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Home My WebLink AboutBLD99-0043 Cancelled Replace Deck - BLD Permit / Conditions - 1/28/1999 PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION 9,11 426 W.Cedar/P.O.Box-186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT JNFORMATION CONTRACTOR INFORMATION Owner lY iLi 0f_/ Contractor Name's - i i co,,.IA &&kslQt, C"'Je4k Mailin� Address 1V6 ZZi�,7 SttO 3 Mailing Address N 44eg,7 a`t kt 3 City <.cl r State Lk)A Zip Code Z4� City t'°`-c f jA�R State � Zip Code Phone 3( 61/, ) 7� yC Other Ph.( ).3ts /G.Z�, Ph. 3( 6G );7K-7f4l Other Ph.(3(4 ) 424 Lien/Title Holder A7454t2 /A�OA cz Contractor Reg. # 5 t)t w8G Z I PB Address P o Y 9 .t ()rc h d)A• 9 3G� Expiration U SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer Sy tem Well Water system Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Z 33 Z-- l S"U / c OQ Fire District t_v Legal Description f I - Sh Cf F' Ef & of knf LZ SAM S.Theler-S nnY CAPL*-f1 N I S Site Address(Please include street name, street n mber and city) N6 zz&6 7 R_I Directions to site Cat t w 3 1 r" iu r L`' f' t '.iye i l b4_),f I 04 0 4 1qk) e: f tL41q4 f h (1 ! Will timber be cut and sold in parcel preparation? (Yes/No),— Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Describe Work F'.p In ieo c.- No. of Bedrooms No. of Bathrooms,SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. 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 AFFIDAVIT-I 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 re uI ting 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 onformance th r ith. No changes shall be made without approval. first obtaining aproval. A A, J'-Z- /�A� ,A J") Date o2 X 141L Date FOR O FIC All USE BEYOND THIS. I Accepted by Date Submittal Amount Due Receipt No. pEPARTlV!!EI�TAI» REVIEW .. APPROVED: DENIED CONDITION GODES Building Department Occ Group Rr,5 Type Constr.%:1rW1 y Planning Department Environmental Health Department Public Works Department I Fire Marshal 16 9 Valuation $ FEES ES _. ..... .. _ _ _ _.: Building Permit Fee 7 7S Site Inspection Plan Review Fee l��s 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 ( ) •iiY,},'•.i ti:::iii:ti:i�i rii:iiiiiiiviiiif:LfYX:>ti:•:::•:%i::i'r'.•'i::i:\iti�i'ti:ii'.LiLv::•::.i::::i}:i : »a�k�<I>>»;�>:�« �:� .a�i. :tw.�«:tt�. ••��:�:<.:t�{.� ;:vr«::<>»>:...:, TOTAL FEES iittiy:t,2;:•:•:•:•i;:.::{•lii^?•:�v'i•�+w.•:fFr:i:`•::}??.:•:•i::l�} '{+.•:::s•. .::,{Llti:•:�iiiiY:•:•:•t::i:>ii::8>.'ry.: . ts:7:•:it:;�k:t�r.+.tadhayx.:t.:•;Sret•:<•:ae•:t.:ortr,.w•,.,N/.•'fr:?etttt;•.t•.'•:t:>�ictt:�:.u::•:+rx.<n:ka:::tt<�ft•:r.'� a- PERMIT NO.: BLD MASON COUNTY ' BUILDING PERMIT APPLICATION a" 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION r CONTRACTOR INFORMATION r Owner A i;I, `,e;iLJ l.;. i _. _ Contractor Name'- t f l !t.,r{/ L�e)s .J�r c. .k" c Mailing Address 7 f ' Mailing Address N 1?1-j S/ 'j 3 City/ r r State ;i r` Zip Code ' 7 1�_ City r,_r i I r i R States i t, Zip Code "r r ?` Phone( ' Other Ph. xn< < _71. Ph.(fi 7^'r L I,Other Ph.( . Lien/Title Holder -,I J r ;t k c+t-sC� Contractor Reg. # `� ICI0 !r Z r' i+ Address P f' r+%ram�; r L )sA i� ii A. )gjj l Expiration "' `f l cZ 'T 1. 'I%j SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic X Connect to Sewer System Name of Sewer System Well Water System Name of Water System it :Z),,J , _ 41 s 1 _r PARCEL INFORMATION-12 digit Tax Parcel No. /Z 3 3 Z -: ` ., Fire District Le VI Description r ` e Address(Please include street name, street number and city) ZZ ' t Iv I Directions to site ,i_ - +' I l ! 4r,ir rleliL t? `f. f` rlit,t. !ti! i f <.SS tr., t�f t�' Wit' i .ic_ J .' r`_ Will timber be cut and sold in parcel prepara n? (Yes/No) rem Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building De.cribe Work},'- �€""+ ..c , �i N of Bedrooms ','I No. of Bathrooms 7_SQUARE FOOTAGE-1st Floor 2nd Floor rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model 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. NOTICE: THIS PERMIT BECOMES NULL 8.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 AFFIDAVIT-I 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. first obtaining approval. X\. Date ° X rV y— Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. __.. . ........._ ........ . ..._ _...... .. D PAfiTA/I NTAI f EVIEW APPROVED DENIED CONDITION CODE$ _ _ Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ EI=,� . .. .. .. _.. .. 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 FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD, COUNTY PROJECT SITE INFORMATION Case No. NameBrISko PARCEL NUMBERIZ,:E-.S22—aene2, -3 Date 4IX4&�' SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements 11 Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line- I , <-adjacent property line I I I I p Z 4 &heck I lS/ I I I I I \ I I I I I 1 r I I I I adjacent property line-) I <-adjacent property line SAMPLE SITE PLAN adja1 nt property lined 3zO� . _ _ _ <-adjacent property line D 3o r R V soil i' CREEK \ I I, I HOM t i .&rA&0_KJ I > PrioPaseD se Pt:c R I 6 0' I I VAG1n,T I c nrtAad I i I 30' I i DP.oPosCa T A&RsCLLLruJXAL 50 1 I I � I I 80, --91 t I I /--e-LL I I I I /00' I adjacent property line-;� i a"• \i Fad'acent properiy line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dist9nG0- to Srt ruttl.�Yt Slop'. --c¢ to t Signature Date v . m „ cn 00 :37 IF 10 Q _ - 00 jSz - - D = Nh 1 � } „ — s } � _ , Y IZ 00Ol C O t z - m 10 0- ODQ i