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Home My WebLink AboutBLD2008-00901 Final Bldg 2 ATF Windows, Dishwasher - BLD Permit / Conditions - 9/8/2008 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NGr,->Z0ut7 PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar•P.O. Box 186, Shelton, WA 98584 ac-9 o I Shelton (360)427-9670 - Belfair(360) 275-4467 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLIC T R ATI CONT CTOR INFORMATION Owne Company me Mailing Add Mailing Addr City tat Zip Code City S Zip Code Phon Other P Phone Other Ph. Lien/Title Holder Contractor Exp. E mail address E Mail ress Drivers Lic.# DOB Dr' rs 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 Systern PARCEL INFORM I - 12 Di ' Par a o. —412 Fire District Legal Description Site Address(Please in Jude sRreet name, street numb rand ci Directi s to site Will tfin6er be cut and sold in parcel preparation?Yes o Is property within 200'of Saltwater � 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 o TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Works t yl�o,o No. of Bedroom 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 MANUFACTU D HOME INFOR N -Make Year L gth idt Seri o.— oms athrooms Ty of W t urchase Price$ Replacement Unit? Yes/No InsiMer Name Certification No. CiMtR/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 day or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY jMjIFAP1 R SSINSP CTI ACTIVITY OF THIS PERMITAPPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. Dat � Owner/ ners epresentative/ o tractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department ' Planning Department abUt'6C� Environmental Health Department 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 PERMIT NO. PLEASE PRESS HARD MASON COUNTY �I PLUMBING/MECHANI(�AL PERMIT APPLICATION !.�� 426 W.Cedar•P.O.Box 186,Shelton,WA 98584 Shelton(360)427-�67Q;Belfair(36)275-4467/a usma(360)482-5269 APPLIC IN 10 v m wee wWw C R INFORMATION Owner Company Na , Mailing r ailing Address Ci tat Zip City a Zip Code Phon Other P Phone Oth Li NT'le Holder A Contra eg. Exp. E a' ddress E Mai Address Dr L B Drivers Lic.# DOB RPTAP INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of SbweQ stem PARCEL INFORM i it Parcel No. Fire Distr' Legal Description Site Address(Please include street name,street nu city) Directions to site Is property within 200'of Saltwater River/Creek Pond Wetland Seasonal Run Stream SI or Bluffs > 15% TYPE OF JOB - Add Alt Repair Other Use of Building Locati ures/Units- 1st Floor 2nd Floor Basement Gara a_ Closet PLUMBING FI ORES(Show Number of each) 111rN G NICAL UNITS Type of Fixture No. of Fixtures Fees F :Electric_ LPG Natural Gas_ Heat P Toilets No.of Units ees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kit s WoodGas/Pellet Stove ishwasher Kibdtert Exhaust Hood l s Dryer Vent Other Other Base Fee tMECHANICAL TOTAL PLUMBING N- J OVVNERIBJLDER Acknowledges subrnission of inaccurate information may result in a stop work order or pemtit revocation.Adviowledgement of such is by signahue 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 pemtR and conduct the work proposed. The owner or agent on owners behalf,represents that the information Is accurate and Vards iMd Pftson County access to tits above described property and structure for review and inspection. BY MEANS OF A PROGRESS INSPECTION. Date: ? Owner/Owners Rep entative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by; Planning Pd Date BId Pd Receipt No. DEPARTMENTAL REVIEW DENIED NOTES Building Department Occ Group-Type. Constr. Planning Department 4wf, Environmental Health Department FEES Plumbing&Base Fee Site Inspection Meehan"1&ftle fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES 3 s 14;z 3,S t 2r4� �' gr 7Z L{-7 `72 g k 39 - _^ � 2 ~ � I z 3 Xz- X R-4�- -7 Z, 31 /.,7- ckc?' 114� 2� 3q 3 il �2 3 lz! 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