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
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