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HomeMy WebLinkAboutCOM2007-00105 Final Covered Area at Entrance - COM Inspections - 11/14/2007 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 vv eJ Shelton (360) 427-9670• Belfair (360) 275-4467• Elma (360) 2-5269 On the web www.co.mason.wa.us APPLIC N I FOR MATI N CONTRACTOR INFORMATION Owner E � Company Name Maili Add s Mailing Address City tate Zip Code City State Zip Code Phone MOV-9-2540 9 Omber P Phone Other Ph. Lien/Title Holder WI A Contractor Reg.# Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMFfW1tir;S0VFS nnect to New Septic Existing Septic Connect to Water System Name tem. Well Water System Nametem PARCEL INFORMATION- 12 Digit Parcel No. 1,1733a qO QQQF7 Fire District Legal Description Site Address (Plea a inchAde tree name, street n mb id city) Directions to site P 0�1 3 wytlE r 3` 52. [C(o 1 rtLV0 !j 0h Will timber be cut and sold in parcel preparation?Yes N 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?Yes/No TYPE OF JOB - New Add Alt Repair Oth r r R 2 CE SEASONAL ❑ Use of Building Describe Work No.of Bedrooms No.of Bathrooms Square Footage- 1stFloor 2nd Floor 3rd Floor Basement` Deck Covered Deck Other Sq.ft. Garage-- Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATI N ke Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase c $ Replacement Unit? Yes/No Installer Name Certification No. OIVVVER/BULDER 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 appl for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provi is accurate an is ployees of Mason County access to•the above described prope nd structure for review and inspection. P F CONTIN N ORK IS BY MEANS OF A PROGRESS INSPECTION A� rty X -7 Date caner/ e resentativ /Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Departmen Public Works Department Fire Marshal FEES B uilding Permit Fee Site Inspection view Fee EH Review Fee Plumbing& Base Fee PlanningReview Fee ical & Base fee Other od/Gas/Pellet Stove Fee State Fee tior Fee Pre-Paid at Submittal `lion $ TOTAL FEES MASON COUNTY 'PE464 Now r J 7l'1 tj)t BUILDING PERMIT APPLICATION i 426 W.Cedar• P.O. Box 186, Shelton, WA 98584 i Shelton (360) 427-9670 • Belfair (360) 275-4467• Elma (360) 2-5269 On the web www.co.mason.wa.us APPLICAN I FORMATION CONTRACTOR INFORMATION Owner � 4-' Company Name Maili Address Vi Mailing Address City State 141A Zip Code City State Zip Code Phone - _i -(o Other P Phone Other Ph. E Lien/Title Holdea All fail?! k Contractor Reg.# Exp. f E mail address z E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMRf *tr nnect to New Septic Existing Septic f Connect to Water System Namestem Well Water System Namestem PARCEL INFORMATION- 12 Digit Parcel No. Fire District Legal Description Site Address (Please inclyyde street name, street number and city) Directions to site IJ ©IU N(rJy 3 to tot-E- .. AWV3`L 5i2 in(Q. 1 /-I Lyaklu ©A i Will timber be cut and sold in parcel preparation?Yes N 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?Yes/No TYPE OF JOB - New Add Alt Repair Oth r R E CE SEASONAL ❑ Use of Building Describe Work t' No.of Bedrooms No.of Bathrooms Square Foo = 1st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached etached Carport Attached Detached :.:. MANUFACTURED HOME INFORMATIJNJ Ake Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase c $ 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 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 i permission from them to appl for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provid is accurate an is ployees of Mason County access to the above described property nd structure for review and inspection. PR F CONTIN N WORK IS BY MEANS OF A PROGRESS INSPECTION a3 X Date: caner/ e resentativ /Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: - Date 1 I DEPARTMENTAL REVIEW 4PPROVED DENIED NOTES 4 Building Department Planning Department 0 Environmental Health Departmen X003-o 000 S _ Public Works.Department Fire Marshal FEES Building Permit Fee 3 Site Inspection I Plan Review Fee f 3. . Co EH Review Fee Plumbing & Base Fee Planning Review Fee Mechanical & Base fee Other Wood/Gas/Pellet S ove Fee State Fee Violation Fee Pre-Paid at Submittal TOTAL FEES Valuation$ �O O X 3Co•9 I = 7c3� ° MASON CUUN I PEAKAIh No' �; h? BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 �J v Shelton (360) 427-9670 - Belfair (360) 275-4467- Elma (360) 2-5269 On the web www.co.mason.wa.us It �:--- APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 4 - Company Name Maili Address Mailing Address City—State WA Zip Code City State Zip Code Phone - -6 Other P Phone Other Ph. Lien/Title Holder_ F-C-t� u M A f2t L Cam#° Contractor Reg.# Exp. E mail address :b. E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATI '- onnect to New Septic Existing Septic Connect to Water System Name stem Well Water System Name f t ystem PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description _ Site Address (Please include street name, street number and city) j -l i• Directions to site fJ Ai AUR 3 to 4-ME IL. 1Ai0`L)3= �i1 1 L !W j if,Ly(.t fr fA k. Will timber be cut and sold in parcel preparation?Yes N Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff --' Stream ... Slopes or Bluffs > 15% i Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No I TYPE OF JOB - New Add Alt Repair Other R E CE SEASONAL ❑ Use of Building Describe Work r No.of Bedrooms No.of Bathrooms Square Footage- 1 st Floor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached petached Carport Attached Detached MANUFACTURED HOME INFORMATI N ke Model Year Length Width Serial No. No.of Bedrooms No.of Bathrooms Type of Heat Purchase c $ 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 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 proaccurate a %NWORK loyees of Mason County access to the above described property nd structure for review and inspection. JPRt�F CONTIN IS BY MEANS OF A PROGRESS INSPECTION. X Date• _ -7 (caner,/ e resentativ /Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Accepted by: DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department A. Plannirfg Department U Vg _ C-) _ h , Tom Environmental Health Department Public Works 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 f Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES r MASON COUNTY PERMIT No. i -- BUILDING PERMIT APPLICATION 1i 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-4467• Elma (360) 4 2-526 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner . 17'ri 4-O'i O Iv sty_r cj, !- Company Name Mailirtg Address 13,t) r)i;x '71<�j Mailing Address City -5:L�i A 11,, State_i0i� Zip Code— ^`" City State Zip Code Phone Bt:C- 9 =a 4. ,�s 5 Other Ph_ Phone Other Ph. 4. Lien/Title Holder Al tE+ i�rR 0 /,r i'+o. 6 - } r -- Contractor Reg.# Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATIp ; onnect to New Septic Existing Septic Connect to Water System Name �1IIYa stem Well Water System Name f W t System PARCEL INFORMATION- 12 Digit Parcel No. 1�3 ° r- Fire District Legal Description Site Address (Please include street name, street number and city) Id'Al "i-r't k e`=it., � ; Directions to site kl �.0 t1tO " _Ti, +t'31 IL t,jj = If t.^ 'a. 1, Will timber be cut and sold in parcel preparation?YesJ No Is property within 200'of Saltwater Lake River/Creek -- Pond Wetland Seasonal Runoff Stream Slopes or Bluffs 1 15% Is this pgrmit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE5OF JOB - New Add Alt Repair Other R ENCE SEASONAL E] Use of Building Describe Work ." "" 0, +` No.of Bedrooms No.of Bathrooms Square Footage-1st loor 2nd Floor 3rd Floor Basement Deck Covered Deck Other Sq.ft. Garage Attached-- Detached Carport Attached Detached MANUFACTURED HOME INFORMATION,= T e Model Year Length Width �� Serial No. ' No.'of Bedrooms No.of Bathrooms Type of Heat PurchaseiiPtrc $ 1 Replacement Unit? Yes/No Installer Name I Certification No. OWNER/BUII..DEA 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 find 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. 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CD / t . 3 . 2 ) m x CD . m 3 a § � / 7 0 / c ¢ to \� 3 § m a E A . . . o § k % , . ncn CD 0 2 a § \ 2 ] a CD 1 CD 0 § aR � . s & W « E ) n O Z N CONCRETE MECHANICAL MANUFACTURED HOME - 00 o Footings/Sobacks Fete By Ribbons Gas Piping = o Interior Date By Interior-Date By Data By 3 Exterior Data By Exterior-Date B Sot-upN Point Load/Isolated Footings INSULATI3N Dote By O Date By Btu r SLAB INSULATION z Date By FIRE DEPARTMENT m Foundation Walls Floors Date By Date By Data By DECKS m FRAMING Walls Date By N Date By Data By PROPANE TANKS PLUMBING vault Date By Mate By OTHER Groundwork Attic Date By Date By Type: DRYWALL Date By n D.W N 'Gyps: int Brace Wall Date By 0 Date By Date B 3 �` FINAL I PLTION c Water Line Fin Separation O Date By Date By Data it T By V O Pass or Request Inspect. o Type of Insp. Fail Date Datq Done By Comments � 01 0