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Box 186, Shelton, WA 98584 Shelton (360)427-961t*8elfair(360)275-4467• Elma(360)482-5269 On the web www.co.mason.wa.us APPLIC INFORMATION CONTRACTOR INFORMATION Owner LLL Company Name ` Mailing Address Maili Ad ss o �o x �.� City State _Zip Code °t S City S;1 o e rdal-e State�i_Zip Code gifi 3 Other Ph. Phone, O - _Other Ph. Phone Contractor Reg.# I S as UeN Title Holder E Mail Address C`-,o -I+�► Email address 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 PARCELINFORMATION-12 Digit Parcel No. y�y Fire District Legal Description Site Address(Please incl de str t name,street number and city) Directions to site 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 9 15% Is the lt submittal the result of a Stop Work Notice,Correction Notice or culler enforcement action?YesMo I TYPE OF JOB-New Add Alt Repair Other PRIMARY RES E s S SONAL ❑ j Use of Building Describe Work 1 No.of Bedrooms No.of Bathrooms Square Foots -1 st Floor 2nd 0ioor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Ga a Attached Detached Carport Attached Detached la 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. 0V*4ER/BULDER Acknowledges subMISSM Of Kraocurats irdwraton rnay result in a stop work order or pernyt revocation.A ftwWledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I ftrbier deuce that 1 am entitled ib receive this permit and io do the work as proposed in the application..I declare that I have obtained the penirission from ar the necessary parries,b perrr1ission is required from any easement holder or any other party in interest regarding this application or the work proposed in the applicallon,I have obtained pem�ssion from them to apply for this perMt and conduct the work proposed. The owner or agent on owners behalf,represents that the informbon provided is acaxate and grants employees of Mason Courty access to the above described property and sUi rcarre for wAew and inspection. CON11N1*TION1.1 IS BY MEANS OF A PROGRESS INSPECTIONLl XM Date owner/Owners rx mis which one FOR OFFICIAL USE BEY D THIS POINT Accepted Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEE Buildina Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base fee Omer Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal i Valuation$ TOTAL FEES MASON COUNTY PERMIT NO.r nl'✓��+/ " C.C��� 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 On the web www.co.mason.wa.us CONTRACTOR INFORMATION APPLICANTINFORMATION _ t Owner - Company Name Will n Add Ws? Mailing Address C? h�J K Cny State�. Zip Code q Sa City S;1 e rc(a) State Zip Code 9f33 Phone Other Ph. Phone.+110_14 Other Ph. Lien/Title Holder Contractor R # SO as i E mail address Cs,.1 t'YtG;t!°Li' '"'���C�f�I E Mail Address P 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 IQ AA 75TOS oc3,4 O Fire District Legal Description Site Address(Please incljjde stcpet name,street number and city) Directions to site c: 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 > 151% Is this pennit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?YeWft TYPE OF JOB-New Add Alt Repair Other PRIMARY RES E ¢ S SONAL ❑ Use of Building Describe Work No.of Bedrooms No.of Bathrooms Square Foota -1st Floor grid oor 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. CV&4ER/ELDER Admawledges subrrrission d kwauate information may-result in a stop work order or pern t mvoc0on.Aclax wledgernent of such is by suture below.I declare that 1 am the owner,owners legal repro,or the contractor.I further declare that I am entitled to receive this PWt and to do the work as proposed in the application.I declare to I have obtained the permission from all the necessary parties.If Pwnlssion is required from any easer nerd holder or any other party in interest regarding the application or the work proposed in the application,I have obtained perrrrssion from them to ap*for this permt and conduct the work proposed. The owner or agent on owners beef,tepmsenis that the inlorrrwtion provided is accurate and grants employees of Mason County access to the above desabed property and structure for review and irepechon. PROOF COWi1NUATION RK IS BY MEANS OF A PROGRESS INSPECTION. X Date; �/�/� Owner I Owners traomr indicate which one FOR OFFICIAL USE BEY6AD THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department �0'71,1 Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Piannin Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT NO.�/�I'►'1 BUILDING PERMIT APPLICATION 426 W. Cedar-P.O. Box 186, Shelton, WA 98584 Shelton (360)427-9670-Beffair(360)275-4467- Elma(360)482-5269 On the web www.co.mason.wa.us APPLIC INFORMATION CONTRACTOR INFORMATION Owner Company Nameri in- Mailin Ad?ass Mailing Address (? a�� x Q Q P City State w `fit Zip Code °� S City- ;{ )e idol•e State W A Zip Code 3�nFi� Phone Other Ph. Phone.( Q- - �.SZ Other Ph.— Contractor Reg.# 4 AISb s a I LieNTitle Holder E Mail Address Cs F . c;ee�a E mail address �-��.� � � �auc�r 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,_s, 3 3 a sD9 v©y O Fire District Legal Description Site Address(Please incl de stmet n e,street number and city. b Directions to site Will timber be cut and sold in parcel preparation?Yes No Is property within 2W of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs ) 15�0 Is this subittal m the result of a Stop Work Notice,Correction Notice or other ?YssMo TYPE OF JOB-New Add Alt Repair Other PRIMARY RES E s S SONAL ❑ Use of Building Describe Work No.of Bedrooms No.of Bathrooms Square Foots -1 st Floor 2nrl Aoor 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$ F Replacement Unit? Yes/No Installer Name Certification No. OVOER/BUILDER Aclunowledges submwm of irra =;Eds ir*xrration may result in a stop work order or permit WX81li0n.Advnowledgement of such is by signature below.I declare that I am the owner,owners legal roue,or the contractor.I itrtl�er declare that I am ertfitled b receive this permit and ID do tine work as proposed in the applicatio I declare#01 have obtained the perrrlsslorn from all the necessary Parkes ff penrlssion is required from arty easement holder or arty other party in interest regarding tills application or the work proposed in thethe inForrrnation perrrnsaior►from Msm to apply for this permit and conduct ttne work pro Th posed. e oven w or agent on owners behalf,represeris provided is accurate and grants employees of Mason County access to the move described property and oucture for review and inspection. PROOF CONTINUATION OfjVORK IS BY MEANS OF A PROGRESS INSPECTIOIL /) 9 ' XLlDated—. Owner/owners tractor rite which one FOR OFFICIAL USE BEY64D THIS POINT Accepted b : Date DEPARTMENTAL REVIEW APP D DENIED NOTES Building Department 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 Planning Review Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee �� Violation Fee / D C Pre-Paid at Submittal 1 valuation$ TOTAL FEES Look Up a Contractor,Electrician,Plumber or Elevator Professional License Detail Page 1 of 2 Information in Spanish I Topic Index I Contact Info Home Safety Claims&Insurance Workplace Rights Trades&Licensing • ................................................................... .................. ...................................: Find a Law(RCW)or Rule(IVAC) Get a form or publication l Return to List > Start a New Search > Printer friendly i General/Specialty Contractor A business registered as a construction contractor with L&I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. i y Business and Licensing Information E 5 Verify Workers' Comp Premium Status Check for Dept. of Revenue Account Name HANSON SIGN CO UBI No. > 600251243 INC Phone No. (360) 613-9550 Status ACTIVE 4 Address PO BOX 928 License No. HANSOI*221 J 1 p License Type �> CONTRACTOR CONSTRUCTION Suite/A t. City SILVERDALE Effective Date 4/21/1978 State WA Expiration Date 5/8/2010 Zip 98383 Suspend Date County KITSAP Previous License Business Type Corporation Next License Parent Associated Company License Specialty 1 Av GENERAL Specialty 2 UNUSED Business Owner Information 4% Hide All Name Role Effective Date Expiration Date HANSON RANDOLPH J PRESIDENT 04/21/1978 HANSON, CINDY VICE PRESIDENT 03/14/2007 WALKER KRISTA L AGENT 04/21/1978 03/14/2007 HANSON, HAROLD PRESIDENT 04/21/1978 03/14/2007 https://fortress.wa.gov/lni/bbip/Detaii.aspx?License=HANSOI*221JI 3/10/2009 PLANNING MASON COUNTY 96" 62" 16" 14" 12"V.0. 21"VA. 21"V.0. 20 y -- d ------- -- --� 2E- - -- $ 43/4" fn D O r P 21/2" 51/2" -i (� < CA n m p o o = o 'v Z c O m z -I m z G� w x a ma m mz cn m C "u Vv n O z cA (i) W'v r� x N a z m a m zi -C •� � T_ -< cN m a � a m ao p T O > v 1 r - O Z 1 I p f�Tt a 2 n s►. 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