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HomeMy WebLinkAboutBLD98-00871 Cancelled Tree House - BLD Application - 8/1/1998 Y111 fty PERMIT NO.: BLD D U >Y 'Al ) . BUILDING ERMrT APPLICATION 8/3/ 426 W.Cedar/P.O:Box 186,Shelton,WA 98584 ` Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 64-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner A P, IF y Contractor Name -S/4M gffl Mailing Address C) 1-1 Mailing Address CityT/g,qu LIA State Zip Code !24S9 e City State Zip Code Phone GFI )372-Z1200 Other Ph.( Ph.0 Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration S PTI ATER SyfTW INFORM -Connect to Septic -6"istiv Septic onnect o mof wer S Na a of Se er Syste Well Wate ysfem Na Wt r Syste PARCEL INFORMATION-12 digit Tax Parcel No.:9 2.20 7 /-15'0 O_Q 93J. Fire District_g Legal Description C4.YMPS C 6,oAcd TA /3—A 2- MR)( /ZOO /V—/ ]-P�' � o'FSp/ �6 Site Address(Please include street name, street number and city) OR Q 6 0 Directions site ( S a u I 911cf M 6 a I-jz f ' I Will timb be cut and sold in parcel preparation. (Yes/No)NO Is your property within 200' of the following: Body of Water(Name) WC00 0 *9 NA L. Saltwater_ Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building ;EA g g //Cc, E ` Describe Work —7r A. /-Z .t No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor�y• 2nd Floor r 3rd Floor Loft Basement --- Desk� O Garage '— Carport Other sq. ft. �.�--".� p 7 Er us E FAO 4 f MOB LE HO FORMATION-Make Model Mo Lengt W th Seri o. No. o edrooms No. o athrooms Type f at P chase Price $ lac nt Unit ?(Yes/N Install 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. 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 inspection of this project. Acknowledgment of such is by signature below: t: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 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 E 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 shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without t approval. 7/1 a first obtaining approval. ¢ X ' / ate X Date C ` FOR OFFICIAL USE BEYOND THIS POINT i Accepted by-, _ Date Submittal Amount Due D..5 Receipt N . ,. :...:......:............:...:...:> >.:...:.:.......:... .::.;::.:;>;:.;::.::....1.t.:�..i....p.......�..�.C...t..�.. ............ i. r:?a:i:T'flf Ixfh 7F:iwi:F:`:;::: _ '...:<::::;::r};;`}:::....':::;::i::y:i:::ji::i:;:.,[y,, } .:{ .��•"...y`"'�'�. yy�{�'<2::::::«::i<:::r::: ..: i ... ..M'+Rl R ., :!Rl 1..1T: o �TT..................... I PENTAi»::1 #tllll :>:>:::»:>.......................................IBNit~IE?....................;.....:...:.. .. ... . ... 7►....:....................................................................................... ........................................................................................................................................................:....:......... r Building Department Occ Chou Type Constr. Planning Department Environmental Health Department Public Works Department ir Fire Marshal Valuation $ :.::::.;;'.;.............;:.:'::.;:;.;:.;:.;:.::;:.;:.:;:.;':.;:.;:.;:.;:.;:.;:.;:.;:.;:::.::;.::::.;'::::.;:.;:.;:.;:;:.;;;:.;:.:::.;:.;.............:::::::::::::::::::::::.;:;;<::;::::::::.:.;:.;:.;:.;:.;'.;:.::.;:.;;:.;;;:::;;::::<::;:.............................;:.;;:;;.;:.;:.;:.;;:.;:.::<.;:.;:.;:.:. . .................71............................................................................................................................................................. Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee r Plumbing & Base Fee Public Works Review Fee E, Mechanical &Base Fee Other `Qellet Stove Fee Other Pre-Paid at Submittal ( ) m.,. TOTAL.F€ES' FORM MUST BE COMPLETED IN INK ii t PLI?ASE PRESS HARD PERMIT NO.: BLD O D� MASON COUNTY BUILDING PERMIT APPLICATION f 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275- 467 Elmo 360 2-5269 Seattle 206 6"968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 2, D s~' A C Contractor Name -S 41'1.7 0 Mailing Address C; - Mailing Address City / YA State Zip Code City State Zip Code Phone(3f,O )372-7400 Other Ph.( ) Ph.( ) Other Ph.0 Lien/Title Holder Contra9tor Reg. # Address Expiration S TI ATER S INFORM -Connect to Septic xistl Septic _ onnect ewer Sy to Na of Se r Syste Well Wate ystem am of W r Syste �IARCEL INFORMATION-12 digit Tax Parcel No. 3 220 7 / 5 0 93 Fire Distri Legal Description Gc. YP-I P C AOIJC,, —4L=±:X42C6 IV-1 7X Z � Site Address(Please include street name, street number and city) ,er' Crf//-V T pvyA Directions site i r°'1 ; S o r..r -t f- , J?C Will timb)w be cut and sold in parcel preparation. (Yes/No) C Is your property within 200' of the following: Body of Water(Name) 114C,0 0 #9 1yA L Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New . Add Alt Repair Other Use of Building ]''s2,6 E but F Describe Work r1U-<,W A(4x4,T 2 c 10 - Y . 47 , No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor-jfi_q-' _2nd Floor 3rd Floor Loft --- Basement -- DecEk 0"Garage Carport -�-- Other sq. ft. `"'",•, * �!2 T F � C f r440 A MOBIVHOFORMATION-Make ModelLengtWI th Seri o. No. of edroc ms OO No. of Type P hase Price $ lac nt Unit ?(Yes/NInstall Certification No. 11 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. 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 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 AFFIDAVIT4 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 shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. tOG0 IC .7,,,t' j6L�,n C first obtaining approval. X Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by _._ Date ,YSubmittal Amount Due _ Receipt No.4/c'` �,,. > N-T-ME ::::>::>::APIRt < > :' Building Department Occ GroupType Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation$ .. X. jixxx ........ . ............... .................................................................................................:....::::::.:::::::::::::::::::::::::::::::::::::.:::::::,.:: ..... :: Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal TOTAL FEES BUILDING PERMIT # DATE � ' \ Planner Area I32 CHECKLIST FOR PROPOSED CONSTRUCTION Yes No [ ] Within 200 FT of designated shoreline, wetland, or associ ated wetland Where? clnc� [ 7 [ 7 Proposed construction on/over/in wetland [' 7 [ Proposed construction within floodplain [ [ l Eagle nest State road access needed 17 [ 7 Commercial Development (parking standards, sign ordinance, public works review, other applicable agencies) [ ] [ ] Mobile Home or RV Park [ 7 [ ] Exempt from building permit application [ 7 [ ] Exempt from SEPA process (WAC 197-11-305, WAC 197-11-800) [ ] [ 7 Meets all requirements (which section(s) of SMP does proposed construction pertain to?) [ 7 [ ] Variance or Conditional Use Permit required [ ) [ ) Exempt from Shoreline Substantial Development Permit process (Wac 173 -14-040) I ] [ ) Exempt from Substantial Development, but within Army Corp_ jurisdiction (WAC 173-14-115) 1 ( ] Address needed MASON COUNTY PERMIT ASSISTANCE CENTER Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shefton,WA 98584 (360) 427-9670 Belfair(360) 275-4467 Elma (360) 482-5269 Seattle (206)464-6968 60A 10 V'f d � r 7~-ee ho 9 .-36 _7s t � � � Qp � i , t l �Q rJ Z- G_G lzg-S 19 /moo T G IlE iO _ L ,F ®6r- A e ,7- v� i �t N At.:Y--^/ rr / F 77W e 4� ��So /� �X 6' _ /97Z-ocsz v ozSTS X �� _ Jet S'_ _ Ol/�9 L C IV_ TaG' 82 oo Nr 2 Fs % Oh/ _ 1Ze,wwv� � -�on�et / ��r,ov �:.de EwGsuEE�zsIuG owr �iln.o i C� 1 r �� ,. 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