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HomeMy WebLinkAboutCOM2008-00019 Final Handicapped Ramp - COM Permit / Conditions - 2/20/2008 FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. PLEASE PRESS HARD BUILDING PERMIT APPLICATION (' 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 L l U�l� *�helton (360) 427-9670 - Belfair(360) 275-4467 - Elma (360) 482-52 ,4n On the web www.co.mason.wa.us APPLIqANT INFO MATT N CONTRACTOR I FOR ATION /� Owner n LJn Comm, s Company Name ew l Vn. c �-V� ' Mailin Add ss Maili,,,n���Address 13D O'I-eAr l S-t IQ V7 - City e, State Zip C de City t State�$— Zip Code�18502- Phone `P 1-9470 24t S20Other Ph. ► ke �'�n- Phone -86�- 1 8�f- Other Ph. Lien/Title Holder Contractor Reg.# 1g90L5 Exp. (p jj ff wag E mail address E Mail 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 Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 3 2 0- 00 o Fire District Legal Description o m � ers Drh�e (ar L D f O Of S P#2 73 PTN TR 1 5 l oo' Site Address (Please include street name street number and city) 21 orho-nG(t, Wil be-A fk, V" Directions to site H w)f 3 0 jb $ea-FL;y- , /w le_ oo�t 2� . !'� w.��l le-�-f•. Will timber be cut and sold in parcel preparation?Yes/® Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye TYPE OF JOB - New V Add Alt Repair Other .RRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work _ KAn2r p. No. of Bedrooms No. of Bathrooms Square Footage'- 1st Flo 2nd Floor 3rd Floor Basement Deck Covered Deck— Other Q�_Sq. ft. Garage Attached Detached Carport Attac ed Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Widt Serial No. No a rooms No. of ms Type of Heat l5ase Price$ Replacement Unit>WT,NO Installer me 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 application, I have obtained 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 review and inspection.This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEAN/SOFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION.� X �c"r16— Date: Owner w resentative Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department ()O Planning Department Environmental Health 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 Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. 4.',()►>"� , ©� T BUILDING PERMIT APPLICATION i 'ti lx, . ry, 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 f 'Shelton (360) 427-9670 Belfair(360) 275-4467 Elma (360) 482-5269 o' On the web www.co.mason.wa.us T APPLICA 'T INFORMATION CONTRACTOR INFORMATION Owner ,f� '; t.t�ri� . ' fY�i1� - idl`t �.. Company Name l� 'f�a c'f firer c.. Mailing Add ss14 11 V.)f I Mailing Address City ► State Zip Code % Citya i ----State �'r _ Zip Code Phone f'�`-�'r��7* - Other Ph. }4 ��=.� �u P Phone Y.> � - 1 Other Ph. ' Lien/Title Holder Contractor Reg. #V-Ek�;"�C,C_V G Exp. k- r E mail address E Mail 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 Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. ` 'a 2-- 0- t �" Fire District Legal Description ' yt�y r:i11 fit,>r f Z H :` 7 1*7TK -rR I Site Address (Please include street name, street number and city) t.�.Directions to site .� /.-,' �.: afi-:*' Al-F�� ✓ t`ir �.. r. r , t - k-,. ~,4 Will timber be cut and sold in parcel preparation?Yes/0 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-D TYPE OF JOB - New Add Alt Repair Other �RIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work��' No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck �ther CO2, Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Widt Serial No. / No H3fd'rooms No. of k+rcOTfSs Type of Heat ase Price$ Replacement Unit? Y o Installer e / 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 application, I have obtained 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 review and inspection.This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFAPROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X Date: Owner/ w sentative A ontractor (indicate which one) —r FOR OFFICIAL USE BEYOND THIS POINT Accepted byi Date «"« DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department '� > -y Planning Department A& o. Afe Environmental Health Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base Fee Plannin 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. ILDING PERMIT APPLICATION 1R 426 W. Cedar• P.O. Box 186 Shelton WA98584 %rj 9 helton (3601427-9670 • Belfair(360) 275-4467 • Elma (360) 482-526 m On the web www.co.mason.wa.us APPLICANT INFO MATT N r; CONTRACTOR I FOR14ATION Owner " �"�t-u 1 G C11 fYl ` :,t t"" Company Name ylu Yn fu ctl' UN Mailin Addr ss Mailin Address j� G'L160 a�' IJ City? e- _State Zip Code City State Zip Code'T Phone if 7-yb70 L,�t a6 Other Ph._K I K&- u*&r Phoneme -gfCfa- 1+Sq— Other Ph. Lien/Title Holder Contractor Reg #E&S(� ,i?!OLt5 Exp. (01L512,009 E mail address E Mail 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 Welt Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. 32--50- 17COLf O Fire District Legal Description DD'►- ` a-r v L.c,f L) of P P— ?a PTM TK 1 3 Io0' Site Address(Please include street name street number and city) t arnc�rl , ! 'e-I fl. r Directions to site �"e W '�� r M► I' .t U e_ w Will timber be cut and sold in parcel preparation?Yes/9 Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye TYPE OF JOB - New Add Alt Repair Other ARIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building describe Work—H '� No. of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck ther Sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model Year Length Widt Serial No. No rooms—No.,of,,B� 17TfSs ase Type of Heat P Price$ Replacement Unit? o Installerpe< 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 76ceive this permit and to do the work as proposed in the application. I declare that 1 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 application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the informaticn provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null& void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X ')(y)0 Date: ; 2_n cS Owner Qw=sZoresentative Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted byj Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department 1'�C� ' : ` Planning Department Environmental Health 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 Pre-Paid at Submittal / Valuation $ A421 TOTAL FEES FORM MUST BE COMPLETED IN INK MASON COUNTY �IIIT NO. �,c7i�YhSoAN PLEASE PRESS HARD BUILDING PERMIT APPLICATION M 1XQd�3 L�('�� � 426 W. Cedar- P.O. Box 186, Shelton, WA 98584&Af - Z� 6 `%helton (360) 427-9670 - Belfair(360) 275-4467 - Elma (360) 482-526 m On the web www.co.mason.wa.us APPLI N�.RMATIQ N CONTRACTOR I FORN►ATI IN /� Owner n Ltn7- C,ornm� S Company Name_ �✓'C'�n5t'fu-c�rJ Mailin Add ss_ Mailin Address 130 O'LeaY'`l 15-r N Cit State Zi C d _ City State�_ Zip Code g18502-- p Y @ - - 1 $ her Ph. Phone �r0 ���Other Ph. � ke w er Ph one 8W� Other Lien/Title Holder. Contractor Reg. L OL Exp. S 2-oQ E mail address—_— E Mail 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 Sevier System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. lZiM 2- o- 20010 Fire District Legal Description,3 2. 's arhle ar L_o O of P#2 ?3 p?1J TIR I 5 loo' Site Address(Please include street name street number an city) 2-1orno nG� Directions to site_H 3 "b '•�'' �'� ) U e- c.Ja► Will timber be cut and:sold in parcel preparation?Yes//0 Is property within :200' of Saltwater Lake River/Creek Pond Wetland _Seasonal Runoff Stream Slopes or Bluff— s 515% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye TYPE OF JOEI New Add Alt Repair e�dti ,p,RIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building. Describe Worker No. of Bedrooms— No. of Bathrooms Square Footage- 1 st F1 r _2nd Floor 3rd Floor —'3asement Deck Covered Deck Other Sq. ft. Garage ._ Attached Detached Carport Attac ed Detached MANUFACTURED HOME INFORMATION - Make _ Model Year Length Widt �—Serial No.. No a rooms No. of r�SFr's Type of Heat .— P ase Price$ Replacement Unit? o Installer me_� Certification No. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of suci 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 application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, •epresents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.This permittapplication becomes null& void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRES>INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 1 0 DAYS WILL INVALIDATE THE APPLICATION. X 1)U10, Date' o Owner )vy4et' resentative Contractor (indicate which one) �— FOR OFFICIAL. USE BEYOND THIS POINT Accepted by Date• - - DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Depart ent n0 Planning Department Environmental Health Departmen Fire Marshal '—' FEES Building Permit F_ee Site Inspection Plan Review Fee EH Review Fee Plumbing & Base! Fee Plannin Review Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES Mason County Planning Intake Checklist ,Q nn.�x Owners Name: 17 C-ovn E1QL &V)"las Date: a- ;L i - D8 Project: I Reviewed.B Proposed use(s)of stru u p �L,� .j ,�, Commercial Development: YES O PLANNER: GBM TSW PBC RDH REC MS Site Plan: ❑ North Arrow ❑ Survey required in Allyn UGA - o AF# ❑ Monuments ❑ Property Dimensions: X ❑ Streets and Driveways Shown. Road name: ohol.n C.___, Al-A, Qom. - U n" 4 ❑ All Existing Structures shown with setbacks and use ❑ Well Location, Septic and Drain-field Shown with se cks ❑ Identify all surface water(streams, ponds, sho e, wetlands, natur?i ^r 1-16-�- drainage ditches) SLR Q�/� r) ❑ Topography(slopes) ❑ Minimum Structure Setbacks (Di 'on/Setback): F: / R: Si: / S2: — S lift, -�-ti ❑ Utility and Drainage Easem ts: Yes No (if yes enter condition #� A M P ❑ Other Easements ❑ Accessory Appurte ces: Propane / Heatpumpx ❑ Does site plan s w landings at all exits? � n ❑ Variance ap i for: Yes / No - parkingi spaces allotted? Yes / No ❑ County Ass Permit Needed (add condition #0010) ❑ State ccess Permit Needed (add condition #0020) S ndard Conditions to be added to all Building permits that planning re Site Access: Are there any impediments (dogs/gates)that my restrict ac Is the site clearly marked? How? ❑ Address ❑ Name Zonin : ❑ Other: Comte n: Rural Zoning: UGA Zoning: 0 Rural 0 RR 2.5 5 10 20 ❑ RT/RTC ❑ R-1 0 R-5 ❑ HC 0 BI ❑ RAC ❑ RMF ❑ Unknown ❑ R-1P ❑ R-10 ❑ LTA ❑ VC ❑ .l llyn UGA 0 RC 1 2 3 ❑ Agricultural ❑ R-1R 0 PD 0 T Ifair UGA ❑ RI 0 In-holding ❑ R-2 ❑ PF A ❑ MHP ❑ Shelton UGA ❑ RNR ❑ LTCFL 0 R-3 0 POS ❑ GC 0 BP ❑ Tribal ❑ GC-CI Critical Areas: (streams, ponds, shoreline, wetlands, steep slopes) Shoreline Designation: N/A 0 Urban ❑ Rural ❑Conservancy ❑ Natural 0 Unkown Water Body(type of waWif unnamed): Yl SEPA: Yes/ Unknown Flood Plain: YES/N Unkno Map# , Aquifer Recharge: YES/NO Unknow Map# Tags/Cases: RLC/SPI Case: 6-Year Dev. Moratorium: Y Eagle Nest Tag: YE NO Other Y S/NO Revised: 02-07-2008 I:\PLANNING\PAC\PLANNING INTAKE n o N fn W ao N ' T n1O o c mmmo .. = -1v ., m -0 r °' � c CD a m > D tD o c 'a > ?c CD n ;1 W n r m 21 � D 3 aimmz c (n 21 � G) O � K 3 y ; D -n+ .r o n ao O 0mm0m p o CA 5 fl 7 y < C Z c c o D ^' N m to m CD p Cn _ p Z U D .C(D C^ L WvJv O *. 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