HomeMy WebLinkAboutCOM2003-00125 Final Frame 127" x 94 1/2" Wall - COM Permit / Conditions - 9/10/2003 3 CONCRETE MECHANICAL MANUFACTURED HOME
c Footings/Setbacks Date By Ribbons
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MASQN COUNTY PERMIT NO. BLD((-'nA)-('t,&
BUILDi/ E !�*PPLICATION
42 L I /
Shelton,WA9 M
Shelton(360)4g7,.967 Betlair )27 7 1 a(360)482-5269 Seattle(206)464-6968
INFORMATION ( CONTRACTOR INFORMATION
Owner � / 'si4G�ERrS / Contractor Name FON �.►
Mailing Address /aG! J&X /0 4)f i Mailing Address Pe Cox
Clty,AJ--#-_'-1-4 StateN&Zip Code � _ City, a-04 fCr4r& Statq&d_Zip Code
Phone&-,_0 )_Z?S"'-"rb Other Ph. ( ) Phone Lv)XIS"'-6 7.74 Other Ph.
Lien/Title Holder [E♦►Tewma&, GooContractor Reg.
E-mailAddressRS •,► E-mall Address
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic x Connect to Sewer
System_Name of Sewer System Well X Water System
Name of Water System
PARCEL INFORMATION- 12 digit Tax Parcel No. j22.31 / Itl / wti ie Fire District. S�
Legal Description
Site Address(Please include street name,street number and city)/ S
Directions to site C', fit S'. or tt vv t A —e&JT /rAC►r PEAL s i# i 3
:1
Will timber be cut and soli in parcel preparation?(Yes/No)
Lake River/Creek Pond Wetland Seasonal Runoff Stream
Slopes or Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB-New Add - Alt, _Repair Other Use of Building
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?(Yes/No) lVb
Describe Works-A&V Iwo /,2,7 " X 0)4%i ' ¢✓OV4 e%ei ' ge*,t-S' �
No.of Bedrooms No.of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor
r 3rd Floor Loft Basement Deck Other sq.ft.
Garage Attached Detached Carport Attached Detached
MOBILE HOME INFORMATION-Make Model 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.
NOTICE:THIS P RMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN It 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,reprekerns that the
Information provided is accurate and grants employees of Mason County access to the above described property and struc(ures for review and Inspection
of this project.Owner/Butlderadkrnowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgment
of such Is by signature below:
OWNER AFFIDAVIT-1 certify that 1 am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a
the Contractor Registration taw RCW 1827 and am aware of the ordi- contractor In the State of Washiroon and that I am aware of the ordhmw
trance requirements for which this permit is Issued and that all work will be requirements regulating the work for which this permit is Issued and all
done in conformance therewith. No changes shall be made without fist work shall be done M conformance therewith.No changes shall be made
obtaining proval. without*9 obtaining approval.
X Date 4.2-1,03 X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted `�1. Date��2 1 Submittal Amount Due ReQe"No. 4
Building.bepartment
Occ IM Constr. &
Planning Department
Environmental Health Department
Fire Marshal '
f
valuatgrt$
Building Permit Fee Site inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base fee A Other
Wood/Gas/Pellet Stove Fee Mate Fee
Violation:Fee Pre-Paid of Submittal
TOTAL FEES
"PERMIT NO. BLD
MASON'COUNTY f_ x D
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 1 W,Shelton,WA 9&%4
Shelton(W)427-9670 BeftIr(3W)275-W7' a(360)482-5269 Seattle(206)464-6968
On the Web*Wcojmpon wa•us
APPLICANT' NFOA 111ON CONTRALTO INMAMA•110H j
(?ufiner I Contractor Name Tc�r�N r r �+0
Mailing Address 04 X t01 j Mailing Address l� 00.x 411A '1 �
City 4s+rA/ Stated Zip Code ? S' W City. S. O'L e%foL Stated zp Code
Phoney. , �S"-GE►t�b Other Ph.( ) Phone( ►) 7<;'i ��*/ Other Ph.(_
Lieitll"ttte.H older , € Te�rr�ri�at+.< xK Contract&Reg. i�l tr,Tt�l ExP•.
E-mail Address R'. rtse«i "% ir-�J .daGl�I E-mail Address
SE C/1MATER$Y$T1=11A INFORMATION L,Con=to Near Septic Septic �C Connect ija Sower
Well Water System
System,,,_•, Name of Sewer System ,— —
N m
�.4 PARGEI! ON=12 digifTatf Parc+t No'.
Fire i)istrict ,
Legal "tilptlon
Site Address(Plealse include street name,street number°and
Dil eCtionB fo' ite ` / R i' Rs9rt s` #T
Will timber be,cut and sold in I re on? esM0) f4
P� P P
Lake'° River/Creek Pond Wetland___,Seasonal Runoff____—Stream
ti
w or luf�
PERNIANEN'i'pESID�NiCi=:Ct SEASO SfQE +
TYPE OF JOB-New ,Add Alt Rep' *, __Other Use of Building
Is this permifsutxnittal the result of a Stop r1�Netice,Correction No etar other enforcement action?(Yes/No) Aa
Describe Work 'T" Q �` Nl` • '* I`
No.of Bedrooms No.of Bathrooms SQUARE FOOTAGE-1 st Floor 2nd Floor,
3rd Floor Loft Basement_ Deck Other __ sq.,ft•
Garagi_ ._Attach
Detached Carport. Attached_Polwhed
MOBILE HOME INFORMAVON-Make Model Model Year
LentFr _Width Serial No. �' No.of Bedrooms No.of Bathrooms
Of Purchase Price$ Aeplaoement Unit?"Y Nd)
Cotiific�tkwrt No.
F
: HI RMIT i l- VOID OR N IS NOT GO i80DA IF
RUCTION WORK IS SUSPENDED OR ABANDONED fOR A PERIOD OF 180 DAYS AT ANYTIME AFtER THE W!gRl�IS COMMENCED.
OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.The owner or agent on owner's leiiletf.represents that the
p*kIed Is accurate and gm�employees of Mason County access to the above describedproperty and structiirssfor'rsvlaw and Inspection
e0i"Owner/tlulder adchbwledges submission of inacanate information may result in a stop Work order or permit revocatlon.Adcnowledgrnent
of such is by signature below.
OWNER AFFIDAVIT-I certify.#w I am exempt from this requirements of CONTRACTOWSAFFIDAVIT-I owft that I tam currently regWered as a
the<' or Registration tAW RCW 1827 and am aware of.the ordi- COn o1 in the State of Wasf►indtorl and that I am aware:of the ordinance
nance required for which this permit Is Issued and that an work will be requiremet►ts rsgtng trte vrorii for whk:h this`permK fssu6d and all
dpte in ogrriorrr+ance therewith.No changes stall be made Without first work shah be done in Dios therewsh.No changes shah be made
obtaining aval. without fkBt.obtalhing approval.
f �= dy,•+w, Dane
X` Date
FOR OFFICIAL USE'BEVOND THIS POINT
r Date / Slobinittal Amount Due. R No.
_ Al
EI Via``'`
TA)e Co
Xt
i
Planning Department. GF-&*0
Environme tat Health Department
Sd
Ire ar hW
Permit Fee
Site inspection
Plan Review Fee f EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Fee
Violation Fes `PrH%Paid at bubmittal ( )
TOTAL FEES
-- -
Mason County Permit Assistance Center
Planning Intake Checklist
Owners Name: Date:
Project: Reviewed By
Commercial Development. NO Comments:
Planner: SAL GBM D YRD
Site Plan:
o North Arrow *A;F Ai I&.-,
o Property Dimensions: X
❑ Streets and Driveways Shown.Road name: '
o All Existing Structures shown with setbacks
❑ Well Location, Septic and Drain-field Shown with setbacks
❑ Identify all surface water(streams,ponds, shoreline,wetlands, etc.)
o Topography(slopes)
❑ Proposed Structure Setbacks(Direction/Setback):
F: / R: I S 1: / S2: /
o Utility and Drainage Easements: Yes No (if yes enter condition#5022)
❑ Other Easements
o Accessory Appurtenances o 6 YR TIP
❑ Would you like to be present for site inspection? YES/ NO
Shoreline and Planning Info
Setbacks: Shoreline: Slope:
Shoreline Designation: Comprehensive Plan: Rural Zoning:
0 Not Applicable ❑ Agricultural ❑ RR 2.5 5 10 20
0 Urban ❑ In-holding 0 RMF
0 Rural ❑ LTCFL 0 RC 1 2 3
0 Conservancy .0 Rural 0 RI
0 Natural ❑ RAC ❑ RNR
0 Unknown 0 RCC-Hamlet ❑ RT
0 Urban Growth Area ❑ MPR
❑ Unknown 0 Unknown
Water Body(type of water if unnamed):
SEPA: Yes No Unknown
Flood Plain: YES NO Unknown Map#
Aquifer Recharge: YES NO Unknown Map#
Tags/Cases:
RLC/SPI Case: 6-Year Dev. Moratorium: YES NO
Eagle Nest Tag: YES NO Other YES NO
Addressing: Check box if needed Reviewed by:
q County Access Permit Needed(add condition#0010)
❑ State Access Permit Needed(add condition#0020)
Standard Conditions to be added to all Building permits that planning reviews:#5019 and#0700
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Phn: (360)275-6050 * Fax: (360)275- UK * www st mtch-island-com
General Contrsotor
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DATE: A A 3
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P.O. BOX 488 •BELFAIR,WASHINGTON 98528•(360)275-6734•FAX(360)275-6775
08/25/2003 07:11 FAX 360 427 7798 MASON CO PERMIT CTR Q 001
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FROM: Michael CAvhs
MASON COUNTY PBABOT ASSISTAN(W C&V=
P.O. Box 186, Shelton, WA 98584
Phone: (360) 427-9670 E Cr. 595
Fax: (360)427 7798
B Mail: lVRcbelgQco.mason.wa.us
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S7EPHEN JOHNSON, INC. f r��
General Contractor 6
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P.O. Box 488
BELFAIR, WA98528 LETTER
Phone (360) 275-6734 r 1
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09/09/2003 12:17 360-275-6184 STRETCH ISLAND FRUIT PAGE 01
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