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HomeMy WebLinkAboutBLD98-1066 Enlarge Bldg - BLD Application - 11/4/1998 FORM MUST BE COMPLETED IN INK PERMIT NO.: BLD �� T PLEASE PRESS BARD MASON COUNTY BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275.4467.Elma 360 82-5269 Seattle 206 64-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ksay La Contractor Name Mailing Address Mailing Address City State 44 Zip Code Z City State Zip Code Phone(,7CD )22i=,C5$6 Other Ph. 6d qT1'-7191Z Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic )LExisting Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. <0 / 00 orq Fire District 2 Legal Description 3 E - 17 -177.4 Site Address(Please include street name, street number and city)Z rtifer 144,,V3 EG Directions to site d6&L 2sFcT/oj/ Og NON 3 r /bb Will timber be cut and sold in parcel preparation? (Yes/No)1A O 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?giYATg, cL&-.& Describe Work _C0-,4& j6' AVII Wt'STR✓CTyRfr FrX- ln7Q jKLAIg No. of Bedrooms No. of Bathrooms 2 SQUARE FOOTAGE-1st Floor 6 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 ag ent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the ab s#�TAM y e review and LSinspection of this project. Acknowledgment of such is by signature below: iL3� OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AVIT-I certify that I am currently red as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Was a re of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the wofk 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. �w Date/t'ZZ ^ x HEALTH SERVIIggS FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date--11/y Submittal Amount Due Receipt No. ... . . . ..:.... >>.... ..... .... :.::::: . . fEPR?l ..' ..:RiAF APPRQVE#� t? NiRCNI31T1174 Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ ..... 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 ` 9S>'C ' PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT APPLICATION 42'W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 l3elfair 360 275-4467. Elma 360 82-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner A161 A *#V 4 Contractor Name Mailin Address - fi 7KZ Mailing Address City f.t f��IC� State 44 Zip Code F�Tjjv City State Zip Code Phone(„ %0)$x--JrJr$b Other Ph.(.?66 )41?11-7/Y& Ph.(_ Other Ph.( ' Lien/Title Holder Contractor Reg. # Address Expiration / / SEPTIC/WATEP.SYSTEM INFORMATION-Connect to New Septic )LExisting Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Fire District Legal Description 4 Site Address(Please include street me, s et number and city)$ 90 A!Ier Directions to site gf- T o 1 ON wk., Will timber be cut and sold ' parcel preparatio ? (Yes/NW1! Is your property within 20 of the following: Bo of e'r(Name) M/A Saltwater Lake River/Cre Pond We d Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add epair Other Use of Building Tifil +-✓ Describe Work ✓ No. of Bedrooms No. of Rnthroofns S ARE FOOTAGE-1st Floor � 31 2nd-Floor 3rd Floor Loft Baseme Deck Other ' -s ft. Garage Attached Detached ort Attached Detached MOBILE HOME INFORMATION-Make el �Model Year Lengtty, Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit?(Yes/No) Installer Name Ce ification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONS RUCTION AUT rner OT COMMENCED WITHIN 180 DAYS OFtIF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PE D OF 180 r ATME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS I N. agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County acces a ove described property and structures Tor 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 CONTRAC A VIT-1 certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the tate 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 reg ating or which th' ermit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in confor ante the with. anges shall be made without approval. first obtaining approval. Dateld-24 f X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by ` ` Date s� Submittal Amount Due r � Receipt No. ................................. P RTM NTAI...RIwk I i f:'<::::>>:;::::;::>;><> P#?Rt Vlw#� t 6NI ... 0 . Building Department Occ Group Type Constr. Planning Department ° Environmental Health Department I Public Works Department .l l Fire Marshal i f i Valuation $ ::.::;:.:: IEx ............................................. .................................... 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 q 8_ ) 0 PLEASE PRESS HARD PERMIT NO.: ` MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 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 INFORMATION CONTRACTOR INFORMATION Owner &0EV4 /h&04 &6LES Contractor Name Mailing Address Mailing Address CityRE46!!ka State A Zip Code City State Zip Code j Phone(34o)7?,!�--49R!r0ther Ph.( )qW-71VZ Ph.(_ Other Ph.( Lien/Title Holder Contractor Reg.# Address I Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. /Z"Z / -:52!) / 000&41 Fire District_ Legal Description w Site Address(Please include street name, street number and city) Directions to site 104 f ALA!:f ..3 SA&I74— 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 ReIVi 7-e—O .y1? Location of Fixtures/Units 1 st Floor =2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Tvae of Fixture No. of Fixtures Fees LPG Natural Gas __&Heatpump Toilets Type of Unit No. of Units Fees Bath Basins Furnace Bath Tubs �_ Heatpumps Showers Vent Fans Water Heater Propane Tank Laundry Wsher 19 Gas Outlets Sinks Wood/Gas/Pellet Stove Dishwasher _�_ Direct Vent? Other Other Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 jinspection 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. Date /d�.260 X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. `:M :` :11tj�S�::<::.;:.;;::;:.;:.;;:.;;::.;:.;:.;: .Ftil1F. ::: j, Building Department Occ Group Type Constr. t Planning Department Other Other Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES FORM MUST BE COMPLETED IN INK n 4 w v PLEASE PRESS HARD "i D PERMIT NO.: MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670'Belfair 360 275-4467 Elma 360 -5269 Seattle 206 64-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner /Vf Lb=S Contractor Name Mailing Address Mailing Address City L/c/,I+/t State WA Zip Code City State Zip Code Phone 9 7S6LIS'SOther Ph.(?l© ) - ! Ph.( Other Ph.c Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC INFORMATION-Connect to New Septic Existfng Septic Connect to Sewer System Name of I Sewer System � PARCEL INFORMATION-12 digi. a el No. Z2'�'�' �' % / Fire District_ Legal Description dV a Site Address(Please inclu street name, str et number and city) f Directions to site J ,r,. Is your property wi in 200'of the following: Body of Water(Name) Aff�.. Saltwater Lake River reek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs ,9 TYPE OF JOB New Add Repair Other Use of Building ! 7" Location of Fixtures/Units 1st Floor! 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number4ffeach MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG Natural Gas__A_Heatpump Toilets Type Type of Unit No. of Units Fees Bath Basins OJ Furnace Bath Tubs — Heatpumps Showers Vent Fans —� Water Heater Propane Tank Laundry Wsher Gas Outlets SinksWood/Gas/Pellet Stove Dishwasher ct Vent? Other her Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCT N�RIZEOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECT 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 a inspection of this project. Acknowledgment of such is by signature below: ' i 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 grill 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. Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. AIv .......INIEr.................... Building Department Occ Group Tvpe Constr. Planning Department Other Other ..Permit Fee k .... ....... ........................................ ::::::::::::::::::::::::::::.................:...::::::::::::::::::::::::•:::::::::::::.::•:::::::::..:::.::::::::::•:::::::::.:::::::. Site Inspection 1 Plan Review Fee UFC Plan Review Fee l Plumbing&Base Fee Other (, Mechanical&Base Fee Other j i Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES 1 i i