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Home My WebLink AboutBLD98-1180 Storage - BLD Application - 12/30/1998 PERMIT NO: BLD MASON COUNTY BUILDING PERMIT APPLICATION IJy 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 t-+* F R�• Contractor Name Mailing Address 31 So `i' Mailing Address City k-c ILfAlk- State Zip Code 16SZS City State Zip Code Phone(_) `` Other Ph.( Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. Z3�J o / / p o o o n Fire District Legal Description e 4 SC Y4 Sty +oj 3o T u,P 2- 1N T ( L- Site Address(Please incloe street naXne, street number and city) "F- Z(f 5)kWd MILL D Directions to site t C I N 1�1t L FA t2 TA Kf "7 Soo weSr T� t+it L °A-D c(P h ti I I I t Duo ' Will timber be cut and sold in parcel preparation? (Yes/No) No Is your property within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek )C Pond Wetland Seasonal Runoff Stream Slopes or Bluffs No ralrV-4,9 TYPE OF JOB New Add Alt Repair Other Use of Building S1-m LZ�f? Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor f,L o 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 $ Replacernent 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 issued and that all work will be done in requirements regulating the work for which this permit is issued and all work rmance wit No chang shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without ap first obtaining approval. X Date /� X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL" REVIEW APPROVED DENIED CONDITION CODES Building Department 2- f- i Occ Group —I Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES 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 ( ) !.,* O AL FEES •}Y:`'" •^•' :{L •\•:•i:•::Vii:;:ijj<;::j ;.r1p;..,v,:;;.%riy:' •S'.+}•j�f.%i�.'fiA •�i%^:?•i:i$ii'r: �jY::4iii>ii'r MASON COUNTY PROJECT SITE INFORMATION Sunk{ak. &AX. Case No. Name PiRo A . 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 lined 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 adjacent property lined I Fadjacent properly line SAMPLE SITE PLAN adja t property lined Rio" _ _ _ E-adjacent property line D 30' rR�SCRvE gel SEAS w�AL_ �, lC ti fi L _�PTSL i \ F �• � Hoc.a3a I I PrloPose.n s�Qt:e --'�I 1 I30 � I R � VACAr,T I fi c,-nrtAc-s \ I I o VRaPnsCD h\ ��vI l� `� � ArsRzCLLITLLRAL SO I K—40 - , \ yo• I I /• / I I I I I 1 I 1 1 I adjacent property line-q� I \; Fadjacent property 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 di s+.2"C-0- -hn SrFru-�i-L.�YG S�opa t a¢ dts+anc� to t Signature Date PERMIT NO.: BLD W"1 n MASON COUNTY BUILDING PERMIT APPLICATION 1' 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 Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone( Other Ph.(_____) Ph,( Other Ph.( ) Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing 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 Site Address(Please include street name, street number and city) Directions to site 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 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-1 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 . [ X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED _DENIED CONDITION CODES Building Department Occ Group Type Constr. Planning Department Environmental Health Department S Public Works Department Fire Marshal Valuation $ FEES 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 ( ) >t<<>':><<> :.: ::::.::::.�:::::..::.::...:::.::::.::<... TOTAL FEES PERMIT NO . BLD MASON COUNTY / BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner it- I-� ��I r, Contractor Name Mailing Address !r ' ``` 1y _ Mailing Address City State Zip Code City State Zip Code Phone) Other Ph.(____j Ph.( Other Ph.( Lien/Title Holder Contractor Reg. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing 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 N t= f Site Address(Please include street name, street number and city) M - 210V 5A-Np MIIL _- : 7 11 �r Directions to siter�� r� T�i Kr hw7 3 ��Sr TY ^''0 r+r��- t �h� Will timber be cut and sold in parcel preparation? (Yes/No) A30 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 No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq ft. Garage Attached Detached-Car poll 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-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 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 f_ f X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES .. .....::...........:.. Building Department Occ Group Type Constr. Planning Department -L Environmental Health Department W4 e4 VP Public Works Department Fire Marshal Valuation $ FEES 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 ( ) `:.tiro-'r>f+ >`• `:o '<>>s' >»>>`':> <><z<««>< >;<� T OTA FEES ...................... ...............:::.: