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HomeMy WebLinkAboutBLD2001-01326 Floating Dock - BLD Permit / Conditions - 12/31/2001 PERMIT NO.: BLD �+�/���✓�� MASON COUNTY BUILDING PERMIT APPLICATION '426 W.Ced_4r/P.O.Box 186,Shelton,WA 98684 Shelf n 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLI ��,TT,���� M ''TI�Q CONTRACTOR INFORMATION Owner I.Flft %LME A. L WM Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone ' 'MOther Ph. Ph.( Other Ph.( Lien/Title Holder shm Contractor Reg. # Address 51%ME Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System R/A Well Water System Name of Water System { I P RCEL INFORMATION- di ' T Pa ! / istr t Legal Description uA ' d"(r-[ Site Address(Please include street name, street number and city i`JFJ! W. Directions to site Sf,o �IIII�E ON lGEiZ./Mk15S101 , B1ACrc MAIL Will timber be cut and sold in parcel preparation? (Yes/No) CC Is your roperty within 200' of the following: Body of Water(Name) VC _Saltwater Lake River/Creeks Pond ,-' Wetland . - Seasonal noff .' Stream .,- Slopes or j Bluffs_ • PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add AIt . Repair Other Use of Building Describe Work No. of Bedrooms No. of Bathroo i�f S SQUARE FOOTAGE-1st Floor 2nd Floor 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 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 ANYTIME 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-I certify that I am exempt,from the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 the work for which this permit is issued and all work i conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining approval. X 121 Date 1 •31-0 1 X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by r `_`% Datek-� Ibmittal Amount Due Receipt No, .:. ............. .. .. I 1JI PARTMEI :::RE�I� �A{. APPROVED DENIED ; ON CODE Building Department ' Occ Group T e..Constr. Planning Department j= 'itsdrottire, j -6 i e :>HGL aoo4-- cck)oZ 00-?p Environmental Health Department aula 00 Lt Public Works Department 0044 I v.>0 I, Fire Marshal eveo yc 3 y Valuation $ E. I 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 F Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES PERMIT NO.: BLD h i MASON COUNTY • ° '�� BUILDING PERMIT APPLICATION 1ZI "51 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-A467 Elma 360 482-5269 Seattle 206 464-6968 APPLI�` qQ MATI CONTRACTOR INFORMATION Owner^� L�. IV L�fUt1.��lL K. CAL NA Contractor Name Mailing Address Mailing Address City PQKT QIKMED StateW& Zip Code City State Zip Code Phone( - 91Other Ph.( ) Ph.( Other Ph.(_ Lien/Title Holder ShME Contractor Reg. # Address 5WE Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System R/h Well Water System Name of Water System � - PARCEL INFORMATION-1 di T Pa e o. / / © Dist ct Legal Description * Site Address(Please include street name, street number and city) Directions to site 8/t0 MILE KNI11 OIL TIGUZ/AMMIDt\L LRIN. LEFT 8 l E BLANK MAILSOL MIN ED INUMBEOSOW 1 Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) 4,GEQzLA14.E Saltwater Lake_ River/Creeks Pond_ Wetland „- Seasonal noff_ Stream -.- Slopes or Bluffs ,/ PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Other Use of Building Describe Work _, r �r ��" L No. of Bedrooms No. of Bathro' G4ns SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached i 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 PERMIT BECOMES-NULL 8,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-I certify that I am exernAfrom the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 the work for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval.n �1 first obtaining approval. Date/.c•31^a j X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by �' Date ubmittal Amount Due Receipt Not b :DEP; RTI,l1E lTAI.-RE1/!�V1f AE?PRf?11 p D NIi»p CONDITIO O+i?aES: << . Building Department dJ®3 Occ Group Type Constr. < L Planning Department For-- Re-SolvtJ- n Environmental Health Department Public Works Department Fire Marshal i i i Valuation $ fS 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 F i Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION pll''��� Case No. Named CH fiW Elf T-bb YL PARCEL NUMBER IEJJS S1 M9,00 Date 1.2-31-0 t SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography t,J Well Location (including adjacent) Drainage Plan Names of Streets Easements 11 Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property iine4 6 0 i I E-adjacent property line AMU /5'—�I �-- I• I I � I �► � � Lake. I ESC15irlkl& BillkNfkD \\4LAPSzE0 BU1jalr fly � /30 ��I 95e52� adjacent property line d* 'acent property line DRIVEW SAMPLE SITE PLAN saCdEjR,a4Es�EoI uGt property o\p]Ie rty line I�II. ^cR� fi1 IFH3O iM6c 0 t' --ISO•.—_.��1II1II , Fadjac,GNeOanuat E3pufri o perty line 3a' r 1;,, ve_ L J-" PriOP �j p VTACAPu I I i I 31 P0.oPo�CD I A&R=1LLT&&RAL 50 I I�--9.O•—� \ yo• I I , I I I I I I L— LL I I � /00 adjacent property line-:� i I E-adjacent propert'line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE distoncs to r"'C1 L4-'e. dcst'a r.« t -< .57o o p0by. _A � L�u4 L St aQa. fie¢ dis+anaa �•- 3l�Pf t o (?- L Signature Date MASON COUNTY PROJECT SITE INFORMATION 1((��pp[[�� rr ��AA �}t Case No. NameRl t tYi'lM ' _WK k1 f B t PARCEL NUMBER feTS -51 illI 7CJtJ Date /2.3/-O l SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography t- Wgll Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line4 , tt , E-adjacent property line 1Pt 10 'X I5'--- -� I -.. 1 I 1 Lakes 1 _171Pf , I adjacent pro ert line ° Ijacent property line E SAMPLE SITE PLAN , i adja ent property line- 3zo' _ f-adjacent property line 1 v so� �>u�avE 3�1 .g6A_SC J AL.. 1• _SE�TSL T�,� J. A fi HOM t , Ciz�K j 1 HOu.sQ jP0.0Post0 smpf.C- f+— bo' —/So- �1 i I 1 4 VACAtuT c*nrtA �I,`r\ PaoPmen I A6RSLLLLTwtiAL SO t I 1 � I 1 1 I I I I L. e-LL I I i /00. 1 i R 1 adjacent property lined ; \; E-ad'acent rop ert'line TOPOGRAPHY PROFILE(Show a side view of property. E how slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) 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