HomeMy WebLinkAboutBLD2006-00713 Retaining Wall 106' Final - BLD Permit / Conditions - 6/27/2006 F11UST BE COMPLETED IN INK MASON COUNTY PERMIT NO. AJ�6 _
PLEASE PRESS HARD BUILDING PERMIT APPLICATION per ? rs
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 INFORM N
Owner 0A% A• `(A-irs S Company Name l L-0 tit _S C*
Mailing Address o .a M MailingAddress .n Ai )( IV O
City 3�Eeam A State Zip Code 8 W °"1 City t-L _„. StateWA Zip Z
Phone 7_5347S L-1 13 3 Other Ph.Z-'S 3 2P%-q 4 q Phone-3b'o-7-75--&t,09 QOther PhCode. 1
Lien/Title Holder 4Z c; Contractor Reg.� go pe a Ex p.
E mail address PAM •C04 . E Mail Address
Drivers Lic.# ATI�.S3Ay°ll DL DOB - 13-5 Drivers Lic.# ' DOB
SEPTIC!WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic
Connect to Water System Name of Water System
Wells_ Sewer Systera_2�_ Name of Sewer System A okJ
PARCEL INFORMATION -12 Digit Parcel No. -Z _z -- o a Fire District
Legal Description e-
Site Address(Please include street name, street number and city) S?- v Z 0 aEL_s*9?__WA
Directions to site 310 EaJ
Will timber be cut and sold in parcel preration?Yes IdW
Is property within 200'of Saltwater . pa._Lake River/Creek and
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?YesJW
TYPE OF JOB-New Add Alt . Repair Other PRIMARY RESIDENCE aSEASON L
Use of Building Describe Work 108760 tal 4, L21ALL �v
No.of Bedrooms - No.of Bathrooms . Square Footage- 1st Floor 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq.ft.
Gara a 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 Admowledges submission of Maccurate 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 d are
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 all
the necessary parties.if permission is required from any easement holder or any other party in interest regarding this application or the rk
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner r
agent on owners behalf,represents that the Information provided is accurate and grants employees of Mason County access to the a ve
described property and structure for review and inspection.This permit/application becomes null&void if work or authorized construcl ion is
not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK S BY
MEANS OFAPR ESSINSPE�ITOF THIS PERMITAPPLICATIONOF180DAYSWILLINVALIDATETHEAPPUCATIO .
x Date: 7_5-o
Owner/ ners Rep ntative/Co ractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW PROVED DENIED NOTES
Building Department
Planning De artment
i
Environmental Health Department
Fire Marshal
FEES
Buildinq Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing& Base-Fee Piannin Review Fee
i
Mechanical&Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES
I
PERMIT NO.
MWUUST BE COMPLETED IN INK MASON COUNTTYPLICA„r1ON
.EASE PRESS HARD BUILDING PERMIT A WA98584
426 W.Cedar•P.O. Box 186, Shelton,
Shelton (360)427-on0
he Weeb irwww 02
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son wa usma(36
.
482-5269
CONTRACTOR INFORM IN �ti1 S
Company Name
APPLICANT INFORMATION �Ar� �.i3oX O
Owner �A`M S �,� tz. Mailin Address tale Zip Code $ z
Mailing Address �$ �g�{ o"i City �g Other Ph. - f
Cityc '"` A Gate Zip Code 444 Phone b��Z�
Phone 75 "'r 1 3 Other Ph. - Contractor Reg.# Exp.
Lien/Title Holder C� � ',CjDM�►1 E Mail Address
DOB
E mail address �i 13-S1 Drivers Lic.#
Drivers Lic.# AT�S 5A4a11 flL- DOB Existing Septic
SEPTIC I WATER SYSTEM INFO mM of Water Sy temt to New Septic_-----
Connect to Water System Name of Sewer Syste A o�
Well Sewer Systeiu..�- _.Z. c o Fire District
'Z
PARCEL INFORMATION-12 Digit PaiGl No.
Legal Description
Site Address(Please include street name, street number and city)
Directions to site
o
Will timber be cut and sold in parcel preparation?Yes River/Creek____ ---Pond__
within 200'of Saltwater . .-Lake._..._.-- Slopes or Bluffs 15%
is property Seasonal Runoff_______Stream_____..._-
Wetland__ SEASON
t submittal the result of a Stop Work Notice,Correction Notice orR MBAR n RES DENCEffon? e
la thispermi air Other_________- P #jj U Wpm. -+
TYPE OF JOB- New Add _Alt y Rep u,AQ0
__ nbscribe Work 2nd Floor
Use of Building Bathrooms--
ofSquare Footage-1st Floo_------
No.of Bedrooms No. Covered Deck Other ------Sq•ft. —
3rd Floor Basement Deck- ----- a ched Detached —
Detached —Carport Year
Garage Attached __—Model
MANUFACTURED HOME INFORMATION-Make No.of Bedrooms No.of Bathrooms
Length Width Serial No. Replacement Unit? Yes./No
Type of Heat Purchase Price$ Certification No.
Installer Name permit revocation. re
BUILDER gdcnowledges submission of It information may result in a stop work order or r t rrnission
OWNER 1 low,1 declare that 1 am the owner,owners legal l pryer 1 have obtained the Pe fu ee rk l
Acknowledgement of such is by signature be proposed in the applieaUon.I ecl this appllcatwn or
in interest regarding The owner r
that 1 am entitled to receive this permit and to do the work as propo i for this permit and conduct the work proposed. to the e
the necessary parties.If permission is required from any easement holder f any other party
proposed in the a plication,l have obtained ermission from them to apply
p ppnd ins lion.This permitlappiication becoma s PROOF OFCO TINUATION OF WO O S BY
agent on owners behalf,represents that the informattp in provided is accurate and grants employees soles of d if work or access C R
described property and structure for review
TY OF THIS PERMITAPPLICATION OF 180 DAYS Wlt-t-INVALIDATE THE APP
not commenced within 180 days or if construction work is suspended for a period o Y `7
MEANSOFAPR ESSINSPETION.INA ate
X
Owner 1 ners Rep ntative/Co ractor (indicate which one) Date
Accepted b : s
FOR OFFICIAL USE BEYOND THIS POINT NOTES
DEPARTMENTAL REVIEW APPROVED DENIED
3
Buildin De artment
Plannin De artment
Environmental Health Department
Fire Marshal FEES
4
Site Ins action
Buildin Permit Fee EH Review Fee
Plan Review Fee Plannin Review Fee t
Plumbin &Base,Fee
Other E
Mechanical&Base fee State Fee
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal
THIS PARCEL INCLUDES
RECORDS FROM THE
AUDITQRS OFFICE
PARCEL # i 9) �a � 006,�o
AF DOCUMENT
AF# DOCUMENT
AF# DOCUMENT
AF# DOCUMENT
AF# DOCUMENT
AF# DOCUMENT
i
i
THIS MAY NOT INCLUDE ALL DOCUMENTS
RECORDED ON THIS PARCEL
MASON D, ' ' �! . Y oL .D t. ' `NNING
SITE PLAN `;EQUIRP' `0 BE OWN SITE
N ES SUSJEC T TO APPRO AL
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APPLICANT TO DRAW TOPOGRAPHY BELOW:
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Date By Daft By DECKS
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Date By Data By __ PROPANE TANKS
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t By OTHER
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