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Home My WebLink AboutMIS99-0284 Retaining Wall - MIS Application - 5/26/1999 MASON COUNTY PERMIT ASSISTANCE CENTER Mason County Bldg.III 426 W.Cedar P.O.Box 186 Shelton,WA 98S84 (360) 427-9670 Belfair(360) 275-4467 Elma(360) 482-5269 Seattle (206) 464-6968 NOTICE OF EXPIRATION February 24, 2000 Jack Johnson PO Box 1119 Belfair WA 98528 Re: Mis99-0284 (Retaining Wall) To Whom it May Concern, The above reference building permit will be stamped null and void if not picked up by March 16, 2000. We allow six months after approval to issue. You have exceeded this time. The balance due is $525.84. Please feel free to call the office if you have any questions regarding this issue. Thank You, -2J&+ SV- / Trish Wagner Mason County Permit Assistance Center PO Box 186 Shelton Wa 98584 (360)427-9670 Ext 352 IT NO.: MIS- CI Z(( M SON COUNTY MISCELLANEOUS PERMIT APPLICATION a 7 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-467 Elma(360)482-5269 Seattle(206)464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner 4: Contractor Name Mailing Address Mailing Address City ~.- + r State �.!<� Zip Code City State Zip Coder Phone X� c Other Ph.(� Ph.( ) -; _ - ;; Other Ph.( . ,. ) Lien/Title Holder Contractor Reg. # Jr, 11 1 T. ,, P Address Expirations / z t / PARCEL INFORMATION-12 digit Tax Parcel No. / '=: / _.g ;_ Fire District Legal Description T Site Address(include street name and city ;✓t -<x Directions to site: v 12 Will timber be cut and sold in parcel preparation? ffeslq) �< Is your property within 200' of the follow' : Body of Wa-fer(Name) (fwat'2r Lake River/Creek , Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building r- 'l Describe proposed construction "�� <: C /vk'i w :` ; ) SHORELINE PROJ Ne Replacement Repair Expansion Bulkhead Material (concrete, rock, oo , etc.) Length Height -A FLOOR PLAN AND PLOT P AY R I ED DEP �INGONHE TYPE OF PERMIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF W K OR CONSTRUCT UTHORIZED IS NOT C MMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDON FOR A PERIOD OF 0 DAYS AT ANY TIME FTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF ROGRESS INSPEC ION. The owner or a nt on owner's behalf,represents that the information provided is accurate and grants employees of ason County access o the above descr' ed property and structures for review and inspection of this project. Acknowledgment of such is by si ature below: OWNER AFFIDAVIT-1 certify that I am exempt from the requirements CONTRACTOR'S AFFIDAVIT-1 certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the 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 ordinance requirements regulating the work for which this permit is issued will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtaining approval. be made without first obtaining approval. X' I Date �.Z (� GI 1 X Date ?b j 1 ✓' FOR OFFICIAL USE BEYOND THIS POINT Accepted by r' DateSubmittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department 4r. CoND Occ Grp Type of Const. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ /CA 7 3g " CoaT 8tD FEES Building Permit Fee Z-7 y, -z S Site Inspection Plan Review Fee 1-7 g•sy Other UFC Plan Review Fee Other sr- Fie 4 s o Violation Fee Pre-Paid at Submittal (• ) >•6 TOTAL FEES ,• �� m FORM MUST BE COMPLETED IN INK �f_o2_c7 PLEASE PRESS HARD PERMIT NO.: MIS / MASON COUNTY MISCELLANEOUS PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275- 467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFOR ATION CONTRACTOR INFORMATION Owner �'.t 5 .. <� Contractor Name , �, Mailing Address ,a 1 Mailing Address r City +. State ; , Zip Code c,z .; City ; ,. „ , State;j ;=, Zip Code Phone( °:,,, ) �;-aw her Ph.( Ph.( ',;> ) ;c� 5,goa Other Ph.( Lien/Title Holder Contractor Reg. # z Address 7 1 Expiration_/ t / =4 a. Lo nE, 5 S t tao-) PARCEL INF RMATION-12 di 't Ta Parcel No l r7 � l .:,;; -¢- � i� z Fire District Legit Description �t:�_,f. z ,�. E 1 1 F 7� Pite Address(include street name a city Directions to site: Will timber be cut and sold in parcel pr ! arati ,n? (Ye rN j Is your property within 200' of the follo ing: Body of Wa Name) `� 1 <• �� <<• !� c-SCltw ate - Lake River/Creeks Pond Wetland Seasonal unaff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Rep Other Use of Building Describe proposed construction I.43 b- ?i- SHORELINE PROJi& Nevin Replacement Repair Expansion Bulkheed Material (concrete, rock, vVp , etc.) Length Height ,A FLOOR PLAN AND PLOT P'L,A`N MAYBE REQUIRED DEPADING ON THE TYPE OF PERMIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WC)�tK OR CONSTRUCT AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDON FOR A PERIOD OF 0 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF Af ROGRESS INSPEC ON. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of M' son County accessAo the above described property and structures for review and inspection of this project. Acknowledgment of such is by sigtkature below: `o OWNER AFFIDAVIT-[certify that I am exempt from the requirements CONTRACTOR'S AFFIDAVIT-]certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the 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 ordinance requirements regulating the work for which this permit is issued will be done in conformance therewith. No changes shall be made without and all work shall be done in conformance therewith. No changes shall first obtaining approval. be made without first obtaining approval. X %7___y Date } (� J X I ` Date i� FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Grp Type of Const. Planning Department /0r - 1 Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee Other'-V_ � b� r UFC Plan Review Fee Other Violation Fee Pre-Paid at Submittal (. ) }�,fi` i1 tKrr k"• )i r.., .... •. ` a Kz<k TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name PARCEL NUMBER Date 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 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 I E-adjacent property line I I I I I I I I I I I I I I I I I I I I I I I � I I I I I I I I I I � I I � I I � I I I I I I I I I I I I I I I I I I I I I adjacent property lined I I Fad'acent ro ert line SAMPLE SITE PLAN adjar�nt property lined Fadjacent property line I D 30' �R�SCRvE gp�l CQcf V, I P HOnn tr I �1 n I HOusE I F4V I PRoPosGn smpt:c 1 — I t*-- 60' I R I VAGn,TnrtAa� I 30 I(� PAoPosCD \ Sp'—�I I \ T n&rtscu.LrL�MnL- I I I I /00' I \ I L- -e.LL I � I I I D' --� A I adjacent property line--) f-adjacent ro ert� line TOPOGRAPHY PROFILE(Show a side view of property. 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P.O.BOX 1119 BELFA1R.WASHINGWN 98= PNONE CM)275-6400 FAX CM)278-6MO 6�rntaA C4nimcim MCK J0187A11 oaTE . . . . .4 .—.Z�3: Gl . . . . . . . « TO FAX #t TOTAL PAGESe . �.�.r. . . . . . . . . ATTENTION �I .G1rA�. . . . . . . . . . . . . . . . . . . . . . . . . . . NESSAGE s . . . (.' 'h.V� l;(J r� . . . . . . . p� � - 05 � . . . . . . +i;�v:`:�.r.�. . . .. . . . 1, . . . . . . . . . . . . . . . . . . . . . . . . . • . + . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . « . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SIGPIi:Di . . . . . . . . . . . . . . . . FROM FAX $_ "Q0- - - - - T r� T o ¢. 3 N 3 � 3 k � 0 I� 1 BUSINESS LIQLN City of Bremerton --------- Tax and License Division Licena, Number 239 Fourth Street Bremerton, WA 98337 liurfiiess Site (360) 473-5311 License IYP(-' "MI'l 1-11.1 ALL SEASONS ENERGY/ ALL SEASONS GAS PAYl I ()5,00 1338 E KINGSLEY ST #D SPRINGFIELD MO 65804-7216 Issuance of this Business License does not indicate compliance with other require(! (:lt,v :—I , m