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HomeMy WebLinkAboutBLD2001-00588 Fence - BLD Application - 6/1/2001 PERMIT NO.: BLD ¢' MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 82-5269 Seattle 206 464-6968 APPLIC, NT INFORM TION CONTRACTOR INFORMATION Owner C � Contractor Name '•' �J�' �'"" Mailipg A dress Mailing Add ess `t's - !E ,1 City t`' .. � J Stat Zip ode City �...� � State tAJ k. ZI Code Phone(` 1 ) "UZtrGOther Ph.( Ph.( " 011-2Other Ph.( ) Lien/Title Holder - ----- contractor Reg. # M L5 � Address ------- Expiration_" / > / SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System T CEL INFORMATION-12 digit Tax Parcel No. ' ' z 1 . l d 19AidJ1 Fire District al Description > l,T s . •Address(Please include street name, street number and city) E.: d KI:ft,ctions to site v AvJ\; Vtl 10 to to a, � .F Will timber be cut and sold in parcel preparation? (Yes/No) AJ k ! Is your property within 200' of the following: Body of Water(Name) oL ?a-� ►fit Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE CX TYPE OF JOB New Add Alt Repair Other Use of Building . f Describe Work" i " No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 13rd 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 ANY TIME AFTER THE WORK 1S COMMENCED. .vim 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 a 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 conformance therewith. No changes hall be made without first obtaining shall be done in 'ontprman(e therewith. No changes shall be made without approval. f' first oFhaming atprovol. , , G --X Date t3 . )" Date FOR OFFICIAL USE BEYOND THIS P INT f Accepted by Dat ubmittal Amount Due r', Receipt No 1( _. . ..... Building Departme Occ Grou We Constr. Planning Department L i Environmental Health Department i Public Works Department E Fire Marshal I Valuation $ 1 Building Permit Fee Site Inspection i I Plan Review Fee EH Review Fee k Plumbing&Base Fee Planning Review Fee I Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee l Violation Fee Pre-Paid at Submittal ( ) i z .. : .;,. .�........ TOTAL FEES PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORM TION CONTRACTOR INFOR TION Owner R J L Contractor Name Maili g A dress�l Mailin Add ess sr-_ '% City V State A, Zip Code 01 g p City State Zip Code Phone Z-O -0Z000ther Ph.( Ph.( M Other Ph.(� Lien/Title Holder Contractor Reg. # 0 K 0 Address Expiration_ _/ / Z SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Wate System Name of Water System PARCEL INFORMATION-12�Wit Tax Parcel ,No. ZZZZ/It / 156 gel og Fire District Legal Description V-- Site Address(Please include street name, street qumoer and city) t7t FTDs'o Pt12 Directions to site 0 O A.Rlt15 U I^ .�� Will timber be cut and sold in parcel preparation? (Yes/No) � Is your property within 200' of the following: Body of Water (Name) 4,,-oot ✓4.,1 Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs I PERMANENT RESIDENCE❑ SEASONAL RESIDENCE CX TYPE OF JOB New Add Alt Repair Other Use of Building 'SF Describe Work N k �� No. of,Bedrooms Wo`o fl doors 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 ANY TIME AFTER THE WORK IS COMMENCED. wp. 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 r" 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 conformance therewith. No changes all be made without first obtaining shall bed in on rmanr therewith. No changes shall be made without approval. first o ain prov I. --�' Date v X Dat FOR OF ICIAL USE BEYOND THIS P INT Accepted by Dat Submittal Amount Due Receipt 1�EPARTAl E . �VI�; Ai?PRQVEQ UENtED :; �fJNpITl�I� C+C�<7tM� - Building Departme Occ Groupe Constr. EnJF Planning Department f Environmental Health Department Public Works Department Fire Marshal I &0 LFX 575- Valuation $ i Building Permit Fee �L3,5-0 Site Inspection Plan Review Fee S, a 8' EH Review Fee Plumbing&Base Fee Planning Review Fee i Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( /Jr ;2 8, ) TOTAL FEES } PERMIT NO.: BLD MASON COUNTY . ._N -� BUILDIN ; PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Bej ietr 360 275,4467 Elma 360 482-5269 Seattle 206 464-6968 APPL1q#NT INFOWATION CONTRACTOR OR,MATION Owner Wt3, bSJt�-� Contractor NameIN �h}}-- w Mail' g A dress �, `t' 4 - Mailin Ad ess O 6'� S City 4 Stat Zip Code 00 City � State Zi Code g l Phone(V(o )'�`f1-D7.a0 Other Ph.( ) Ph.( 36a ) ' \ Other Ph. Lien/Title Holder Contractor Re # SC c7 Address Expiration 9 / 3 o L SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATI N-12 di I Ta Parcel No ZZZ _ "o / Fire District Legal Desc6ption_- S`c � / C4 4, , )� Site Address(Please include street name street number and city) Directions to site 001, -\-0 W L3 \O Ae_ >n 5 F1 tO-r. ice°, Will timber be cut and sold in par el preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) `�00-0 C_A�,A_, Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENC 1TYPE OF JOB New Ad AltR air they Use f Build no Describe Work "� No. of Bedrooms No. of Bathrooms SQUA E 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) i 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 a6d grants employees of Mason County access to the Iabove described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-1 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 gu the w rk for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done nfor n t erewith. No changes shall be made without approval. first inin p prova. X Date -D XX Dateb (.o t FOR OFFICIAL USE BEYOND THIS POINT gr Accepted by Date Submittal Amount Cue Receipt No. ©I l 1EPARTME: :. 111 APPROVED I2EN1j~D; 13NDITtN Cid Building DepVMen __ 7 Occ Grou k'.W yType Co str. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ Building Permit Fee Site Inspection I Plan Review Fee 407,7p EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other i Wood/Gas/Pellet Stove Fee State Fee Violation Fee -- Pre-Paid at Submittal ( ) TOTAL FEES 3 �1-OO�oS S PERMIT NO.: BLD MASON COUNTY r BUILDIN PERMIT APPLICATION o� 426 4edar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 B it 60 275-tt467 Elma 360 482-5269 Seattle 206 464-6968 APPLIQANT INFORMATION CONTRACTOR IN. OR AIIT St Owner E ' Contractor Name !! CC�� Mailj�ng A dress % E - 'r, 4. Mailin Ad ess City ` �v Stat Zip Code City h! State Zi Code 1 b Phone(V� )�tpb Other Ph.( Ph.( 36C ) Other Ph. Lien/Title Holder Contractor Re # 1 t — Address Expiration/ / C , 7d/ SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 d_iatI Ta Parcel N � L / (7 Fire Distric Legal Description 4" 1 I O !SO4 tn141 Site Address(Please include street name street nu beer and city) r/ Directions to site ? Al`� l 1 fist r Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) I�00 3 k1 Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs I PERMANENT RESIDENCE❑ SEASONAL RESIDENC TYPE OF JOB New A AIt�YR air they Use f Build I Des-6ribe Work Q. ^� t No. of Bedrooms No. of Bathrooms SQUA E FOOTAGE-1st Floor 2nd Floor 13rd 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 F 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 ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. Ae owner or agent on owner's behalf,represents that the ' inform;ation provided is accurate and grants employees of Mason County access to the above described property and structures for review and t 1++ inspection of this project. Acknowledgment of such is by signature below: ,p OAWIr R AFFIDAVIT-1 certify that I am'exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a F" Contractor Registration Law RCW 18.27 and am aware of the ordinance A,` 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 , g i the rk for which this permit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in onfor ric therewith. No changes shall be made without ;y t approval. F first in a prova. X .:a! --.._ Date k.'ro'i Date CJ ' FOR OFFICIAL USE BEYOND THIS POINT Accepted by DatezAtbj Submittal Amount Due Receipt No. ...................._......... ......_..................................._ _.........................-..._....... .. ........._......._............................................................. .. - t?EN1E Ct [�1D1. ON CODES _.. _ Building Departmen '7 ,,� Occ GroupT e Co str. Planning Department AL71 Environmental Health Department "T (r`7 Public Works Department Fire Marshal Valuation $ FEB Building Permit Fee Site Inspection i Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee I Mechanical&Base Fee Other I Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES r f r � i a•#'r t t r � 011� E x�J�`�•/l g .l 1/ l� 771 BUILDING Z_�gor CHANGES SUBMIT CHAN^E3 FOR APPROVAL PRIOR TO PER!JR".gI VG WORK PLANS MUST BE .*X' uN THE JOB SITE FOR INSPECTION. 4*0 s ,�_ •;;fir' ,` e.- k- l POLAer 0 \/,E P E-x ' nq SiA`es f `' x �A,NNING or AV f - '� -•,__• Y * .r-� F / f •° 'k.,it �r+its,;�a,r,.,;,, . i Y:= J `+i•;;yes'` �'� ---- e _ j 4� .t f BUMDING ! v CHANGE c UIRMIT GHAWN E FOR ,APPROVAL pip I-�, p R"^,�,� d, 'GRK f r 1, ,� �� ., t•w{ }� J�1�r, y r .FL q �! /� p� f y;fli l: ,eR Are r� ct f�. ter 1�L ANS MUST BE TF iE JOB SITE ;YfJlir�r+ .Q s-CAR INSPECTION. rr� Ir i ! i r d FORM MUST BE COMPLETED IN INK I PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name PARCEL NUMBERZZ// 50 9491/ Date zZev: 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 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 line- i \\ ) 1 I E-adjacent property line -- > I I I I I I — I I , cam' � I adjacent property line4 I C� ;�, T ' E-adjacent propelline SAMPLE SITE PLAN adjacent property lined 3io' _ _ E-adjacent property line D 30' rRZ-s RvE SEA-So%J AL_ I C � _�L'BTSG___,�3�1 I• fi HOM b ' �, IiC.,aQ I ) PRO Pos6D 1 , I r— 60' pit I R I VAGnNT I 7 C.Artn&,S \ I PM1oPosCD � A&RZCLLLT�flAL SO — I 1 I i eo' I \ I c- -e-LL I I /D� --� I I IMIA, adjacent property lined �ad'acent ro ert line TOPOGRAPHY PROFILE(Show a side view of property. 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