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HomeMy WebLinkAboutBLD2005-00170 Final SFR - BLD Permit / Conditions - 3/10/2005 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT N0.JV'6)5_ 00170 PLEASE PRESS HARD BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton,WA 98584 :f h om �2 p Shelton (360) 427-9670 • Belfair (360) 275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATI CONTRACTOR INFORMATION i Owner Q0 4,61 Jh Company Name S Mailing A ress_/�u 41 /O Mailing Address / City —State L-A. Zip Code M77 Citj7W- _6MA State 64AS I Zip Code Phone Other Ph. Phone 2s3-5737-2 33 Z- O her Ph. Lien/Title Holder Contractor R ( • xp. E mail address E Mail Addr 5� Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFOR ATIC?N - 12 Digit Parcel No. 04 2-3 Fire District Legal Description f �^ Site Address (Please include street name, street number and city) 59 Directions to site daw­- IV. Sko►c- ',ram +0 *4& ors rt. Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake 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 actionti2t TYPE OF JOB - New Add Alt Repair Other I RESIQENCE ONAL ❑ Use of Bu T WY ilding Describe Work —►'f:' a( No.of Bedrooms No.of Bathrooms Square Footage- 1st Floor 2nd Floor 3rd Floor Basement Deck Covered CYeck Other 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 permission from all the ne =ion is required from any easement holder or any other party in interest regarding this application or the work proposed in the I ined 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 a PROOF OF CONTI UATION OF WOR BY MEANS OF A PROGRESS INSPECTION. � � X Date: /3, 4S'-- 4ELFAIR. OFFICE Owner/Owners Re sentative/Contractor indicat hich one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Departmen Public Works 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 •S Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO.C�0(257 OU I BUILDING PERMIT APPLICATION 426 W.Cedar• RG. Box 186, Shelton;WA 98584 ��U Shelton (360) 427-9670 • Belfair (360) 275-4467• Elma (360) 482-526 `1 On the web www.co.mason.wa.us APPLICANT INFORMATI CONTRACTOR INFORMATION Owner � Comphny Name 1� Mailing A ress Z /00 Mailing Address / '`'� S City State Le". Zip Code City�T/9ca�rr�g State Zip Code Phone Other Ph. Phone 25"3- 537-2 33 Z O her Ph. Lien/Title Holder Contractor R,fig. xp. E mail address E Mail AddrN Six -• Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATI?N- 12 Digit Parcel No. Fire District Legal Description b L Site Address (Please include street name, street number and city) 5"9 e' Directions to site da-In rV. Skorc- RA +o +►c�� ors t- Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 1 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action Y o TYPE OF JOB - New Add Alt Repair Other P =�— RESIDENCE r ONAL ❑ Use of Building Describe Work No.of Bedrooms No.of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other 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 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 appa permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,repr a lion provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. PROOF OF CONT UATION OF WORKp BY MEANS OF A PROGRESS INSPECTION. FEB 0 3 2005 X wt . Date--a94A-Jr777 w OFF Owner/Owners Re sentative/Contractor indicat hich one)_ ELFAI(2 FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department C Planning Department " Environmental Health Department Public Works Department Fire Marshal FEES 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 Lt.6 Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO.C�V3(.I� "OQ f 7 o E BUILDING PERMIT APPLICATION �"' 426 W.Cedar• P.O. Bdx 186, Shelton;WA 98584 I ') Shelton (360) 427-9670• Belfair (360) 275-4467• Elma (360) 482-52611 On the web www.co.mason.wa.us APPLICANT INFORMATIQN CONTRA TOR INF RMATION Owner >l Company Name heM,2 Mailing A ress /O Mailing Address / " �' City —State L R• Zip Code City-714e6A„a State Zip Code Phone Other Ph. Phone ZT 3 - 537-Z 33 Z O her Ph. Lien/Title Holder Contractor R AD. 'LV E mail address E Mail Add r L6W w COYt Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION- 12 Digit Parcel No. - Fire District Legal Description n Site Address (Please include street name, street number and city) Directions to site dav-­� ► - S4 o," +4 +0 "0kA ° Or" Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake 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 action Ye o TYPE OF JOB - New Add Alt Repair Other MM RESIDENCE ONALUse of Bu P ilding Describe Work Ke KLi fi= No.of Bedrooms No.of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other 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 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 ti I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,re� ation provided is accurate and grants employees of Mason County access to the above described property and structure for review an in p PROOF OF CONTI UATION OF WORK BY MEANS OF A PROGRESS INSPECTION. / CEOVLD Q 3 2005 X - wt ey Date Z As- Owner/Owners Re sentative/Contractor indicate hich one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department 1 -- -7 Planning Department Environmental Health Department Public Works Department Fire Marshal FEES 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 J• Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO..a � j,� % BUILDING PERMIT APPLICATION 426 W.Cedar• P.O. B$x 186, Shelton;WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467• Elma (360) 482-5269 ` On the web www.co.mason.wa.us APPLICA T INFORMATION CONTRACTOR IN"RMATION Owner {t '1+#r 44 Company Name /h =. ,..a f� ?fi✓ •4 +9 , ( - > Mailing Address �t ' ,do" Mailing Address jGe/,/- State 1 ^ _Zip Code 1 7 City-7'r�c c r*, State i Zip Code 7 Phone Other Ph. Phone -�Y ' S 37-2 3.1 Z Other Ph. Lien/Title Holder Contractor Re # 1 E mail address E Mail Addrefs � Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION- 12 Digit Parcel No. 3 '%- Fire District Legal Description i Site Address (Please include street name, street number and city) '- .,y' ' Directions to site i­ r}• `,`..,' z_ J J .1 Will timber be cut and sold in parcel preparation?Yes/No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement actioniVes0o TYPE OF JOB - New Add Alt Repair Other Pal ARY RESIDENCEUse of Building Describe WorkiWEAtONAL I No.of Bedrooms No.of Bathrooms Square Footage- 1st Floor 2nd Floor { 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage-- Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase Price$ 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 permission from all the necessa rmission is required from any easement holder or any other party in interest regarding this application or the work proposed in the appl' , �6�i r� permission from them to I for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that a iroTRration rovided is accurate and grants employees of Mason County access to the above described property and structure for review in � ,�pe,ti n. PROOF OF CO UATION OF WORK BY MEANS OF A PROGRESS INSPECTION. i1'Cp X '. Date BELFAIIt OFFIC . Owner/Owners Re sentative/Contractor indicate' hich one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal ` FEES Building Permit Fee f... t C Site Inspection ' s Plan Review Fee EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee t `J Violation Fee �� �'= Pre-Paid at Submittal �"� Valuation$ TOTAL FEES Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 3 Topic Index I Contact InfoLabor and Industries - Se�rch _ , wom sdety Claims&k urance9 Warkplace RlgiM@ Trades Licensing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber General/Specialty Contractor I 1A business registered as a construction contractor with Lltl to perform construction work within the scope Hof its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. License Information License THOMPRG070DZ Licensee Name THOMPSON ROOF Et GUTTERS INC Licensee Type CONSTRUCTION CONTRACTOR UBI 601228416 Verify Contractor Premium Status Ind. Ins. Account 40201201 Id I Business Type CORPORATION Address 1 417 E 99TH ST Address 2 City TACOMA County PIERCE State WA Zip 98445 Phone 2535372332 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 3/9/1993 Expiration Date 12/2/2006 Suspend Date Separation Date a Parent Company Previous License WESTCGC101CH Next License Associated License Business Owner Information https://fortress.wa.gov/lnilbbip/detail.aspx?License=THOMPRGO70DZ 2/3/2005 t � V C + + - ^mLk c qt th l fV q r - a �{ C .Voy �� ` � --� f JV NA ✓' t�I �X { � �5 y, �,�� .�+��'tl�C�.r�a .•4 IC�.�d4i"t�4S.• v r c ,a yt �`` `7 3 * fin SO .S� / m � CD a 0 ;o O o m 3 0 m r cn = n< CD i o c� O -4 m C) � o 0m Dv D CD c c = -r9 cnn vn ={ 0 1p 3 c'p o � mmMZ Q a X (n i 0 -4 0ZD -I m c T 5 r' O Xco > 3 o m z CD o > CD z X � X � o y -n o' n 0 �' v = =ONco = v v D X 0K) � 0T ° Z •-' -n 3 c " Ul Dto � ILJ Z 00 °D z zoz0 � C Dn, Oz cp Z rw m � = p �Z � C - - - T Wzo . > oz � m 0. 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Date By Date By FINAL INSPECTION Water Line Date -/©- — By 7—X2 , D ate By Date By a a 0 -� bd r y d � o 8 O � a 7d 0 O v t I i S f 1 -1 0 I` I i