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Home My WebLink AboutBLD2004-00579 Final Storage Bldg - BLD Permit / Conditions - 4/23/2004 MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar e 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 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Mailing Addre '� Mailing Address City ' St te,i Zip Code City State Zip Code Phone ry ` "` ' Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address Z r, ' E Mail Address Drivers Lic.# .. fVXeIDOB f ' 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 Site Address (Please include street name, street number and city) Directions to site 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 > 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action Me o TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE EASONAL ❑ Use of Building„1r& `f ' Describe Work y 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. ONNER/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 permis- sion from all the necessary partie ,f permission is required from any easement holder or any other party in interest regarding this applica- tion e work propos�+n t lica' I have obtained permission from them to pply for this permit and conduct the work proposed. /17 X ' Date:4 -) wner/own-e,& a ntative 7 Contractor (indicate which one) FOR OFFICIAL USE BEYOyQTHIS POINT a ' W Accepted by r Planning Pd ."� Gk# "� ?_� . Date 'f . ]I`' ` e Bld Pd Receipt Nq DEPARTMEuTAL REVIEW APPROVED DENIED NOTES Building Department f Planning Department Environmental Health Department v Public Works Department Fire Marshal b FEESRECEIVED Building Permit Fee Site Inspection Plan Review Fee EH Review Fee 4 Plumbing & Base Fee PlanningReview Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES LL' MASON COUNTY PERMIT NO. 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 APPLIC NT INFORMAT ON CONTRACTOR INFORMATION Owner Company Name Mailing Addr Mailing Address City t to Zip Code City State Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. Email 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 Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) p Directions to site 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 1 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action e o TYPE OF JOB - New AddX Alt Repair the R MARY RESIDENCE ( SONAL Use of BuildingsT04"� Describe Work V�� L ❑ No.of Bedrooms No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. (441 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 permis- [tijon ion fro all the necessary partie f permission is required from any easement holder or any other party in interest regarding this applica- work propo t lica' I have obtained permission from them to pply for his permit and conduct the work proposed. Date: caner/Owne e ntative TContractor (indicate which one) FOR OFFI E BEYO TU INT Accepted by: lanning Pd�""Ck# DateU Bld Pd �419leceiptNaV—/" DEPARTME LREVIEW APPROVED DENIED NOTES Building Department E 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 OtherCEDAR 5L Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. � '"' j BUILDING PERMIT APPLICATION t 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 APPLICANT INFjQRMATJON CONTRACTOR INFORMATION Owner N Company Name Mailing Addr Mailing Address City QVILIP6,&je Zip Code *ii� City State Zip Code Phone Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg.# Exp. E mail address , E Mail Address Drivers Lic.# !J 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. "' i Fire District Legal Description -' Site Address (Please include street name, street number and city) , Directions to site 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 1 15% Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action(Yes#10 TYPE OF JOB - New AddX Alt Repair ther f RMARY RESIDENCE SONAL ❑ Use of Buildinn.I'f' AAA Describe Work s f 01,11 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. j OVVNER/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 permis- sion fro all the necessary pa ie f permission is required from any easement holder or any other party in interest regarding this applica- tion work prop t lic I have obtained permission from them to pply for his permit and conduct the work proposed. 1 x Date: wner/Ownef Repregtrntative/Contractor (indicate which one) FOR OFFI 1A E BEYO INT Accepted by:4;�)Planning Pd.A66 - N# Date Bld Pd Receipt N W -� 1 DEPARTMEFAAL REVIEW APPROVED DEFIED NOTES Building Department (,.' t+. Planning Department -ISC 4).29,0-4 Environmental Health Department Public Works Department Fire Marshal { "? 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Date By Date By FINAL ECTIQ Water Line Date Date By Date By v 0 m o f co v CD r o r 8 d r a ca ,p �] 0 y o d 0