph..:-53- 773 - ; v ;' ') Phone Other Ph.
Lien/Title Holder ABN A1490 "'0Kr6'fGr 00vP 7-- - Contractor Reg.# Exp.
E mail address —P- u % 1 4- sG< t�! 'I '� ,4 h�<«. c.G.� E Mail Address
Drivers Lic.# Fv2Umrr,O Y3 6 T DOB Drivers Lic.# DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic X L +sr
Connect to Water System Name of Water System 2z7o3
Well > Water System Name of Water System
PARCEL INFORMATION - 12 Digit Parcel No. 2,330 .So ` 0 0 '3,T' Fire District
Legal Description L a S�L- anot !3�
Site Address (Please.,include street name, street number and city) '00 Nr 4. A y P4 4/A ?eS�?S'
Directions to site SEF A rTA c IFA,,T
Will timber be cut and sold in parcel preparation?Yes/(No
Is property within 200'of Saltwater Lake x River/Creek Pond
Wetland Seasonal Runoff _ ---Stream Slopes or Bfuffs > 15%
Is this permit submittal the resuft of a Stop Work Notice,Correction Notice or other enforcement action?Ye"o
TYPE OF JOB - New Add X Alt Repair Other PRIMA RE SEASONAL
Use of Building Describe Work B,,,,-
j No.of Bedrooms No.of Bathroo Square Footage - 1 st F o n Floor
j 3rd Floor Basement he, Sq.ft. L60
Garage Attached , 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 permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this apj*a-
tion or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed.
i� r
X j-+.cc.Z�c� Date: �///CIo
Ownerj Owners Representative/Contractor7 .(indicate which one) '-'
R OFF USE BEY T I P INT
i
Accepted b PI nnirrg"Pd Ck# 3 Date ,� Bld Pd '� � Receipt No
DEPARTMENAAL ALVIEW APPROVED DENIED NOTES
Building Department rj D l 'rl(,%
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal U-C. 426 W. CEDAR ST
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 $
MASON COUNTY PERMIT NO s'�'
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
i Company Name
Owner
Mailing Address �'` �'� Mailing Address
City Staff Zip Code 1 =' - City State Zip Code
Phone ' Other Ph. Phone Other Ph.
Lien/Title Holder A 6'y ,Nix v 1-r76 46 f GA"'15 r—C 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 X Z.4r7 /It/ j
Connect to Water System Name of Water System z/G
Well ? Water System Name of Water,System
PARCEL INFORMATION - 12 Digit Parcel No. 2,I -"O - S") - L(l `"`:' Fire District
Legal DescriptionSite Address (Please include street name, street number and city) 140 AIr )I tl- 7-,vwhc , GiA ^vf5f0`
Directions to site T 7,A ` /I
Will timber be cut and sold in parcel preparation?Yes/`No;,
Is property within 200'of Saltwater Lake X River/Creek Pond
Wetland Seasonal Runoff .Stream Slopes or Bluffs > 15%
Is this ftermit submittal the result of a Stop Work Notice,Correction Notice or other enforcement actionZKe&No
TYPE OF JOB - New Add X Alt Repair Other PRIMA Y RESI ENCE ` SONAL
Use of Building Describe Work j6,,rk
No.of Bedrooms No. of Bathrooms Square Footage- 1 St.F o77
n Floor
3rd Floor Basement Geaeetecf-Brck' her 00 c�< Sq.ft. 160
Garage Attached 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 permis-
sion from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this app)ica-
tion or the work proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed.
X ` rr�.%c.- �c-f ... ,.-�-- Date: Zf //4`
Owner Owners Representative/Contractor' (indicate which one)
FOR OFF IAL.USE BEYT,HI ;!INT
Accepted b PI nning-Pdji.` "'""Ck# Date f Bld Pd / - '' Receipt No
DEPARTMENfAIL REVIEW APPROVED DENIED NOTES
Building DepartmentrNA
Planning Department �
Environmental Health Departme
Public Works Department 0�
i Fire Marshal I 1 420
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
STgrFo� MASON COUNTY
c DEPARTMENT OF COMMUNITY DEVELOPMENT
uPlanning
Division
y N y o P O Box 279,Shelton,WA 98584
(360)427.9670
1864
I
i
NOTIFICATION OF INCOMPLETE APPLICATION
i
t
April 27, 2004
MARK FURUMASU
7406 127TH PL SE
RENTON WA 98056
Parcel No.: 223305000138
Project Description: 4'X 40' dock.
Dear Applicant:
You have submitted a permit application (case no. BLD2004-00535)for proposed
construction or development in the county. Upon review of your application, I have
'! determined that the contents of the application are incomplete or do not provide
enough detail for review.
Therefore, review of your application will not proceed until the necessary information
is provided (see the comment section of this letter for details.) Once the information
is submitted and the application is complete, I will continue to process your
application accordingly. If the additional information is not provided to the County
within 180 days of this request, the application shall expire and no further action on
the proposed development shall take place.
Please contact me at (360)427-9670, ext. 577 if you have questions.
S'
Rick Mraz
i Land Use Planner
Mason County Planning Department
Donne"ts: A review of the site plan and associated documents suggests that the
proposed structure may cross property lines as they extend into the
water of Haven Lake. Mason County will not issue permits for
construction that crosses property lines. Please provide a revised site
plan that indicates the dock as it is oriented to the waterward property
lines. Thank you.
4/27/2004 1 of 1 BLD2004-00535